Common Diagnostic and Treatment Errors to Watch out for, in Daily Practice
Common Diagnostic and Treatment Errors
1) Confusing the symptoms of Hyperactivity, Impulsivity and Distractibility [HID] with ADHD, then using Stimulants, rather than treating the underlying disorder
2) Mistaking Unipolar Depression for an unstable Mood Disorder using SSRI’s and other anti-depressants, rather than using a mood stabilizing medications
3) Missing vocal and motor tics, often disguised as a somatic problem, like a habit cough, or speech fluency problem, occasional stuttering, or an Obsessive Compulsive[OCD] movement or sound, and either not treating this as the primary disorder with biologically based treatment that is a neuroleptic, or using the wrong treatment like an SSRI, or not treating at all believing these findings are insignificant or “normal” or “will pass”
4) Confusing extreme anxiety and panic with psychotic anxiety and mild paranoia, and thus using anti anxiety med vs. an anti psychotic
5) The possible Atypical Brain Chemistry of a PDD NOS person or any psychiatric presentation is not appreciated
6) Confusing apathy-flatness-anedonia or a thought disorder with depression
7) Circular tangential thinking with looseness, and derailment missed if mild and subtle as a significant thought problem
8) Confusing the slow thinking of psychomotor retardation of depression with thought blocking of a thought disorder
9) Missing that overly vivid and loud thoughts, or any sensation of vision, smelling, taste, touch may in fact be psychotic or anxiety related hallucinations
10) Confusing relatedness symptoms of the Autistic Spectrum [PDD NOS] vs. Schizophrenic Spectrum symptoms
11) Missing that a somatic issue is causing the problem for example sleep apnea leading to ADHD type symptoms
12) Missing that a primarily somatic presentation such as headache, especially migraine or irritable bowel, or any “psychosomatic” presentation is the first and perhaps the only manifestation or a serious mental health diagnosis like Bipolar, or Major Depression, or Panic, or Schizophrenia to name a few
13) Non psychiatric brain problem due to missing that it is environmental stress, PTSD and its variants, including mismatch of environmental structure too much vs. too little, at work, home and school.
14) Over stimulation from daily exposure to “normal” stimulation is bring out symptoms, like over exposure to video games, internet, TV, “computer use” and other electronic media
15) Treatment, any treatment biological or non biological like psychotherapy, is making matters worse
16) Dose of medication is too low,
17) Dose of medication is too high
18) Medication not being taken consistently
19) Medication not given long enough
20) Multiple meds are needed
21) Multiple biochemical diagnoses of a psychiatric nature are present
22) Missing subtle symptoms of Delirium and Dementia type syndromes, marked by problems with memory, fluctuating attention, mild confusion, and dream like states, caused by medications, toxins, drugs and alcohol, medical especially neurological problems
23) Non psychiatric brain problem is present like learning disorder
24) Non psychiatric brain problem like clinical or subclinical seizure or other hard neuro disorder
25) Non brain chemistry problem like personality disorder, in children and teens the ODD or Oppositional Defiant Disorder, or Anti Social Conduct Problems, or Under Socialized Aggressive or other Conduct disorder
26) Psychological and social effects are too powerful, mind vs. matter and the mind wins
27) Missing the “something is just not right diagnosis”
28) Confusing abnormal development or delays in development with actually biologically based symptoms, as in the neglected, abused child, or otherwise traumatized person, or in certain PDD NOS people