any comments about bipolar disorder

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taji

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Hi everybody
I've diagnosed with Bipolar disorder,
If anybody has any thing to say or any help pl. let me know.
I'm going to get my Dental License so work as a dentist.but I don't know by this situation that I'm in How can I practice as a dentist and earn money as a dentist!

THX:thumbup:

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I'm not sure what you're trying to say exactly, but it seems as if you are saying that you have recently been given the dx of Bipolar Disorder and you're wondering if this will limit you as a professional. Are you seeking medical advice or is this in regards to being licensed?

If it's medical advice, this is the wrong place to be seeking this. You need to follow up with your clinician/psychiatrist.

And if you want to know if this will impact your ability to be licensed, I have no idea. My thought is that they can't discriminate, but I'm not sure where you're practing. From your English, I'm guessing that you might be a foreign graduate. Are you seeking to practice in the states.

Good luck.
 
Agree with the above. It violates our ethics & standards of care to give medical advice to a person over the internet. You need to talk to your own doctor about this.
 
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As long as the discussion remains related to working as a dentist with a psychiatric disease, the potential dangers, the nuances, the thread can continue. However, other posters are correct. Solicitation of medical advice cannot be allowed on SDN.
 
Bipolar disorder is a depressive illness and brain disorder that causes persons mood, energy, and ability to function. it typically develops in early adulthood.It can lead healthy and productive lives when the illness is effectively treated.
The symptoms of bipolar disorder is cannot sleep and thoughts of death or suicide attempts.
Medications for bipolar disorder are prescribed by doctors with expertise in the diagnosis and treatment of mental disorders.

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sabina

Dual Diagnosis

http://www.dual-diagnosis.net
 
I'm not sure that it is unethical to offer advice (as a professional) over the internet. There is controversy... But there is also a move to conducting such things as diagnostic interviews by way of teleconferencing equipment for people who are in rural areas (for example).

That being said, it is clear that the purpose of this site is for professionals to have a place where they can discuss professional issues.

There are a number of consumer boards out there:

psychcentral being one and psychobabble being another. A number of professionals with mental health issues also post to those sites. It would be appropriate to post to those. Good luck in your search for info and / or advice.
 
I'm not sure that it is unethical to offer advice (as a professional) over the internet. There is controversy... But there is also a move to conducting such things as diagnostic interviews by way of teleconferencing equipment for people who are in rural areas (for example).

That being said, it is clear that the purpose of this site is for professionals to have a place where they can discuss professional issues.

There are a number of consumer boards out there:

psychcentral being one and psychobabble being another. A number of professionals with mental health issues also post to those sites. It would be appropriate to post to those. Good luck in your search for info and / or advice.

The APA ethics code specifically states that advice or clinical opinion cannot be given regarding a patient that has not been examined by a psychiatrist. The commonly cited example (and board question) is the news media outlet that contacts a psychiatrist looking for a clinial opinion on a highly publicized case (i.e. Highway sniper or Virginia Tech massacre).

I know what you mean though. My first impression is always to try and help. Often I wish I could give some simple advice. More than this however (and unfortunately) is largely due to litigation (i.e. suicide resulting from misconstrued advice, or failure to protect, etc) which will result in the physician being held to the standard of malpractice when not in a treatment relationship.

Yes, there is a growing subset of telepsychiatry, and I think that this is a good thing. Telepsychiatry, however, implies a properly arranged therapeutic relationship with clear doctor/patient stipulations, documentation, and the like.
 
> The APA ethics code specifically states that advice or clinical opinion cannot be given regarding a patient that has not been examined by a psychiatrist.

So then I guess the issue becomes whether there are psychiatrists who aren't required to follow the guidelines of the American Psychiatric Association (because they aren't in the US, for example). This brings up issues about where the 'advising' is being located when the patient is in one country and / or state, the psychiatrist is in another, and the server is in yet another. I guess it is also up for grabs whether an 'examination' can be conducted by way of message boards...

How about consumer sites where a Clinical Psychologist or a Psychiatrist writes a response to a particular query that a person has (typically about themself or someone they know)? How about medical sites that do the same? It is often said that you can't diagnose over the internet... But about about advising on the basis of what the person says their diagnosis is?

The whole thing is a can of worms, I guess. I respect that this site is aimed as a place where professionals can talk to one another and that if consumers posted their queries then it would take away from the main aim of the site. The medication board at psychobabble was initially set up so that clinicians could suggest medications to other clinicians (for clients who hadn't had much luck with previous medications). For clinicians to ask about what side effects etc other clinicians had had reported to them by their clients etc etc etc. Over time... The consumers basically took over and the majority of professionals stopped posting there. It is still a valuable resource but the focus has changed significantly. It isn't what it once was, that is for sure.
 
The APA ethics code specifically states that advice or clinical opinion cannot be given regarding a patient that has not been examined by a psychiatrist. The commonly cited example (and board question) is the news media outlet that contacts a psychiatrist looking for a clinial opinion on a highly publicized case (i.e. Highway sniper or Virginia Tech massacre).

I remember in my 2nd year of med school during our neuro/psych class we were handed a list of famous artists and writers in the past who were thought to have suffered from bipolar or depression. The topic was creativity and mental illness, especially bipolar. The list included all the usual suspects--Virginia Woolf, Van Gogh, Hemingway, etc. I'm just wondering when a famous person's mental health problems become part of the public knowledge, because clearly, in the case of many famous people, it already has. I can't imagine most of those people on the list we got had been evaluated properly and/or given the chance to sign some kind of confidentiality waiver during their lives.

Does the APA position on this have a parallel in internal medicine or family practice? For example, what about physicians who speculate publicly about Kennedy maybe having Addison's disease, or an obvious one, like FDR having polio and being paralyzed? Are psychiatrists beholden to the APA code regarding medical issues in people they haven't themselves examined? Or does the APA code not apply outside psychiatry? In that case, what does apply? I can think of living people as well where these discussions come up. Or what about a political candidate and their age? I guess age is a vital stat or identifying feature so it's fair game? I know it sounds silly, but many aspects of a person's medical record could also be seen as very reasonable information for the public to have, and it seems contrived to prohibit psychiatrists from discussing those facts. You could take it to an extreme and say, we cannot discuss whether Castro is alive or dead because we haven't examined him and assessed his mental status! Same goes for Elvis!

There must be exceptions too, I'd think. What if you are a psychiatrist, and your neighbor is standing on their apartment window ledge, threatening to jump? Of course you must be allowed to advise them to get off the ledge and try to lead them to safety. That's still giving "advice" even if they haven't been examined.
 
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So then I guess the issue becomes whether there are psychiatrists who aren't required to follow the guidelines of the American Psychiatric Association (because they aren't in the US, for example). This brings up issues about where the 'advising' is being located when the patient is in one country and / or state, the psychiatrist is in another, and the server is in yet another. I guess it is also up for grabs whether an 'examination' can be conducted by way of message boards...

It's more than just APA ethics for ethics' sake. Professional codes have implications in standard of care. In the case of internet advice, you may be held liable for malpractice if you've offered, in a jury's opinion, sufficient medical advice which resulted in what they determine to be a treatment relationship, and if subsequent harm came to the patient.

An examination cannot be done via a message board. A person can be on one end of the computer insisting that their atypical antipsychotic is worthess, in the meanwhile they're dressed in a clown suit with a pile of feces on their head with wild goats in their apartment which they feel will protect them from the impending alien invasion of the intergalactic goat rebellion. None of this comes through on a message board.

How about consumer sites where a Clinical Psychologist or a Psychiatrist writes a response to a particular query that a person has (typically about themself or someone they know)? How about medical sites that do the same? It is often said that you can't diagnose over the internet... But about about advising on the basis of what the person says their diagnosis is?

This becomes more complicated, and I'm not sure if there's case law to determine who, if anyone, is liable should harm befall a patient based on advice given in such a manner. I wouldn't want to be the landmark case in this respect. I'd err on the side of caution unless there was an airtight contract involved. Even then, it's risky.

The whole thing is a can of worms, I guess. I respect that this site is aimed as a place where professionals can talk to one another and that if consumers posted their queries then it would take away from the main aim of the site. The medication board at psychobabble was initially set up so that clinicians could suggest medications to other clinicians (for clients who hadn't had much luck with previous medications). For clinicians to ask about what side effects etc other clinicians had had reported to them by their clients etc etc etc. Over time... The consumers basically took over and the majority of professionals stopped posting there. It is still a valuable resource but the focus has changed significantly. It isn't what it once was, that is for sure.

Psychobabble and similar sites have promulgated, perhaps through no real fault of their own, some of the most incorrect, utterly inaccurate, and outright bizarre medication "facts" I've ever come across. Those sites, from what I've seen, basically amount to "psychotropic napster," where patients are trading medications and creating insane cocktails of meds that they feel "they need." Virtually thread has the original post paraphrase, "Doctor X prescribed me this. It doesn't work! I said I needed Xanax but he won't give it to me! I KNOW MY OWN BODY BETTER THAN ANYONE! I NEED IT!!!"

I hadn't been on that site in quite a while, so I popped over. The second thread from the top had a patient receiving Cozaar from another poster to deal with "MAOI Hypertensive crises that happen from time to time." Another poster recommended they take some ritalin when this occurs.

Unbelievable.
 
I remember in my 2nd year of med school during our neuro/psych class we were handed a list of famous artists and writers in the past who were thought to have suffered from bipolar or depression. The topic was creativity and mental illness, especially bipolar. The list included all the usual suspects--Virginia Woolf, Van Gogh, Hemingway, etc. I'm just wondering when a famous person's mental health problems become part of the public knowledge, because clearly, in the case of many famous people, it already has. I can't imagine most of those people on the list we got had been evaluated properly and/or given the chance to sign some kind of confidentiality waiver during their lives.
The concept of the "psychiatric autopsy" is slightly different and implies something even more different when it comes to public figues. One can speculate if Abraham Lincoln had Marfan's syndrome, for example, but since he is a public figure, the law sees this as more "fair game." However, if a physician publicly asserted that Tom Cruise had a paranoid personality disorder, for example, that might be open to a slander or libel lawsuit.

Does the APA position on this have a parallel in internal medicine or family practice? For example, what about physicians who speculate publicly about Kennedy maybe having Addison's disease, or an obvious one, like FDR having polio and being paralyzed?

It's less commonly believed, but likely more accurate that FDR had Guillain-Barre syndrome. This, again, is based on public assertion, and is not a specific claim made by a physician attesting to a particular diagnosis. It seems similar, but there is a difference.

Are psychiatrists beholden to the APA code regarding medical issues in people they haven't themselves examined? Or does the APA code not apply outside psychiatry? In that case, what does apply?

If I understand your questions correctly, I can say that the APA ethics code asks that a diagnosis or speculation not be made about a particular person which one has not examined. There is a similar standard (I believe) which applies to physicians in general. I don't think one could ethically claim, for example, that Oprah has diabetes since she has trouble controlling her weight.
I can think of living people as well where these discussions come up. Or what about a political candidate and their age? I guess age is a vital stat or identifying feature so it's fair game? I know it sounds silly, but many aspects of a person's medical record could also be seen as very reasonable information for the public to have, and it seems contrived to prohibit psychiatrists from discussing those facts. You could take it to an extreme and say, we cannot discuss whether Castro is alive or dead because we haven't examined him and assessed his mental status! Same goes for Elvis!

Age is not a disease, and in fact, there is great speculation as to whether public official health records should be released at all, and if this should have bearing on voting outcomes. McCain, for example, has released all records regarding his 3 melanoma removals, but refuses to release his psychiatric records. There is further speculation that there are lingering PTSD symptoms which may interfere with his ability to govern effectively. Psychiatric records, for better or worse, are often held to a higher standard of confidentiality than other medical records. The most obvious example of this is the doctor-patient confidentiality privilage which was borne out of the therapist/patient relationship.

There must be exceptions too, I'd think. What if you are a psychiatrist, and your neighbor is standing on their apartment window ledge, threatening to jump? Of course you must be allowed to advise them to get off the ledge and try to lead them to safety. That's still giving "advice" even if they haven't been examined.

This falls under still a different standard, and involves (in most states) a Good samaritan situation. Some states actually have a rarely-enforced sort of 'opposite' of that law under the same name, which requires a bystander to offer help to someone in imminent danger.
 
'sazi, you mentioned telepsychiatry....I've been wondering about people's opinions on this, as I first heard about it last year (I know someone who worked abroad who setup a telepsych practice). From what I know about it, I think it is an okay setup once an on-site physician assesses and asks for assistance/expertise with prescribing, but without a full evaluation...it seems awfully dodgey.
 
I remember in my 2nd year of med school during our neuro/psych class we were handed a list of famous artists and writers in the past who were thought to have suffered from bipolar or depression. The topic was creativity and mental illness, especially bipolar. The list included all the usual suspects--Virginia Woolf, Van Gogh, Hemingway, etc. I'm just wondering when a famous person's mental health problems become part of the public knowledge, because clearly, in the case of many famous people, it already has. I can't imagine most of those people on the list we got had been evaluated properly and/or given the chance to sign some kind of confidentiality waiver during their lives.

Yeah, that's always bothered me too. I don't think we can know what some deceased famous person might have suffered from. Or living people for that matter. Like there is this poster I saw once hanging on the child side of our inpatient unit that talks about famous people past and present who were/are Asperger's. And I just don't know how one would be able to diagnose that only having public persona to go on. Did you actually interview Einstein to come up with that conclusion? And in the case of the current celebs who as far as I know have not come public about having a dx of Aspergers (Like Al Gore, Bill Gates) how would you like to have your name associated with some dx you may or may not have hanging on the wall of an inpatient psych unit?
 
>
So then I guess the issue becomes whether there are psychiatrists who aren't required to follow the guidelines of the American Psychiatric Association (because they aren't in the US, for example). This brings up issues about where the 'advising' is being located when the patient is in one country and / or state, the psychiatrist is in another, and the server is in yet another. I guess it is also up for grabs whether an 'examination' can be conducted by way of message boards...

Not all US psychiatrists are members of the APA.

I wonder if the APA's rules apply to psychiatrist-sleep specialists? For example, I wonder if it's unethical for a psychiatrist-sleep specialist to recommend a cpap titration on a polysomnogram interpretation report for a patient with severe sleep apnea who he hasn't seen yet (I don't have to worry about this since I took my sleep boards through the American Board of Internal Medicine and follow the ethical principles of the American College of Physicians).
 
One can speculate if Abraham Lincoln had Marfan's syndrome, for example, but since he is a public figure, the law sees this as more "fair game." However, if a physician publicly asserted that Tom Cruise had a paranoid personality disorder, for example, that might be open to a slander or libel lawsuit.

Yeah, that makes sense. Tom Cruise is currently alive, not a public figure in the same sense as Lincoln, and in any case, how could any psychiatrist responsibly comment about someone's "personality" without examining them? Now on the other hand, what if the celebrity was, say, Willie Nelson, and the diagnosis being suggested was cannabis addiction? He's been arrested for possession of that, I believe. His concerts and song lyrics do not exactly do much to dispel suspicion. I can see where it is less than admirable for a psychiatrist to go around commenting on a case like that. It's tawdry and lowbrow and possibly untrue. But if there is already overwhelming evidence, AND it turns out to be true, is it still unethical? I mean, for a journalist to make these two comments, there would be a huge difference--a potentially libelous comment on the one hand, and a statement summarizing known facts on the other hand. But for a physician, whose responsibility is to examine patients and protect their confidentiality, it would be the same?

And how about celebrities who've had obvious or botched plastic surgeries? Could a surgeon comment about those cases publicly without it being an ethics violation? I'm not really sure what they'd gain by commenting, but these debates do go on in practically every tabloid.

(BTW I just checked out the plastic surgery forum to see if they had discussed this. Under "ethics" all I could find was a reprinted pamphlet about advertisements using before and after pictures, and a post from some guy who did a rhinoplasty on his brother...)

It's less commonly believed, but likely more accurate that FDR had Guillain-Barre syndrome. This, again, is based on public assertion, and is not a specific claim made by a physician attesting to a particular diagnosis. It seems similar, but there is a difference.

Do you know who made the public assertion? If not a physician with knowledge of FDR, then who would be in a position to make that suggestion? A journalist with medical knowledge, maybe? It's just interesting that doctors can't talk about patients they HAVEN'T examined, and they can't talk about patients they HAVE examined for confidentiality reasons--leaving only non-physicians to debate these medical mysteries!

Age is not a disease

Yes, very true, and also, age is available from sources other than a patient's medical record, such as their birth certificate, so it's really not a confidential matter.
 
Yeah, that's always bothered me too. I don't think we can know what some deceased famous person might have suffered from. Or living people for that matter. Like there is this poster I saw once hanging on the child side of our inpatient unit that talks about famous people past and present who were/are Asperger's. And I just don't know how one would be able to diagnose that only having public persona to go on. Did you actually interview Einstein to come up with that conclusion? And in the case of the current celebs who as far as I know have not come public about having a dx of Aspergers (Like Al Gore, Bill Gates) how would you like to have your name associated with some dx you may or may not have hanging on the wall of an inpatient psych unit?

I bet that poster was made by some well intentioned advocacy group, hoping to dispel stigma and make patients feel less bad about their own diagnoses. But it misses the point we're talking about here, which is that you shouldn't label a person with this or that disorder if you haven't examined them and they haven't agreed to become a poster child! I think that poster actually sounds much worse than the list of famous artists we got--at least the artists were notoriously ill enough that they'd passed the test of time (like Van Gogh, who did cut off his ear, after all, or Sylvia Plath, who wrote poems about getting ECT). How on earth can someone in some office making a poster know whether Al Gore has Aspergers??

Here's a whole different question I have--say I had an Axis II disorder, and my personal life was really a mess as a result. I bet I could come onto SDN, post questions in forums asking for advice about my relationships and career, and get lots of suggestions from well-intentioned people. I could even get away with some of that here in the psychiatry forum if I was clever and never mentioned the Axis II part of things, I bet! Just as an example, I could ask what is appropriate attire to wear as a medical student. You might not know that for the past 8 years I've worn seductive, histrionic clothing to work and gotten fired from a string of jobs! But now I'm looking for help so I can change. I bet I could get advice if I asked in the right way. Meanwhile, I might keep my job but get into worse problems because other personality issues would surface. Would that count as my receiving advice or clinical opinion from someone who hadn't examined me? (This isn't true about me, by the way!)
 
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I really was in awe when I watched the whole Anna Nicole thing go down. The media had that case so wrong it was scary. Bottles of methadone in her refrigerator, etc. Not once did I see a physician on the tv talking about how "no," this bottle of liquid methadone was not rx'd for her back pain. I mean get real...

A psychiatrist can comment on generalities regarding medical issues. In this case for example, a psychiatrist can come on the TV and report on the common uses of methadone, opiate dependence vs. pain, the differences in doses, administration, route of administration, and ways to tell how one might be taking methadone for either pain or opiate addiction.
 
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