Anyone Else Feel Like They Have Asperger Syndrome?

[jillio]

ADHD among American Schoolchildren

But it is being over perscribed in pockets of areas.

And prevelance and incidence also increase in pocket areas. That would be consistent for all disorders. So to assume that it is a matter of overprescription is fallicious.

 

[sequoias]

I never heard of that before, so I wouldn't know what it is like to meet someone who has one even tho I read it on wikipedia. I think it's gonna give me a better idea if I met someone who has it. I have met people who has bi polar, add, adhd, etc.

 

[fredfam1]

You have still only come up with a correlation. Too many variables are not being accounted for. Correlation and anecdote do not prove cause and effect. Just as likely is a diagnosis of Somatization Disorder, especially when nothing can support the claim of an actual disease process being present in the individual that would explain the presence of the symptoms.

Somatization Disorder would only apply if blood work and lab values had not indicated nutritional deficiencies. (Yes NDs do order blood work ups) and subsequently values indicated correction. It was not SD. Why didn't the MD order nutritional status work up? Probably wouldn't have been paid for by insurance since there were no indicators of potential nutritional problems. (ie, poverty, poor appetite, etc).

 

[jillio]

Somatic illness in psychiatric patients
ERWIN K. KORANYI M.D.1

1 Professor of psychiatry at the University of Ottawa, health sciences faculty, and director of education at the Royal Ottawa Hospital

The author reviews a dozen studies conducted over a period of 40 years and shows that approximately half of a total of over 4,000 psychiatric patients had major medical illnesses. Somatic conditions were directly related to the psychiatric symptoms in 9% to 42% of the cases. Approximately half of the patients' referring physicians had not diagnosed their physical illnesses. These findings and five brief case reports point up the need to follow a medical model on psychiatric services.


Somatic illness in psychiatric patients -- KORANYI 21 (11): 887 -- Psychosomatics

*


Evaluation of patients who present to hospitals or physicians with altered behavior and/or mentation can be time-consuming and difficult and may lead to symptoms being quickly and prematurely dismissed as psychiatric in nature. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the psychiatric presentation of a medical illness is classified as a "mental disorder due to a general medical condition." These disorders are characterized by the presence of mental symptoms that are the direct consequences of an underlying medical condition. Therefore, understanding common psychiatric symptoms and the medical diseases that may cause or mimic them is of utmost importance. Failure to identify these underlying causal medical conditions can be potentially dangerous because serious and frequently reversible conditions can be overlooked. Proper diagnosis of a psychiatric illness necessitates investigation of all appropriate medical causes of the symptoms.

The following features suggest a medical origin to psychiatric symptoms:

* Late onset of initial presentation
* Known underlying medical condition
* Atypical presentation of a specific psychiatric diagnosis
* Absence of personal and family history of psychiatric illnesses
* Illicit substance use
* Medication use
* Treatment resistance or unusual response to treatment
* Sudden onset of mental symptoms
* Abnormal vital signs
* Waxing and waning mental status

So it is possible that sudden onset of psychiatric illness can be caused by medical problems. Though I suspect that this childs nutritional issues were undiagnosed largely due to the fact that the family ate organic meats and whole raw foods, and the family was generally very healthy, so a practicioner in questioning would not consider it to be likely the cause. It just goes to show that not every thing can be quantified or classified.

Late onset of symptoms would also be indicative of trauma that results in somatization, particularly in the case of conversion disorder.

A known underlying medical condition would rule out the diagnosis of somatization disorder. That is what you are failing to understand.

Absence of personal or family history of psychiatric disturbance only rules out a past history. It does not indicate that the disorder is not currently present.

Illicit substance abuse also rules out the case of somatization disorder, and is identified on one of the 5 axes of which I have spoken.

Medication use would fall under General Medical Conditions on Axis 3. Again, that would rule out a diagnosis of Somatization Disorder, if the medication could be responsible for presenting symptoms.

Abnormal vital signs would also fall under Axes 3. Referral for cause of abnormal vital signs.

Waxing and waning of mental symptoms is quite common with all disorders. Environmental conditions will often be responsible, and waxing and waning of symptoms is indicative of the cyclical nature of many mental disorder.

Please, fredfam, inform yourself on the diagnostic process of mental disorders before you go any further. All of the things that you continue to bring up are controlled for with a multi axial diagnosis.

 

[fredfam1]

Late onset of symptoms would also be indicative of trauma that results in somatization, particularly in the case of conversion disorder.

A known underlying medical condition would rule out the diagnosis of somatization disorder. That is what you are failing to understand.

Absence of personal or family history of psychiatric disturbance only rules out a past history. It does not indicate that the disorder is not currently present.

Illicit substance abuse also rules out the case of somatization disorder, and is identified on one of the 5 axes of which I have spoken.

Medication use would fall under General Medical Conditions on Axis 3. Again, that would rule out a diagnosis of Somatization Disorder, if the medication could be responsible for presenting symptoms.

Abnormal vital signs would also fall under Axes 3. Referral for cause of abnormal vital signs.

Waxing and waning of mental symptoms is quite common with all disorders. Environmental conditions will often be responsible, and waxing and waning of symptoms is indicative of the cyclical nature of many mental disorder.

Please, fredfam, inform yourself on the diagnostic process of mental disorders before you go any further. All of the things that you continue to bring up are controlled for with a multi axial diagnosis.

All of the things I bring up are supposed to be controlled for on the Axes. In real life they are not. You sound like you would take all these things into account. But other doctors do not. In the VA hospital in Calif I was given anti depresents with out blood work ups because they assumed the trauma I experienced in the military caused my depression. (probably agravated it but it was not the cause) When I did my RN clinical in Anchorage Alaska at the native hospital, as a student nurse I tried to use the Axis criteria in the patient I was assigned to. She was having pain and needed more meds. There was a language barrier as well. The doctor I was working with expressed exasperation saying she was just wanting more meds because she liked the high. YES he said that to me. He didn't even want to look at the vitals I had taken indicating pain response. He didn't order any additional tests. He ignored her. He said this was typical of these patients. She hurt following hip replacement. And I am informed. I just disagree with you.

 

[jillio]

All of the things I bring up are supposed to be controlled for on the Axes. In real life they are not. You sound like you would take all these things into account. But other doctors do not. In the VA hospital in Calif I was given anti depresents with out blood work ups because they assumed the trauma I experienced in the military caused my depression. (probably agravated it but it was not the cause) When I did my RN clinical in Anchorage Alaska at the native hospital, as a student nurse I tried to use the Axis criteria in the patient I was assigned to. She was having pain and needed more meds. There was a language barrier as well. The doctor I was working with expressed exasperation saying she was just wanting more meds because she liked the high. YES he said that to me. He didn't even want to look at the vitals I had taken indicating pain response. He didn't order any additional tests. He ignored her. He said this was typical of these patients. She hurt following hip replacement. And I am informed. I just disagree with you.

Once again, you are confusing diagnostic procedures for mental disorders and diagnostic procedures for diagnosing physical disorders. They are not the same.

Blood work ups would not have determined whether you needed to be on antidepressants or not.

Saying that trauma is connected to the manisfestation of depressive symptoms is a precipitating factor, not the etiology of the disorder. Precipitating factors relating to the manifestation of symptoms is a different thing altogether from the etiology of the disorder.

Level of pain is routinely underrdiagnosed by pshysicians. You can blame DEA laws that restrict physicans and make them subject to criminal prosecution for an unacceptable level of pallative care. And again, you are referring to a patient with a physical illness, with a readily discernible cause for her physical pain. And again, vitals are not the only indicator of pain. To assume that just because one's BP is elevated is evidence of severe pain is to ignore all the other variables that could be responsible. Elevated BP could just as easily be indicative of medication response.

Trying to use a multi axial diagnosis and actually understanding the way a multi axial diagnosis works is two different things. And when it comes to using a multi axial diagnosis for mental disorders, you obviously are lacking in understanding, as evidenced by your own posts.

You can disagree with me. That's fine. But if you are going to disagree, you need to substantiate the valid reasons for disagreement, and not simply disagree because you don't have a complete understanding of the diagnostic process.

 

[fredfam1]

Once again, you are confusing diagnostic procedures for mental disorders and diagnostic procedures for diagnosing physical disorders. They are not the same.

Blood work ups would not have determined whether you needed to be on antidepressants or not.

Saying that trauma is connected to the manisfestation of depressive symptoms is a precipitating factor, not the etiology of the disorder. Precipitating factors relating to the manifestation of symptoms is a different thing altogether from the etiology of the disorder.

I am saying they didn't check out the possibility. Assumptions were made based on subjective data only. Blood work ups would have helped to rule out or prove a medical cause for depression. The Axis is a way to provide for all possibilites. They didn't use it. It was only used here in the VA hosp in Oregon. And a medical cause was found. And the doctors said the trauma caused the disorder, not me.

 

[jillio]

I am saying they didn't check out the possibility. Assumptions were made based on subjective data only. Blood work ups would have helped to rule out or prove a medical cause for depression. The Axis is a way to provide for all possibilites. They didn't use it. It was only used here in the VA hosp in Oregon. And a medical cause was found. And the doctors said the trauma caused the disorder, not me.

Not all physical disorders are detectable through a blood work up. Obviously, you were not presenting with symptoms that would have warranted a blood work up, or you failed to reveal symptoms to your physician that would have indicated the need for a blood work up.

No, the doctors said the trauma was a precipitating factor. And you, yourself, admitted that the trauma may indeed have exacerbated the depressive symptoms.

You presented with depressive symptoms. You did not present with symptoms of a physical disease.

 

[fredfam1]

Once again, you are confusing diagnostic procedures for mental disorders and diagnostic procedures for diagnosing physical disorders. They are not the same.

Blood work ups would not have determined whether you needed to be on antidepressants or not.

Saying that trauma is connected to the manisfestation of depressive symptoms is a precipitating factor, not the etiology of the disorder. Precipitating factors relating to the manifestation of symptoms is a different thing altogether from the etiology of the disorder.

Level of pain is routinely underrdiagnosed by pshysicians. You can blame DEA laws that restrict physicans and make them subject to criminal prosecution for an unacceptable level of pallative care. And again, you are referring to a patient with a physical illness, with a readily discernible cause for her physical pain. And again, vitals are not the only indicator of pain. To assume that just because one's BP is elevated is evidence of severe pain is to ignore all the other variables that could be responsible. Elevated BP could just as easily be indicative of medication response.

Trying to use a multi axial diagnosis and actually understanding the way a multi axial diagnosis works is two different things. And when it comes to using a multi axial diagnosis for mental disorders, you obviously are lacking in understanding, as evidenced by your own posts.

You can disagree with me. That's fine. But if you are going to disagree, you need to substantiate the valid reasons for disagreement, and not simply disagree because you don't have a complete understanding of the diagnostic process.

Perhaps I need a review. But I never said elevated BP is evidence of severe pain. Like increased resperation it is only a clue that should point to the need for further investigation. Not just ignoring the patient because he assumed due to the fact she was Native American that she would become addicted to the pain meds.

 

[jillio]

Perhaps I need a review. But I never said elevated BP is evidence of severe pain. Like increased resperation it is only a clue that should point to the need for further investigation. Not just ignoring the patient because he assumed due to the fact she was Native American that she would become addicted to the pain meds.

How do you know that he was assuming it was because she was a Native American? And the fact of the matter is, there is a higher incidence of addictive disorders in the Native American population. That has been known for years. So while one can't assume that Native American heritage automatically leads to addiciton, it is neither unreasonable to look at it as a possibility.

You said the the doctor refused to look at your recording of the vital signs. I simply used BP as an example of one of those vital signs. And, perhaps your readings were consistent with this particular patient's history. They would be notable if they were outside the norm for this particualr patient.

Perhaps this particular patient had a history of drug seeking behaviors, a history of drug addiction, or a history of alcoholism that her doctor was aware of, but that you were not, given that you did not have access to a complete medical history. Again, you are making assumptions without considering all of the variables.

 

[fredfam1]

Not all physical disorders are detectable through a blood work up. Obviously, you were not presenting with symptoms that would have warranted a blood work up, or you failed to reveal symptoms to your physician that would have indicated the need for a blood work up.

No, the doctors said the trauma was a precipitating factor. And you, yourself, admitted that the trauma may indeed have exacerbated the depressive symptoms.

You presented with depressive symptoms. You did not present with symptoms of a physical disease.

Exactly. I am atypical. In practically everything in my life. You are familiar with the questions one must answer in order to be classified as depressed. One of the questions was, "Have you ever considered suicide." I always responded no. This is because I have always felt life is good and when bad things happen eventually they will pass and things will get good again. Because I had positive responses to some of the other questions, I was repeatedly questioned about this one. "was I certain?, Never? Not even once in a while?" etc. Now in my opinion if one is apparently depressed but deep down optimistic about life in general, and never had thoughts of suicide, shouldn't that clue you to check for medical causes to the depression? And they attributed my other symptom, fatigue, to the depression. Perhaps this is indicitive of the military medical system? But the VA doc here in Oregon got it right.

 

[fredfam1]

How do you know that he was assuming it was because she was a Native American? And the fact of the matter is, there is a higher incidence of addictive disorders in the Native American population. That has been known for years. So while one can't assume that Native American heritage automatically leads to addiciton, it is neither unreasonable to look at it as a possibility.

You said the the doctor refused to look at your recording of the vital signs. I simply used BP as an example of one of those vital signs. And, perhaps your readings were consistent with this particular patient's history. They would be notable if they were outside the norm for this particualr patient.

Perhaps this particular patient had a history of drug seeking behaviors, a history of drug addiction, or a history of alcoholism that her doctor was aware of, but that you were not, given that you did not have access to a complete medical history. Again, you are making assumptions without considering all of the variables.

I presented my evidence to my nursing supervisor who said that she would check on it. His exact words were, "Don't worry about it, Native Americans have a propensity for drug dependence." Maybe he didn't give me her medical history. But this was a training situation. Or it was supposed to be. I think if she had a medical history of substance abuse, he should have indicated that to me, and reviewed with my why he chose not to prescribe additional pain meds. She was not at the max allowed and remember this was at a time when doctors would rather allow pain then risk the possibility of addiction, (20 years ago). I believe that is better monitored now. He should have used this as a opportunity to train me. His dismissive attitude towards her and me told me alot more about his approach as a healer than anything else. Yes I know he could have been tired, or preocupied thinking, "oh Lord save me from another Student RN who think she knows more than me". Yes all that is true, but his other job was to teach and I would have welcomed the instruction.

 

[Bottesini]

I presented my evidence to my nursing supervisor who said that she would check on it. His exact words were, "Don't worry about it, Native Americans have a propensity for drug dependence." Maybe he didn't give me her medical history. But this was a training situation. Or it was supposed to be. I think if she had a medical history of substance abuse, he should have indicated that to me, and reviewed with my why he chose not to prescribe additional pain meds. She was not at the max allowed and remember this was at a time when doctors would rather allow pain then risk the possibility of addiction, (20 years ago). I believe that is better monitored now. He should have used this as a opportunity to train me. His dismissive attitude towards her and me told me alot more about his approach as a healer than anything else. Yes I know he could have been tired, or preocupied thinking, "oh Lord save me from another Student RN who think she knows more than me". Yes all that is true, but his other job was to teach and I would have welcomed the instruction.

Physical difference is smaller liver that causes the specific problem of higher rate of addiction.

 

[fredfam1]

Physical difference is smaller liver that causes the specific problem of higher rate of addiction.

That is one, and in addition their bodies have not had time to upregulate to a change in diet, from their traditional nutriant dense diets, to the modern one of fast food chains and processed foods. Resulting in malnutrition at the same time as problems with obesity. There is also a higher incidence of Deafness in the population due to viral and bacterial infections in the winter and lack of medical treatment. (20 year old info)

 

[jillio]

Exactly. I am atypical. In practically everything in my life. You are familiar with the questions one must answer in order to be classified as depressed. One of the questions was, "Have you ever considered suicide." I always responded no. This is because I have always felt life is good and when bad things happen eventually they will pass and things will get good again. Because I had positive responses to some of the other questions, I was repeatedly questioned about this one. "was I certain?, Never? Not even once in a while?" etc. Now in my opinion if one is apparently depressed but deep down optimistic about life in general, and never had thoughts of suicide, shouldn't that clue you to check for medical causes to the depression? And they attributed my other symptom, fatigue, to the depression. Perhaps this is indicitive of the military medical system? But the VA doc here in Oregon got it right.

Quite frankly, no. Answering in the negative to thoughts about suicide is not an indication that a person is not depressed, not does it lead to the conclusion that physical illness is the cause of the depression. Answering in the postive is no more conclusive. Results are obtained using the entire assssment. And you continually ignore the fact that you were presenting with depressive symptoms. But you were not presenting with symptoms of any physical illness. Fatique is a well known symptom of a depressive illness. Since you were presenting with depressive symptoms, the conclusion would be logical and consistent with standard medical procedure.

What you are suggesting is that patients be subjected to a battery of diagnostic tests when there is no indication what so ever that the tests are indicated. Would you approve of exploratory surgery to look for sinus tumors in a patient that presents with symptoms of a common cold?

 

[jillio]

I presented my evidence to my nursing supervisor who said that she would check on it. His exact words were, "Don't worry about it, Native Americans have a propensity for drug dependence." Maybe he didn't give me her medical history. But this was a training situation. Or it was supposed to be. I think if she had a medical history of substance abuse, he should have indicated that to me, and reviewed with my why he chose not to prescribe additional pain meds. She was not at the max allowed and remember this was at a time when doctors would rather allow pain then risk the possibility of addiction, (20 years ago). I believe that is better monitored now. He should have used this as a opportunity to train me. His dismissive attitude towards her and me told me alot more about his approach as a healer than anything else. Yes I know he could have been tired, or preocupied thinking, "oh Lord save me from another Student RN who think she knows more than me". Yes all that is true, but his other job was to teach and I would have welcomed the instruction.

And his statement was correct. Being of Native American heritage increases the risk of addiction disorders. There is a higher incidence in those of Native American heritage.

Why should he have reveiwed this patient's entire medical history with you? He was the one responsible for diagnosis and treatment. He is under no obligation to explain or justify his treatment decisions to you.

There is a reason that nurses (and particularly student nurses jsut beginning their clinicals) are not permitted to diagnose. Your story is ample evidence of the reason behind that law. There is also a very good reason why nurses, except for nurse practitioners with advanced medical training, are not permitted to treat other than under the direct supervision of a physician.

And his job is not to teach. That is the job of your nursing school instructors. His job was to supervise.

 

[fredfam1]

Quite frankly, no. Answering in the negative to thoughts about suicide is not an indication that a person is not depressed, not does it lead to the conclusion that physical illness is the cause of the depression. Answering in the postive is no more conclusive. Results are obtained using the entire assssment. And you continually ignore the fact that you were presenting with depressive symptoms. But you were not presenting with symptoms of any physical illness. Fatique is a well known symptom of a depressive illness. Since you were presenting with depressive symptoms, the conclusion would be logical and consistent with standard medical procedure.

What you are suggesting is that patients be subjected to a battery of diagnostic tests when there is no indication what so ever that the tests are indicated. Would you approve of exploratory surgery to look for sinus tumors in a patient that presents with symptoms of a common cold?

Fatigue is also a well know symptom of medical illness as well. And no it would not only be a waste of resources but since some diagnostics carry with it the risk of injury then they are only warrented when indicated. I really think more of a focus on family medical histories is necessary. ie My dad had evidence of some sort of GI problems, eczema, bloating, soft tooth enamal. Had I checked this off on a questionaire perhaps the process would have led to the discovery of my condition sooner. I have been Gluten free for a very long time now. And I probably see gluten ghosts in other people. But the process as it stands now is flawed and I only hope that the new developments in diagnostic screening with genetic markers and such will prevent these type of things in the future. I am hopeful that technology will provide better diagnostics, but it will still be up to the practitioner to treat the patient wholistically.

 

[jillio]

Fatigue is also a well know symptom of medical illness as well. And no it would not only be a waste of resources but since some diagnostics carry with it the risk of injury then they are only warrented when indicated. I really think more of a focus on family medical histories is necessary. ie My dad had evidence of some sort of GI problems, eczema, bloating, soft tooth enamal. Had I checked this off on a questionaire perhaps the process would have led to the discovery of my condition sooner. I have been Gluten free for a very long time now. And I probably see gluten ghosts in other people. But the process as it stands now is flawed and I only hope that the new developments in diagnostic screening with genetic markers and such will prevent these type of things in the future. I am hopeful that technology will provide better diagnostics, but it will still be up to the practitioner to treat the patient wholistically.

Yes, fatigue is correlated with several physical illnesses. However, it is not idicative of a physical illness in of, and by itself. You presented with depressive symptoms and fatique. You did not present with symptoms of any physical illness that could account for the fatigue.

It is not the diagnostic process that is so flawed as is your reasoning. And that is "holistically".

 

[fredfam1]

And his statement was correct. Being of Native American heritage increases the risk of addiction disorders. There is a higher incidence in those of Native American heritage.

Why should he have reveiwed this patient's entire medical history with you? He was the one responsible for diagnosis and treatment. He is under no obligation to explain or justify his treatment decisions to you.

There is a reason that nurses (and particularly student nurses jsut beginning their clinicals) are not permitted to diagnose. Your story is ample evidence of the reason behind that law. There is also a very good reason why nurses, except for nurse practitioners with advanced medical training, are not permitted to treat other than under the direct supervision of a physician.

And his job is not to teach. That is the job of your nursing school instructors. His job was to supervise.

It is every practitioners job to teach. No it was not in his job description, but I go beyond my job description on a daily basis. (and even though you are correct about the laws, a subsequent review instigated at the request of my supervisor, indicated she would have benifited by more pain meds) It was a lucky guess on my part based on green horn school training and yes I could just have easily have been wrong. But we were taught to question and learn.
This was really a communication problem because she did not know any English. I saw pain, and admitedly that is entirely subjective.

 

[fredfam1]

Yes, fatigue is correlated with several physical illnesses. However, it is not idicative of a physical illness in of, and by itself. You presented with depressive symptoms and fatique. You did not present with symptoms of any physical illness that could account for the fatigue.

It is not the diagnostic process that is so flawed as is your reasoning. And that is "holistically".

Flawed reasoning based on personal experiance and education?
My reasoning is different than yours. Not flawed.