Diagnostic and therapeutic difficulties in atypical illness

The discipline of psychiatry often polarizes clinicians into "biologically" and "psychoanalytically" oriented camps. The former use drugs to treat and focus on symptomatic relief while the latter attempt to resolve core psychological problems and eschew pharmacological aids. Atypical psychoses confront both groups with major problems. As the underlying etiology may be epileptoid, the analytically oriented clinician may miss diagnostic clues. His biologically oriented colleague may dismiss the psychological triggers to the episodic disturbance. Diagnostic difficulties are compounded by the mix of behavioral disturbances with affective features and by the erratic course of the illness. It is difficult to find colleagues to help with the diagnosis of atypical psychoses. Neurologists often focus on "hard" signs only while parameters for "abnormalities" vary among electroencephalographers. Some EEG labs are intolerant of patients who will not cooperate with sleep or hyperventilation procedures or are not acquainted with drug activation techniques for identifying limbic system dysfunction. It is known that psychological factors influence seizures, and increase or decrease the need for anticonvulsants. Yet pharmacological suppression of a seizure state may lead to personality change or deterioration. The changing picture of illness and its divergence from classical "textbook" illness may evoke anger and frustration in the therapist as he comes to view the patient as noncompliant.