Bipolar Spectrum Disorder - Geek Alert!

Hello all!

Okay, we've talked about this in several threads, so I thought I'd just open up a topic and start the ball-a-rollin'. Please understand that if you choose to read on, you are reading a post from someone who LOVES to research and look things up. You may be asleep by the 2nd paragraph! LOL

The DSM-IV (the Diagnostic and Statistical Manual, Fourth Edition), which is the be-all-and-end-all for Pdocs, Psychologists, social workers, licensed counselors and other mental health practitioners, has only TWO (yes, 2) forms of Bipolar in it. However, the DMS-IV was written in 1994. It's a little OLD....phew! I mean... dusty old. I can't think of any other group of disorders that is still being diagnosed with FIFTEEN YEAR OLD standards other than mental health. (oh, sorry... almost got on a soapbox)

Simply put, Bipolar I (one) is depression plus mania. Bipolar II (two) is depression plus hypomania. There are very strict criteria for each of those diagnoses. You can look at those criteria at:

Bipolar I:
http://www.mentalhealth.com/di...
Bipolar II:
http://www.mentalhealth.com/di...

The DSM-V (five) will not be out for at least another three to five years. The "Bipolar Spectrum" is supposed to be in the DSM-V... at least, that's what I hear from my friends who practice in the field.

Dr. Hagpop Akiskal, out of the University of California, San Diego, is one of the leading experts and one who is WAY ahead of the pack with these so-called "soft" bipolar diagnoses. Here are his identified subtypes of bipolar disorders known as the bipolar spectrum.
______________________________________
Akiskal's Schema of Bipolar Subtypes

(Psychiatric Clinics of North America 22:3, September 1999; Medscape Family Medicine, 2005;7[1])

Bipolar I: full-blown mania
Bipolar I ½: depression with protracted hypomania
Bipolar II: depression with hypomanic episodes
Bipolar II ½: cyclothymic disorder
Bipolar III: hypomania due to antidepressant drugs
Bipolar III ½: hypomania and/or depression associated with substance use
Bipolar IV: depression associated with hyperthymic temperament
Bipolar V: recurrent depressions that are admixed with dysphoric hypomania
Bipolar VI: late onset depression with mixed mood features, progressing to a dementia-like syndrome
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You can read about these categories at: http://www.psycom.net/depressi...
Another good page to read is:
http://www.psycheducation.org/...

As for the bipolar spectrum... I'm a believer. I have read enough and experienced enough to know that I have a "soft" bipolar. But, I can tell you that at times, if feels anything BUT soft. Sometimes it slams me up side the head like a cast iron skillet. Depending on who's spectrum chart you look at (there's more than Akiskal's), I have bipolar that is aggravated with antidepressants and I have depression that is associated with a hyperthymic temperament. (Bipolar III, and IV) I'm double trouble... LOL.

I hate that there are so many people out there who are running around without a proper diagnosis because the DSM-IV is so dag-gum old. Primary care docs are so overwhelmed that they can't keep up with every specialty area to know that there's even such a thing as a "spectrum." I would have NEVER been diagnosed if it weren't for my completely untreatable sleep disorder. That is what landed me in at my pdoc's doorstep. Thank God. My life has changed SO much for the better now that I have mood stabilizers on board.

Okay.... I'll hush now. I think I've put plenty of fodder for discussion out on the table.... that is, if any one is interested. If not.... I had a good time writing it anyway... LOL.

Be well,
Jules

Thanks Jules!

I look forward to having time hopefully tomorrow to read more of Dr. Akiskal's work. I'm already a huge fan of Dr. Phelps and it looks to me like the two of them have a lot of similar ideas about mood disorders.

K

Hi Jules and Kef. Jules, I think we have a lot in common about researching things, only you restate them better. You are almost certainly correct about primary care--which would also include cardiologists and internal medicine these days -- not being able to keep up outside of their own areas. Which is a good thing as it means many advances have been made, but its bad for those of us who sometimes have to have them help with our brain biochemical problems.

When I was practicing as an RN, on a medical and oncology floor, I really tried to keep up with other areas. But even for a nurse it was almost impossible and doctors have a whole bunch more to keep track of. I stopped working around 2002 because I wasn't confident of my concentration under fire--which had previously been one of my strong points. I think the Bipolar spectrum was probably just a faint blip on the horizon for people not affiliated with universities then.

Two weeks ago I got my diagnosis from my primary nurse mental health practicioner and she had been cued in by my talk therapist who told her I was too tense and talking too fast. When I told her I felt like I wanted to crawl out of my skin and would it please happen faster and be over with because the feelings were so unpleasant she said I was "quoting the bipolar two textbook". I said "Whats that." I had never heard of it, Bipolar one was all I had learned about. I knew I didn't have that, so I was Unipolar (since 1999) right? right? oh ok--stop snickering you two. So suddenly the anxiety that isn't phobic and is not quite panic is explained. And my irritability isn't a moral failing after all. I had honestly believed it was poor self control on my part.

Some of the mood control meds are frightening for me, because I have used them---on comotose siezures patients in very high IV doses. I definitly have to reframe some of my thinking. Lithium is the only one I knew of outside of the seizure/epilepsy content. And the people who got hospitalized were always among the worst case scenarios for the siezure end of things too.

Regarding the DSM---yeah--no other field would use a manual that out of date. I can hear our oncolgist now, we participated in the U of North Carolina Chapel Hill Reasearch Program even tho we were in Wisconsin, and he got weekly--sometimes daily updates. And thats not counting conferences and Journals from other sources. Using out of date info was considered Malpractice not Standard of Care. Of course there were lab tests and others, CTs, MRIs, and other methods to actually have a physical way to see patient progress which psych mostly does not have. No wonder they are so wordy.

i just hope the Insurance Industry doesn't have input about the new version---they like manuals that let them exclude whole chunks of patients. Can you tell I had a rough day? Is it hypomanic when the opinion reflects facts I have seen and experienced.? We had 2 nurses who did almost nothing but plot ways to have our patients covered--and two social workers that helped with that too and we were one ward in a small hospital. I don't want to know what they do in urban areas.

K... I'm glad that the info has piqued your interest. I'm actually excited that there may be a few people on the forum who like this stuff too.

Lizabeth... thank you for your kind words. I so much enjoy learning and putting things together into some usable format. It is music to my ears (and my heart) when I hear that it benefited someone!

I agree with you about doing a major "reframe" of the mood stabilizers for yourself. Let me tell you the reframe that I had to manage in order to allow my pdoc to treat me. I went to see him to "fix" my sleep disorder. I didn't see a dx of "bipolar" coming from a million miles away. As a matter of fact, when he broached the subject of bipolar, I sat my prissy self upright in my chair, looked at him and said, " I came here for you to help me get to sleep... NOT for you to give me a psychiatric diagnosis..... so, if we could just get back to reason that I came here for, that would be fine with me."

ROFL... jeeeeze. I just shake my head. My resistance to the dx of bipolar was from my own hx of working in an Emergency Room doing emergency psychiatric intakes/crisis intervention. My only exposure to bipolar disorder had to do with people brought into the E.R. in full-out manic episodes that often had to be put in 4-point restraints in order to keep them from harming themselves or others. I knew that I was little more "bouncy" or "Peppy" than the average person, but I was NEVER manic like what I saw in the E.R.

Amazingly, my pdoc was incredibly patient, kind, and respectful of me and my past experiences. He gave me information and research papers on the bipolar spectrum and helped me get past my resistance to the mere thought of the dx. I reacted so strongly to mention of Lithium that he gave me three mood stabilizers to research and come back to him with a recommendation. (they were obviously all meds that he would feel comfortable starting me on, anyway... but the thought was there!) I'll post my med list below.

My doc wanted to taper me off of my Cymbalta while he titrated up my Tegretol. He was very concerned about how "bouncy" and irritable an SSRI (SNRI) can make a person with BPII. But, every doc has their own philosophy. I do know that I started sleeping better once I was off the Cymbalta and on the Tegretol and the Seroquel. My doc added just a touch of celexa a little later to slow down my "round and round" thinking.

So, that's my story... at least part of it. I had to do a major, major reframe to accept treatment. I'm really glad I did. My life has been significantly improved.

Be well,
Jules