Archives for 

Bipolar Disorder

Bipolar Disorder

Bipolar Disorder and Adolescents

Symptoms of bipolar disorder in children and adolescents may look like other disorders

Traditionally bipolar disorder has been thought to first show in early adulthood – and more often in females.  Bipolar disorder was considered to be quite rare as few as 20 years ago, to be more exact. The first emergence came in the early 20s, mainly in females. But, our knowledge about bipolar disorder has grown rapidly in the last 20 years.

Instead of the single manic-depressive diagnosis – which included diagnostic criteria of both depressive periods, alternating with manic periods – described as “euphoria”?

Those who did not have clearly rhythmic, alternating periods of a “happy” and frantic manic phase with a classic depression period were mishandled, misdiagnosed, mistreated, or dismissed.

Bipolar ChildrenIn addition, it wasn’t really known that bipolar disorder could start in adolescence or even childhood, or that there are different types of bipolar disorder.  Today, it still isn’t “officially” recognized in the “psychiatric bible” – the Diagnostic Statistical Manual of Mental Disorders (DSM), but at least more practitioners do know that it exists.

Today, we don’t exactly know what causes bipolar disorder (only that there is a genetic link of some kind, and often some past trauma). But, we can at least identify adolescent and childhood bipolar illness.  We also recognize a variety of different types of bipolar disorder (Such as mixed manic episodes, rapid cyclers, people without a depressive phase, hypomania, dysphoria rather than euphoria and cyclothymia). We also have a “catch-all” type – Bipolar NOS or “not-otherwise-specified”.

Adolescent or childhood bipolar disorder is official known as: “early onset bipolar disorder”.  In fact, childhood bipolar disorder can be more serious than a similar disease in adults and may have slightly different symptoms.

Symptoms of bipolar illness in children can often be more severe, and the cycling period may be more frequent.  Children also have more mixed episodes.  Children also have slightly different symptoms – so even the depression phase of the cycle may not be obvious.

Pediatric patients (children and adolescents) with bipolar disorder may have:

Bipolar Disorder in Children•    Abrupt mood swings
•    Periods of hyperactivity followed by lethargy
•    Intense temper tantrums
•    Frustration
•    Defiant behavior
•    Chronic irritability

These symptoms have to appear in more than one setting (school and home) and cause “distress”.

The problem is that many of these symptoms may look like other disorders.  They might be disorders such as ADHD, childhood depression, anxiety disorder, obsessive compulsive disorder, conduct disorder, premenstrual syndrome, oppositional defiant disorder and others. The danger might come from a misdiagnosis and improper treatment.

Bipolar disorder is treated with anti-manic agents (lithium), anti-convulsants (Depakote, lamotrigine) or atypical antipsychotics (Abilify, Risperdal).  In many cases, anti-depressant won’t be needed.  Treatment for other disorders like ADHD or depression may make bipolar disorder worse. Childhood bipolar disorder is something that desperately needs treatment as the distress caused to the patient, and the family can predispose the youngster to

•    Drug or alcohol abuse
•    Stealing
•    Involvement with law enforcement
•    Poor social integration
•    Poor academic performance
•    Suicidal tendencies
•    Premature sexual behavior

The Balanced Mind has a good self-check list of symptoms that can help a parent or a teen decide if bipolar disorder might be an issue.  Self-testing is not always accurate and should be discussed with a doctor, (preferably with test results in hand).  Not all doctors accept pediatric bipolar disorder. Parents may have to seek advice from more than one mental health professional and be aware that insurance may not cover the illness.

Melissa Lind

Ellen Forney – Bipolar Artist and Author

A bipolar book by the cartoonist Ellen Forney

Nearly 3 percent of adults in the U.S. have bipolar disorder – and that is known cases.  The question might be – how many people have it that don’t know about it?  Still, 3 percent is quite high, and the World Health Organization lists Bipolar Disorder as the “sixth leading cause of disability in the world”.

People with Bipolar Disorder face innumerable challenges – some personal, some professional.  Aside from the daily struggle to come to terms with the mental illness and manage symptoms, relationships and medicationbipolars often face stigma in the “regular” world.  Whether it is family members, friends or work associates, unless they have bipolar disorder, they are likely to have a skewed image and often little understanding.

Bipolar-1 Disorder - Ellen ForneyCartoonist Ellen Forney, of Seattle Washington, also a teacher at the Cornish College of the Arts released a graphic memoir – a graphic novel produced in a manner similar to her other published work.  In it, she describes what it is like to be bipolar from her perspective and how she struggled to find the right treatment.  Forney, along with her book; “Marbles: Mania, Depression, Michelangelo, and Me: A Graphic Memoir” were recently featured in the Huffington Post.

Being of an odd combination of scientist and artist – and particularly nosy. (some would call it inquisitive – but I prefer just nosy)

I have read a lot of books on bipolar disorder. I have read professional journals, research papers, self-help books, and books written by people with bipolar disorder – most of which were supposed to explain the illness, how to treat it, or tell what it is like to be bipolar.

Some of the books were well written, some were sadly misguided.  The most famous book by Kay Redfield Jamison, “Unquiet Mind” is considered “THE” book by many people, professionals and patients alike.  Though it is well-written, educational, and true – it doesn’t always fit, and many who are bipolar probably can’t read it when they need to.

Ellen Forney’s book is different.  It isn’t a manual; it isn’t a self-help book, it is simply a terrific depiction of bipolar disorder and even if you aren’t bipolar yourself, you should check it out. It is worth a look.

Melissa Lind

“Sex in Comics:” The bipolar Ellen Forney and R. Crumb

•    “My own BRILLIANT UNIQUE personality was neatly outlined right there, in that inanimate stack of paper.”
•    “My PERSONALTY reflected a DISORDER…”
•    “… SHARED by a group of people.”
•    “This sank in like the sun had gone behind the clouds…”
•    “… like I`d been covered by a heavy blanket, like a parrot…”

What Type of Bipolar Disorder Is It?

Each bipolar disorder illness is unique!

Uniqueness of Bipolar DisorderWhen nearly anyone thinks about bipolar disorder, they think of the symptoms of “regular” bipolar disorder.  Not that any person with bipolar disorder is “regular” (and most would not want to be), but there are several different subtypes of bipolar disorder.

One big problem with bipolar disorder is that each illness is unique.  Psychiatrists may classify them into categories – but they don’t always fit.  Here are some case scenarios: (bipolar episodesbipolar groups)

•    Jennifer has episodes where she is extremely agitated and unhappy and never seems to sleep very much.  These periods seem to last for a long period of time – but can alternate with months where she is simply unhappy and doesn’t feel like doing anything.
•    Max has had periods of depression before.  A lot of times, they go away after a couple of months and then he seems normal but recently he “disappeared” for a couple of weeks after some really bizarre behavior.  His friends never knew that he was any kind of bipolar until he told them he had been at the hospital.
•    Ben has periods of depression that can last for several months but when he is not depressed, he is productive and seems quite outgoing.
•    Sandra’s mood state can switch erratically.  One day she is all about shopping and the next time you call her, she is still in bed at noon.   This is a constant issue – and you never know what you are going to get.

These are three examples of bipolar disorder that don’t seem to fit the “normal” pattern.  None of these patients seems to be “regular” bipolar.

Bipolar disorder is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as:

Bipolar Disorder TypeBipolar I Disorder: manic or mixed episodes that last at least 7 days – or if manic symptoms are severe enough to need hospitalization.  This, usually, includes periods of depression that last at least two weeks.
Jennifer and Max both fit into this category.  Even though Max never had a severe manic episode, having a bipolar episode that warrants medical attention, he qualifies for the Bipolar I category.  Jennifer has mixed episodes – rather than euphoria or traditional mania – she has periods of “dysphoria” where she is agitated, irritable and irrational but with an excess of energy.

Bipolar II Disorder: depressive and hypomanic episodes in a pattern – but manic episodes are not severe.
Ben has Bipolar II disorder.  He has periods of depression that are debilitating, but his non-depressed periods are quite productive, and he doesn’t exhibit manic behavior.

Bipolar Disorder Not Otherwise Specified: (Bipolar Disorder NOS) symptoms of illness don’t meet any other group, but the symptoms are clearly not within the standard range.
Sandra has BP-NOS.  She is what is commonly called a “rapid cycler,” meaning that she switches back and forth from mania to depression much faster than other people with bipolar disorder.

There is also a very mild form of bipolar disorder known as cyclothymia.  It is a cyclical pattern of hypomania alternating with periods of mild depression.  Many people would not even realize this is a problem.

Bipolar disorder is hard to classify.  It may be easy to determine that someone has a problem – but the uniqueness of each bipolar case makes it more difficult for even a patient to identify with the diagnosis.  Each type of bipolar disorder is, usually, treated the same medically. With an anti-manic agent (Lithium), anti-epileptic (Lamictal, Depakote) or atypical antipsychotic (Abilify, Zyprexa) – and sometimes with an antidepressant.

Melissa Lind

Lots of People don`t Know they are Bipolar

It seems to be a lot of people that don`t know what bipolar disorder is

There are people that I know that probably are bipolar, but they just don`t know it.
They have never been to counseling at a mental health professional to get diagnosed, because no one has told them that their problems, in fact, can be a mental illness.

Mental Mind SpiralOften-lot, grown-up people (age from 30 years and up) are not informed about what bipolar disorder is all about. They don`t know what it means, what it includes, how to get help and where to get help. Often-lot, not always.
The whole thing started probably when they were young, when bipolar disorder and all other mental illnesses were hush-hush and taboos’.

Of course, taboos and lack of information are not only a concern for those who might be bipolar, but for all kinds of mental illnesses that I know about.

If one suspects that a family member, a close friend or a coworker, has a mental illness, it is not easy to tell the person about what one believe/suspect.

Some people might suspect (themselves) that they have a mental illness, but are too proud to admit it, and for that reason not seek help from a counselor. They will probably never take any advice from others either regarding such sensitive personal things, having all taboos’ fresh in mind.

So, how do we approach these people – what are we supposed to do to let them know about our thoughts? Letting them know that there might be a “solution” to their problems. That it is somehow treatable – using medications. Tell them that it`s not their fault – they have an illness. They may at least feel better just by knowing.

Since IBipolar Mental Illnness suspect that a friend of mine is bipolar, should I contact a mental health professional just to ask for advice about how to approach my friend? I must admit; the thought has crossed my mind in several occasions related to some friends of mine, and especially in the case of member of my family.

I didn`t expect it to happen, but not long ago I got an opportunity to ask this special person in my life (my family member) how he felt about me asking a psychologist questions.

Just to get sorted things out. His answer was: don`t!
He didn`t want me to ask because he meant he had everything under control, and wanted to “mind his own business”. It wasn`t said in a rude way, he wasn`t angry with me, so, since he is an adult, I had to let it go.

Was that the right decision to make? I don`t have an answer to that question right now, so if anyone out there have an input to come with, please do – right here on this site, or on our Facebook page.

Lots of people that don`t know what bipolar disorder is

Mental Disorders Failure to Take Medications Consistently

Don’t skip your meds – even if you are sick!

It is cold and flu season in the Northern part of the world, and though that isn’t the only time people get sick, it brings up an issue common in Bipolar disorder and other mental disorders.

Medication - Mental DisordersOne of the biggest problems in maintaining a level mood state or semblance of “normalcy” in people with mental disorders is the failure to take medications consistently.  In a lot of instances, mentally ill persons will stop taking the medication on purpose because they are “better” and “don’t need it”.

As mentioned many times before – this is, usually, done in secret. Without consultation with professionals, friends or family members who do not find out until someone with a mental disorder has gone “off-track” and had an “episode”.

But, another cause of medication non-adherence is forgetfulness. Forgetfulness wouldn’t seem to be a big deal as many medications are “forgotten” one day and resumed the next – blood pressure medicine, birth control pills, and antibiotics etc. All with each of their own ramifications.  In the case of the forgotten anti-depressant, anti-manic agent, anti-psychotic, a different set of events comes into play.

Mentally ill people may “forget” the first day but by the second day, the thoughts of “I am OK” start to intrude.  This may lead back to the first case of non-adherence where the patient then decides to quit purposefully taking their medication – obviously without telling anyone.

Mental MindWith your illness, you may not feel like getting up.  You may not feel like eating.  You may not feel like taking your medicine – but you should.  You must.  Even when your mental illness seems secondary to a physical illness, the medicine that keeps you functioning on a semi-even level is vital.  Allowing yourself to skip, even one day can ultimately cause a “relapse”.

If you skip today because you don’t feel good, you may skip tomorrow.  If you skip today and tomorrow, because you didn’t feel good, you will probably hear the voice that always says, “I am doing OK,” because you are OK – for today.  A week or two, maybe a month or two – you won’t be OK.  You haven’t been in the past and likely you won’t in the future.

No matter why you skip your meds – don’t.

There are legitimate medical reasons not to quit without supervision – such as drug withdrawal and increases in seizure potential which are real, unpleasant, and possibly dangerous. But the biggest reason is the same as it has always been.  Eventually, it will lead you back down the path, and you won’t know until you are already out of balance.

One of the biggest challenges for a bipolar or schizophrenic (or many other) patient is to ignore the impulse to give in to “See, I’m OK and I don’t need this”.  In your rational mind, you know that you do.  You may resent it, but you know.

You may have to remind yourself of how far you have come – and remind yourself that this wasn’t the first time that you had to dig yourself out of a mess.

Remember how it was, how awful it was, and how hard it will be the next time to recover.

Melissa Lind

The medicine that keeps you functioning is vital – even if mental disorders seems secondary to physical illness!

Bipolar Disorder Research Funding – Poorly Directed

Prepare yourself for a bit of a bipolar rant!

An article entitled “Bipolar Disorder in Youth Not as Chronic as Thought” in Medscape Pharmacists e-newsletter came across my email and while I was initially quite interested, I soon became annoyed.
Bipolar and Borderline (BPD)A recent study done at the University of Pittsburgh School of Medicine shows that bipolar disorder may not always be a chronic condition. While this may look like good news and you might see it pop up in the media as a big positive – cheerleader kind of thing, it really isn’t.

The study followed 413 children and adolescents who were 7 to 17 years of age and diagnosed with bipolar disorder at the time of study enrollment.  The patients and family members were interviewed about every eight months, for eight years.  What they found was that some of the patients were “ill” most of the time, some were “well” most of the time, and some were both ill and well.  Sorry, but that result isn’t astounding.

I find a couple of things wrong with the published results.

  1. They didn’t say whether the patients were stabilized on medication during the study – what medication, whether the medication was changed, whether the patients took the medication – in fact the publication doesn’t mention medication at all.
  2. The data collected was based on “interviews.”  Sorry, but being bipolar inherently predisposes you to lack of complete transparency.  Bipolar patients are likely to hide and lie – whether it is purposefully or subconscious behavior, it is a known problem.
  3. The patients were ages 7 to 17 when entering the study, meaning they were 15 to 25 at the end.  Many of the patients went through puberty during the study and what pubescent child or the post-pubescent adolescent is truly stable…or honest for that matter.  Interviews with the family may have partly balanced this but we also know how “well” our families may know us…some, not at all.

What I did find a little more relevant was that the patients tended to be “well” more of the time if they:

Though true, this is not astounding either.  It is easily recognized that if your family has a history of mental disorder, you are more likely to have a mental disorderBipolar disorder and substance abuse go hand in hand, and sexual abuse makes nothing more manageable.

Incidentally they also showed that patients would be more stable if they:

•    Had less history of severe depression, manic or hypomanic symptoms
•    Had fewer subsyndromal episodes

So basically, if the patients had a history of fewer episodes, they would have fewer episodes……really?
Not discounting the fact that any academic attention given to bipolar disorder, especially in juveniles should be welcome, I am disappointed because the study results didn’t show anything.  This is all information that anyone could guess – and the funding for mediocre “non-results” could have gone elsewhere.

This sort of news can easily lead to an “it will go away” thought process, lack of medication and lack of attention to and acknowledgment of the real and long-term challenges that a bipolar patient can face.  Yes, let’s all believe that bipolar disorder is not a chronic medical condition… let’s undo all the progress that has been made.

Melissa Lind

Academic attention given to bipolar disorder should be welcome!