This is why people laugh at us..

[psych844]

Starting about 1:32. This woman is an expert in bipolar? She sounded like a freakin bad psychic (ie let's ask a lot of very general questions that can apply to almost anyone)..I felt embarrassed listening to that.

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[smalltownpsych]

I didn't listen to the whole thing, but to be fair it sounded like she was a bit nervous. I don't know how well my clinical interview skills would look in that setting either. Most of the time, there will be some follow up clarification or examples of the key symptoms, but is there really time for that on a tv show?

My main critique would be that from what I know of Charlie and other people with drug problems teasing out substance induced mood from bipolar would be most important.

 

[psych844]

I didn't listen to the whole thing, but to be fair it sounded like she was a bit nervous. I don't know how well my clinical interview skills would look in that setting either. Most of the time, there will be some follow up clarification or examples of the key symptoms, but is there really time for that on a tv show?

My main critique would be that from what I know of Charlie and other people with drug problems teasing out substance induced mood from bipolar would be most important.

did you hear the actual questions she asked starting at about 1:32 in? (those could apply to almost anyone)

 

[WisNeuro]

Meh, it's the Dr. Oz show. These people already came looking for pseudoscience and quackery, they don't want real doctors.

 

[psych844]

Meh, it's the Dr. Oz show. These people already came looking for pseudoscience and quackery, they don't want real doctors.

She was introduced as a leading expert in this area.

 

[WisNeuro]

Everyone on Dr. Oz is a "leading expert." He's brought on anti-vaxxers and treated them like actual scientists. Dr. Oz specifically picks people who will say stupid and sensationalistic BS that people like to hear. He doesn't seek out actual experts.

 

[WisNeuro]

Just listened to the part where she is assessing symptoms. She actually is asking about symptoms of mania, she's just not asking followups to make sure about the specificity of symptoms and get an accurate time course. It has to fit into a 5 minute show segment, rather than a whole diagnostic interview. I say meh, it's daytime TV. I've seen far worse portrayals of mental health. Look at Dr. Phil ffs.

 

[Spydra]

Wow. I get that this was not a full assessment, but most of Dr. Oz's followers won't get that and will think this is how easy it is to diagnose something like this. Not only could those questions apply to almost anyone, but anyone who has checked out the tabloid rags regarding Charlie Sheen in the few months could have said those all apply specifically to him. I'm not even sure why he'd agree to be on the show to explore his mental health when that isn't necessary. Given all of his health issues he really just needs to go off the grid for awhile and get help privately.

 

[ProspectiveKidd]

Wow. I get that this was not a full assessment, but most of Dr. Oz's followers won't get that and will think this is how easy it is to diagnose something like this.

The first thing she said was that it is a complicated diagnosis..

 

[Spydra]

And I bet that was the first thing regular viewers forgot once she started rattling off that handful of questions.

 

[ProspectiveKidd]

And I bet that was the first thing regular viewers forgot once she started rattling off that handful of questions.

She said it again after the questioning.. "it takes much more than 5 minutes to make this diagnosis" . She was also more than a little nervous and dumbed some things down for TV; something I'm sure most viewers of this show do understand.

 

[psych844]

And I bet that was the first thing regular viewers forgot once she started rattling off that handful of questions.

Pretty sure Dr. Oz said something like "she has some very SPECIFIC questions for you"...then she asked the most general/apply to everyone questions that she could.

 

[thoffen]

Hmm this is what I get for checking out the psychology forum. Personally I could not expect a better mania screen than that. Emphasis on screen, which she also qualified multiple times.

I think there is no way in hell Charlie did not know exactly what questions were coming. If he did not, the outrage should be ethically grounded instead. Even with all the informed consent in the world, I still would not have done this myself.

 

[smalltownpsych]

Hmm this is what I get for checking out the psychology forum. Personally I could not expect a better mania screen than that. Emphasis on screen, which she also qualified multiple times.

I think there is no way in hell Charlie did not know exactly what questions were coming. If he did not, the outrage should be ethically grounded instead. Even with all the informed consent in the world, I still would not have done this myself.

Hey! Don't pick on our students! They tend to be idealistic and have no practical experience when they are in undergrad. In other words, they have never actually done a clinical interview. We do want them to ask questions about the reliability and validity of various diagnostic methods though. They could also start thinking about the balance between sensitivity and specificity and which direction one would want to err.

 

[thoffen]

Hey! Don't pick on our students! They tend to be idealistic and have no practical experience when they are in undergrad. In other words, they have never actually done a clinical interview. We do want them to ask questions about the reliability and validity of various diagnostic methods though. They could also start thinking about the balance between sensitivity and specificity and which direction one would want to err.

Sorry! I was a little delirious working a 24 hour. I was inspired by your admission of cross posting, and didn't really factor into account the variability in stage of training here.

To your point though, it's a great concept to pay reverence to in mental health since we have developed (especially in psychology) tools for great diagnostic precision and yet forget that we have no assurance of the accuracy in our classification of illness.

RE: screening and sensitivity/specificity, screening tests want high sensitivity with relative disregard of specificity. Basically, you want a set of general questions that lead you to the next step in evaluation rather than definitive diagnosis. We psychiatrists don't usually get the luxury of doing hours of diagnostic testing. Sadly, there are a lot of bipolar diagnoses made on far fewer questions than this, and many clinicians will not seek to verify history of mania when seeing a patient with this historical diagnosis.

Hardest thing to figure out is also the most important -- that is, episodic nature of illness with concurrent symptoms. As you point out, any of these symptoms may occur separately with high frequency.

 

[smalltownpsych]

Sorry! I was a little delirious working a 24 hour. I was inspired by your admission of cross posting, and didn't really factor into account the variability in stage of training here.

To your point though, it's a great concept to pay reverence to in mental health since we have developed (especially in psychology) tools for great diagnostic precision and yet forget that we have no assurance of the accuracy in our classification of illness.

RE: screening and sensitivity/specificity, screening tests want high sensitivity with relative disregard of specificity. Basically, you want a set of general questions that lead you to the next step in evaluation rather than definitive diagnosis. We psychiatrists don't usually get the luxury of doing hours of diagnostic testing. Sadly, there are a lot of bipolar diagnoses made on far fewer questions than this, and many clinicians will not seek to verify history of mania when seeing a patient with this historical diagnosis.

Hardest thing to figure out is also the most important -- that is, episodic nature of illness with concurrent symptoms. As you point out, any of these symptoms may occur separately with high frequency.

Many of our psychological tests don't have very good psychometrics when used for diagnosis of psychological disorders either. I had a good discussion once with a neuro guy about one of my diagnostic assessments where I based my findings more on the history than the testing results. I still maintain that I was right since that is what our diagnostic system is based on. Off the top of my head, the only diagnoses that I make based primarily on testing results are intellectual and learning disabilities. I often will do cognitive testing for ADHD diagnoses but more to find potential learning problems as we don't have good tests for that diagnosis. When I was in training, I was told that we did, but then that was demonstrated to be inaccurate. Back to the drawing board.

Edit to add: Oh and welcome to the forum!