What do you know about bipolar disorder?

Discussion in 'Pre-Medical - MD' started by oldman, Mar 28, 2002.

  1. oldman

    oldman Senior Citizen
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    I just got blood from a patient who has bipolar disorder. I didn't know he was diagnosed with it until after I showed the name to a Med Tech (post-drawing). This guy kept talking to me and asking questions very rapidly while I was drawing his blood. The way he talked reminded me of dustin hoffman in "rainman."
     
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  3. Suz177

    Suz177 Senior Member

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    Do you ever watch ER? Abby's mom on there is bi-polar. Anyways, back to reality. Its a form of depression, where the person goes back and forth between two fairly extreme states of depression and mania. It is also called manic depression. This guy sounds like he was in a manic state.
     
  4. I know a lot personally about bipolar disorder because my family has a huge history of it. It can manifest in very different ways in different people, and I thought the portrayal of Abby's mom on ER was generally well-done. In the manic phase, the person can be agitated, talking fast, or have delusions of grandeur (thinking they can tackle a global problem singlehandedly), be a workacoholic to an extreme (no sleep and unable to sleep), be extremely irritable or angry, etc. In the depressive phase, bipolars are at increased risk for suicide. It sounds to me as if your patient was not well medicated at all; most bipolars can function very well with the right medication (usually lithium). If you want to learn more about bipolars (who are often very intense, intelligent people) you should read Dr. Kay Redfield Jamison's book "An Unquiet Mind" about her struggle with manic-depressive illness.
     
  5. oldman

    oldman Senior Citizen
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    that's really interesting.

    i guess this guy was doing the whole talking really fast bit.

    i met another patient who was bipolar. she started to laugh histerically when i put the needle in her arm. she said it tickled.
     
  6. Vader

    Vader Dark Lord of the Sith
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    There have actually been quite a few very famous and successful people who were bipolar. Beethoven is one that comes to mind. Many actors and artists experience the illness. One of the major difficulties in treating patients with bipolar is that some patients get a sort of "high" off of the manic phase... being able to think quickly, generate an enormous amount of creativity, and produce wonderful things. The treatment often takes some of that away. Patients don't like to lose that high and will often stop treatment in part for that reason.

    Bipolar is usually progressive and there seems to be a strong genetic component (often runs in families). It correlates with higher socioeconomic status and education. There are actually several subclasses of bipolar, and you can see quite a diverse range of symptoms in practice. Lithium works for some patients, but its toxicities prevent its use by many. Other patients primarily need the antidepressant effects of SSRIs and other drugs, so they are prescribed those. There are some newer drugs on the market that affect multiple transmitter systems and show some promise for treatment of bipolar.

    Hope this information helps. :D
     
  7. nebula7

    nebula7 Senior Member

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    a member of my family (who is only 11 yrs old, by the way) has been diagnosed with bipolar, and Katie described it perfectly...he is really energetic, talkative in the manic phase. like others posted, I have read that people with bipolar tend to be very creative and intelligent, and this shows through especially during the manic phase. About medications...the child in my family who is being treated is on Risperdal, Depakote, Adderall, and Wellbutrin (Whoa..a lot of meds for an 11 yr old!!). When treated primarily with an antidepressant(Paxil), he gradually slid into a pretty bad depression. I guess it varies from patient to patient as to what works best, but in this case the antidepressant just didn't cut it for bipolar treatment.
     
  8. oldman

    oldman Senior Citizen
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    thanks for the info, very informative. :) pbl baby!
     
  9. Vader

    Vader Dark Lord of the Sith
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    Hey nebula,

    Thanks for sharing your experience! :)

    Treatment of children with bipolar (or diagnosis for that matter) is a very complicated issue. Much of it is diagnosed as attention deficit disorder, but when treated the symptoms only worsen. There seems to be a lack of knowledge surrounding childhood bipolar disorder, as it differs in many respects from the adulthood disorder.

    Furthermore, virtually all of the studies to date on treatment options have been done in adults. Safety, efficacy, and other measures have not generally been evaluated in children. There has been a push recently to fund more child-based clinical research to find better treatments/combos for kids with such disorders. Right now, however, it is often trial and error, with variable dosing and empirical trials of different drugs to see what works best. Often very frustrating for the family.

    Hopefully in the coming years we will learn more about the childhood disorder and how best to treat it.
     
  10. alice

    alice Senior Member

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    i'd just like to second: READ KAY R. JAMISON'S BOOK!!!! it was really illustrative. my family has a strong history of mood disorders and i found her story comforting and encouraging.
     
  11. nebula7

    nebula7 Senior Member

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    vader, you are right about it often being treated as ADD in kids. this child has been "diagnosed" with bipolar, ADHD, a Tourette's tic, and opposition-defiant disorder. (I say "diagnosed" because I'm not sure if he really has all these disorders, even though I do feel his Dr. is pretty good...a specialist in adolescent/childhood psychiatry).

    There definitely needs to be more research with children..some of the drugs he has been on aren't even approved for use in kids, and the effects on children could be different from those in adults. I too hope more is learned about the condition in children in coming yrs :)
     
  12. oldman

    oldman Senior Citizen
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    All this talk makes pyschistry sound very challenging.
     
  13. CoffeeCat

    CoffeeCat SDN Angel

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    I have a young cousin (early teens) being treated with Lithium. I haven't seen her much since she started on it, but I've heard in general that it really "dulls" your personality.

    Also, I've heard more than once that it's very difficult to get people to stay on the medication in the manic phase because it feels so good to them and the medicine takes it away and makes everything more level...I've heard they throw the meds out and declare themselves "cured". It's a difficult disease!
     
  14. Starflyr

    Starflyr Manic Faerie

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    Oldman, if you (or anybody else) wants more information on bipolar, you can either PM me or go to <a href="http://bipolar.about.com" target="_blank">http://bipolar.about.com</a> This site has a LOT of good articles and explanations about bipolar - there are also message boards and a chatroom. If someone is "talking fast" it could be an indication of hypomania or mania, or it could just be part of their personality. Bipolar is progressive if not treated (and many of us become noncompliant with medications because it can be YEARS between episodes, depending on the type of bipolar you have - I was noncompliant and stable for all 4 years of college, am now back on lithium following a manic episode). It can be misdiagnosed as ADHD, ADD, major depression, schizoaffective disorder (if the person has psychotic manifestations of mood episodes), and others, though those four are the main ones.

    It is hard to deal with children who are diagnosed - I was 15 when I was diagnosed bipolar I. Luckily for me, I am responsive to lithium. Many people are not, especially people with type II bipolar (Type I have full blown mania, type II have hypomania, which means they can still function "normally"). The other two complicating factors that decrease probability of responsiveness to lithium, they are called "Mixed states" and "Rapid Cycling". Mixed states is defined as a mood episode that meets the criteria for both a depressive episode and a manic episode. Rapid cycling is defined as having more than four distinct episodes (2 cycles) per year.

    There are four medications that are "proven" to work as mood stabilizers in BP. Lithium is the only one that is FDA approved, though. The others are carbamaezpine (tegretol), olanzepine (zyprexa), and valproate (depakote). Others that are used include: gabapentin (neurontin), topirimate (topomax - everybody wants this one, its the ONLY one that helps you LOSE weight, all the others make you gain weight), lamotrigine (lamictal), Clonidine (Klonopin),...I dont rememberm anymore off the top of my head.

    Also: many bipolars are extrememly sensitive to antidepressants, even on mood stabilizers. They can throw us for a horrible manic loop, so be careful if you're prescribing amitriptyline for anxiety or pain control - get a good history first.

    One last thing: many bipolar people are extremely intelligent and are capable of succeeding in life (some of us are even in medical school). Others have disease so sever that they cannot work and are on social security disability. Do not assume anything about a bipolar patient - especially that they are in some way "mentally deficient" (someone in an acute psychotic episode being somewhat of an exception)

    I hope this helps. Feel free to PM me.

    Star
     
  15. oldman

    oldman Senior Citizen
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    Star, Thanks for that info.

    I think you are living proof of the success for someone diagnosed with a bipolar disorder. :)
     
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  17. Thewonderer

    Thewonderer Senior Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Starflyr:
    <strong>Lithium is the only one that is FDA approved, though. The others are carbamaezpine (tegretol), olanzepine (zyprexa), and valproate (depakote). Others that are used include: gabapentin (neurontin), topirimate (topomax - everybody wants this one, its the ONLY one that helps you LOSE weight, all the others make you gain weight), lamotrigine (lamictal), Clonidine (Klonopin),...I dont rememberm anymore off the top of my head.

    Also: many bipolars are extrememly sensitive to antidepressants, even on mood stabilizers. They can throw us for a horrible manic loop, so be careful if you're prescribing amitriptyline for anxiety or pain control - get a good history first.

    One last thing: many bipolar people are extremely intelligent and are capable of succeeding in life (some of us are even in medical school). Others have disease so sever that they cannot work and are on social security disability. Do not assume anything about a bipolar patient - especially that they are in some way "mentally deficient" (someone in an acute psychotic episode being somewhat of an exception)

    I hope this helps. Feel free to PM me.

    Star</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Bipolar is both a devastating and yet fascinating illness.

    another reason why people don't take meds is sometimes they love being in the hypomanic phase. If you think about it, it is a wonderful feeling and compared to the depression that a bipolar person undergoes, that hypomanic phase is like heaven! But of course, before you know, you lose control and proceed in the irritable, nerve-wrecking manic phase. Meds don't work that fast if you want to take them right at the hypomanic phase. Plus, in that phase, you feel invisible; nothing can touch you including the illness...then you suffer from your mistake within a week or two.

    Both Lithium and Depakote are FDA-approved for bipolar. The future is toward combination therapy. However, topomax and zyprexa are gaining more recoginition.

    lastly, people do react differently to these drugs. Depakote is more popular than Li+ at this point in the US. A lot of it is due to clinical experience. The psychiatrist I follow prescribe Depakote because of fewer side effects and because he has seen pts on Li that develop renal problem in 10-15 years. That scares him but it is not based on any hard clinical data.

    There is still much unknown about the disease.
     

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