November 1, 2007

Bipolar Rates Are Increasing As Long As You're Willing To Call Everything Bipolar And Defy God's Will

Do you dare defy the Will of God?

In 1994, there were 20,000 visits for pediatric (under age 19) bipolar disorder.  In 2003, the number was... 800,000.  The diagnosis, therefore, was 25/100,000 in 1994, and now it's 1000/100,000.  In other words, 1% of the population. 

To compare: for adults the rates were 905/100,000 in 1994, to 1679/100,000 in 2003.  In other words, 0.9% up to 1.7%. 

I've heard this justified as a step forward.  While "visits" isn't the same as incidence or prevalence in a population, it makes sense as a proxy.  The adult rate is about 1-2%, consistently.  Bipolar was severely underdiagnosed in 1994, and it's better diagnosed today.  Since bipolar is a biological disorder with a strongly heritable component, it only makes sense that the child rate should be the same as the adult rate, assuming good diagnostic skills.  So the diagnosis rate has simply risen to match the adult rate.

The only problem is this: in 2003, 2/3 of the children visiting were males.  But 2/3 of the adults were females.

So you have some options:

  1. The male children have a disorder that is actually different than the adult females have, i.e. one of them is not bipolar.
  2. The male children with bipolar got cured during puberty.
  3. Bipolar disorder turns boys into women sometime around age 19, obviously using the power of Satan.

The ridiculousness of this increase in diagnosis is only exceeded by the potential harm such an increase is actually causing.  Forget about the safety or lack of safety of bipolar medications in kids, which is worrisome enough.  A problem few seem to want to talk about is the impact of a bipolar diagnosis on a person, for the rest of his life.  Let's say, for the sake of argument, pediatric bipolar is overdiagnosed.  Then all those people who were misdiagnosed are, in fact, not bipolar; however, they have no way of ever finding that out.  They have to carry this with them for the rest of their life.  When they're 30 years old, and they're asked on routine checkup if they've ever had a psychiatric diagnosis, they have to say, "well, pediatric bipolar, but I think that's not right."  Sure it isn't.  When that 30 year old guy has kids, and those kids grow up, they'll be asked, do you have a history of major psychiatric illness in your family?  Hmm.  "Maybe bipolar... but my Dad told me he thinks that wasn't right."  Oh, ok.  Did your Dad have a temper?  "Well, he did yell a lot when he was mad."  I see.  Did he go without sleep?  "Oh my God, when we were kids-- lots of times."  Then it's settled.

If pediatric bipolar is being accurately diagnosed,  then either psychiatrists are now more sensitive to its detection-- a unlikely possibility since the diagnosis has been around for a long, long time-- did we suddenly develop a better test for it?  Or else something has changed in the world to cause it to be more frequent (a toxin in bottled water?  MySpace?  Iraq?)


Early treatment of bipolar-- let's call it the "real" bipolar-- doesn't slow down the progression of the illness.  It helps you today,  but it doesn't change symptoms 10 years from now, they way aggressive early treatment of diabetes actually prevents physical pathology from worsening.  So it may be worth, oh, I don't know-- conservative management? 






Comments

Maybe a child should be ass... (Below threshold)

November 2, 2007 4:34 AM | Posted by robotslave: | Reply

Maybe a child should be assumed sane until proven DSM-insane?

No? OK, would that be a fair assumption for adults, then?

From another angle, what I am asking is: how does the courts-sanctioned phrenolo--er--psychiatrist distinguish situational or environmental abnormal behavior from genetic or faith-based abnormal behavior?

Do we simply assume that the behavior of people classified as children is either genetic or environmental?

If so, does that make even the slightest bit of sense?

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The abuse potential of such... (Below threshold)

November 2, 2007 7:13 AM | Posted by Whatever: | Reply

The abuse potential of such classifications is unimaginable. Sometimes...less is more. But it looks like western societies like the USA will have to find this out the hard way. In more ways than one.

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Is the ratio of male to fem... (Below threshold)

November 2, 2007 7:32 AM | Posted by resonance: | Reply

Is the ratio of male to female children being taken to doctors the same as the ratio of male to female children going to doctors as adults? Equal diagnostic criteria only give equal diagnostic rates if that's true.

I've heard multiple times, as an attempt to support the hypothesis that depression rates between men and women are equal, that men are less likely to voluntarily seek help.

What do you think would be a feasible way to change the system so that fewer boys are diagnosed with bipolar?

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While I agree with you gene... (Below threshold)

November 2, 2007 9:38 AM | Posted by rubyvoyager: | Reply

While I agree with you generally here, I would contend that early diagnosis of bipolar can have major impact 10 years on. If people are able to have less dramatic and less frequent episodes they have greater opportunities for life, identity, recovery: to make deep and lasting relationships, maintain those with family, have less opportunities for development of addictions, more likely to complete education and move into a stable work life, etc etc. treatment may include the whole gamut as above, plus extra attention to sleep, exercise, self care. there is some fluffy data that I have not scrutinized suggesting stopped lithium trials may breed more resistance. Sure there is wild overdiagnosis [much can be attributed, in my opinion, to attachment issues too], but no need to throw the bathwater out]

Alone's response: Has anyone actually ever thrown a baby out with the water? But your point is well taken, I was specifically referring to early treatment resulting in a change in physical pathology-- and yes, the lithium story is an interesting one, but, to my point all over again, the lithium bipolar story is only about a specific form of bipolar (I) and not generalizable to anything else. Also, I am not insensitive to the plight of parents who need some help with their situation, and early "diagnosis" may be what's necessary to get the kid/family into a new environment looking to change dynamics, behaviors, etc, even if it is with meds.

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This is an excellent post.T... (Below threshold)

November 2, 2007 10:57 AM | Posted by Stephany: | Reply

This is an excellent post.Thank you.

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Bipolar is overdiagnosed in... (Below threshold)

November 2, 2007 12:10 PM | Posted by sorrel: | Reply

Bipolar is overdiagnosed in both children and adults, but for different reasons. This explains the gender skew.

In kids it has become a catchall diagnosis for anyone with out-of-control and aggressive behavior. Most of the kids with out-of-control or aggressive behavior are boys.

In adults it (bipolar II specifically) has become a catchall diagnosis for anyone who's generally moody, emotionally labile, and prone to periods of (pick a few) weepiness, anxiety, insomnia, irritability, compulsive shopping, etc. Most of the people who fit this description are female (and don't jump on me for sexism here; I'm female too.)

I have seen plenty of sources (older ones, probably) saying that the incidence of bipolar is equal in men and women. Probably when it's pared down to the "real" cases of bipolar, it would be equal.

The increase in diagnosis is not from improved detection, but from a loosening of the diagnostic definition.

So, new to my blog?

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The point is a good one tha... (Below threshold)

November 2, 2007 7:49 PM | Posted by ANONYMOUS: | Reply

The point is a good one that it changes someones life forever and that lore could be passed down to children because then it turns into a "positive family history". But hopefully there will be a time where being identified with having "bipolar disorder" through some biological/imaging/genetic test does not spiral someone's life out of control. The same way that having HIV is no longer a "death sentence". Its more about stigma that it is about the diagnosis. That isn't the fault of those in good faith trying to diagnose things and provide relief to people who suffer. Its not that psychiatrists are all irrational, it is just that they feel desperate to try and help people who suffer. Maybe working on stigma in society for what it means to have mental illness (that its not moral weakness) is more important than being in denial that this neuropsychiatric illness exists. Then the field of psychiatry would be able to more openly scrutinize itself instead of having to assume a defensive posture against a public so scared and angry of being called "ill" that they are dying to bring it down. Of course scientology being the worst offenders (which largely is consisted of people so defended against being "labeled" that they'll channel all of that fear into an organized movement against good faith medicine. I bet a not insignificant portion of them have bipolar disorder. A clinical exam that shows thought disorder (racing thoughts and loosening of associations), psychomotor agitation, rapid uninterruptible speech and euphoria and impulsivity that is disconnected from reality all in the context of a lack of insight is a pretty darn reliable and meaningful physical exam finding of a syndrome. Especially if you can get some longitudinal collateral data and a negative urine drug screen. Its pretty much the same thing as seeing somebody have a tremor and shuffling gait and masked facies and calling them Parkinsons. Its just that motor lesions are more easily identified in 2007. I'd give it about 30 years and boy oh boy will we have some neat tests for the biological underpinnings of these things.

Of course, I'm really talking about adult bipolar not the conundrum that is pediatric bipolar. But I think pediatric bipolar researchers who are paying attention actually look for more neurocognitive/affective signs that are pathologically apparent on clinical exam that differs from just "my child gets mad and irritable". Doesn't it make sense that some kids with unstable reactive moods end up being adult bipolars? Is it flawed to try to figure out who those people are?
Beating one's chest about inconsistencies or flaws in the diagnostic process does nothing to advance the science or the medicine of it. It makes you look clever and all the readers who are in denial of their diagnosis will jump on your blog though. You are the Evangelist of the mentally ill. And you are developing a cult following. We should start calling you L.Ron...maybe one day you'll be as big as he was. But he doth protested too much...of course, thats the example of a single specific male...any generalizations are on you.

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Diagnosing children is full... (Below threshold)

November 2, 2007 8:46 PM | Posted by AK: | Reply

Diagnosing children is full of pitfalls.

IMO I dont think it is possible to do a responsible job of assessing and assigning a diagnosis to a child until the child's family and home routines have been assessed.

I am not denying that bipolar and ADD are valid diagnostic catagories; they are.

But there are a lot of dysfunctional families in which its easier for the adults to dodge scrutiny by letting one of the children become the identified patient.

Family routines also have to be scrutinized.

I know of a child who has been hung with an ADD diagnosis. Now, maybe he really and truly has ADD, maybe he does not.

But I do know, from having been a guest in that household, that the parents, marriage is a mess, the father is weak and everyone covers for him, both parents cannot set limits on the children, and the level of noise and quarrelling is as sandpaper to the nerve endings.

Even the family dog barks non-stop.

The excess sensory bombardmetn would leave most normal non ADD kids feeling hyper and anxious.

A child with ADD would probably have his or her condition aggravated.

But..this family is affluent, determined to keep its secrets, so rather than fess up and go in for systems family therapy, its easier to just slap one of the kids with an 'identified patient' DX.

A bipolar DX could be wrongly assigned in the same way.

(regarding this family's level of sensory bombardment, I was an overnight guest for 2 days & developed insomnia and stress dermatitis. I also had episodes of dissociative amnesia when witnessing the crap that the wife put up with.

If I reacted this way as an adult, able to escape via Supershuttle and Southwest Air, Lord knows what the impact has been on the children)

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I learned to talk on schedu... (Below threshold)

November 2, 2007 8:56 PM | Posted by AK: | Reply

I learned to talk on schedule, then suddenly, around age 3 or 4, stopped talking.

I came within an ace of being hung with a diagnosis of autism.

Fortunately that wasnt the case.

At age 19, after I had self referred myself for therapy, I told a resident psychiatrist, with desperate courage, that I feared I was retarded or brain damaged.

She asked what on earth led me to think that.

I said, 'All my life, I have sensed that there is something important, something I need to know, that is out there, all around me. But I am just too stupid to understand what it is.'

Thirty years later, after opening and reading family letters and sending away for and obtaining copies of marraige certificates, I discovered that all 3 of the adults who raised me had systematically lied to me about their lives, and that after they died, a family friend whom I trusted as a mother surrogate continued to maintain the cover up and kept lying. Nearly everything my parents had told me about their relationships was not true.

All this was kept secret, but I had sensed it. Dreams I had that had seemed insane, turned out to be full of coded symbolic references to the stuff that had been concealed.

I wasnt autistic. I was unusually sensitive to nonverbal cues and was surrounded by adults who had systematically lied. It would have been so very easy for me to get stuck with an autism diagnosis--or at age 19, for that resident to assign a diagnosis of paranoid delusion.

I am not denying there are conditions that children can and do suffer from, but all too often, families and the sensory stimulation level in the households are not given enough attention.

What must it be like for a quiet introverted child to be in a set up where the assumption is made that children need constant socialization, noise, and stimualation?

What happens to the introvert kids these days?
Unlike introverted adults, kids dont often have the option of being able to take breaks and get respite for themselves.

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"So it may be worth, oh,... (Below threshold)

November 2, 2007 10:56 PM | Posted by Stephany: | Reply

"So it may be worth, oh, I don't know-- conservative management?"

No. Sorry, this is what my 19 year old's outpatient doc says now, and I don't buy that cop out answer.

"conservative management". IS what her pdoc did and look where the fuck it got her.

I want real answers.

Cheers: you are now officially on 3rd base.

3rd base?

But I wasn't intending it as a specific answer to your situation, just a comment on the general course of illness. As for specific answers, I don't have any; I can tell you if a treatment makes sense (like Clozaril+Abilify) or is just marching in step (Depakote). Beyond that, I'm not much help, I'm afraid.


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"3rd base", meaning ... (Below threshold)

November 3, 2007 11:09 AM | Posted by Stephany: | Reply

"3rd base", meaning I'm hopeful someone will hit get to home- and find real answers.
There reads my frustration, that over the years, and now --using your bipolar kids analogy, about how the person will never "really know" , makes me wonder what we are/were conservatively managing. I appreciate this post, because it's does explain how one gets/or can get from point A to B, and yet when arriving as that 30 year old, I come back to this same question "what were/are we conservatively managing"? Which brings me to another complex question: could child bipolar dx be actually the prodrome to schizophrenia? [in some cases if that ends up being the dx]. Thanks for this post.

Answering your last question first: technically technically, bipolar (real bipolar I) does not become schizophrenia. In fact, in heritability studies, a fam hx of bipolar or schizophrenia does not predispose you to the other one (but either does predispose you to depression, for example.) And Kraeplin made his money by basically saying, "I know they look a lot alike, but they're not, and if you wait 50 years I'll prove it"-- by which he meant bipolars have the cycles for the rest of their life, but they don't get worse, while schizophrenics deteriorate (dementia praecox=dementia early).

Unfortunately,-- and maybe I should write a post about this-- unless the diagnosis is very obvious one or the other (a "no duh" diagnosis of schizophrenia, for example) then the two diagnoses really only tell you one thing: schizophrenia=black, bipolar=white. Not because psychiatrists are racists. Only because they're lazy, especially with black patients. So in your (daughter's) case-- who knows?

Bringing me to the most important of the three points: the diagnosis isn't just irrelevant, it's misleading. Assuming it isn't the hard core, first rank type schizophrenia, distinguishing between the two has little utility: the meds you use in both end up being the same, regardless of what flowcharts say; and what we can bipolar today is just a cluster of sxs that may end up being something else, or several something elses, later on. For example: bad diabetics eventually lose their kidneys, and without dialysis, they retain fluid and get hypertension and die. That's TWO separate things. Imagine a world where we know it's diabetes, but don't know about the existence of any other internal organs. We don't know there are such a thing as "kidneys." So what we (think we) see is a diabetic patient who is swollen and not peeing, and we say, "his diabetes is bad" and so we give him MORE INSULIN-- which obviously will do nothing, he'll still die of renal failure-- but we won't know that, because we don't know kidneys even exist.

That's where we are in psychiatry. We have some modestly effective treatments that we don't know why they work (knowing pharmacology is not the same as knowing why it works-- I know everything about lithium, yet nothing) and we know nearly nothing about any of the disorders we talk about all the time. Nothing. Saying nonsensical things like "the amygdala is involved in fear" is like saying "Venezuela is involved in the UN." Knowing what treatments to use when doesn't imply you know anything about what's going on underneath. But, in reverse, not knowing what's going on underneath doesn't prevent me from making a good guess at what to do.

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"I can tell you if a tre... (Below threshold)

November 3, 2007 11:44 AM | Posted by Stephany: | Reply

"I can tell you if a treatment makes sense (like Clozaril+Abilify) or is just marching in step (Depakote)."

The 2 antipsychotics make sense? sorry to be a pest, I'd give you rum if I could. Does this mean I can let go of the concern of how [just her example]she got to this point? and do what people tell me, is "accept her dx she has now"? I hate those "what if's".

Oh, now I think I understand your question. Well, like I said, Clozaril+Abilify makes more sense than any other two antipsychotics together, because Clozaril is a last resort med (and if you've reached this point, you have to try different things) and Abilify is different enough from Clozaril that it's worth a shot (e.g. Motrin + Naprosyn makes no sense, Motrin + Tylenol at least makes some sense.) As for the dx, while obviously can't tell you if it is right or not, I can tell you that (for me at least) the dx is far less important than what helps the situation. For example, just because thyroid meds help someone's depression, doesn't mean they should be called hypothyroid.

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The only problem is this... (Below threshold)

November 3, 2007 12:01 PM | Posted by Yann: | Reply

The only problem is this: in 2003, 2/3 of the children visiting were males. But 2/3 of the adults were females.

So you have some options:

1. The male children have a disorder that is actually different than the adult females have, i.e. one of them is not bipolar.
2. The male children with bipolar got cured during puberty.
3. Bipolar disorder turns boys into women sometime around age 19, obviously using the power of Satan.

There's a #4 option : bipolar disorder is more lethal in boys than in girls, for some reason.

Nah, I'm not advocating that this is THE answer, I'm just teasing you.

Actually, I did think of using that as one of the jokes; but I didn't because, if it was lethal in boys, then the rate in kids would have to be much higher than 1%, in order for the rate to be reduced to 1% in adulthood after all the boys were dead.

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good post, I think it is cl... (Below threshold)

November 3, 2007 4:06 PM | Posted by anonymous: | Reply

good post, I think it is closely connected to your previous post on "borderline" I have been considering for sometime however, how these issues (childhood psychiatric illness in general and adult bipolar, medication usage) are being informed by the pursuit to end stigma surrounding mental health. In and of itself I think this is an admirable, a crucial step for society, and I think it has done much good. Perhaps though, in our attempt to be politically correct and accepting we've just given many an excuse to lean on rather than taking responsibility for their lives. Meanwhile, those with chronic mental illness are sadly still often considered subhuman.

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Anonymous wrote: “Maybe wor... (Below threshold)

November 4, 2007 10:11 AM | Posted by William Wrightz: | Reply

Anonymous wrote: “Maybe working on stigma in society for what it means to have mental illness (that its not moral weakness) is more important than being in denial that this neuropsychiatric illness exists.”

Can we be “in denial” of the existence of a “neuropychiatric illness” that cannot be reliably and objectively identified by any known neurological diagnostic test? We might better be considered heretics, since the actual physical existence of serious psychiatric disorders such as Bipolar Disorder and Schizophrenia must be accepted on faith alone. NONE of the following commonly used diagnostic procedures for identifying nervous system disorders can be used reliably to diagnose psychiatric disorders: CAT scans, EEGs, MRIs, EMGs, NCVs, PETs, arteriograms, spinal taps, evoked potentials, myelograms, neurosonographs, ultrasounds.

Anonymous wrote: “A clinical exam that shows thought disorder (racing thoughts and loosening of associations), psychomotor agitation, rapid uninterruptible speech and euphoria and impulsivity that is disconnected from reality all in the context of a lack of insight is a pretty darn reliable and meaningful physical exam finding of a syndrome.”

I do not believe that the “clinical exam” Anonymous speaks of could actually be called a “reliable and meaningful PHYSICAL exam.” What physical evidence could be collected to demonstrate “racing thoughts” or “lack of insight?” (“Lack of Insight”: psychiatrese for “Does not agree with my diagnosis and is likely to disobey me”)

Anonymous wrote: “Its pretty much the same thing as seeing somebody have a tremor and shuffling gait and masked facies and calling them Parkinsons.”

I guess you could start out by “calling them Parkinsons” as a working hypothesis, but if you were my doc, both I and my insurance company would expect a lot more rigor in your diagnostic testing (see above). The first thing you might want to do is find out if one of your colleagues has dosed up Mr. or Ms. “Parkinsons” with one or more antipsychotics.

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Outpatient psych removed Ab... (Below threshold)

November 4, 2007 1:55 PM | Posted by Stephany: | Reply

Outpatient psych removed Abilify, he noticed restlessness, and didn't like her being on 2 antipsychotics. Finally, she's got a doc who appears to get what you write here. Thanks for all of this information, I appreciate it.

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William Wrightz wrote: I g... (Below threshold)

November 4, 2007 4:26 PM | Posted by ANONYMOUS: | Reply

William Wrightz wrote: I guess you could start out by “calling them Parkinsons” as a working hypothesis, but if you were my doc, both I and my insurance company would expect a lot more rigor in your diagnostic testing (see above).

What exactly would you do to confirm Parkinson's? Please inform me of your magical, currently in clinical use test of Parkinson's disease? I guess I missed that lecture in medical school. I'm sure there are newer imaging tests that are becoming more clinically useful, but they probably aren't cost effective...when compared to a good clinical examination. I never said I don't want to determine to biological underpinnings of true bipolar disorder, all I said was that it exists and is diagnosed the same way Parkinson's is. The mental status exam is a physical exam of neurologic function largely...despite the stigma of it. And watch two separate neurologists do a physical exam and "identify the lesion". If you see it enough you realize that all of "clinical medicine" could benefit from better objective tests. And then when you realize that two separate radiologists looking at the same CT scan will find different things a not insignificant portion of the time, you realize that nothing is perfect in medicine, not even a "gold standard". All disease is socially constructed based on dysfunction as a large aspect of diagnosis. We just aren't there yet for "objective brain disease" that causes bipolar disorder. There is a balance between "blaming" somebody's social environment and "blaming" their biology, but what's most import is to realize that the developing brain is a biologic reflection of how one's genetics interacts with its environment. I just try, as a psychiatrist, to help people with both the best way I know how. I don't "punish" them for being sick by withholding symptomatic relief. And lithium is the best symptomatic relief for somebody with bipolar phenotype.

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"the dx is far less impo... (Below threshold)

November 4, 2007 10:50 PM | Posted by Stephany: | Reply

"the dx is far less important than what helps the situation. For example, just because thyroid meds help someone's depression, doesn't mean they should be called hypothyroid.".

Thank you.

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Thank you,so very much for ... (Below threshold)

November 4, 2007 11:15 PM | Posted by Stephany: | Reply

Thank you,so very much for thinking with me.

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Another question: my daught... (Below threshold)

November 5, 2007 12:06 AM | Posted by Stephany: | Reply

Another question: my daughter is 19 and a friend's wife is in her 60's w/Alzheimers. We have the same stories. it's as if their brains have a short circuit. is this a protein factor in the brain? how are these 2 ppl. similar? why? it is as if we are discussing the same ppl.

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As far as the gender based ... (Below threshold)

November 5, 2007 12:00 PM | Posted by Glen: | Reply

As far as the gender based differences go, I don't think that is is fair to imply biased diagnostic opinion. Like Autism, there may be reason for the gender bias. Most current research is pointing towards the neural plasticity cascades as the cause of BD. As such, there is some research that implies that male brains have a longer period of GABA-mediated excitation of early innervation. How this effects gender specific refinement and the implications for BD is a worthy question.

Best,
Glen

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17823921&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

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Dear Stephany,"the... (Below threshold)

November 12, 2007 8:00 AM | Posted by herb: | Reply

Dear Stephany,

"the dx is far less important than what helps the situation. For example, just because thyroid meds help someone's depression, doesn't mean they should be called hypothyroid." --- The Last Psychiatrist


It is interesting that your eye and reading caught the same quotation which I would have commented upon.


Dear Doc,

So I just want to state, thank you doc as I also thank those caring physicians who have attended to my spouse for understanding our bottom line needs “what helps the situation” or more importantly, the patient.

Let the debates continue until the cure is found and applied and until such time I would hope others are so fortunate to come upon caring, compassionate and knowledgeable professionals as you exhibit.

Warmly,
Herb
VNSdepression.com

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A friend pointed me to this... (Below threshold)

November 24, 2007 12:21 AM | Posted by amberite: | Reply

A friend pointed me to this blog -- I'm liking it so far.

I have a delayed sleep phase disorder. When I was fourteen, I stayed home from school a lot, because I simply couldn't sleep enough and also get there. My mother took me to a psychiatrist, who recommended taking me to an outpatient hospital program. "It's like school," he said. (It wasn't.) The program "doc" questioned me for about ten minutes, and on finding out that sometimes I had insomnia and stayed up all night, said "Ah, you're manic-depressive, we must put you on lithium and check you in for ten days." Someone else in the management must have known he was an idiot, since none of this happened, I didn't get a recorded diagnosis, I called my mother and told her I was in the hands of fiends, and I went home that afternoon and didn't come back. I'm still thankful for my narrow escape.

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anonymous,thank-god for the... (Below threshold)

January 15, 2008 3:56 AM | Posted by Diane Abus: | Reply

anonymous,thank-god for the last psychiatrist! You sseem to value the biological approach to mental illness/wellness.who is sane?That generalization i'll trust to my inner gyroscope and others on the same planet,hopefully venus.cheers

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Yes, Bipolar and ADD are ov... (Below threshold)

February 4, 2008 6:56 PM | Posted by Anonymous: | Reply

Yes, Bipolar and ADD are overdiagnosed in "troubled" children but thanks to the media drawing attention to that fact, it is now extremely difficult to get diagnosed with Bipolar unless you have had a complete breakdown and are unable to care for yourself. Those of us who seek help in the early stages are viewed as attention-seekers or hypochondriacs and told that our symptoms are not severe enough to qualify. It does not occur to anyone that having a strong personality, a guilt-heavy upbringing and selfless maturity might mean that the same disease manifests itself in a less dramatic way. Therefore plenty of "true" Bipolars are suffering twice as much as those who are unable to care for themselves and have their guilt complexes worsened by incompetent or resource-challenged doctors and contemporaries who believe everything they read in the paper. I often fear I will commit suicide before anybody takes me seriously...but if I could just be a little more self-absorbed I'd get all the help I need. Hint: Consider the consequences of your actions, whether that be writing a severely one-sided article or ignoring an ill friend simply because they don't look "ill enough" to you.

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what does satan have to do ... (Below threshold)

February 14, 2008 10:13 AM | Posted by huxley: | Reply

what does satan have to do with anything. when I was a child I was not diagnosed bipolar, but I was, thanks to a traumatic childhood I remember things others would forget.the one thing i remember is bipolar did not turn me into a girl.

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I agree with the general be... (Below threshold)

November 17, 2008 3:26 AM | Posted by ItsTheWooo: | Reply

I agree with the general belief that bipolar is overdiagnosed, especially in pediatric patients.

However, there is an easy explanation for the disparity in adult vs pediatric gender rates.

I hypothesize that male patients with bipolar disorder are far, far more likely to be outwardly destructive, aggressive, and violent during their mixed episodes/hypomanias/manias. Females are more likely to direct their intense thoughts on themselves.
So if you have a little boy with a bipolar spectrum illness, he's going to be throwing his trucks around the room acting like a maniac, being a big problem for mommy and daddy. Mommy and daddy then take baby boy to the headshrinker because they can't deal with his ridiculous aggression and outward violence.

If you have a little girl with a bipolar spectrum illness, she's may occasionally have rages, but most of her dysphoria and extreme thoughts will be inwardly directed as opposed to physically outwardly directed the way a little boy might. She'll develop a different set of symptoms, perhaps eating disorders, drug addiction, hypersexuality, psychotically extreme paranoia, self reproach, delusions/phobias, etc.

Because the female manifestation of bipolar disorder is less violent and intrusive into family life, parents are less likely to take their daughters to the doctor for such symptoms.

Honestly, if little boys with bipolar spectrum didn't go on rages so frequently pediatric bipolar would stop dead in its tracks. Parents would no longer have a need for treatment. It's all about the rages. Depressed kids are common, and ignored. The rage is the real problem, the reason they're drugged to hell.

As for the increased rate of adult females with bipolar... well, duh. Females as adults are more likely to seek help for emotional/mental problems. If you have the full blown type 1 disorder there's no hiding that crap of course... but the spectrum disorders are much more subtle and easily hidden. That is to say, in soft bipolar, treatment is optional because you are not obviously insane as a person might be in mania.

I hypothesize men who are afflicted with soft bipolar are more likely to become alcoholics, deny a problem, live life raging and lagging alternating. Females with the same problem are more likely to admit distress and seek treatment.

In other words, when other people are in control, men with bipolar disorder are brought for treatment because the male manifestation of bipolar energy is often violent and dangerous to others (whereas the female manifestation is more often self-directed and less violent).
On the other hand, when the people WITH the disorder are in control, it's females who seek treatment more often because females are more likely to be honest about experiencing distress and do not feel any ambivalence about receiving help.

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