Like So Many Others Young Mds Working Under Stress In Internships Residencies Or Still In Med School Also Have Their Lives Torn Apart By Bipolar Disorder
One morning when she was 27, Suzanne Vogel-Scibilia, MD, went to work, a young, up-and-coming resident at a major Pittsburgh hospital and left, hours later, as a person with bipolar disorder.
The her own and later confirmedtook place as she was routinely questioning a distraught patient who, after spraying her neighbor with a hose, had been brought into the emergency room by police.
How much sleep had the woman been getting, Dr. Vogel-Scibilia asked. Not much, she answered. Maybe a couple hours a night.
And Im thinking, me too.
How about food? Was she eating? Oh, I had some dinner last night, the woman responded. I wasnt very hungry.
And Im thinking, thats interesting. Same as me.
Was she under ? Sure, the woman said. But you know whats really annoying me? Theyre talking about me on the PA system.
And at that moment, I could hear the PA system and theyre not talking about her. Theyre talking about me. And Im not hearing a damn word this woman is saying. Im just thinking, What diagnosis does this woman have? Bipolar? Oh my god! Suzanne, youve got bipolar disorder!
Dr. Vogel-Scibilia was convinced that her diagnosiswhich she now traces back to age 15, the first time she attempted suicidewould mark the end of her career.
Just because weve trained in psychiatry doesnt mean weve purged ourselves of out-dated and discriminatory attitudes, says Dr. Myers.
doctors told her parents that the most she could expect was to work on an assembly line.
What Is Bipolar Disorder And What Causes It
Bipolar disorder, sometimes called manic depression or manic-depressive illness, is a brain disorder that causes extreme shifts in mood, energy level and behavior. Everyone has ups and downs, but people with disorder have higher “highs” and lower “lows.” They may repeatedly go from feeling very energetic or extremely irritable to feeling crushing sadness and hopelessness. Bipolar disorder is a lifelong illness with no cure, but it can be successfully treated.
There are several types of bipolar disorder, each defined by the severity and pattern of manic and depressive episodes. Recognition of bipolar disorder is critical since, left untreated, it can have significant negative impact on a persons life. In addition, the treatment of bipolar disorder is different from that for the more common unipolar depression.
Though the cause or causes of bipolar disorder have yet to be uncovered, scientists are working on identifying a genetic connection. New research is looking at genes that are thought to be linked to the development of bipolar disorder as well as .
What If Im Not Happy With My Treatment
If you arent happy with your treatment you can:
- talk to your doctor about your treatment options,
- ask for a second opinion,
- get an advocate to help you speak to your doctor,
- contact Patient Advice and Liaison Service , or
- make a complaint.
There is more information about these options below.
How can I speak to my doctor about my treatment options?
You can speak to your doctor about your treatment. Explain why you arent happy with it. You could ask what other treatments you could try.
Tell your doctor if there is a type of treatment that you would like to try. Doctors should listen to your preference. If you arent given this treatment, ask your doctor to explain why it isnt suitable for you.
Whats a second opinion?
A second opinion means that you would like a different doctor to give their opinion about what treatment you should have. You can also ask for a second opinion if you disagree with your diagnosis.
You dont have a right to a second opinion. But your doctor should listen to your reason for wanting a second opinion.
What is advocacy?
An advocate is independent from the mental health service. They are free to use. They can be useful if you find it difficult to get your views heard.
There are different types of advocates available. Community advocates can support you to get a health professional to listen to your concerns. And help you to get the treatment that you would like. NHS complaints advocates can help you if you want to complain about the NHS.
What You Can Do To Get The Proper Diagnosis
Being correctly diagnosed is an important step toward getting the right treatment for your bipolar disorder so you can manage your condition and live a healthy, active, and fulfilling life.
One of the most important things you can do to increase your chances of receiving an accurate diagnosis is to talk with your doctor about all of your symptoms and emotions both the good and the bad says Schwartz. It helps to create a fuller picture of your experience, he explains.
Once you receive your diagnosis, you can always ask your doctor about their reasoning, especially if you have any doubts or questions, notes Zimmerman. Ask the doctor why they have made the diagnosis, he says. A good doctor should be willing to discuss the reasons and to explain if theyre uncertain about it. If you dont receive satisfactory answers, he adds, an opinion from another doctor may be in order.
Additional reporting by Deborah Shapiro and Jessica Migala
What Can I Do If I Think A Loved One Has Bipolar Disorder
If you suspect that a loved one has bipolar disorder, talk with the person about your concerns. Ask if you can make a doctorâs appointment for the person and offer to accompany the person to the visit. Here are some tips:
Bring with you a summary of all medications that you are taking.Â Some medicines can have negative effects on mood and could play a part in understanding yourÂ symptoms.
How Doctors Diagnose Bipolar Disorder
Figuring out whether someone has can be a challenge for doctors. Doctors cant diagnose mental diseases with a blood test. Diagnosis is also hard because bipolar disorder symptoms mimic those of other illnesses.
For example, the “lows” of bipolar disorder can be much like . During a period of highs, bipolar disorder can look like hyperactivity, rage or .
Doctors need to carefully check your symptoms to know for sure whether you have bipolar disorder. This starts with your primary care doctor. Your doctor will check whether other health problems might be causing your symptoms.
Tests and brain scans cannot identify bipolar disorder. However, they can help eliminate other possible causes, like a or a . If your doctor rules out other illnesses, you should see a or other mental health professional. This specialist will check for symptoms of both mania and .
Is Your Relationship With Your Psychologist Psychiatrist Or Therapist All That It Can Be Heres How Building A Productive Partnership To Treat Bipolar Can Be A Team Effort
If you have a psychiatrist on your bipolar disorder treatment team, ask yourself this: Are you making the most of your relationship?
Do you come prepared for your appointments with solid information on your recent symptoms and other issues? Are you honest and forthcoming? If not, youre losing out on the benefits of this professionals expertise.
When people need to see psychiatrists, it makes sense to make the visit as productive and helpful as possible, notes Kevin Turnquist, MD, a consulting psychiatrist for the state of Minnesota who has written extensively about humanistic psychiatry.
On the other hand, do you feel that your opinions are respected? Is your psychiatrist responsive to your concerns? If not, theres work to be done in forging a more constructive partnership.
In the best-case scenario, you and your psychiatrist are allies in the campaign for recovery. Collaborators who each contribute to a successful outcome, as defined and dictated by you. Thats the model for person-centered care, which has gained traction in the mental health field in recent years.
The idea that patients should somehow be less than equal partners in a relationship designed to affect the quality of their own lives is pretty silly when you think about it, points out Turnquist, who practices at Touchstone Mental Health in Minneapolis.
But the pendulum has been swinging back toward reintegrating pharmacotherapy and psychotherapy .
When Is Bipolar Diagnosed
Bipolar disorder is typically diagnosed during the late teen years or early adulthood, says Simon A. Rego, PsyD, Chief Psychologist at Montefiore Medical Center and Associate Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine in New York City. Occasionally, bipolar symptoms can appear in children.
To be diagnosed with bipolar disorder, the person must have experienced at least one depressive episode and one manic or hypomanic episode.
Should I See A Doctor
It is always a good idea to speak with a doctor when there is concern about severe mood swings that seem to come and go or make it difficult to work.
The best person to start with may be a primary care physician or family doctor. However, they will likely refer someone with these symptoms to a psychiatrist, or a specialist who cares for people with mental health disorders.
Someone who notices these symptoms in a friend or loved one can also speak with their doctor about their concerns. The doctor can help find local support groups or other mental health resources.
Types Of Bipolar Disorder
There are three basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely up, elated, and energized behavior or increased activity levels to very sad, down, hopeless, or low activity-level periods . People with bipolar disorder also may have a normal mood alternating with depression. Four or more episodes of mania or depression in a year are termed rapid cycling.
- Bipolar I Disorder is defined by manic episodes that last at least seven days or when manic symptoms are so severe that hospital care is needed. Usually, separate depressive episodes occur as well, typically lasting at least two weeks. Episodes of mood disturbance with mixed features are also possible.
- Bipolar II Disorder is defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.
- Cyclothymic Disorder is defined by persistent hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as hypomanic or depressive episodes. The symptoms usually occur for at least two years in adults and for one year in children and teenagers.
- Other Specified and Unspecified Bipolar and Related Disorders is a category that refers to bipolar disorder symptoms that do not match any of the recognized categories.
Bipolar Disorder In The Media
In recent times, a public awareness of bipolar disorder has spread through the internet, radio and television shows such as MTV’s True Life: I’m Bipolar, and BBC’s The Secret Life of the Manic Depressive. The latter was first shown in 2006 and repeated in 2007. It presented the public with an honest portrayal of what it is like to have bipolar disorder.
Diagnosing Bipolar Disorder In Children
Bipolar disorder isnt only an adult problem, it can also occur in children. Diagnosing bipolar disorder in children can be difficult because the symptoms of this disorder can sometimes mimic those of attention-deficit hyperactivity disorder .
If your child is being treated for ADHD and their symptoms havent improved, talk to your doctor about the possibility of bipolar disorder. Symptoms of bipolar disorder in children can include:
- emotional outbursts
- periods of sadness
The criteria for diagnosing bipolar disorder in children is similar to diagnosing the condition in adults. Theres no particular diagnostic test, so your doctor may ask a series of questions about your childs mood, sleep pattern, and behavior.
For example, how often does your child have emotional outbursts? How many hours does your child sleep a day? How often does your child have periods of aggression and irritability? If your childs behavior and attitude are episodic, your doctor may make a bipolar disorder diagnosis.
The doctor may also ask about your family history of depression or bipolar disorder, as well as check your childs thyroid function to rule out an underactive thyroid.
Psychiatry Can Help You
There is no cure for bipolar disorder. Still, there are ways to manage the effects of this challenging condition. A psychiatrist near you can determine the nature of your condition. The doctor will then customize care for you. The science of psychiatry will use a multi-faceted approach to help you achieve a good quality of life. You can once again feel well and have the peace of mind that you have been searching for.
Get more information about Evolve Psychiatry in Massapequa at .
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The Psychiatrist Has Experience
One of the biggest benefits of choosing psychiatry to help with this disorder is that the psychiatrist has experience treating patients. The doctor will have seen similar issues in different individuals. The psychiatrist can compare situations and use treatments that worked well for other people. Even the most significant cases will not be foreign to a doctor. This person has the knowledge and training in bipolar disorder that patients and loved ones can feel good about.
What Are The Signs Of Mania Or Hypomania
In a manic episode, for at least a week a person must feel either so euphoric or so irritable that there is significant impairment of social or occupational function. In addition, if the mood is euphoric, he or she must have at least three of the following symptoms. If the mood is irritable, at least four of the symptoms must be present:
- Increased energy, activity and restlessness
- Racing thoughts, talking very fast and jumping from one idea to another
- Inability to concentrate, very easily distracted
- Little need for sleep
- Having an inflated feeling of power or importance, or an unrealistic belief in one’s abilities and powers
- Showing poor judgment, such as going on spending sprees or taking part in inappropriate sexual activity
- Abusing drugs, particularly cocaine, alcohol and sleep medications
- Exhibiting aggressive behavior
- Denying that anything is wrong
The symptoms of hypomania are similar to those of mania, but they are less severe and often of shorter duration. Hypomania causes little or no functional impairment and does not result in hospitalization.
Mental Health Treatment Locator
The Substance Abuse and Mental Health Services Administration provides this online resource for locating mental health treatment facilities and programs. The Mental Health Treatment Locator section of the Behavioral Health Treatment Services Locator lists facilities providing mental health services to persons with mental illness. Find a facility in your state at .
What Is A Normal Mood
It would be a mistake to think that normal moods are steady. We all have moods that fluctuate some days we feel motivated, energetic, and ready to engage with the world, and other days we just want to curl up and hide away. Many of these fluctuations happen in response to things that are happening in our lives, but our moods can fluctuate with the seasons, our health, or our hormonal cycle
Why Does The Diagnostic Label Matter
Overall treatment recommendations, monitoring, and prognosis can be different for a child diagnosed with BP and a child diagnosed with, say, ADHD, a learning disability, or PTSD. However, because the medications used to treat these different diagnoses can also be the same, one might ask: what difference does it make which diagnosis a child receives?
Gabrielle Carlson responded that even if many of the same medications are prescribed for BP and some of its diagnostic cousins, the overall treatment plans and prognoses for the children are different. For example, stimulants can trigger mania in people with BP , and there is evidence that antidepressants can also . Conversely, children who actually have ADHD, depression, or anxiety and who are treated with the standard BP medications may experience the side effects of those medications and not improve. Moreover, because DSM’s diagnostic labels are meant to facilitate research, applying them inconsistently can compromise it .
As Carlson also emphasized, focusing on BP can “blind clinicians to the fact that there are other things they might be focusing on.” That is, because BP is associated with high heritability estimates and is treated primarily with medications, physicians may infer that psychosocial treatments will not be helpful, or may be less inclined to delve deeply into the quality of the child’s home environment or family relations.
What Is A Hypomanic Episode
A hypomanic episode is essentially a milder version of a manic episode. The mood and behavior changes seen in a hypomanic episode are not as extreme and they often do not last as long as a manic episode, although the emotional and behavioural changes are still definitely abnormal for the individual. Hypomanic episodes can feel more manageable than manic episodes and may not interfere so much with daily life, although other people may notice changes in the individuals behavior.
Building Trust With Your Bipolar Treatment Team
There are two parts to the successful partnership that Jacques describes. First, your time and effort to assess your current status and figure out your agenda for the future. Second, a psychiatrist who is ready to listen to what you have to saysomeone who will honor the job, in the words of Philip R. Muskin, MD, a distinguished life fellow of the American Psychiatric Association.
Muskin, a professor of psychiatry at Columbia University Medical Center, talks about the trust required to share sensitive information. Getting to that place isnt easy, he admits.
Everybody censors what they say in therapy until one day you slip or you realize you have to say something, he says. Then the process moves forward.
If youre thinking about seeing a psychiatrist who does psychotherapy, Muskin suggests asking yourself the following questions: Can I talk to this person? Do I feel comfortable?
And heres a doozy: Am I willing to hear what needs to be heardeven if unpleasantand to work on it? Having a psychiatrist who hesitates to tell you hard truths wont do you any good in the long run.
Its important to feel youre getting something out of the appointments, something more than you would from chats with your hairdresser, Muskin says.
Is your hairdresser going to tell you youre manic? You hire me as the psychiatrist. I work for you so you can engage in a unique kind of relationship you wont get from anyone else.
Complexities Surrounding Pharmacological Treatment
As indicated by the 2007 practice parameter that appeared in JAACAP, the first mode of treatment for children with strictly-defined mania is a combination of drugs, including traditional mood stabilizers such as lithium, anticonvulsant mood stabilizers such as divalproex and carbamazepine , and the newer, “atypical” antipsychotics such as olanzapine , quetiapine , and risperidone . However, there are virtually no published research studies evaluating either the long-term effectiveness or the safety of these pharmacological combinations. Support for their use is based on studies of individual medications or, in rare instances, on adjunctive treatment.
Moreover, according to some workshop participants, the efficacy of some individual medications used to treat children with BP is either unimpressive or not yet adequately established. Workshop participants Gabrielle Carlson and Julie Zito assessed the data on the efficacy of the mood stabilizers lithium, divalproex, and carbamazepine in treating children as “weak.” That is, response rate in these medications did not beat placebo. Response rates for atypical antipsychotics show a better, 60-80% response with monotherapy for treatment of acute mania or mixed episodes compared to about a 25% response to placebo .
From Diagnosis To Treatment
Although bipolar disorder is a challenging diagnosis, its an important one to get right. Bipolar disorder, as with other mental illnesses, can worsen without treatment. There are many effective treatments that can make the highs and lows of bipolar disorder less severe and tolerable. Medications and other forms of therapy can improve the quality of life for people with bipolar disorder. All of these factors make careful diagnosis by a mental health professional very important.
Brain Structure And Function
Researchers are learning that the brain structure and function of people with bipolar disorder may be different from the brain structure and function of people who do not have bipolar disorder or other psychiatric disorders. Learning about the nature of these brain changes helps doctors better understand bipolar disorder and may in the future help predict which types of treatment will work best for a person with bipolar disorder. At this time, diagnosis is based on symptoms rather than brain imaging or other diagnostic tests.
Ruling Out Other Conditions
If you experience extreme shifts in your mood that disrupt your daily routine, you should see your doctor. There are no specific blood tests or brain scans to diagnose bipolar disorder. Even so, your doctor may perform a physical exam and order lab tests, including a thyroid function test and urine analyses. These tests can help determine if other conditions or factors could be causing your symptoms.
A thyroid function test is a blood test that measures how well your thyroid gland functions. The thyroid produces and secretes hormones that help regulate many bodily functions. If your body doesnt receive enough of the thyroid hormone, known as , your brain may not function properly. As a result, you may have problems with depressive symptoms or develop a mood disorder.
Sometimes, certain thyroid issues cause symptoms that are similar to those of bipolar disorder. Symptoms may also be a side effect of medications. After other possible causes are ruled out, your doctor will likely refer you to a mental health specialist.
Coping And Reaching Out
Long before Dr. Vogel-Scibilia examined the patient who had bipolar and saw herself reflected back, she had figured out ways of adapting to her seasonal mood swings. Anticipating in winter, she scheduled her most challenging coursework for the fall.
Id do the research, pick the cards, and do the bibliography, she says, so if I had to write the paper Id just have to write the text out. I would try to compensate for things, study stuff in advance.
if youve been the doctor first and then you get sick, you have a hell of a hard time being a patient.
Now a practicing clinical psychiatrist in Beaver, Pennsylvania, she operates an independent mental health clinic and serves as clinical assistant professor at Western Psychiatric Institute, the same hospital where she did her residency and diagnosed herself.
Today, she is president of NAMI at the national level and a consultant for psychopharmacology projects at the National Institute of Mental Health and is a grant reviewer for the federal government.
But at least once a week, she gets a call from a young medical student or resident doctorusually, she says, its a psychiatric resident secretly struggling with mental illness. Some of them offer to fly or drive long distances for a consultation.
You could do a study , but thered be no sample, because nobody would agree to be interviewed. Actually I could just poll my friends. The trouble is it wouldnt be a random sample. It would be the friends of Suzanne.
The Dsm Iv View Of The Bp Spectrum
DSM-IV lists four BP subtypes: BP-I, BP-II, Cyclothymic Disorder, and BP-NOS . In adults, the bar to getting the BP-I diagnosis is set fairly high and the classic symptoms of mania are relatively easy for a well trained physician to identify. Much of the disagreement about diagnosing BP in children, however, revolves around determining just what mania looks like in children.
According to DSM IV, a full-blown Manic Episode entails “a distinct period of abnormally and persistently elevated, expansive, or irritable mood” lasting for at least 1 week. The central question in the pediatric debate is whether this episodicity criterion should be altered to include children who exhibit chronic irritability or cycle very rapidly between elevated mood and euthymia or depression. Under DSM, to meet the criteria for mania, when the patient’s mood is elevated or expansive she must exhibit at least 3 of the following 7 symptoms: grandiosity, decreased need for sleep, pressure to keep talking, flight of ideas, distractibility, increased goal-directed activity, or excessive involvement in pleasurable activities that have a high potential for painful consequences. Alternatively, to meet the criteria for mania, when the patient presents with irritability, she must exhibit at least 4 of those 7 symptoms.