Medication Clusters with Atypical and Delirium Criteria
Summary of Medication Responsive Clusters-with criterion for “Atypical-ness” and Delirium-Dementia
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 than 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-dementia 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.
Some of the symptoms-problems seen in this proposed group are:
1) [ ]Uneven development as infant-child, loosing & gaining functions unpredictably like speech and language
2) [ ]Transitions cause panic anxiety or rage attacks, physical symptoms like hives, irritable bowel, headaches
3) [ ] Unusual sensitivities to touch, taste, positioning, sound, lights.
4) [ ] Poor eye contact, and poor non verbal communication using gestures, body language
5) [ ] Not getting social rules, and cues from other, not getting the point of jokes or riddles or social moves
6) [ ] Socially stiff, and awkward, verbally and non verbally, marches to his or her own drummer
7) [ ] Unusual or peculiar relatedness, but not overtly strange or bizarre, slightly off emotionally
8) [ ] Something just “not right” about how they relate, respond, react to people, even those they know well
9) [ ] Get stuck in doing something, and has to finish it, and if not panic, gets angry, or too upset
10) [ ] Unusually high and over developed abilities in some areas of usually in the area of the thinking and doing mind, with unusually low function if not actual deficits in other area especially those related to the experiencing-relationship-feeling mode of the mind.
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 awareness 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, forgetting 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 activity 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.