Electronic Letters to:
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eLetters: Electronic letters published:
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Deficit State
- Raghavendar Baburaj (29 May 2008)
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Labelling people is not helpful
- Ruchi Thakur (29 May 2008)
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Raghavendar Baburaj, ST3 Psychiatry
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drrbaburaj{at}hotmail.com Raghavendar Baburaj
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I read with great interest of the importance of IQ as an accompaniment in the diagnosis of difficult cases of suspected schizphrenia and of the reported cases where IQ has remained stable and in a significant few dropped quite a few points. The issue that I would like to raise is the constant ''cold war'' between General Adult Psychiatrists and Learning Disability psychiatrists regarding the care of a particularly disadvantaged group of patients who may at times present as if they had a developmental disability . This presentation could be a reflection of the defect state but there has been a lot of debate as to the best team to cater for their needs. The visible reduction in rehabilitation services has not done much to favour these patients. I wish to highlight the plight of this particular patient group. Do people think that a dedicated service with a Consultant in Adult or Learning disability with special interest in the care of such patients would help to offer better management? |
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Ruchi Thakur, MRCPsych ,SPR psychiatry UCL
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ruchithakur{at}yahoo.com Ruchi Thakur
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It was interesting to read of the correlation between psychiatric symptoms and decline in IQ during the acute phase of mental illness. However, I do not agree with the author that the patients described in the case examples had schizophrenia. The IQ test is not specific and labelling such patients with a diagnosis of schizophrenia will have lifelong implications. If there are concerns that borderline cases are not given support by early intervention services then these teams need to revise their criteria rather than us labelling more people with such a diagnosis. It is also important to know in what way the author thinks the management is going to differ after the label of schizophrenia… In the 1st case the young man got antipsychotics, intensive help from the CMHT and support to stay off recreational drugs. So why label him with schizophrenia? Also, use of street drugs could be a confounding factor for the decline in his IQ. In the 2nd case the lady seemed to be suffering from alcoholic hallucinosis which is associated with first rank symptoms of schizophrenia. Labelling her with schizophrenia would just affect her anxiety levels and self-esteem. Keeping such people on long-term antipsychotics is not needed. The 3rd case outlines the need for better psychiatric services rather than the need to label more people with early schizophrenia. This case shows how various teams have developed strict inclusion and exclusion criteria which are not helpful to patients in the community. In brief, it is useful to do baseline IQ tests but one cannot use these tests to support an early diagnosis of schizophrenia. Clinicans should be careful in labelling people with such a diagnosis at an early stage as some of them will do well and never relapse again. |
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