Article: The hidden links between mental disorders

Andy

Andy

Retired committee member
Psychiatrists have a dizzying array of diagnoses and not enough treatments. Hunting for the hidden biology underlying mental disorders could help.
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Ya think??

In 2018, psychiatrist Oleguer Plana-Ripoll was wrestling with a puzzling fact about mental disorders. He knew that many individuals have multiple conditions — anxiety and depression, say, or schizophrenia and bipolar disorder. He wanted to know how common it was to have more than one diagnosis, so he got his hands on a database containing the medical details of around 5.9 million Danish citizens.

He was taken aback by what he found. Every single mental disorder predisposed the patient to every other mental disorder — no matter how distinct the symptoms1. “We knew that comorbidity was important, but we didn’t expect to find associations for all pairs,” says Plana-Ripoll, who is based at Aarhus University in Denmark.

The study tackles a fundamental question that has bothered researchers for more than a century. What are the roots of mental illness?
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https://www.nature.com/articles/d41586-020-00922-8
 
I thought this was an interesting article but it seems a little hard to believe as well in some places. Better understanding of the relevant biology could do a lot to advance care for patients.

One notes a certain similarity to the diagnostic criteria problem in ME/CFS. They struggle with the heterogeneity: either they are very simple, perhaps dangerously so, or they are complex to the point of not being usable in most contexts, or something in between but also imperfect. It's a very difficult problem and maybe this means the natural entity is just not something that can be described with a simple set of items.
 
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Not sure where else to put this. This got me thinking about diagnostic criteria. Does anyone else think that a mismatch between expected ability to do things, and actual ability might be an important feature of ME/CFS?

Where patients start things, thinking they'll be able to finish but then they unexpectedly begin to struggle with fairly normal activities (due to rapid fatigueability on same day or symptom worsening on subsequent days). On an intellectual level they know this due to repeated experience, but they're prone to do too much anyway because they feel capable regardless of that.

There is a part of the brain that has the task of planning ahead and estimating whether some activity is feasible, how much energy it would take, and so on. This part seems to have difficulties taking ME/CFS into account, and so tends to overestimate what is realistically achievable.

Other people observing patients make the same mistake too. They think the patients should be able to do more.
 
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strategist said:
Not sure where else to put this. This got me thinking about diagnostic criteria. Does anyone else think that a mismatch between expected ability to do things, and actual ability might be an important feature of ME/CFS?

Where patients start things, thinking they'll be able to finish but then they unexpectedly begin to struggle with fairly normal activities (due to rapid fatigueability on same day or symptom worsening on subsequent days). On an intellectual level they know this due to repeated experience, but they're prone to do too much anyway because they feel capable regardless of that.

There is a part of the brain that has the task of planning ahead and estimating whether some activity is feasible, how much energy it would take, and so on. This part seems to have difficulties taking ME/CFS into account, and so tends to overestimate what is realistically achievable.

Other people observing patients make the same mistake too. They think the patients should be able to do more.
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There was a whole field of psychology about why people are bad at making decisions in tasks where the outcome of that decision was delayed, for example like steering an oil tanker where you have to start the manoeuvre well before it actually happens.

Unfortunately my knowledge is some forty years out of date, however could it be just that with PEM the effect is removed in time from the cause, which people are likely to be bad at spotting whether they have ME or not.
 
Andy said:
Psychiatrists have a dizzying array of diagnoses and not enough treatments. Hunting for the hidden biology underlying mental disorders could help.
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There, no need to read further. But doesn't "biological psychiatry" (which is interesting!) cross into neurology territory? And are most researchers in psychiatry well trained in molecular biology, structural and functional imaging, (epi)genetics? If not, or rather if they are essentially trained in psychology, shouldn't they go back to uni or med school?
 
Sarah94 said:
That's not funny. Mental illness is real.
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I liked @Barry's post but also want to let you know I don't find mental illness remotely funny.

I liked the post because I find it ironic that while the likes of the BPS cabal are pushing for mental health treatments for an ever increasing range of conditions and aim to use mental treatments such as IAPT to delay, if not actually deny, access to tests for physical ailments, already scarce resources are being diverted from those with serious mental health conditions.

Based on our own experiences, psychiatric research seems to have incredibly low standards that simply wouldn't be acceptable in other fields of medicine.
It's a field where if the patient fails to improve or recover it's because the disease is so complex, or it's the patient's fault, while any improvement is down to the psych's expertise.

Despite the fairly low rate of recovery in mental health some groups of psychs are desperate to reclassify perfectly normal life experiences such as caffeine withdrawal, or still being bereaved more than a few weeks after the loss of a loved one.

If anyone is making a mockery of mental health problems it is these jackasses who place their empire building above the suffering of patients.

I am also aware there are excellent, competent and caring mental health professionals out there. They are not only having precious resources diverted away from them but their reputations tarnished by association.

Edit -spelling
 
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Sarah94 said:
That's not funny. Mental illness is real.
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I'm sorry, it was meant to be tongue in cheek, but as always I overlook that in an online forum such things get easily lost. I can assure you, you are preaching to the converted, because I am only too well aware of the truth in what you say. Very few families escape this. What I was really meaning was a certain 'breed' of psychiatrists, but I guess only those who know me well would have realised that. I'll delete it.
 
Sarah94 said:
That's not funny. Mental illness is real.
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I agree. Real mental illnesses are real. But our "mental illness" isn't real, it was invented by psychs. And that's not funny either. And accusing us of stigmatising mental illness is a card they like to play to shut us up and invalidate us when we point out that we don't have a mental illness. Which is fairly direspectful to PWME and people with mental illnesses. So let's not fall out about it amongst ourselves, I don't think anyone here thinks mental illnesses aren't real, PWME suffer from mental illnesses and have to deal with them and are aware of them as much as any other section of the population.
 
Being stressed, for any reason whatsoever, causes an increase in stress hormones, cortisol and adrenaline. This is an adaptive response that would happen to anyone and everyone and has helped humans to stay alive. If the stress does not reduce because it is something the sufferer can't control e.g. being ill with a health condition nobody takes seriously, being in chronic pain, having too little money, living in an unsafe neighbourhood, working for a bully, then those stress hormones will probably become chronically high.

I have wondered why psychiatric drugs don't try and reduce those stress hormones back to "normal" levels. After all, it is the stress hormones that alter people's behaviour so surely they are what need to be altered. But psychiatry expects people to do this by sheer strength of will then blames the patient when they fail to improve, and prescribes vile drugs that cause dreadful side effects. Then psychiatrists blame the patient for the side-effects and assume they are caused by an exacerbation of the original "mental" disorder (stress) and so they pile more drugs on top.
 
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Sarah94 said:
That's not funny. Mental illness is real.
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TiredSam said:
I agree. Real mental illnesses are real. But our "mental illness" isn't real, it was invented by psychs.
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Mental illnesses are real, and it is important to know of their existence, I think. There is no clear border between mentally ill and mentally healthy. Homosexuality had been classified as such an illness, but the classification itself should display mental illness. It is not without sense to claim that a mental suffering can influence the body. I guess a study that claims that CBT helps to some extent to heal from cancer, might be right.

The question is what the profession (some of the professionals) makes of it. They may know that they are only a tiny crowd at the edge of mankind, but most mighty in their importance, they are concerned with the prerequisite of the sense of life itself, the brain, and even more striking, with the brain having been formed by life.

One must but say that the last 200 years have been very fast, which makes it not easier. And what is a good definition of mental health/illness? Tu function, to cope with conflicts, to be content?

Then, I wanted to post a short list of merits and possibilities, maybe I have forgotten, or maybe I had too much fantasy. However, it´s not only that humans can set things which then may exist, no, also psychiatrists can!
 
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Arnie Pye said:
Being stressed, for any reason whatsoever, causes an increase in stress hormones, cortisol and adrenaline. This is an adaptive response that would happen to anyone and everyone and has helped humans to stay alive. If the stress does not reduce because it is something the sufferer can't control e.g. being ill with a health condition nobody takes seriously, being in chronic pain, having too little money, living in an unsafe neighbourhood, working for a bully, then those stress hormones will probably become chronically high.
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Do you think living in a tribal scenario, living without permanent shelter, relying on insecure food sources and potentially under threat from warfare is any less stressful?

What is a "normal" level of cortisol or adrenaline?
 
Snow Leopard said:
Do you think living in a tribal scenario, living without permanent shelter, relying on insecure food sources and potentially under threat from warfare is any less stressful?
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My list of possible life stressors was not intended to be a complete one, by any stretch of the imagination, and I made no claims that my list was complete. Regarding tribal living, I have no knowledge or experience of tribal lifestyles so would quickly come unstuck if I had mentioned them and I'm not sure why you think I should have mentioned it in my post.

Testing labs provide a reference range for just about everything that can be tested, and that includes cortisol. I've never had adrenaline tested but I'm sure it can be and it has an associated reference range. Doctors refer to the reference range, rightly or wrongly, as the "normal" range.
 
Snow Leopard said:
Do you think living in a tribal scenario, living without permanent shelter, relying on insecure food sources and potentially under threat from warfare is any less stressful?
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It reflects such a sheltered life for someone to seriously argue that modern life is more stressful than what our ancestors endured. I'll always be amazed at the mediocrity of it, it doesn't even pass the laugh test. Yes, buddy professor of the mind, you totally have it worse than our hunter-gatherer ancestors and information can totally fry weak-willed people's brain, they are so fragile, unlike yours. Especially as the early depictions of ME was of bored middle class housewives, the epitome of a sheltered life free of stress. It's both too much stress and too little stress and in fact any amount of stress. May be. Can be. Possibly. Or any variation thereof.

The same people who would have argued not long ago that the human body could not possibly endure the physical stress of ... going at 25 km/h on a train or that it's laughable to suggest tiny invisible "life" could kill a fully healthy adult. The most remarkable truth of those who see hysteria everywhere is that they are themselves the worst catastrophizers in the world, trying to argue that a single slight in an otherwise sheltered life is a rational explanation. Completely ridiculous.
 
The cause could be not stress by itself but a reduced stress tolerance that turns ordinary stress into an overly difficult problem.

Claims that stress triggered some illness could be due to the illness causing a reduced stress tolerance. The illness could start at a level of severity where it is not recognizable yet, even though it's already having an effect on the person. When it gradually worsens over time, the experience for the patient could be that of slowly struggling more and more and feeling overwhelmed and stressed with ordinary daily activities, until they reach a point where it is apparent that something is wrong. If they are then diagnosed, it could look exactly like stress caused the illness.
 
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