Lynn Martin

last login — 20/03/2012 @ 05:12PM



BiPolar Disorders

01/06/2011 06:32PM


BiPolar Disorders  

If you think you may have bipolarity, have been diagnosed with a bipolar spectrum disorder, or have a family member, partner, or friend so affected, I can help.

First, some important considerations:

  • Making a diagnosis of bipolar disorder can be tricky, even for trained professionals, so it’s best to see a psychiatrist rather than a family doctor for medication. 
  • Bipolar can often be over diagnosed.  According to Mark Zimmerman, MD, professor of psychiatry and at Brown University,” In about half of patients previously diagnosed with bipolar disorder, we couldn't confirm the diagnosis."
  • There are real dangers to over diagnosis; among them are unnecessary prescriptions for mood stabilizers and their powerful side effects, and the associated social stigma.
  • Patients with anxiety, agitation, irritability, and restlessness that do not persist are sometimes misdiagnosed with bipolar disorder.
  • One reason the disorder is over diagnosed is because so much has been written about it being under-recognized.

The experience of bipolarity is different for every person affected.   One shared feature is a lack of insight into mood variations. Tracking moods is important to help identify mood changes before they become self-reinforcing and turn into full blown episodes.

A person’s inability to track mood changes is more prominent in hypomanic and manic episodes than during depression.  Getting out ‘ahead of the curve’ can make a great deal of difference, as there is a self-perpetuating aspect to bipolar episodes.  Suicide attempts are a serious concern during depressive episodes.

The first symptom of an upswing can be a dream about gambling.  If this is not recognized as the precursor to risk taking, the behavior, once begun, is more difficult to stop.  And financial loss can far outlast the mood elevation. 

Insight is not only impaired during elevated or depressed mood cycles, but is also present in euthymia (normal mood states).  In the last decade, cognitive aspects have been identified.  These involve more than distractibility, and go to the core of the reason people with bipolar spectrum disorders have difficulty with socialization.  E.g., persons may feel left out of conversations because of a lack of eye contact, self-focused attention, and dysfunctional attitudes.  Underlying issues with executive functioning have been identified, in particular difficulties with changing attention sets.

Mood charts, diaries and journaling are useful tools to track mood, symptoms, and socialization.  Some individuals find these tools no more than an added distraction, or find tracking tedious. Modifications can be made, and time limited tracking, or simplified charts can be used.  Charting helps identify high caffeine consumption, sleep issues and food that contribute to mood destabilization.

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