Thread by @awaisaftab

1. Great paper by @HengartnerMP & @Altostrata, based on quantitative analysis of a case series. Given the paucity of previously published literature on this, this is an important contribution. Some thoughts and questions that come to my mind:

journals.sagepub.com/doi/full/10.11…

2. Chouinard & Chouinard criteria also specify criteria related to reversibility of symptoms & partial/total response to reintroduction of discontinued drug. It is unclear if these criteria were also applied as selection criteria.

3. To the best of our knowledge, unless future studies show otherwise, PWS appears to be a rare occurrence, but even rare occurrences can become common if the number of people being treated is large enough, & this is no reason to disqualify the suffering of those afflicted.

4. The suicide in the individual with post-SSRI sexual dysfunction... it is unclear if she had withdrawal symptoms other than sexual dysfunction. If not, should post-SSRI sexual dysfunction by itself be considered protracted "withdrawal"? I'm not sure. >>

4*. >> Does that mean *any* adverse effect post-discontinuation is "withdrawal"? Such use would seem to stretch the meaning of the word "withdrawal" beyond what is typical usage in medical contexts.

5. We still lack criteria with demonstrable reliability & validity that can distinguish b/w PWS, relapse of prior psychiatric disorder, onset of new psychiatric disorder, medically unexplained sx, etc. I'm not saying PWS doesn't exist; I'm saying its not always straight forward.

6. It occurs to me that "withdrawal" & "relapse" need not be mutually exclusive the way we tend to think. Especially from a symptom network point of view, withdrawal sx could v well lead to a self-sustaining activation of the same symptom network which comprised prior >>

6*. >> psychiatric disorder, in which case there will never be a sharp distinction between withdrawal and relapse as mutually exclusive entities.