Residency Programs that specialize in Bipolar Disorder

[Waldeinsamkeit]

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I am just looking around to apply and make sure I didn't miss any. Any advice would be appreciated. Thanks!

 

[wolfvgang22]

Isn't this sort of like asking for internal medicine residencies that specialize in diabetes?

 

[WisNeuro]

Don't worry, if my experience in healthcare is any indication, I'm sure most residencies will train you to misdiagnose cluster B as Bipolar Disorder just fine. 😉

 

[Stagg737]

Don't worry, if my experience in healthcare is any indication, I'm sure most residencies will train you to misdiagnose cluster B as Bipolar Disorder just fine. 😉

This is legit one of my biggest pet peeves. I mean, is it really that hard to screen for mania?

 

[Waldeinsamkeit]

Isn't this sort of like asking for internal medicine residencies that specialize in diabetes?

There's a difference in programs who treat those patients (all of them) and programs that receive large NIH grants for studies, have specialized labs focused on the disorder, have preeminent doctors who frequently make contributions to that field of study (not all of them).

 

[wolfvgang22]

Just saw a Vietnam veteran in clinic today who has very clear PTSD, but had been diagnosed as Bipolar I for many years. Nobody had ever asked him about trauma and just assumed he was having mixed episodes because he was irritable most of the time. Turns out he had suffered multiple traumas and assault in the military.
Really surprising, given PTSD is probably over diagnosed in the VA in my experience.

But, I digress. Are there certain academic programs doing research focusing on Bipolar disorder? I'm sure it is an area of interest for a lot of researchers. I was being cheeky with my diabetes comment. Tell us which ones you know about already and maybe someone can add to the list.

 

[WingedOx]

Don't worry, if my experience in healthcare is any indication, I'm sure most residencies will train you to misdiagnose cluster B as Bipolar Disorder just fine. 😉

Hell, anxiety as bipolar is another one that I see plenty too, possibly with a similar frequency.

We seriously don't teach residents how NOT to diagnose people as bipolar well enough.

 

[WingedOx]

have preeminent doctors who frequently make contributions to that field of study (not all of them).

Be careful when dealing with these people. To a hammer, everything is a nail.

/If you want a very topical example, there's a particular well-known researcher around here who I'm really tempted to call out by name on this topic, but this really isn't the forum for it.

 

[FatherPsychiatry]

Don't worry, if my experience in healthcare is any indication, I'm sure most residencies will train you to misdiagnose cluster B as Bipolar Disorder just fine. 😉

You mean to tell me that mood switching 23 times a day isn't a form of super-ultra-rapidian subtype of bipolar disorder?

 

[clausewitz2]

There's a difference in programs who treat those patients (all of them) and programs that receive large NIH grants for studies, have specialized labs focused on the disorder, have preeminent doctors who frequently make contributions to that field of study (not all of them).

For what it is worth, UPMC has an enormous service line with its own inpatient unit and client focusing on adult and child bipolar. I have read the assessments they do on all their inpatients and they are very long and involve a fair amount of psychological testing I am not qualified to evaluate. Very big research program, we invented IPSRT etc.

They have a whiff of bipolar imperislism about them but they are not, as a supervisor memorably put it today, "bipolar jihadis"

 

[Waldeinsamkeit]

For what it is worth, UPMC has an enormous service line with its own inpatient unit and client is is focusing on adult and child bipolar. I have read the assessments they do on all their inpatients and they are very long and involve a fair amount of psychological testing I am not qualified to evaluate. Very big research program, we invented IPSRT etc.

They have a whiff of bipolar imperislism about them but they are not, as a supervisor memorably put it today, "bipolar jihadis"

THANK YOU 🙂

 

[Waldeinsamkeit]

Just saw a Vietnam veteran in clinic today who has very clear PTSD, but had been diagnosed as Bipolar I for many years. Nobody had ever asked him about trauma and just assumed he was having mixed episodes because he was irritable most of the time. Turns out he had suffered multiple traumas and assault in the military.
Really surprising, given PTSD is probably over diagnosed in the VA in my experience.

But, I digress. Are there certain academic programs doing research focusing on Bipolar disorder? I'm sure it is an area of interest for a lot of researchers. I was being cheeky with my diabetes comment. Tell us which ones you know about already and maybe someone can add to the list.

George Washington University and UPenn are the 2 I've found at this point that either have more than one professor looking into bipolar disorder, or UPenn's clinical research lab looks like they have a bipolar or at least mood disorder bent.

 

[st2205]

This is legit one of my biggest pet peeves. I mean, is it really that hard to screen for mania?

Not hard to screen for, but I’ve found it among the most clinically useless things we do. I’d hypothesize half or more people who have been manic would screen negative and be completely insightless. Then there’s everyone else answering “oh yeah!” where further time is wasted answering followup questions.

 

[clausewitz2]

Not hard to screen for, but I’ve found it among the most clinically useless things we do. I’d hypothesize half or more people who have been manic would screen negative and be completely insightless. Then there’s everyone else answering “oh yeah!” where further time is wasted answering followup questions.

Easily 75% of the people I have ultimately diagnosed with bipolar I came out early in the interview with some variant of "people say I'm bipolar but I don't think that's right."

 

[romanticscience]

+1 for UPMC. I did an elective in their Bipolar Institute during PGY4. I use IPSRT quite frequently. I contend that a part of liberal diagnosis of bipolar disorder is related to a belief in the pre-DSM III concept of "manic-depression," essentially a broad spectrum which encompasses all mood disorders, with mild non-recurrent unipolar depressive episodes (i.e., MDD) on one end and highly recurrent depressive episodes +/- mania on the other. So, rather than using mania to distinguish mood disorders, the factor would be recurrence.

My ideas and those of one of my mentors at UPMC were influenced by Dr. Nassir Ghaemi. He's written some good papers on distinguishing borderline personality disorder from bipolar disorders.

Ghaemi, S. N., Dalley, S., Catania, C., & Barroilhet, S. (2014). Bipolar or borderline: a clinical overview. Acta Psychiatrica Scandinavica, 130(2), 99-108.

 

[deleted343839]

Just saw a Vietnam veteran in clinic today who has very clear PTSD, but had been diagnosed as Bipolar I for many years. Nobody had ever asked him about trauma and just assumed he was having mixed episodes because he was irritable most of the time. Turns out he had suffered multiple traumas and assault in the military.
Really surprising, given PTSD is probably over diagnosed in the VA in my experience.

This is one of my biggest pet peeves.

I worked with a man who was diagnosed with bipolar I but whose "manic" episodes (actually vivid flashbacks) were always triggered by a predictable set of stimuli that were, not coincidentally, reminders of circumstances surrounding the multiple serious prior attempts on his life in the community and in prison. He had never been diagnosed with PTSD, only ever bipolar disorder.

 

[WingedOx]

Of course PTSD is also treated as a diagnostic trash bin for patients with maladaptive coping skills too.

 

[WisNeuro]

Of course PTSD is also treated as a diagnostic trash bin for patients with maladaptive coping skills too.

We really need to get SLS into the DSM one of these days.

 

[whopper]

University of Cincinnati has some very eminent Bipolar Disorder researchers including Paul Keck. Also while it's true that to a hammer everything's a nail they provide excellent clinical training that will teach you the difference between Bipolar Disorder and other similar looking disorders.

The eminent people there are accessible. It's not like they're in an ivory tower and won't talk to you. They often times work side-by-side with residents and medical students.

UPMC-I never worked there but I do know for a fact they have some solid Bipolar Disorder researchers and their rep for training is excellent.

 

[Stagg737]

You mean to tell me that mood switching 23 times a day isn't a form of super-ultra-rapidian subtype of bipolar disorder?

And there's my biggest pet peeve...I swear this thread is going to give me bipolar disorder PTSD...

Not hard to screen for, but I’ve found it among the most clinically useless things we do. I’d hypothesize half or more people who have been manic would screen negative and be completely insightless. Then there’s everyone else answering “oh yeah!” where further time is wasted answering followup questions.

Sure, but it's not like bipolar is the only disorder where patients are such poor historians that they're completely insightless or screen negatively. I'd still rather ask a few extra questions and get a thorough history than miss something obvious.

 

[WingedOx]

And there's my biggest pet peeve...I swear this thread is going to give me bipolar disorder PTSD anxiety...

There. Fixed it.

 

[WingedOx]

Sure, but it's not like bipolar is the only disorder where patients are such poor historians that they're completely insightless or screen negatively. I'd still rather ask a few extra questions and get a thorough history than miss something obvious.

Yeah, I mean, you should screen, but if the problem is the patient gives you a false positive answer on screening and you can't understand what it means or doesn't mean, that's on you as a clinician.

I can't tell you how many patients I've inherited who got a BP dx based on "poor sleep and racing thoughts".

 

[WisNeuro]

I can't tell you how many patients I've inherited who got a BP dx based on "poor sleep and racing thoughts".

EXACTLY, also my experience a majority of the time I see it. Congratulations previous clinician, you can read through a checklist that you gave the patient! Now, maybe you could at least ask a handful of clarifying questions before embarking on a medication treatment plan.

 

[romanticscience]

EXACTLY, also my experience a majority of the time I see it. Congratulations previous clinician, you can read through a checklist that you gave the patient! Now, maybe you could at least ask a handful of clarifying questions before embarking on a medication treatment plan.

I wish practitioners appreciated the concepts of sensitivity and specificity as they apply to psychological symptoms. Poor sleep and racing thoughts are non-specific symptoms.

 

[WisNeuro]

I wish practitioners appreciated the concepts of sensitivity and specificity as they apply to psychological symptoms. Poor sleep and racing thoughts are non-specific symptoms.

I wish most practitioners actually knew how to comprehend the concepts of sensitivity and specificity, period.

 

[Stagg737]

Yeah, I mean, you should screen, but if the problem is the patient gives you a false positive answer on screening and you can't understand what it means or doesn't mean, that's on you as a clinician.

I can't tell you how many patients I've inherited who got a BP dx based on "poor sleep and racing thoughts".

Of course. You don't just slap a BP diagnosis on someone for insomnia and racing thoughts, but I've seen patients labeled bipolar when the only explanation given was "patient is having frequent mood swings on a daily basis ". I would rather know that someone actually asked the initial questions and just didn't dig deep enough or didn't interpret it properly than someone just lazily slapping BP label on the patient or being so incompetent to believe that frequent mood swings would be enough evidence to prove someone is BP. Like I said though, just a pet peeve of mine since I've seen docs make some ridiculously incorrect statements on the subject to the point that an M2 would be able to point out why they're wrong.

Getting more on topic though, if anyone has recommendations for sources that talk about some of the nuances of diagnosing and differentiating BP disorder I'd love to read them. Especially in relation to psychotic features and symptoms in BP patients.