Is bipolar with multiple cycles in a day (ultradian cycling) actually bipolar?

[tagit570]

I just wanted to say that the people in this thread made me very sad. It seems like a lot of you think there's no such thing at all as ultradian bipolar.
It seems like you wouldn't believe me if I told you, but I do. Or at least I did. My psychiatrist said it'd be interesting to find out now. I don't have as much mania anymore, it's just hypomania.
My bipolar appeared at 9 and I was diagnosed at 10 with ultra ultra rapid cycling bipolar. I traveled 40 minutes in DFW to get to a child psychiatrist who knew anything to do with me. By 15 I had been on 21-24 medications.
I had extreme mania, severe depression, and severe mixed episodes all of the time. I could have an extreme manic episode and depressive episode in the same hour easily.
It makes me really sad that there are doctors out there and people who want to be doctors that think I made this up at age 10. I do understand a lot of people say they have bipolar, when they have no idea what it is. So I hope you're talking about them.
I made this account when I thought I wanted to be a pharmacist (engineering student now), but I logged in just to say this.

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[smalltownpsych]

I just wanted to say that the people in this thread made me very sad. It seems like a lot of you think there's no such thing at all as ultradian bipolar.
It seems like you wouldn't believe me if I told you, but I do. Or at least I did. My psychiatrist said it'd be interesting to find out now. I don't have as much mania anymore, it's just hypomania.
My bipolar appeared at 9 and I was diagnosed at 10 with ultra ultra rapid cycling bipolar. I traveled 40 minutes in DFW to get to a child psychiatrist who knew anything to do with me. By 15 I had been on 21-24 medications.
I had extreme mania, severe depression, and severe mixed episodes all of the time. I could have an extreme manic episode and depressive episode in the same hour easily.
It makes me really sad that there are doctors out there and people who want to be doctors that think I made this up at age 10. I do understand a lot of people say they have bipolar, when they have no idea what it is. So I hope you're talking about them.
I made this account when I thought I wanted to be a pharmacist (engineering student now), but I logged in just to say this.

Not sure why this discussion made you sad. No one in this thread said that there is no such thing as extremely rapid cycling bipolar. We commented on frequent misdiagnosies and how to make diagnostic distinctions between disorders. This type of healthy dialogue between professionals makes me happy as the ultimate goal is to become better doctors for our patients as we try to make sense of complex phenomena.

 

[thoffen]

Obviously, this topic is met with something of a collective groan, and it highlights several problems:
- reliance on subjective report
- motivation for external locus of control for symptoms
- DSM having a simplistic definition of borderline pathology
- more complex definitions can't be made into diagnostic instruments
- diagnostic instruments standardize diagnostic approach but are still neither inherently accurate nor reliable
- despite this, there is no gold standard to assess their accuracy (i.e. you can't determine bipolar disorder or borderline personality disorder on autopsy)
- clinicians defense against countertransference reactions which we are assaulted with in some patients
- systems of care discriminate against borderline diagnoses

And that's just off the top of my head.

I do not believe we'll ever have a clear way to parse these things, but instead of focusing on the diagnosis backwards to treatment, I do think we have the tools to individually assess patients and realize that trileptal isn't going to be a wonder drug for their bipolar because everything else worked great and you were the best doctor in the world until you got ten messages over the weekend because suddenly their left second toe turned green and they just knew it was the medicine so they stopped taking it and need you to rescue them.

If someone has a problem that needs a different approach, even if they reject it, even if they don't have the means to afford it, we have to be diligent about not colluding in unrealistic expectations that treating a misdiagnosis or comorbidity is going to fix that problem.

 

[hamstergang]

It makes me really sad that there are doctors out there and people who want to be doctors that think I made this up at age 10.

I don't think anyone here has suggested or would suggest that you or any of these people are making it up. The question is how we can best conceptualize what it is that they are experiencing. "Bipolar disorder" doesn't seem to be the answer.

 

[Shikima]

"It's my bipolar acting up!"

 

[thoffen]

I think it is fair that people have been harmed by physicians accusing them of making things up or other such rejecting accusations. I hope those doctors really do know better, and I believe there aren't many psychiatrists whose primary motivation is narcissistic.

Nonetheless, the compulsion to enact theses patterns is strong. Usually, it comes from a patient's transference, but sometimes (and most unfortunately), it comes from countertransference from other patient experiences.

Not that the enactment is right. But we are human after all.

 

[hamstergang]

I think it is fair that people have been harmed by physicians accusing them of making things up

If this part was to me, I see my post was missing a few words that were in my head. I didn't see anyone here suggesting symptoms were made up.

 

[thoffen]

If this part was to me, I see my post was missing a few words that were in my head. I didn't see anyone here suggesting symptoms were made up.

Oh no I'm not calling out posters here. Just validating the feelings of a patient. You're better than me, though, if you've never thought a patient was disingenuous with something and found out otherwise.

 

[hamstergang]

Oh no I'm not calling out posters here. Just validating the feelings of a patient. You're better than me, though, if you've never thought a patient was disingenuous with something and found out otherwise.

Well I've certainly thought it, but I still act as though I believe them as that is typically the better mistake to make. Usually these are scenarios when I'm on call and don't have to deal with the consequences of being wrong, so I doubt that makes me better in any way.

 

[Ceke2002]

I think it is fair that people have been harmed by physicians accusing them of making things up or other such rejecting accusations. I hope those doctors really do know better, and I believe there aren't many psychiatrists whose primary motivation is narcissistic.

Nonetheless, the compulsion to enact theses patterns is strong. Usually, it comes from a patient's transference, but sometimes (and most unfortunately), it comes from countertransference from other patient experiences.

Not that the enactment is right. But we are human after all.

I definitely think there's a difference between challenging a patient's internalised or world view when it's clear that view is interfering with the goals of treatment, and just making outright rejecting accusations. From a patient's point of view it can sometimes be hard to a) tell the difference, and b) accept being challenged even when you know what the difference is, especially if you've had a previous negative experience with treatment and/or you've grown up with a message akin to 'there's nothing wrong with you, you're just *insert derogatory statement here'.

 

[Oof.quack]

Hello. I thought it might be useful to share my personal experience with ultradian bipolar. I am diagnosed with bipolar 2 disorder, panic disorder and narcolepsy. I have experienced hypomania in the form of extreme energy and euphoria to the point that I have been bouncing up and down and giggling. I have so much energy that I have to do jumping jacks to release it. Unfortunately, when I experience this kind of happiness and energy boost, I know it will be short lived. My friends know that in roughly 30 min from the start of my hypomania episode, I will become severely depressed, so they keep an eye on me. It feels like all of my happy chemicals are released into my brain all at once and then quickly run out.