Biomedical Engineering Reference
In-Depth Information
if the person is suffering from a diagnosis possibly meriting medication.
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The major diagnostic groups in DSM-IV which are associated with SSRI
treatment are depressive disorders, including dysthymia, which is a kind
of chronic depressive mood and personality type; and anxiety disorders of
different sorts, such as social phobia and post-traumatic stress disorder.
The corner stone of depressive disorders is the presence of what is
called “a major depressive episode” (DSM-IV 2000: 356). This means that
a depressed mood (sadness, emptiness) and a loss of interest or pleasure
have been present most of the day, nearly every day, for at least two weeks,
and, in addition to this, that at least three out of seven criteria are also
fulfi lled for this period. The seven criteria are: signifi cant weight change,
insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or
loss of energy, feelings of worthlessness or excessive or inappropriate guilt,
diminished ability to think or concentrate, and recurrent thoughts of death.
The symptoms in question must also cause “clinically signifi cant distress or
impairment in social, occupational, or other important areas of functioning”,
and they should not be immediately caused by medication or bereavement
(loss of a loved one).
If we turn to the anxiety disorders in DSM-IV, we fi nd a corresponding
pattern of deviant feelings, problems in world engagement and altered
embodiment. The key role here, in the type of disorders treated with SSRIs,
is played by panic attacks, which are triggered by being in different alarming
situations. A panic attack is specifi ed in the following manner: “a discrete
period of intense fear or discomfort, in which four (or more) of the following
symptoms developed abruptly and reached a peak within 10 minutes”: (1)
palpations, pounding heart, or accelerated heart rate; (2) sweating; (3)
trembling or shaking; (4) sensations of shortness of breath or smothering;
(5) feeling of choking; (6) chest pain or discomfort; (7) nausea or abdominal
distress; (8) feeling dizzy, unsteady, lightheaded, or faint; (9) derealization
or depersonalization; (10) fear of losing control or going crazy; (11) fear of
dying; (12) paresthesias; (13) chills or hot fl ushes (DSM-IV 2000: 432). The
anxiety attacks are recurrent and often associated with being in a special
type of situation (meeting and speaking to strangers in the case of social
phobia, for instance). The person in question not only experiences anxiety
in having the dramatic attacks, but is often also constantly
anxious
about
having them.
Although most physicians do not follow these lists of criteria strictly in
making their diagnoses, the criteria clearly indicate what kind of matters
they investigate in their encounters with patients. Diagnosis, in these cases,
is all about phenomenological life-world issues, although the criteria are not
developed in any theoretically refl ected manner. One of the main points of
the development of DSM was, indeed, to make diagnosis without theory
(psychoanalytic or biological) possible, so the fact that concepts are not
defi ned or linked to each other in a theoretical manner of explaining the
disorders should come as no surprise. This, however, does not mean that
