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Allen Frances Profile picture
Allen Frances
@AllenFrancesMD
Author 'TWILIGHT OF AMERICAN SANITY, A PSYCHIATRIST ANALYZES THE AGE OF TRUMP' 'SAVING NORMAL' Chair, DSM-IV Task Force. Former Chair, Duke Dept of Psychiatry
Feb 13, 2022 • 4 tweets • 1 min read
Rule 1 Of Psychiatric Diagnosis: Always be sure symptoms are not due to neurological or medical illness.

I've seen 100s patients misdiagnosed as psychiatric because they hadn't received a thorough medical work-up.

This shocking story is a wake-up call:
washingtonpost.com/health/2022/02… Rule 2 Of Psychiatric Diagnosis:
Always be sure symptoms are not due to medication side effect or withdrawal.

In elderly, sudden onset of new psych symptoms most often due to multiple meds they're taking.

Doses should be lower in elderly/also be aware of drug interactions.
Feb 12, 2022 • 4 tweets • 1 min read
"There is grandeur in this view of life- whilst this planet has gone cycling, from so simple a beginning endless forms most beautiful & most wonderful have been & are being evolved.”
Charles Darwin

'Origin of Species' ends with this poetic tribute to the wonder of life.
1/3 2/3
 Darwin was history's greatest psychologist.
Everything before him was just subjective/everything after a footnote.
Brilliant insight: "To understand psychology, study baboons not philosophy."
Our behavior derives from animal ancestors in same way as body form & functions.
Sep 25, 2021 • 6 tweets • 1 min read
Twitter fosters disagreements by promoting the most colorful views of the noisiest extremists.

But I think a silent majority of sensible mental health clinicians might form a consensus around the 10 statements that follow: Is there consensus on
1)the value of a flexible bio/psycho/social approach
2)clinicians need both technical skills & the human touch
3)diagnosis & formulation are both necessary; neither sufficient
4)meds are overused in the many; essential for the few
Cont
Aug 22, 2021 • 4 tweets • 2 min read
I'd go further in dereifying psych disorders by making clear they are just constructs that don't really take shape til we define them.

Eg What we call #schizophrenia could have been defined in dozens of different ways- no one of which would be much better than any other. 3 epistemological umpires:
#1 Naive realist (Spitzer)- "There are balls & strikes & I call them as they are"
#2 Constructionist (me)- "There are balls & strikes & I call them as I see them"
#3 Solipsist (Szsaz)- "No balls & no strikes til I call them"