discussion of Aaron Kosminski's psychological profile

[corey123]

Hello Pontius,

Yes, these points are all true. Bi-polar disorder is a mood disorder not characterized, but may include in symptoms, psychosis. Schizophrenia is a neurocognitive disease which is characterized, but may include mania or depression, psychosis.

The fact that the ruling in this case changed from 'mania' to 'dementia' speaks the likeness of the disorder being a schizoform disorder. Even with Jacob Isenschmid, who is ruled as suffering from 'recurrent mania 2', and experiences extreame manic episodes is likely to be schizphrenic, for he has many delusions. This in turn would rule the manic episodes a by product of the schizophrenia. Again on dopamine, a major cause of psychosis,(sorry to linger on this once more). Dopamine plays a huge role in both stabilising behavior and balance of the 'punishment and reward' system. A change in dopaminergic function causes, like I have previously said, schizotype disorders, and this disruption would, as with the 'domino effect', disrupt these two systems. In turn causing both psychotic and mood symptoms. Of course, if the negative symptoms are more prevelent, then the affected will be more depressive than manic, the reverse for positive.

What I am trying to say is, when you have a case where psychosis is present, you must rule out certain disorders to present a concrete case for manic depression.

[Pontius2000]

Pontius,

Bi-polar disorder is a mood disorder not usually classified with psychotic symptoms, therefore if psychotic symptoms are present usually the inflicted are not bi-polar. The ruling stictly as bi-polar 1,2 or cyclothymia, is rare when severe psychosis is instilled. As this is the case, the ruling of Manic Depression is very unlikely. Remember, symptoms overlap, and the mosty promonent symptoms make a ruling in this case the psychotic symptoms play a bigger part than the mood disturbances.

I am not saying it isn't possible, but very very less likely than schizophrenia or a shizotype disorder.

that is only partially correct, Corey. Bipolar Disorder is not classifed by psychosis. However, psychosis is common in Bipolar Disorder. The statement that if psychotic symptoms are present that Bipolar is not likely the disorder is not correct.

[corey123]

I would like to offer this quote from what I posted above,

In addition, the episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. . . .

I will finish it off...... and if they aren't better accounted for, the ruling is incomplete, inaccurate, and non-existant. It is a guess at most.

[corey123]

Hello Pontius,

As I am sure you are aware, I posted the diagnostic critera of Schizophrenia. Here it is again;

C. Duration: continuous signs of the disturbance persist for at least six months. This six month period must include at least one month of symptoms that meat criterion A. May include periods of prodromal or residual symptoms.

And for Bi-polar disorder:

Bipolar I Disorder--Diagnostic Features (DSM-IV, p. 350)
The essential feature of Bipolar I Disorder is a clinical course that is characterized by the occurrence of one or more Manic Episodes or Mixed Episodes. Often individuals have also had one or more Major Depressive Episodes. Episodes of Substance-Induced Mood Disorder (due to the direct effects of a medication, or other somatic treatments for depression, a drug of abuse, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Bipolar I Disorder. In addition, the episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. . . .



Bipolar II Disorder--Diagnostic Features (DSM-IV, p. 359)
The essential feature of Bipolar II Disorder is a clinical course that is characterized by the occurrence of one or more Major Depressive Episodes accompanied by at least one Hypomanic Episode. Hypomanic Episodes should not be confused with the several days of euthymia that may follow remission of a Major Depressive Episode. Episodes of Substance- Induced Mood Disorder (due to the direct effects of a medication, or other somatic treatments for depression, a drug of abuse, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Bipolar I Disorder. In addition, the episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. . . .



Criteria for Major Depressive Episode (DSM-IV, p. 327)
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g. appears tearful). Note: In children and adolescents, can be irritable mood.

markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

insomnia or hypersomnia nearly every day

psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

fatigue or loss of energy nearly every day

feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms do not meet criteria for a Mixed Episode.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
E. The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.



Criteria for Manic Episode (DSM-IV, p. 332)
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).
B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
inflated self-esteem or grandiosity

decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

more talkative than usual or pressure to keep talking

flight of ideas or subjective experience that thoughts are racing

distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C. The symptoms do not meet criteria for a Mixed Episode.
D. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatments) or a general medical condition (e.g., hyperthyroidism).
Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.



Criteria for Mixed Episode (DSM-IV, p. 335)
A. The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.
B. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).



Criteria for Hypomanic Episode (DSM-IV, p. 338)
A. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
inflated self-esteem or grandiosity

decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

more talkative than usual or pressure to keep talking

flight of ideas or subjective experience that thoughts are racing

distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
F. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder.

[corey123]

Pontius,

Bi-polar disorder is a mood disorder not usually classified with psychotic symptoms, therefore if psychotic symptoms are present usually the inflicted are not bi-polar. The ruling stictly as bi-polar 1,2 or cyclothymia, is rare when severe psychosis is instilled. As this is the case, the ruling of Manic Depression is very unlikely. Remember, symptoms overlap, and the mosty promonent symptoms make a ruling in this case the psychotic symptoms play a bigger part than the mood disturbances.

I am not saying it isn't possible, but very very less likely than schizophrenia or a shizotype disorder.

[Pontius2000]

auditory hallucinations are associated with schizophrenia first and foremost, before other disorders... actually they are associated with drugs and alcohol first and foremost... then schizophrenia. Most people who do drugs and drink alcohol don't have hallucinations. Same with schizophrenics.

Mike

hallucinations are a 'positive symptom' of schizophrenia, yes. hallucinations are also symptoms of psychotic episodes in bipolar disorder as well.

I'm still not clear on what you're suggesting. It appears that you are either saying that he would not be likely to have hallucinations if he were Bipolar or either the chances of having hallucinations would be much less likely if he were Bipolar. I don't agree. Even if hallucinations and delusions occured 100% of the time in schizophrenia and 50% of the time in Bipolar cases, it would still be just as likely that Kosminski was having psychotic episodes of Bipolar, since schizophrenia is over twice as rare as bipolar.

also, from what I've read, it is more likely to appear 'normal' with Bipolar than Schizophrenia due to the nature of the mania vs depression stage. whereas, schizophrenia is a "split from reality" and I believe to be diagnosed with schizophrenia, you must present symptoms for one month or longer, which would mean that he would have been experiencing major problems for over a month at a stretch, even before going into the asylum.

[The Good Michael]

auditory hallucinations are associated with schizophrenia first and foremost, before other disorders... actually they are associated with drugs and alcohol first and foremost... then schizophrenia. Most people who do drugs and drink alcohol don't have hallucinations. Same with schizophrenics.

Mike

[Pontius2000]

Pontius,

I'm not a psychologist, nor would I want to be, but without looking at wiki, I would suggest that the vast majority of bipolar folks don't have hallucinations. Schizophrenia is known for its hallucinations. Yet, if you want to look online to prove me wrong, go for it.

Cheers,

Mike

manifestations of psychotic episodes can occur in both the manic and depressive stages of Bipolar disorder. I don't believe psychotic episodes are any more common in Schizophrenia than in Bipolar Disorder. You seem to be suggesting that Schizophrenia is characterized by hallucinations, which is not correct at all.

[The Good Michael]

of course they do. the hallucinations are psychotic episodes caused by Bipolar and Schizophrenia. not all sufferers have these psychotic episodes. But someone with Bipolar is just as likely to have psychotic episodes as someone with Schozophrenia. and the style of hallucinations are the same in both.

Pontius,

I'm not a psychologist, nor would I want to be, but without looking at wiki, I would suggest that the vast majority of bipolar folks don't have hallucinations. Schizophrenia is known for its hallucinations. Yet, if you want to look online to prove me wrong, go for it.

Cheers,

Mike

[The Good Michael]

Marlowe,

Like anywhere else, about 10% are stunning. But I like the way they look and the style. It is very Russian with black everything and furs and boots, but they are definitely Asian folks.

Mike

[Marlowe]

Hey there Baron,

So, tell me, what do the women look like in Astana?

[Pontius2000]

I can't see manic depressives having such hallucinations. Mike

of course they do. the hallucinations are psychotic episodes caused by Bipolar and Schizophrenia. not all sufferers have these psychotic episodes. But someone with Bipolar is just as likely to have psychotic episodes as someone with Schozophrenia. and the style of hallucinations are the same in both.

[The Good Michael]

That ergot poisoning thing sounds lame to me. Everyone has tried to blame many things on hallucinations from ergot poisoning. The Salem witch trials, Roanoke, maybe even the Mary Celeste. There are far more rational reasons for all mysteries. One just has to look to find them. I think Kosminski, who had auditory hallucinations to be sure, suffered from schizophrenia. I can't see manic depressives having such hallucinations. It doesn't make Koz the murderer, but he had classic signs of schizophrenia and they worsened over time, much like untreated schizophrenia does nowadays.

Cheers,

Mike

[Abby Normal]

[QUOTE=Pontius2000;155823]

there are periods, like in the example of Bipolar Disorder (as well as other disorders), where the sufferer appears completely normal and is functional, or can 'hide' their disorder and appear normal and functional. Then, periods of mania. He would not have been in a state of constant mania, just as he was not in a state of contant mania after being put in the asylum.

Hi pontius
thanks for the reply. This is what i was looking for.

[Marlowe]

Chris,

You're out of your league and you know it ;-)

Marlowe