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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Squiggles on August 14, 2007, at 9:43:47
I still have issues about unmedicated depression,
but this case i am following may just turn out to
be a miracle; so far so good. I would like to be able to talk about it with a dr. but because it is not my case, there is the matter of confidentiality.So, it's a wait and see thing. I'm concerned about relapse but it hasn't happened-- amazing. It has been about 6 months off the AD. Monitoring is taking place and a hand-out test for self-monitoring.
What I would like to find out is how many cases have been documented of a misdiagnosis only to be discovered after the AD is withdrawn.
Any leads, stories, personal accounts, would be much appreciated.
Squiggles
Posted by Larry Hoover on August 14, 2007, at 10:56:36
In reply to Are there statistics on misdiagnoses?, posted by Squiggles on August 14, 2007, at 9:43:47
> What I would like to find out is how many cases have been documented of a misdiagnosis only to be discovered after the AD is withdrawn.
A significant confound is the natural process of remission. Diagnosis is time-dependent. It may simply no longer be valid, whereas it once was.
You might be interested in this article:
http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1313675&blobtype=pdfLar
Posted by Squiggles on August 14, 2007, at 11:14:15
In reply to Re: Are there statistics on misdiagnoses? » Squiggles, posted by Larry Hoover on August 14, 2007, at 10:56:36
> > What I would like to find out is how many cases have been documented of a misdiagnosis only to be discovered after the AD is withdrawn.
>
> A significant confound is the natural process of remission. Diagnosis is time-dependent. It may simply no longer be valid, whereas it once was.
>
> You might be interested in this article:
> http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1313675&blobtype=pdf
>
> LarThanks for replying to my question Larry; can you say something about "sensitivity" and "foreknowledge" in assessment of criteria-- i am not familiar with these concepts.
tx
Squiggles
Posted by Phillipa on August 14, 2007, at 11:44:37
In reply to Re: Are there statistics on misdiagnoses? » Larry Hoover, posted by Squiggles on August 14, 2007, at 11:14:15
Squiggles also some people have an isolated depression that doesn't return when the crisis or whatever is over or life circumstances change. Phillipa
Posted by Squiggles on August 14, 2007, at 11:53:07
In reply to Re: Are there statistics on misdiagnoses? » Squiggles, posted by Phillipa on August 14, 2007, at 11:44:37
> Squiggles also some people have an isolated depression that doesn't return when the crisis or whatever is over or life circumstances change. Phillipa
Yup, that i have come across in reading cases;
even Kraepelin noticed that there can be a circularity to severe depression which spreads as far apart as 10 years. Depression need not be continuous, can be post-traumatic, can even be biologically dispersed through life, though possibly genetically chronic.Much of the clinical treatment of depression with meds every day is an expedient practice. It's a very difficult area of medicine diagnostic-wise.
I recently saw something about a new antidepressant that acts immediately, sort of like Xanax acts immediately for panic. That sounds interesting-- forget the name.
Squiggles
Posted by Larry Hoover on August 14, 2007, at 12:05:55
In reply to Re: Are there statistics on misdiagnoses? » Larry Hoover, posted by Squiggles on August 14, 2007, at 11:14:15
> > You might be interested in this article:
> > http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1313675&blobtype=pdf
> >
> > Lar
>
> Thanks for replying to my question Larry; can you say something about "sensitivity" and "foreknowledge" in assessment of criteria-- i am not familiar with these concepts.
>
> tx
>
> SquigglesFrom: http://www.poems.msu.edu/EBM/Diagnosis/SensSpec.htm
"sensitivity = probability of a positive test among patients with disease"
"rule of thumb is the acronym "SnNOut", which is taken from the phrase: 'Sensitive test when Negative rules Out disease'."So, the in context of this article, the presence of actual cases of depression among the group "chronic nervous function complaints" indicates that the general practitioners applied foreknowledge in excluding them from the depressed group, reducing the sensitivity of the criteria making up the DSM-IV category of major depression. I.e. these were "false negatives", depressed individuals with other chronic health complaints.
The issue of foreknowledge is well-defined in the first paragraph of the Introduction, IMHO.
The net impression is that GPs may under-diagnose depression a little more than they over-diagnose it; 7 false negatives vs. 5 false positives (difference non-significant). Nonetheless, they're pretty good at diagnosing it, overall.
There are limitations introduced by the different diagnostic definitions used (ICHPPC-2 vs. DSM-IV), but I can find problems with any study. ;-)
Lar
Posted by Phillipa on August 14, 2007, at 20:36:01
In reply to Re: Are there statistics on misdiagnoses? » Squiggles, posted by Larry Hoover on August 14, 2007, at 12:05:55
Lar sounds like that Munckins or really forget the correct name where people present to a hospital and make themselves ill to gain attention. Also as my therapist said a lot of illnesses can be mistaken for true depression takes a good doc to do the proper tests. Examples thyroid disease, autoimmune disease, lymes disease. Hence why my therapist and pdoc want me to see an infection control specialist again or a rheumatologist as have all the documented records of them all with us. Got copies from all the docs who treated the above when we moved. It's hard when you move a lot as no GP gets to know you at all. Love Phillipa also my Son had PTSD and worked through it.
Posted by Squiggles on August 15, 2007, at 7:53:01
In reply to Re: Are there statistics on misdiagnoses? » Larry Hoover, posted by Phillipa on August 14, 2007, at 20:36:01
In this case i'm observing, i'm starting to see the old symptoms of depression coming up-- i maybe be mistaken and it may be just stress. However, one disadvantage that drs. have and therapists for that matter, is that 5 min. to 1 hr. a year is hardly comparable to 24/7 observation over many yrs. pattern. Also, self-observation is hard as Dr. Torrey said.
Only, gross symptoms will eventually reveal any kind of underlying problem.I am still hoping for a miracle though.
Squiggles
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