Bipolar Disorder is a disease. It is not who I am. I am so much more. To say that I AM bipolar may imply that there is no hope of transcending the worst symptoms. The term bipolar itself shows attention only to the extreme moods of mania and depression. Moods do not exist only as these extremes. There is rather a continuum of moods marked by at least 6 divisions. Starting with low mood, there is not only major depression, but also minor depression. People with Bipolar Disorder can also go through long periods of euthymic , or "normal" mood. Then there is mild mania, known as hypomania and full-blown mania. Another point on the continuum would be mixed states, where symptoms of mania and depression are combined,
It may be best also to distinguish between being an addict and having addiction. I am more than my addiction. Even when I was using i had positive qualities and potential. Our self-esteem may be damaged by identifying ourselves with this scourge on humanity. We are learning that there are various markers or "stages" of abstinence and recovery. Our unifying factor is that we are all somewhere on the journey. Also, I believe that those of us with bipolar disorder can be at different places in our recovery.
So what is recovery as applied to bipolar disorder? it seems that medication compliance has been the standard of recovery for many mental illnesses, This seems to assume that the disorder has been properly diagnosed and that the optimal medication is not only currently in existence, but has been correctly prescribed, Unfortunately, it has unfolded that different people with the same disorder respond better to different medications or combinations of medications.
Research has shown that non-medicine approaches to the treatment of bipolar disorder are also effective. To be fair, the best results were achieved with pharmacotherapy (use of medication plus the therapy). One example of this is Interpersonal Social and Rhythm Therapy (IPSRT) developed by Ellen Frank and others. They developed a 5 item social metric which advocates for regularity with 5 behaviors: getting out of bed, first contact with another person, Starting work, school, volunteering or family care, dinner and bed-time. They found that clients gained more mood stability as they got closer to performing theses function about the same time every day. There is also a 17 item version of the social metric. Attention to the consistency of sleep may be another factor in mood stability. Frank and associates seem to have begun the work of helping clients to change their daily routines.
Other empirically supported psychosocial treatments include Cognitive Behavioral Therapy and Marital and Family Therapy. A specific form of family therapy, known as Family Focused Therapy has been shown to be effective for clients with bipolar disorder and their families. A growing body of evidence-based practices implies new parameters for being in recovery from bipolar disorder. My own experience is that different people are attracted to and therefor more likely to practice different behaviors that contribute to mood stability, Perhaps we can see recovery tools as a buffet. As more of the tools are selected and used we can become healthier and healthier. After all, isn't it all about balance?
Wednesday, December 21, 2011
Tuesday, October 25, 2011
Who Does Best on Lithium?
Genetic clues could help fine-tune treatment for bipolar disorder
By Marjorie Centofanti
The amygdala is hit hard in bipolar disorder. The small almond-shaped structure that nestles in each temporal lobe assumes a major role in quality of life. It’s a crossroads for fear, anger,and emotional learning. It also affects mental state. But something happens to the organ in bipolar disease. Blood flow increases and MRIs don’t look the same; there’s a clear loss of volume.
Enter lithium. Although the mood-stabilizing mineral doesn’t help everyone with bipolar disorder, for many, results are remarkable. Functionally, the amygdala acts healed.
But what happens to it physically? Can lithium actually reverse the organ’s structural damage? Pamela Mahon, whose specialty combines neuroimaging and genetics, aims to find out. AS part of Project Match, a broad effort to help people with bipolar disorder find the best medication as quickly as possible, Mahon is surveying brain MRIs from each new patient who joins the study. “We’ll be comparing the images of those who respond well to lithium with those who don’t,” she says. The hypothesis is that the amygdala will plump out to normal size in people helped by the drug.
At the same time, Mahon’s colleagues are doing animal studies and analyzing patients’ DNA sequences, combing for genetic clues that signal who will be a lithium responder.
The next step, she says, will be to match the genetic variations with any physical differences the images reveal. “If things work out, that will let us connect the genes, ultimately, to the mechanisms of bipolar disorder itself. You’re linking gene to brain understanding disease.”
But a clinical benefit could come sooner. With positive results—admittedly a leap, at this point—and more medications tested, comes a prize: a set of genetic markers packaged as a routine lab test. A blood sample could tell physicians if lithium or Depakote is better to even out a patient moods. More studies could tailor antidepressants—Prozac? Effexor? Wellbutrin?—to a person’s brain chemistry. Hitting that goal would change the face of mental illness worldwide.
Hopkins Medicine Fall 2011 (used by permission)
As someone who himself has thrashed about with and from plenty of antidepressants, lithium, Depakote, and now stabilized on Trileptal, wouldn’t it have been preferable to have utilized genetic techniques to or away from lithium, often regarded as the “gold standard” of mood stabilizers. Likewise, down the pike, such investigators may find a superior route to the right antidepressant for those with unipolar mood challenges. We are all hopeful for a smoother journey to peace and tranquility, perhaps going first class rather than coach.
Peter J. Dorsen, MD, LADC
By Marjorie Centofanti
The amygdala is hit hard in bipolar disorder. The small almond-shaped structure that nestles in each temporal lobe assumes a major role in quality of life. It’s a crossroads for fear, anger,and emotional learning. It also affects mental state. But something happens to the organ in bipolar disease. Blood flow increases and MRIs don’t look the same; there’s a clear loss of volume.
Enter lithium. Although the mood-stabilizing mineral doesn’t help everyone with bipolar disorder, for many, results are remarkable. Functionally, the amygdala acts healed.
But what happens to it physically? Can lithium actually reverse the organ’s structural damage? Pamela Mahon, whose specialty combines neuroimaging and genetics, aims to find out. AS part of Project Match, a broad effort to help people with bipolar disorder find the best medication as quickly as possible, Mahon is surveying brain MRIs from each new patient who joins the study. “We’ll be comparing the images of those who respond well to lithium with those who don’t,” she says. The hypothesis is that the amygdala will plump out to normal size in people helped by the drug.
At the same time, Mahon’s colleagues are doing animal studies and analyzing patients’ DNA sequences, combing for genetic clues that signal who will be a lithium responder.
The next step, she says, will be to match the genetic variations with any physical differences the images reveal. “If things work out, that will let us connect the genes, ultimately, to the mechanisms of bipolar disorder itself. You’re linking gene to brain understanding disease.”
But a clinical benefit could come sooner. With positive results—admittedly a leap, at this point—and more medications tested, comes a prize: a set of genetic markers packaged as a routine lab test. A blood sample could tell physicians if lithium or Depakote is better to even out a patient moods. More studies could tailor antidepressants—Prozac? Effexor? Wellbutrin?—to a person’s brain chemistry. Hitting that goal would change the face of mental illness worldwide.
Hopkins Medicine Fall 2011 (used by permission)
As someone who himself has thrashed about with and from plenty of antidepressants, lithium, Depakote, and now stabilized on Trileptal, wouldn’t it have been preferable to have utilized genetic techniques to or away from lithium, often regarded as the “gold standard” of mood stabilizers. Likewise, down the pike, such investigators may find a superior route to the right antidepressant for those with unipolar mood challenges. We are all hopeful for a smoother journey to peace and tranquility, perhaps going first class rather than coach.
Peter J. Dorsen, MD, LADC
Friday, August 26, 2011
Hypomania
By Tim Kuss, LFMT, LADC
Hypomania is sometimes hard to distinguish from true mania. Rather than clear lines between mild mania(hypomania) and “full-blown mania, it seems that there is a continuum of symptoms, thinking and behavior that stretches across from euthymia (normal) to psychosis. I think of psychosis and milder delusional states as belonging to mania. Having said this, some degree of delusional thought seems to exist across such a continuum of mood states. Because of such a spectrum of dysfunction, hypomania although certainly enjoyable to sa person with bipolar disorder, has definitely resulted in self-defeating behavior for me.
I cannot be sure when hypomania first appeared in my life, but it was there before any of my psychotic episodes. Following the start of my recovery from chemicals, I did not have psychotic episodes for almost 10 years. I managed to stay out of psych wards, but experienced other negative consequences from my mood disorder.
Some of the symptom of hypomania can be grandiosity, irritability, rapid thinking, insomnia, loss of appetite, and hyper sexuality. On the positive side I tend to be very motivated and energetic and can get a lot of work done when I get hypomanic. Like many others with bipolar disorder, I frequently can use these positive mood swings while filtering out the negatives.
Hypomania, or mild mania is one of at least 6 mood states of bipolar disorder. By my own personal experience and through observation, I have learned that hypomania can last for months and perhaps years. Hypomania is very seductive, as it feels so damn good! It tends to have benefits such as perceived clarity of thought and decision-making. I have more creativity and psychic energy and use that creativity in an artistic form, which for me is writing and expansiveness which promotes relationships and connections with others. In hypomania, there is unfortunately also a high risk that a person may get into self-defeating behavior that is self-destructive. Three aspects of hypomania have been particularly self-defeating for me.
The first is grandiosity. I have made poor decisions when hypomanic, since I have not had the necessary mental filter to consider that I may be wrong. I have not had the necessary humility to ask others for feedback (or to hear their feedback). Grandiosity combined with expansiveness went into the equation of deciding to use drugs in my early 20’s, which precipitated deeper and deeper mania until I became psychotic and had to be institutionalized. I now have a firm rule about not using any amount of alcohol or other drugs and also limit my caffeine intake. This rule helps my mood to stay more stable.
Irritability is the second aspect of hypomania that has caused me a lot of trouble. I had role-models in my life that were irritable and became aggressive with others. I learned to blame others for “making” me angry and to act out my anger by yelling, throwing things, and, I must admit, on occasion hitting or hurting others. I have been fortunate in restraining my physical acting out to a few isolated incidents that did not hurt others excessively, but I did break valuable things early in my first marriage and I did scream at the top of my lungs at several partners and my oldest daughter. This behavior scared others and most likely created more distance in our relationships. I may have “won the battle, but lost the war”. Sometimes, my earlier behavior sometimes colors my present efforts to connect with those I have always loved.
I have had a long struggle sharing the third aspect of hypomania that caused me a lot of problems. It makes it easier that I speak of it from the perspective of a man in an 18 year committed relationship, with zero acting out with others during that time.
Some of my earlier partners had to deal with a series of affairs I had with other women. I have now learned that hyper sexuality can be a warning sign of growing mania that can lead to psychosis. I used to think that guilt was the main factor in contributing to psychosis after the first of these affairs, Later, I learned that my alcohol use was contributing to a kindling effect to increasing mania, Now, I know that hyper sexuality is a symptom of increasing mania, which could end in psychosis with or without chemical use.
Today, my perspective is that hyper sexuality does not need to be a negative thing as long as one makes positive choices about one’s behavior. These choices could include more sexual activity with my partner or simply pleasuring myself.
Wild thoughts can continue like adrenaline that doesn’t go away. I can’t sleep, have enhancement of my senses, feel irritable and euphoric, am incapable of continuing attention, neglect employment, have accelerated thoughts and speech, flight of ideas, unrealistic self-esteem with grandiosity, delusions, and increased activity. This all can lead to exhaustion, spending sprees, increased sexual activity, increased alcohol and drug use, and, for the unfortunate, death. These are notes from readings on hypomania. As I write many of these words, I am experiencing them. I have so much mental activity that I have been unable to sleep for hours. Luckily, I slept for at least 4 hours before this wakefulness. Fortunately, I was teaching my group about sleep management last night.
I do notice that it is hard to focus and concentrate. I have learned over time to keep redirecting myself to a task. No delusions today. I have my wife, friends, and co-workers to validate or challenge my perception of reality. I am over the buying sprees, the increased sexual activity, the my impulses of increased drug or alcohol use. I’m, planning on not going there again and am practicing my recovery program with help of my support network. Learning and writing about bipolar disorder is part of my recovery with not from bipolar disorder.
I am expecting soon to enter into my daily routine, which helps me stay grounded. It is 5:48 AM and I only need to survive until 6:15 when my wife wakes up. Meanwhile I am using this journaling as a grounding force. Later, I have 3 friends with bipolar disorder to talk with about my hypomania. They will “get it”. They will support me to continue with my routine, attend my support group tomorrow, keep taking my meds, and keep practicing my coping skills. I’m taking a break now to practice progressive muscle relaxation.
So I’m through another episode. My wife is up and we talk. I leave for work. Work keeps me grounded in reality. For 8 hours I will be held responsible by more objective measurements utilizing coherent thoughts and behavior. It is a place where I can apply my mental energy in a positive way. If I have too many days of continued hypomania I know I will need to talk to my doctor about adjusting my meds, as one of my supportive friends has suggested.
Hypomania is sometimes hard to distinguish from true mania. Rather than clear lines between mild mania(hypomania) and “full-blown mania, it seems that there is a continuum of symptoms, thinking and behavior that stretches across from euthymia (normal) to psychosis. I think of psychosis and milder delusional states as belonging to mania. Having said this, some degree of delusional thought seems to exist across such a continuum of mood states. Because of such a spectrum of dysfunction, hypomania although certainly enjoyable to sa person with bipolar disorder, has definitely resulted in self-defeating behavior for me.
I cannot be sure when hypomania first appeared in my life, but it was there before any of my psychotic episodes. Following the start of my recovery from chemicals, I did not have psychotic episodes for almost 10 years. I managed to stay out of psych wards, but experienced other negative consequences from my mood disorder.
Some of the symptom of hypomania can be grandiosity, irritability, rapid thinking, insomnia, loss of appetite, and hyper sexuality. On the positive side I tend to be very motivated and energetic and can get a lot of work done when I get hypomanic. Like many others with bipolar disorder, I frequently can use these positive mood swings while filtering out the negatives.
Hypomania, or mild mania is one of at least 6 mood states of bipolar disorder. By my own personal experience and through observation, I have learned that hypomania can last for months and perhaps years. Hypomania is very seductive, as it feels so damn good! It tends to have benefits such as perceived clarity of thought and decision-making. I have more creativity and psychic energy and use that creativity in an artistic form, which for me is writing and expansiveness which promotes relationships and connections with others. In hypomania, there is unfortunately also a high risk that a person may get into self-defeating behavior that is self-destructive. Three aspects of hypomania have been particularly self-defeating for me.
The first is grandiosity. I have made poor decisions when hypomanic, since I have not had the necessary mental filter to consider that I may be wrong. I have not had the necessary humility to ask others for feedback (or to hear their feedback). Grandiosity combined with expansiveness went into the equation of deciding to use drugs in my early 20’s, which precipitated deeper and deeper mania until I became psychotic and had to be institutionalized. I now have a firm rule about not using any amount of alcohol or other drugs and also limit my caffeine intake. This rule helps my mood to stay more stable.
Irritability is the second aspect of hypomania that has caused me a lot of trouble. I had role-models in my life that were irritable and became aggressive with others. I learned to blame others for “making” me angry and to act out my anger by yelling, throwing things, and, I must admit, on occasion hitting or hurting others. I have been fortunate in restraining my physical acting out to a few isolated incidents that did not hurt others excessively, but I did break valuable things early in my first marriage and I did scream at the top of my lungs at several partners and my oldest daughter. This behavior scared others and most likely created more distance in our relationships. I may have “won the battle, but lost the war”. Sometimes, my earlier behavior sometimes colors my present efforts to connect with those I have always loved.
I have had a long struggle sharing the third aspect of hypomania that caused me a lot of problems. It makes it easier that I speak of it from the perspective of a man in an 18 year committed relationship, with zero acting out with others during that time.
Some of my earlier partners had to deal with a series of affairs I had with other women. I have now learned that hyper sexuality can be a warning sign of growing mania that can lead to psychosis. I used to think that guilt was the main factor in contributing to psychosis after the first of these affairs, Later, I learned that my alcohol use was contributing to a kindling effect to increasing mania, Now, I know that hyper sexuality is a symptom of increasing mania, which could end in psychosis with or without chemical use.
Today, my perspective is that hyper sexuality does not need to be a negative thing as long as one makes positive choices about one’s behavior. These choices could include more sexual activity with my partner or simply pleasuring myself.
Wild thoughts can continue like adrenaline that doesn’t go away. I can’t sleep, have enhancement of my senses, feel irritable and euphoric, am incapable of continuing attention, neglect employment, have accelerated thoughts and speech, flight of ideas, unrealistic self-esteem with grandiosity, delusions, and increased activity. This all can lead to exhaustion, spending sprees, increased sexual activity, increased alcohol and drug use, and, for the unfortunate, death. These are notes from readings on hypomania. As I write many of these words, I am experiencing them. I have so much mental activity that I have been unable to sleep for hours. Luckily, I slept for at least 4 hours before this wakefulness. Fortunately, I was teaching my group about sleep management last night.
I do notice that it is hard to focus and concentrate. I have learned over time to keep redirecting myself to a task. No delusions today. I have my wife, friends, and co-workers to validate or challenge my perception of reality. I am over the buying sprees, the increased sexual activity, the my impulses of increased drug or alcohol use. I’m, planning on not going there again and am practicing my recovery program with help of my support network. Learning and writing about bipolar disorder is part of my recovery with not from bipolar disorder.
I am expecting soon to enter into my daily routine, which helps me stay grounded. It is 5:48 AM and I only need to survive until 6:15 when my wife wakes up. Meanwhile I am using this journaling as a grounding force. Later, I have 3 friends with bipolar disorder to talk with about my hypomania. They will “get it”. They will support me to continue with my routine, attend my support group tomorrow, keep taking my meds, and keep practicing my coping skills. I’m taking a break now to practice progressive muscle relaxation.
So I’m through another episode. My wife is up and we talk. I leave for work. Work keeps me grounded in reality. For 8 hours I will be held responsible by more objective measurements utilizing coherent thoughts and behavior. It is a place where I can apply my mental energy in a positive way. If I have too many days of continued hypomania I know I will need to talk to my doctor about adjusting my meds, as one of my supportive friends has suggested.
Saturday, August 13, 2011
Jail Cells
By Tim Kuss, LMFT, LADC
I’ve had several experiences with arrest and incarceration. With two of them I showed manic behavior. The first of these happened when I was about 21 years old. I had been using hallucinogens like LSD and mescaline experiencing hallucinations and delusions when high. I also had a series of what I considered to be “flashbacks” in which I experienced mostly pleasant delusions when not using. I understand now that my chemical use had triggered my bipolar disorder, serving as “kindling” contributing to increased symptoms.
I had been thinking that billboards and other signs were sending me personal messages and was ”following” these messages to a special place. I believed that my “true love” and good friends would be waiting for me at the end of the message trail, where we would be together. I began thinking that they had arranged a surprise party for me.
At one point my delusions led me to being hospitalized in a psychiatric ward. Later, I was following yet another “sign trail” which included barging through the back yards of some expensive homes on Summit avenue in St Paul. I imagine someone must have called the police. When they caught up with me, I had taken my shirt off and discarded it because I believed that I was supposed to do that. The police arrested me on Vagrancy charges, and put me in a jail cell.
They had taken my belt and shoes, asked me where I lived and my phone number. I began to think of myself as an oppressed man suffering from discrimination. I had been an anti-war protester in college and had spent a month marching with Father Grappi’s people in Milwaukee. i started singing the songs we had sung while marching:
“Oh Freedom, oh freedom over me...and before I’ll be a slave, I’ll be buried in my grave...and go home to my lord and be free” then on with several verses, including a few that I made up to go with the situation.
Then “We shall overcome” and several other songs. I had attended Buddhist temples while out in California, I went next to chanting “Nam myoho rengae kyo” and “Om” for my second hour of vocal renditions. The police did not attempt to put others in my cell. I spent some time attempting to lie on the spring on the lower bunk, as they had not provided a mattress. I think I was into my third hour of singing and chanting when my father showed up. He had gathered the few belongings taken from me and had paid my bail. We drove home quietly.
A similar occurrence happened about 19 years later. I had 15 years of sobriety and had been functioning as a chemical dependency counselor for 11 of those years. I was working the evening shift at a halfway house and went over the center line while making a left turn. It was a difficult turn and I imagine that I was tired. It was July 2nd, just before a three day weekend. One officer followed me into the parking lot behind my apartment building. For some reason, I commented that he had taken quite a risk by following me into this dark, isolated spot. He ran my driver’s license and found that I had a warrant, which turned out to be for a parking ticket I had forgotten about.
I wound up cuffed and put in the back of a squad car, despite protesting that my two daughters, ages 1fourteen and ten, were waiting for me to come home. In the jail cell, I had a deja vu experience of thinking that I had been discriminated against and began my routine of singing freedom songs alternating with chanting. This time I heard fellow prisoners yelling at me to shut up. It was a long 2 hours before my girlfriend arrived to pay the parking ticket and court fees.
Friday, July 8, 2011
Nida Takes on Co-occurring Illness
Peter J. Dorsen, M.D., LADC
Nora Volkow, M.D., Director of the National Institute of Drug Abuse (NIDA), in a recent research report, notes: “ Drug addiction is a mental illness.” She also emphasizes that with addiction, drug-induced changes in brain structure and function occur in some of the same brain areas (as) mental disorders…” Wow! Like we didn’t know this already? Unfortunately, society at large fails to put two and two together (if you will excuse the pun here) and believe that collaborative treatment is a must.
Major populations seem to be slipping through the cracks when it comes to treating those saddled unfortunately with the duality of drug dependence and maybe a preexisting mental challenge: schizophrenia, PTSD, bipolar disorder, you name it. Our prisons are teaming with co-morbidity (75% of offenders at the state or local level have co-morbidity yet “ services are greatly lacking within these settings.”
What about all those brave men and women returning from Afghanistan or Iraq with PTSD ( maybe even 38,000 in the past five years!). You’re damned if you do and damned if you don’t. It’s a case of the lumpers and splitters once again: PTSD programs that don’t accept individuals with active substance problems versus traditional substance abuse clinics (SUDs) clinics who defer treatment of trauma-related issues (combat or noncombat).
When it comes down to discrepancies of treatment there is even an implicit paradox that physicians run the mental health facilities and WILL treat with antipsychotics and anxiolytics while substance abuse venues are skewed to treating just that and may not even have personnel who can or will prescribe despite the predominance of co-morbidity.
Volkow and her team from NIDA emphasize that there is a 40-60% vulnerability to addiction attributable to multiple genes, genetic interactions, and environmental influences. One can joke as one way of relieving angst how mental illness and substance abuse co-mingle by wondering if such predilections start with the drinking water. The study correlates psychosis and marijuana use, how nicotine may lessen symptoms of schizophrenia (a 90% rate of smokers). They note a significant association between mental illness and smoking: “schizophrenics have higher rates of alcohol tobacco, and other drug use.”
They remind us how the neurotransmitter dopamine is pivotal; that it is affected by addicted substances as well as depression, schizophrenia, and other psychiatric disorders.
The chaotic process often begins in adolescence: abusing “gateway” drugs and mental illness. I can relate yet all we had in the sixties was alcohol and nonetheless did a pretty fair job at abusing it. Currently, educators like Dartmouth’s President Kim spend anxious reflective moments disturbed by fears when the next undergraduate will die from alcohol on his campus.
We have on our table promising behavioral therapies that include multisystem therapy (MST) dealing with attitudes, family, and peers; brief family therapy (BSFT) for the oppositional-defiant youngster with a conduct disorder; cognitive behavioral therapy (CBT) helping us change harmful or maladaptive beliefs; therapeutic communities (TC’s) for resocialization, the neglected youth; assertive community treatment (ACT) with an individual approach; dialectical behavioral therapy (DBT) especially for the borderline personality who will self harm; exposure therapy (ET) to create real or simulated reruns and remove fear; and integrated group therapy (IGT) great for bipolar disorder and drug addiction.
The NIDA report is filled with theme and substance offering new ideas for approaching co-occurring illnesses. I heartily recommend obtaining the full report to explore further the direction thinking and treatment must go to better deal with these two illnesses. Not only do they appear to exist in the same part of the brain but should and can be treated better simultaneously often with the right medications and therapy.
Nora Volkow, M.D., Director of the National Institute of Drug Abuse (NIDA), in a recent research report, notes: “ Drug addiction is a mental illness.” She also emphasizes that with addiction, drug-induced changes in brain structure and function occur in some of the same brain areas (as) mental disorders…” Wow! Like we didn’t know this already? Unfortunately, society at large fails to put two and two together (if you will excuse the pun here) and believe that collaborative treatment is a must.
Major populations seem to be slipping through the cracks when it comes to treating those saddled unfortunately with the duality of drug dependence and maybe a preexisting mental challenge: schizophrenia, PTSD, bipolar disorder, you name it. Our prisons are teaming with co-morbidity (75% of offenders at the state or local level have co-morbidity yet “ services are greatly lacking within these settings.”
What about all those brave men and women returning from Afghanistan or Iraq with PTSD ( maybe even 38,000 in the past five years!). You’re damned if you do and damned if you don’t. It’s a case of the lumpers and splitters once again: PTSD programs that don’t accept individuals with active substance problems versus traditional substance abuse clinics (SUDs) clinics who defer treatment of trauma-related issues (combat or noncombat).
When it comes down to discrepancies of treatment there is even an implicit paradox that physicians run the mental health facilities and WILL treat with antipsychotics and anxiolytics while substance abuse venues are skewed to treating just that and may not even have personnel who can or will prescribe despite the predominance of co-morbidity.
Volkow and her team from NIDA emphasize that there is a 40-60% vulnerability to addiction attributable to multiple genes, genetic interactions, and environmental influences. One can joke as one way of relieving angst how mental illness and substance abuse co-mingle by wondering if such predilections start with the drinking water. The study correlates psychosis and marijuana use, how nicotine may lessen symptoms of schizophrenia (a 90% rate of smokers). They note a significant association between mental illness and smoking: “schizophrenics have higher rates of alcohol tobacco, and other drug use.”
They remind us how the neurotransmitter dopamine is pivotal; that it is affected by addicted substances as well as depression, schizophrenia, and other psychiatric disorders.
The chaotic process often begins in adolescence: abusing “gateway” drugs and mental illness. I can relate yet all we had in the sixties was alcohol and nonetheless did a pretty fair job at abusing it. Currently, educators like Dartmouth’s President Kim spend anxious reflective moments disturbed by fears when the next undergraduate will die from alcohol on his campus.
We have on our table promising behavioral therapies that include multisystem therapy (MST) dealing with attitudes, family, and peers; brief family therapy (BSFT) for the oppositional-defiant youngster with a conduct disorder; cognitive behavioral therapy (CBT) helping us change harmful or maladaptive beliefs; therapeutic communities (TC’s) for resocialization, the neglected youth; assertive community treatment (ACT) with an individual approach; dialectical behavioral therapy (DBT) especially for the borderline personality who will self harm; exposure therapy (ET) to create real or simulated reruns and remove fear; and integrated group therapy (IGT) great for bipolar disorder and drug addiction.
The NIDA report is filled with theme and substance offering new ideas for approaching co-occurring illnesses. I heartily recommend obtaining the full report to explore further the direction thinking and treatment must go to better deal with these two illnesses. Not only do they appear to exist in the same part of the brain but should and can be treated better simultaneously often with the right medications and therapy.
Saturday, June 25, 2011
Bipolar Label Soars Among Kids
Peter J. Dorsen, M.D., LADC
Frankly, I am glad that author Jeremy Olson of the Minneapolis Star Tribune in his recent “exclusive,” reports that the upcoming Diagnostic and Statistical Manual (DSM V) due out this summer will categorize a new disorder replacing bipolar disorder in children. It will be called Disruptive Mood Dysregulation Disorder(grade school children with outbursts in more than one location and irritability between outbursts). You may recall, I discussed my own belief of a separation in fact between BD and explosive anger in my last posting.
I have long struggled how people label outbursts or inappropriate behavior simplistically and even inaccurately with the label a “bipolar moment.” The author of this excellent and well- documented article, alludes to the marked concern many parents have with psychiatrists labeling their children with BD and the likelihood of carrying this stigma indefinitely.
Olson offers statistics and interviews how potentially dangerous antidepressant use leveled off since 2004 with the concern about child suicide. Antidepressants leveled off but atypical antipsychotics like Seroquel and Risperdal “surged.” Spending for antiseizure medications like Depakote or Gabapentin increased “sevenfold.” Meanwhile he, explains, how there is a tail wagging the dog process how psychiatrists must label children with BD. Children “ can’t gain insurance coverage for even short stay unless a patient has a major diagnosis.”
The reporter alludes to some worrisome allegations circulating within the academic community particularly Dr Joseph Biederman of Harvard who albeit the “father of the childhood bipolar movement,” has allegedly been part of what many like John Whitaker in Mad in America (Perseus, 2002) allege experts do is travel and speak about off-label prescribing, distort research for the pharmaceutical companies and make handsome sometimes unreported fees.
This article is a wonderful overview of what is perhaps terrifying about what appears to have become a tendency to overcall BD in children. As I mentioned in an earlier posting, what about achieving a level playing field especially with adequate and appropriate medication. How we as clinicians define that ball park may depend on how our friends, loved ones, ourselves or our patients continue to remain compliant to treatment. Certainly Kay Redfield Jamison (An Unquiet Mind, Free Press) is living proof that a return from the ashes is possible. In an upcoming posting, I plan to review Maria Angell’s article “Why is there an epidemic of mental illness,” in The New York Review of Books (June 23, 2011. Vol LVIII.
Like the protagonist, Ms Beckman, of Olson’s solid recent montage, whose defiance for a bipolar diagnosis weakens as the intensity of her daughter’s tantrums and outbursts worsens, living with BD day-to-day means constant reevaluation of our belief system toward this protean illness.
Frankly, I am glad that author Jeremy Olson of the Minneapolis Star Tribune in his recent “exclusive,” reports that the upcoming Diagnostic and Statistical Manual (DSM V) due out this summer will categorize a new disorder replacing bipolar disorder in children. It will be called Disruptive Mood Dysregulation Disorder(grade school children with outbursts in more than one location and irritability between outbursts). You may recall, I discussed my own belief of a separation in fact between BD and explosive anger in my last posting.
I have long struggled how people label outbursts or inappropriate behavior simplistically and even inaccurately with the label a “bipolar moment.” The author of this excellent and well- documented article, alludes to the marked concern many parents have with psychiatrists labeling their children with BD and the likelihood of carrying this stigma indefinitely.
Olson offers statistics and interviews how potentially dangerous antidepressant use leveled off since 2004 with the concern about child suicide. Antidepressants leveled off but atypical antipsychotics like Seroquel and Risperdal “surged.” Spending for antiseizure medications like Depakote or Gabapentin increased “sevenfold.” Meanwhile he, explains, how there is a tail wagging the dog process how psychiatrists must label children with BD. Children “ can’t gain insurance coverage for even short stay unless a patient has a major diagnosis.”
The reporter alludes to some worrisome allegations circulating within the academic community particularly Dr Joseph Biederman of Harvard who albeit the “father of the childhood bipolar movement,” has allegedly been part of what many like John Whitaker in Mad in America (Perseus, 2002) allege experts do is travel and speak about off-label prescribing, distort research for the pharmaceutical companies and make handsome sometimes unreported fees.
This article is a wonderful overview of what is perhaps terrifying about what appears to have become a tendency to overcall BD in children. As I mentioned in an earlier posting, what about achieving a level playing field especially with adequate and appropriate medication. How we as clinicians define that ball park may depend on how our friends, loved ones, ourselves or our patients continue to remain compliant to treatment. Certainly Kay Redfield Jamison (An Unquiet Mind, Free Press) is living proof that a return from the ashes is possible. In an upcoming posting, I plan to review Maria Angell’s article “Why is there an epidemic of mental illness,” in The New York Review of Books (June 23, 2011. Vol LVIII.
Like the protagonist, Ms Beckman, of Olson’s solid recent montage, whose defiance for a bipolar diagnosis weakens as the intensity of her daughter’s tantrums and outbursts worsens, living with BD day-to-day means constant reevaluation of our belief system toward this protean illness.
Sunday, May 29, 2011
Counterpoint to the "Splitters," anger and bipolar disorder
by Peter J. Dorsen, M.D., LADC
I thought this response to my challenges with Billy would be interesting counterpoint to my own thoughts on anger in someone with bipolar disorder.
Dr Gove Hambidge, an unique psychoanalyst who prefers to go in depth with his clients, emphasizes that it is crucial for Billy to "self discover." He further adds that there is implicit danger if you " give instructions"(as I seem to have done with Billy); that he "might think you incompetent." However, “preferably, if he discovers the fact( call it truth) himself, it becomes self-fulfilling."
In his opinion, however, in respect to a relationship between Billy’s explosive anger and his bipolar disorder, "they are always linked.” This “ social organization”, as it were, is part of him: anger-mania-hypomania.
"But Billy is a good learner." In answer to my question why Billy’s mother is calling canceling her son's appointment is that it could represent "a power struggle you are having (with the mother). " You are like a pair of boxers in the ring and she can win by canceling the appointment."
"Keep in mind, it's his job to discover. Be subtle. Empathize. Invite him to look at his behavior (like the incident hitting the door recently." Dr Hambidge added, " He's certainly pissed at his mother. It is for him to look and say "intolerable"-- that's why I recommend self-discovery."
"I suspect you have been suckered into the role of giving instruction. Instead, hand power over to the client/patient.
But the good thing, is that you are (now) more familiar with the family dynamics."
Sometimes, it just seems like such a painful way to learn!
Definitely insightul!
I thought this response to my challenges with Billy would be interesting counterpoint to my own thoughts on anger in someone with bipolar disorder.
Dr Gove Hambidge, an unique psychoanalyst who prefers to go in depth with his clients, emphasizes that it is crucial for Billy to "self discover." He further adds that there is implicit danger if you " give instructions"(as I seem to have done with Billy); that he "might think you incompetent." However, “preferably, if he discovers the fact( call it truth) himself, it becomes self-fulfilling."
In his opinion, however, in respect to a relationship between Billy’s explosive anger and his bipolar disorder, "they are always linked.” This “ social organization”, as it were, is part of him: anger-mania-hypomania.
"But Billy is a good learner." In answer to my question why Billy’s mother is calling canceling her son's appointment is that it could represent "a power struggle you are having (with the mother). " You are like a pair of boxers in the ring and she can win by canceling the appointment."
"Keep in mind, it's his job to discover. Be subtle. Empathize. Invite him to look at his behavior (like the incident hitting the door recently." Dr Hambidge added, " He's certainly pissed at his mother. It is for him to look and say "intolerable"-- that's why I recommend self-discovery."
"I suspect you have been suckered into the role of giving instruction. Instead, hand power over to the client/patient.
But the good thing, is that you are (now) more familiar with the family dynamics."
Sometimes, it just seems like such a painful way to learn!
Definitely insightul!
Tuesday, May 24, 2011
Bipolar Visions: What About explosive Anger?
It has frequently come to my attention that people who happen to have bipolar disorder get “accused” more often than not of having a often inaccurate “bipolar moment.” However, I must be one of those splitters rather than lumpers and think such unfortunates have an independent entity called Intermittent Explosive Disorder(IED).
What I have consistently come to believe is that what we are witnessing, especially in someone diagnosed with bipolar disorder (especially Type 1 more frequently than Type 2), is what the Diagnostic and Statistical Manual of Mental Disorders (DSMIV) has categorized as 312.34, under the broad umbrella of impulse-control disorders(not elsewhere classified.
Here is a case from my practice:
Billy, age 17, enrolled in a special school and additionally carefully supervised there for his bipolar disorder(not otherwise specified, 296.80), is currently participating in a specially tailored weekly outpatient CD program with me, biofeedback and therapy from a mental health counselor, and obtains in-depth psychotherapy and medications(Depakote) from a psychiatrist. He has \demonstrated rapid alterations(over days) between manic and depressive symptoms that meet symptom threshold criteria but not minimal duration criteria for manic, hypomanic, or major depressive episodes.
Billy entered the legal system as a minor at 16 and received probation after totaling his parents’ car while under the influence and discovered carrying an illegal amount of marijuana a week later at school(a possession charge). He also has suffered chronically from anxiety and panic attacks for which his PMD prescribes a long acting anxiolytic(Valium) which is monitored. He endures an abusive dependent relationship with a schoolmate and accepts victimization.’
A week ago, his girlfriend called him out of class while he was on a short break enlisting another girl in a dialogue over a rumor that they were breaking up. He violently and uncontrollably punched the door behind the girl several times and immediately screamed four-letter epithets how she should stay the F out of his business. An xray was taken of his hand that was suspicious of a hairline fracture. In our conversation he admitted regret what he had done but said he could not control himself.. His girlfriend was suspended for 10 days for instigating the incident.
I believe this case is illustrative for demonstrating impulsive aggression (that) is unpremeditated and so characteristic of IED. Curiously, IED belongs to the larger family of Axis I impulse control disorders such as kleptomania, pyromania, and pathological gambling. By definition, it is a “disproportionate reaction to any provocation, real or perceived.” Keep in mind that, prior to the incident, my client was sitting quietly in chair in a “comfi” chair in a short break from a class movie.
It comes as no surprise to me that “the disorder itself is not easily characterized and often exhibits comorbidity with other mood disorders, particularly bipolar disorder or, as I am inclined to say, “true-true, but not related. Here’s where I’m in the “splitters” camp. I believe the two are separate entities.
The consistent pattern of this illness is that outbursts are brief( less than a half hour) and, certainly in our patient, often associated with panic and anxiety. There is an association as well with chest tightness, twitching and palpitations, somatic experiences. One of the comments my client volunteered was, “ I could never hit a woman.” She very quickly scurried off to class immediately after this encounter. He said he wished he had been capable of reacting differently. It was all so instantaneous. It was as if he had explained, “The Devil made me do it!”
Except for known and diagnosed bipolar disorder, my patient lacks other possibilities for his behavior: an antisocial personality disorder. He is not borderline, and does not have ADHD. I am unaware of prior brain injury and he has four months of sobriety from all illicit drugs verified by negative regular and random urine screens. He has had witnessed consumption of Depakote, his mood stabilizer, although admittedly he has not had a level drawn and has requested increasing his dose from 250 twice a day to 500mg twice a day. “I feel better on the higher dose.”
Certainly, there are some exotic theories for an etiology for IED such as a low brain serotonin turnover rate(low 5-HIAA) in the CSF as well as an increased insulin secretion. I am personally aware how volatile any of us can become with low blood sugar certainly a consequence of elevations of insulin.
It is important to address treatment issues for IED. In Billy’s case, we are utilizing the aforementioned interdisciplinary approach to our patient’s documented polysubstance addiction problems. Our method includes addressing mental and physical health issues. Unquestionably, a concern for family dynamics as well as Billy’s difficult dependent relationship with his girlfriend are important in our focus. We are treating him for bipolar disorder as well as endeavoring to find the best anxiolytic because so much of his challenge has been his own self-medicating with marijuana, MDX, alcohol, and opiates.
It is my opinion that Billy definitely has issues with bipolar disorder which we are in the process of stabilizing. We are working with his family as well as generating as much cooperation from Billy who I want to begin assuming more and more responsibility for his treatment as well as his behavior. As with other issues like cursing out his mother, I am trying to help Billy create better alternatives. Cognitive behavior therapy(CBT) is one of the mainstays of therapy. I like to think ours is eclectic and may as a result be even more successful. I am not so quick to incriminate Billy’s primary illness, bipolar disorder as what instigates his IED.
My plan is to approach Billy’s IED both independently and simultaneously with his bipolar disorder and addiction to relearn “uncontrollable” responses to frustration. I would like to see him divert impulsive and disproportionate rage reactions elsewhere or help him anticipate ways of avoiding potential trigger events like the one described he had at school.
In this event, I am attempting to assist Billy prepare by avoiding any potential for such an reoccurrence. I advised developing preventive skills. There is no way I can guarantee we can fully eliminate IED in our client. However, I believe it helps to view IED as an independent entity with its own combustion point that can be anticipated and hopefully modulated.
What I have consistently come to believe is that what we are witnessing, especially in someone diagnosed with bipolar disorder (especially Type 1 more frequently than Type 2), is what the Diagnostic and Statistical Manual of Mental Disorders (DSMIV) has categorized as 312.34, under the broad umbrella of impulse-control disorders(not elsewhere classified.
Here is a case from my practice:
Billy, age 17, enrolled in a special school and additionally carefully supervised there for his bipolar disorder(not otherwise specified, 296.80), is currently participating in a specially tailored weekly outpatient CD program with me, biofeedback and therapy from a mental health counselor, and obtains in-depth psychotherapy and medications(Depakote) from a psychiatrist. He has \demonstrated rapid alterations(over days) between manic and depressive symptoms that meet symptom threshold criteria but not minimal duration criteria for manic, hypomanic, or major depressive episodes.
Billy entered the legal system as a minor at 16 and received probation after totaling his parents’ car while under the influence and discovered carrying an illegal amount of marijuana a week later at school(a possession charge). He also has suffered chronically from anxiety and panic attacks for which his PMD prescribes a long acting anxiolytic(Valium) which is monitored. He endures an abusive dependent relationship with a schoolmate and accepts victimization.’
A week ago, his girlfriend called him out of class while he was on a short break enlisting another girl in a dialogue over a rumor that they were breaking up. He violently and uncontrollably punched the door behind the girl several times and immediately screamed four-letter epithets how she should stay the F out of his business. An xray was taken of his hand that was suspicious of a hairline fracture. In our conversation he admitted regret what he had done but said he could not control himself.. His girlfriend was suspended for 10 days for instigating the incident.
I believe this case is illustrative for demonstrating impulsive aggression (that) is unpremeditated and so characteristic of IED. Curiously, IED belongs to the larger family of Axis I impulse control disorders such as kleptomania, pyromania, and pathological gambling. By definition, it is a “disproportionate reaction to any provocation, real or perceived.” Keep in mind that, prior to the incident, my client was sitting quietly in chair in a “comfi” chair in a short break from a class movie.
It comes as no surprise to me that “the disorder itself is not easily characterized and often exhibits comorbidity with other mood disorders, particularly bipolar disorder or, as I am inclined to say, “true-true, but not related. Here’s where I’m in the “splitters” camp. I believe the two are separate entities.
The consistent pattern of this illness is that outbursts are brief( less than a half hour) and, certainly in our patient, often associated with panic and anxiety. There is an association as well with chest tightness, twitching and palpitations, somatic experiences. One of the comments my client volunteered was, “ I could never hit a woman.” She very quickly scurried off to class immediately after this encounter. He said he wished he had been capable of reacting differently. It was all so instantaneous. It was as if he had explained, “The Devil made me do it!”
Except for known and diagnosed bipolar disorder, my patient lacks other possibilities for his behavior: an antisocial personality disorder. He is not borderline, and does not have ADHD. I am unaware of prior brain injury and he has four months of sobriety from all illicit drugs verified by negative regular and random urine screens. He has had witnessed consumption of Depakote, his mood stabilizer, although admittedly he has not had a level drawn and has requested increasing his dose from 250 twice a day to 500mg twice a day. “I feel better on the higher dose.”
Certainly, there are some exotic theories for an etiology for IED such as a low brain serotonin turnover rate(low 5-HIAA) in the CSF as well as an increased insulin secretion. I am personally aware how volatile any of us can become with low blood sugar certainly a consequence of elevations of insulin.
It is important to address treatment issues for IED. In Billy’s case, we are utilizing the aforementioned interdisciplinary approach to our patient’s documented polysubstance addiction problems. Our method includes addressing mental and physical health issues. Unquestionably, a concern for family dynamics as well as Billy’s difficult dependent relationship with his girlfriend are important in our focus. We are treating him for bipolar disorder as well as endeavoring to find the best anxiolytic because so much of his challenge has been his own self-medicating with marijuana, MDX, alcohol, and opiates.
It is my opinion that Billy definitely has issues with bipolar disorder which we are in the process of stabilizing. We are working with his family as well as generating as much cooperation from Billy who I want to begin assuming more and more responsibility for his treatment as well as his behavior. As with other issues like cursing out his mother, I am trying to help Billy create better alternatives. Cognitive behavior therapy(CBT) is one of the mainstays of therapy. I like to think ours is eclectic and may as a result be even more successful. I am not so quick to incriminate Billy’s primary illness, bipolar disorder as what instigates his IED.
My plan is to approach Billy’s IED both independently and simultaneously with his bipolar disorder and addiction to relearn “uncontrollable” responses to frustration. I would like to see him divert impulsive and disproportionate rage reactions elsewhere or help him anticipate ways of avoiding potential trigger events like the one described he had at school.
In this event, I am attempting to assist Billy prepare by avoiding any potential for such an reoccurrence. I advised developing preventive skills. There is no way I can guarantee we can fully eliminate IED in our client. However, I believe it helps to view IED as an independent entity with its own combustion point that can be anticipated and hopefully modulated.
Saturday, January 29, 2011
Taking Step 1 with Bipolar Disorder
Timothy Kuss, LADC, LMFT
I am in recovery from bipolar disorder and chemical dependency. I also currently work as a CD counselor and family therapist in outpatient and residential CD treatment. I believe that taking step 1 for Bipolar Disorder is a lot like taking step 1 for our addiction. Many of us go through a period of denial. People in our family also go through a period of denial about our bipolar disorder.
Mental illness carries quite a stigma and is often seen as untreatable. Sometimes it is seen as a permanent disability, especially if we’ve seen family members or acquaintances suffering long hospitalizations and recurring tragedy related to episodes over the course of decades. Most people don’t understand that with today’s medications and therapy, hospitalizations can be avoided fewer, or at least briefer. Tragedies can be averted and clients can lead relatively normal lives and have careers and families.
My own Step 1 with bipolar disorder was delayed due to a series of misdiagnoses of Schizophrenia. Bipolar disorder, unfortunately, shares a typical age of onset with schizophrenia of 20 as well as the potential for psychosis during manic episodes. My experience with delusional thoughts was probably heightened by the fact that I had used LSD and other hallucinogens frequently. I was hospitalized and treated for an incorrect diagnosis with anti-psychotics such as Thorazine and Haldol, which made me feel and look like a zombie. Such an error in diagnosis served to make me deny my mental illness. However, fortunately this resulted in volunteering myself for long-term chemical dependency treatment.
Twenty-five years later while continuing my sobriety I had a series of manic episodes resulting in short hospital stays and finally got the diagnosis of bipolar disorder. My reaction was one of relief. They finally got it right! As I learned more about the symptoms of bipolar disorder, I was finally able to understand what had been happening to me. As a professional I have encountered many clients with the same reaction of gratitude after finally getting the right diagnosis. Many have had co-occurring addiction and mental illness.
Unfortunately, many of us struggle with the need to take medications to treat our Bipolar Disorder. I tried to wean myself off them at first, just as I had done with those incorrectly prescribed antipsychotics. Today, I understand that my mood-stabilizing meds do not have any negative side effects. They are my insurance policy. They keep me out of the psych wards and out of potentially life-threatening situations that seem to predictably occur when I get psychotic. During my last psychiatric hospitalization I spent 3 days in intensive care due to high blood pressure that resisted medical efforts to bring it down. I have also put myself in dangerous situations when manic, like when I wandered outside in the dead of winter with no clothing and only a sleeping bag and tennis shoes for cover. Another time, I became paranoid of aliens trying to kill my daughter and almost put her in grave danger.
OUR step 1 includes recognition of some “crazy” behavior and thinking. Others also with bipolar disorder can laugh with us about these old episodes just like other drunks can laugh with us about our crazy earlier drinking episodes. Accepting unmanageability comes with accepting that reality is different from our delusions. We were powerless as individuals to cope with our illness. But together and with help we can be in recovery. Step 2!
In summary, Step 1 of our dual recovery includes recognition that our chemical use increased our mental health dysfunction(symptoms). This is different than saying that the chemical use caused the symptoms. I proved after 25 years of sobriety that I can STILL have symptoms WITHOUT using. I can see, however, a constant stream of clients entering the doors of our MI-CD program because their chemical use led to repeated hospitalizations for psychosis. I’m pretty sure that I wouldn’t have struggled with 5 years of psychiatric admissions if someone had helped me understand that I had to stop using chemicals.
As a family therapist I have seen many co-dependents struggle with accepting the reality of the dual diagnosis of a loved one. To help them with their fears I have done my best to help them understand how addiction and mental illness coexist. Besides referring them to Alanon or Naranon I also refer them to NAMI, the National Alliance for the Mentally Ill, which has both education and support groups for clients and family members. In dual recovery just as with following the twelve steps of alcoholism or other addictions, we all need to practice recovery one day at a time.
I do.
I am in recovery from bipolar disorder and chemical dependency. I also currently work as a CD counselor and family therapist in outpatient and residential CD treatment. I believe that taking step 1 for Bipolar Disorder is a lot like taking step 1 for our addiction. Many of us go through a period of denial. People in our family also go through a period of denial about our bipolar disorder.
Mental illness carries quite a stigma and is often seen as untreatable. Sometimes it is seen as a permanent disability, especially if we’ve seen family members or acquaintances suffering long hospitalizations and recurring tragedy related to episodes over the course of decades. Most people don’t understand that with today’s medications and therapy, hospitalizations can be avoided fewer, or at least briefer. Tragedies can be averted and clients can lead relatively normal lives and have careers and families.
My own Step 1 with bipolar disorder was delayed due to a series of misdiagnoses of Schizophrenia. Bipolar disorder, unfortunately, shares a typical age of onset with schizophrenia of 20 as well as the potential for psychosis during manic episodes. My experience with delusional thoughts was probably heightened by the fact that I had used LSD and other hallucinogens frequently. I was hospitalized and treated for an incorrect diagnosis with anti-psychotics such as Thorazine and Haldol, which made me feel and look like a zombie. Such an error in diagnosis served to make me deny my mental illness. However, fortunately this resulted in volunteering myself for long-term chemical dependency treatment.
Twenty-five years later while continuing my sobriety I had a series of manic episodes resulting in short hospital stays and finally got the diagnosis of bipolar disorder. My reaction was one of relief. They finally got it right! As I learned more about the symptoms of bipolar disorder, I was finally able to understand what had been happening to me. As a professional I have encountered many clients with the same reaction of gratitude after finally getting the right diagnosis. Many have had co-occurring addiction and mental illness.
Unfortunately, many of us struggle with the need to take medications to treat our Bipolar Disorder. I tried to wean myself off them at first, just as I had done with those incorrectly prescribed antipsychotics. Today, I understand that my mood-stabilizing meds do not have any negative side effects. They are my insurance policy. They keep me out of the psych wards and out of potentially life-threatening situations that seem to predictably occur when I get psychotic. During my last psychiatric hospitalization I spent 3 days in intensive care due to high blood pressure that resisted medical efforts to bring it down. I have also put myself in dangerous situations when manic, like when I wandered outside in the dead of winter with no clothing and only a sleeping bag and tennis shoes for cover. Another time, I became paranoid of aliens trying to kill my daughter and almost put her in grave danger.
OUR step 1 includes recognition of some “crazy” behavior and thinking. Others also with bipolar disorder can laugh with us about these old episodes just like other drunks can laugh with us about our crazy earlier drinking episodes. Accepting unmanageability comes with accepting that reality is different from our delusions. We were powerless as individuals to cope with our illness. But together and with help we can be in recovery. Step 2!
In summary, Step 1 of our dual recovery includes recognition that our chemical use increased our mental health dysfunction(symptoms). This is different than saying that the chemical use caused the symptoms. I proved after 25 years of sobriety that I can STILL have symptoms WITHOUT using. I can see, however, a constant stream of clients entering the doors of our MI-CD program because their chemical use led to repeated hospitalizations for psychosis. I’m pretty sure that I wouldn’t have struggled with 5 years of psychiatric admissions if someone had helped me understand that I had to stop using chemicals.
As a family therapist I have seen many co-dependents struggle with accepting the reality of the dual diagnosis of a loved one. To help them with their fears I have done my best to help them understand how addiction and mental illness coexist. Besides referring them to Alanon or Naranon I also refer them to NAMI, the National Alliance for the Mentally Ill, which has both education and support groups for clients and family members. In dual recovery just as with following the twelve steps of alcoholism or other addictions, we all need to practice recovery one day at a time.
I do.
Tuesday, January 18, 2011
Here's a Heads Up on Bipolar Options
Categorization of Bipolar Illness: DSM IV Resources: For Health Professionals
Mood Disorders
Major Depressive Episode: 2-weeks See Beck Inventory, Appendix A
Manic Episode: 1 week, elevated, expansive or irritable mood
Mixed Episode: Both manic and Major depressive Episode: 1-week
Hypomanic Episode: At least 4 days/No hospitalization required
Major Depressive Disorder(MDD). Single or Recurrent(2 Mo Int)
Dysthymic Disorder: Depressed Mood, at least 2 years
Depressive Disorder NOS, Not Otherwise Specified
Bipolar Disorders
Bipolar I Disorder
Single Manic: Presence of only one Manic Episode, no past MDE
Most Recent Episode Hypomanic*: At least one Manic Episode or
Mixed Episode
Most recent Episode Manic*( at least 1 Maj Dep Ep, Manic Ep, or
Mixed Ep
Most Recent Episode Mixed*
Most Recent Episode Depresssed*
Most Recent Episode Unspecified*
*Note: Any of these entities can be associated with rapid cycling
Bipolar II Disorder (recurrent major depressive Episodes With Hypomanic Episodes)*
One or more MDE, at least one hypomanic episode(no manic)
May be in partial or full remission
Note: May occur as rapid cycling
Cyclothymic Disorder
At least 2 years, hypomania, depressive symptoms(not
MDE). One year in children
Can see superimposed bipolar 1 or 2 after 2 years
Bipolar Disorder Not Otherwise Specified
Very rapid alternation (over days) between manic and depressive symptoms meeting symptom threshold criteria but not minimal duration criteria manic, hypomanic, or MDE. Also, the clinician may be unable to determine primary, medical, or substance induced.
Substance-Induced Mood Disorder
The problem developed within a month of substance use or withdrawal
Mood Disorders
Major Depressive Episode: 2-weeks See Beck Inventory, Appendix A
Manic Episode: 1 week, elevated, expansive or irritable mood
Mixed Episode: Both manic and Major depressive Episode: 1-week
Hypomanic Episode: At least 4 days/No hospitalization required
Major Depressive Disorder(MDD). Single or Recurrent(2 Mo Int)
Dysthymic Disorder: Depressed Mood, at least 2 years
Depressive Disorder NOS, Not Otherwise Specified
Bipolar Disorders
Bipolar I Disorder
Single Manic: Presence of only one Manic Episode, no past MDE
Most Recent Episode Hypomanic*: At least one Manic Episode or
Mixed Episode
Most recent Episode Manic*( at least 1 Maj Dep Ep, Manic Ep, or
Mixed Ep
Most Recent Episode Mixed*
Most Recent Episode Depresssed*
Most Recent Episode Unspecified*
*Note: Any of these entities can be associated with rapid cycling
Bipolar II Disorder (recurrent major depressive Episodes With Hypomanic Episodes)*
One or more MDE, at least one hypomanic episode(no manic)
May be in partial or full remission
Note: May occur as rapid cycling
Cyclothymic Disorder
At least 2 years, hypomania, depressive symptoms(not
MDE). One year in children
Can see superimposed bipolar 1 or 2 after 2 years
Bipolar Disorder Not Otherwise Specified
Very rapid alternation (over days) between manic and depressive symptoms meeting symptom threshold criteria but not minimal duration criteria manic, hypomanic, or MDE. Also, the clinician may be unable to determine primary, medical, or substance induced.
Substance-Induced Mood Disorder
The problem developed within a month of substance use or withdrawal
The Latest Info On Life As I Know It
It’s been a few years since my last entry to Crazy Doctor. I am no longer a practicing medical doctor. I surrendered my medical license in 2005. While I was in the transitional process, I became a licensed drug and alcohol counselor (LADC) and tried my hand albeit perhaps less than successfully at two drug treatment jobs. The first offered minimal opportunity to function as an actual bone fide CD counselor and the second left me unhappy both with my new milieu and I encountered insufficient help to unravel the mysteries of the new technology of charting.
So what’s a professional gonna do? I never considered some of the alternative potential of my degrees only recently discovering a teaching opportunity at a Twin Cities acupuncture and Oriental medicine academy teaching Western medicine. Way back then, at the demise of my career as I had known it for thirty years, my ever so tolerant wife had off handedly suggested Sam’s Club which, on a lark, I joined first as a greeter until later moving to their gas station where I quickly discovered how to write, read, and even grade papers on the sly.
My sojourn with “big box” retail has had its heads and tails but a steady paycheck has definitely helped supplement my meager Social Security check. Now too, my teaching stipend has also helped crawling out of credit card debt. Oh, the woes of bankruptcy, divorce, and professional demise.
I have been relatively as clear as anyone can be of problems at Sam’s and have persevered for over four years through heat, rain, snow, and cold. None of the potential problems or issues have arisen as my multiple psychometric testing suggested could. But we were warned, of course, of more intellectual or stressful situations I was told rather glibly. I have shown good judgment, been responsible with work assignments and almost always been timely and never had an unexcused absence ( although I continue to pursue personal diversionary opportunities at a brainless job).
I and a fellow CD counselor who is bipolar 1 also with an addiction history have taken a shot at speaking about bipolar disorder and co-occurring addiction, Tim on bipolar 1 and I on bipolar 2. His journey has been scarred with several hospitalizations for psychosis. Mine has been marked with failures personally and professionally. Together, we have established and manage the blog, Bipolarvisions.blogspot.com and mutually try to report on our experiences with the co-occurring challenges of addiction and mental disorder.
It is extremely comforting receiving consistent feedback from intimate friends of a positive transformation to a euthymic state show compared with an earlier emotional lability. People with bipolar disorder are known to wreak havoc with marriage. I know, I’m on my second and so is Tim. Although neither of us are ready to report a bliss state, gone are the impossible psychotic episodes or, in my case, explosive anger.
Those of us with this challenge, are known to change jobs frequently sometimes with the frequency “normies” change underwear. I have been at Sam’s over four years and am engaged in a monogamous relationship and marriage I must work at continually. Sure, I still make my share of mistakes, have my emotional ups and downs, trials and tribulations. I still cherish that I can be there to give what I can to this relatively new relationship. I often must struggle just to offer another adult presence for my wife’s four now-adult children. Sometimes, it is hard for me not to judge her children or to adjust to the lack of space in my new family environment.
It has been readily clear from the outset that my moods can certainly reflect conflicts or challenges dealing with stepchildren but only rarely with my new primary relationship. I show impatience dealing with stubborn post adolescents who very much deserve a mind of their own.
My medications, the anti seizure mood stabilizer, Depakote has no side effects other than lowering my platelet count. I have none of the tardive dyskinesia (TD) I experienced on Zyprexa with or without Abilify ( in my mind falsely advertised as an antidepressant). I am readying my two classes for next trimester and feeling comfortable with these challenges. My biggest challenge in one will be how to enliven the presentation to keep students awake.
Those in the Mankind Project (New Warriors), where I derive so much peer support, respect my “gold,” as we call our strengths or accomplishments for which we must take credit. My fellow “I” or “Integration” group partners with whom I meet for three hours biweekly, encourage me to risk change and seek greener pastures. I have grown increasingly disillusioned with cognitive behavioral therapy(CBT) and received recent strokes from a practicing octogenarian psychiatrist that I demonstrated an impressive gift for dynamic interactive therapy. He has offered to supervise me with any clients I should undertake to counsel. I am heartily prepared to go that direction. There are some delightful opportunities awaiting me just by opening up the myriad of possibilities that await me
So what’s a professional gonna do? I never considered some of the alternative potential of my degrees only recently discovering a teaching opportunity at a Twin Cities acupuncture and Oriental medicine academy teaching Western medicine. Way back then, at the demise of my career as I had known it for thirty years, my ever so tolerant wife had off handedly suggested Sam’s Club which, on a lark, I joined first as a greeter until later moving to their gas station where I quickly discovered how to write, read, and even grade papers on the sly.
My sojourn with “big box” retail has had its heads and tails but a steady paycheck has definitely helped supplement my meager Social Security check. Now too, my teaching stipend has also helped crawling out of credit card debt. Oh, the woes of bankruptcy, divorce, and professional demise.
I have been relatively as clear as anyone can be of problems at Sam’s and have persevered for over four years through heat, rain, snow, and cold. None of the potential problems or issues have arisen as my multiple psychometric testing suggested could. But we were warned, of course, of more intellectual or stressful situations I was told rather glibly. I have shown good judgment, been responsible with work assignments and almost always been timely and never had an unexcused absence ( although I continue to pursue personal diversionary opportunities at a brainless job).
I and a fellow CD counselor who is bipolar 1 also with an addiction history have taken a shot at speaking about bipolar disorder and co-occurring addiction, Tim on bipolar 1 and I on bipolar 2. His journey has been scarred with several hospitalizations for psychosis. Mine has been marked with failures personally and professionally. Together, we have established and manage the blog, Bipolarvisions.blogspot.com and mutually try to report on our experiences with the co-occurring challenges of addiction and mental disorder.
It is extremely comforting receiving consistent feedback from intimate friends of a positive transformation to a euthymic state show compared with an earlier emotional lability. People with bipolar disorder are known to wreak havoc with marriage. I know, I’m on my second and so is Tim. Although neither of us are ready to report a bliss state, gone are the impossible psychotic episodes or, in my case, explosive anger.
Those of us with this challenge, are known to change jobs frequently sometimes with the frequency “normies” change underwear. I have been at Sam’s over four years and am engaged in a monogamous relationship and marriage I must work at continually. Sure, I still make my share of mistakes, have my emotional ups and downs, trials and tribulations. I still cherish that I can be there to give what I can to this relatively new relationship. I often must struggle just to offer another adult presence for my wife’s four now-adult children. Sometimes, it is hard for me not to judge her children or to adjust to the lack of space in my new family environment.
It has been readily clear from the outset that my moods can certainly reflect conflicts or challenges dealing with stepchildren but only rarely with my new primary relationship. I show impatience dealing with stubborn post adolescents who very much deserve a mind of their own.
My medications, the anti seizure mood stabilizer, Depakote has no side effects other than lowering my platelet count. I have none of the tardive dyskinesia (TD) I experienced on Zyprexa with or without Abilify ( in my mind falsely advertised as an antidepressant). I am readying my two classes for next trimester and feeling comfortable with these challenges. My biggest challenge in one will be how to enliven the presentation to keep students awake.
Those in the Mankind Project (New Warriors), where I derive so much peer support, respect my “gold,” as we call our strengths or accomplishments for which we must take credit. My fellow “I” or “Integration” group partners with whom I meet for three hours biweekly, encourage me to risk change and seek greener pastures. I have grown increasingly disillusioned with cognitive behavioral therapy(CBT) and received recent strokes from a practicing octogenarian psychiatrist that I demonstrated an impressive gift for dynamic interactive therapy. He has offered to supervise me with any clients I should undertake to counsel. I am heartily prepared to go that direction. There are some delightful opportunities awaiting me just by opening up the myriad of possibilities that await me
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