Phillip Dawdy, the Blogger responsible for the content of Furious Seasons called for a description of the new “syndromal level hypomania or bipolar 2 NOS sub-threshold disorder.” Since Clinical Psychology Blog and Phillip have been extensively researching this new diagnosis that enables PHARMA to push yet another set of possibly non-efficacious and certainly off label indications for rehashing of old molecules. With my total bias on the table, and in “Giles” I nominate QAD or QUESTIONING AUTHORITY DISORDER.
1. .Thinking Independently (TI). These are patients who can think for themselves and not blindly follow the rules of their immediate socio-geographic or bio-psychophysical environments. Examples of this disorder are people who are passionate about a mission with intensity and feelings, or to quote Dr. Killer “They got soul, but they are not soldiers”1.
2. Rapid Emotional Cycling (REC) – Due to the patients’ brain chemistry and not their life stress or environment (hurricanes, child abuse, rape, war) the patients demonstrate labiality during normal conversations that takes the forms of laughter, tears, hand gesturing, and anger. Special severity codes should be billed if the patient experiences more than .4 of the therapy time angry at the therapist. A good differential should eliminate actors, Italians, street performers and teenagers
3. Sleep Deprivation (SD) – this symptom can lead to serious medical complications and needs to be treated STAT with a host of efficacious synthetics. Examples of this symptom are when a patient reports that they only slept 3 to 5 hours and upon rising, worked for several hours at home, before working a full day at the office. This is a life impairing symptom, and must be stopped at all costs. If the patient reports that this symptom is “manageable” then remind the patient, that thinking that way, IS part of QAD, and therefore, questioning ANY of the symptoms, immediately adds a severity code to the diagnosis.
4. Losing Weight (LW) – despite our drive to improve the health of our patients using guilt, ostracism, radical surgery, starvation, mouth wiring and PHARMA methodologies, our patients are still fat. Depressed people tend to gain weight, even when they feel sick as dogs. For this reason, when patients develop QAD and manifest weight loss, providers need to treat this condition STAT, by giving them medications that can get these obese depressed patients to maintain their weight, because if they lose weight, they are very sick, and in need of treatment for their health risk behaviors.
5. Passionate Productivity (PP) – Patients with PP will be highly successful in whatever they choose to do with their skills. However this is a very serious life threatening symptom that demands immediate medical intervention. A provider should immediately question the patient about the impulsivity of the relationship between the patient and their said “passion”, “mission” or “calling to help others.” Examples of people who could use intervention would be zealots calling for medication as a third line intervention for mental illness as opposed to first line, and those working to serve the disadvantaged such as those who give up large incomes to work in charitable pursuits.
6. Over Productivity (OP) – This symptom applies to patients who do at least 2 full time jobs. For example, mothers who work full time, run a family and are partnered are good examples of those who are over productive. Medication should be titrated immediately to a dose effective to overcome this symptom and induce normal “couch potato” behavior and give the patient release from the burden of OP).
7. Excessive Connection Disorder (ECD) – this new sub- sub- syndrome has tremendous health implications. Just because the medical community or populous just doesn't understand the content of information proffered by a patient with this disorder, it still demands immediate treatment. This includes changing patient reality using psychotherapeutic methods or by chemical induction. Patients with ECD are extremely treatment resistant and non-compliant, due to an excess of information often gathered from the internet or disease specific support groups. This includes but is no way limited to individuals who believe contrary to popular opinion about medical reality, those who believe in conspiracy theories, those who question authority and those who promote alternative view points. Severity codes should be added for patients who present more than one page of printed and documented treatment related information, or those who question MD authority.