Diagnostic Symptom Clusters or Groups
Major Symptom Clusters or Groups of Biological Based Medication Responsive Mental Health Problems
There are common biologically based mental health problems, that should not be missed, because adequate treatment at the earliest age offers the most hope for symptom relief, remission, and prevention of relapses and complications. Being biologically based medication may be needed, perhaps essential, but should only be used based on sound diagnostic principals. One approach to organizing and diagnosing these problems follows.
A) Diagnosis is a Process: One can begin the diagnostic process by classifying biologically based mental health problems into six major groups based on their symptom presentations and predicted responsiveness to certain specific medication classes.
B) Specific Provisional Diagnosis: These groups do not represent an individual’s specific diagnosis which requires detailed information about the symptoms their beginnings and progression , the individuals and their family history of mental health problems, traits, disorders and responses to treatment.
C) Final Diagnosis: Many time the individuals specific diagnosis descriptively and biochemically requires more and more history and the responses from multiple medication trials, sometimes from different groups, having diverse mechanisms of actions, before the final diagnosis is clear and the best medications are found.
The Six Medication Responsive Groups or Clusters: The general groupings are briefly described with common presenting symptom clusters followed by the medication classes that are usually considered the medications of choice[MOC]. These are presented only as a possible initial screening tool that must be followed by further diagnostic procedures.
Note Well-NB! More then one symptom cluster or diagnostic group may be present at the same time!!! For example Mixed Bipolar has cluster 1) and 2) present by definition at the same time.
1) Unstable Mood-Atypical -Bipolar Like Cluster: May begin depressed, but mainly Mood swings in days, weeks, months , even years from , sad-mad-glad , irritability, anger outburst, rage attacks, big unrealistic ideas, need to be the boss, the bully, need little sleep, fast talker, too many ideas, difficult to live with, walking on egg shells, Dr Jeckle & Mr. Hyde. Medicine of Choice [MOC]- mood stabilizers, neuroleptics, [Risperdal, Abilify, Seroquel, Geodon, Zyprexa, Thorazine, Haldol, Trilafon, Prolixin] anticonvulsants [Depakote, Tegretol, Lamictal], and Lithium.
2) Stable Unipolar Depressive Type Mood Cluster : No extremes of mood, Sad, depressed stable mood, lack of pleasure, little to no interest in things, tired, fatigue, mind slow, hard to think, negative about self, past, present , and future, hopeless, better off dead. [MOC]- SSRI/NRI’s [Prozac, Zoloft, Paxil, Luvox, Celexa, Lexapro, Cymbalta, Effexor], tricylic antidepressants [ imipramine, amitryptilene].
3) Generalized or Other Anxiety Cluster: Worried too much about past , present , and future, tense, keyed up, easily fatigued, panic attacks, fears, phobias, shy, avoids things, afraid to sleep or be alone, trouble going and staying in places like school, rituals like hand washing, counting, sequencing, ordering, getting things just right. [MOC]- SSRI/NRI’s, benzodiazepines [ Valium, Xanax, Klonopin]
4) Motor-Impulse Tic Like Cluster: Motor movements around eyes like blinking, twitches of nose, face, neck, shoulders, sounds like snorting , sniffing, throat clearing, coughing. [MOC]- is a neuroleptic.
5) Thinking Problems –Deficits in Relatedness-Reality Testing Cluster: Blunted, shallow, inappropriate emotions, loss of interest, drive, motivation & ambition, little or disorganized , illogical speech, odd, peculiar, strange, secretive, mistrustful, paranoid behavior, loaner, isolates self, in their own world, voices, visions. [MOC]- is neuroleptic.
6) Attention-Impulsive Type Cluster: Classic ADHD & biochemically related disorders- no mood swings, no depression , no worry & anxiety, no motor/vocal tic-sounds, no thinking-relatedness problems . Medication of Choice [MOC]-stimulant like Adderal, Dexedrine, Focalin, Ritalin, Metadate, Concerta, Daytrana, Vyvanse.
Two other cluster of symptoms or problems are included for diagnositic and therapeutic accuracy. The first is "psychiatric" but doesn't fall into a typical pattern of responses, thus has Atypical brain chemistry, and the second in "non psychiatric" by definition, that is mental health or psychiatric symptoms or problems that have known or discoverable physical causes and can present as isolated symptoms or as mild to severe versions of the deliurm-demention syndrome spectrums.
Atypical Cluster: not fitting into anyone category, having some features of more than one seen in the “Atypical Child/Person”. This may not represent not only a residual category but a distinct symptom cluster grouping with its own specific medication responsiveness based on unique brain chemistry. This group often has atypical development that is marked by unevenness, losing and gaining mental functioning in an unpredictable and episodic manner. [MOC]- none! These people often represent a dilemma diagnostically and therapeutically with medication management with unexpected and unpredictable responses, to the usual medication picked for the usual indications. Multiple trials careful done following the rule “start low and go slow” often very slow and very very low, using micro dosing, applies here more than any other grouping.
Delirium-Dementia Cluster: This cluster is to rule in or out non psychiatric causes, those caused by medical disorders, medications, either prescribed or OTC, other substances, like those of abuse or anything else that that a person may ingest, food supplements, energy drinks-foods, vitamins, herbs, other natural remedies, and environmental toxins like lead. If symptoms and signs are rapid developing and changing this points to a delirium, in more stable and progressing slowly this may be dementia, however both may be present. These non psychiatric causes result in changes in A. level of awarenesss from overly alert to dreamy to looking asleep, B. attention from hyper attentive to inability to concentrate, C. orientation, being confused about who you are, where you are, and the time, D. memory is poor, fogetting old things, and not able to learn new things, E. decreased ability to solve problems of daily living, F. speech and language is altered, G. changes in mood, thinking speed and acitivity level from too fast to too slow, H. misperceptions like illusions, hallucinations, paranoia, and delusions, that come and go.[MOC] none, one treats the underlying cause.