Sunday, July 06, 2008

primary psychiatric illness

This is a therapyfirst comment from Philip Dawdy's FS where there has been a discussion on primary psychiatric illness and diagnosing other diseases as such when they are not:

One of the more boneheaded mistakes of my field was to include addiction as a psychiatric diagnoisis, so now addicts literally get dumped onto psych units to be treated, and since most insurance companies seem to think that addiction is not a mental illness and not reimburse for it as the primary diagnosis, psychiatrists have to give a major psychiatric diagnosis for the hospital to be paid. And, since most addicts are all over the place with mood and thinking in intoxication or withdrawal, what is the most convenient diagnosis: Bipolar Disorder! And (wait, there is one more) what do most psychiatrists these days do with bipolar diagnoses, give the patient not one, not two, but usually three or more meds, all while in the hospital for the 4 to 7 days the patient usually stays before dumped back on the street.

I'm waiting for DSM V to include neurological illnesses as psychiatric ones, just so the book is even bigger and more inclusive with the specialty it shares as its Board Certification status (the American Board of Psychiatry & Neurology, for those not aware).

Another mistake was to include dementia as a primary psychiatric diagnosis. These patients become our responsibility most often now too, and our cluelessness to use antipsychotics like pez with them is coming back to bite us in the ass, as you have read here and other places.

Not that these two areas of illness do not have psychiatric aspects to them, they are just not primary psychiatric illnesses. But, make subspecialties like addiction and geriatric psychiatry, and these boneheads have to find ways to make their money.


A tip for those interested: once you identify someone as an active addict not showing any effort or interest in recovery, do not trust them. Addiction is terminal selfishness until the addict has accepted there is a problem and it needs treatment.

Noted by one who worked in an addiction rehab program for over three years. They need help, not for us to be their victims."

Posted by: therapyfirst at July 6, 2008 05:31 PM

The problem I see is that the person and their families claim that the active addicted is bipolar but hide the fact that he or she uses cocaine or other drugs. I've asked many times if he only used pot and he said that it was only pot he took. I asked if he took cocaine and for three times he said NO.
Only when I've found out that the wallet was stolen and asked him what he did with the money he said he used the money to pay for cocaine. I said: "-So you really use cocaine!" "-Yep!" was his answer. He also said he took some beer with the money. And her mother told me "-He cannot drink."
It's getting harder and harder to make sense on all of these issues.

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