When GI was here, we talked about bipolar people (he has a few patients who are bipolar). GI said that the ones he knows don’t work, even though they are medicated. Somehow it came up that the meds are anti-psychotics. I asked what psychosis was and he replied that it’s a lack of contact with reality (difficulty relating to it).
I don’t have that!
He agreed, and said that I should ask my shrink in what way I am out of touch with it.
This has me moderately worried–was I misdiagnosed or am I being wrongly medicated?
So I went to the National Institutes of Mental Health (NIMH) http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-publication.shtml and downloaded the following
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What Are the Symptoms of Bipolar Disorder?
Bipolar disorder causes dramatic mood swings—from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.
Signs and symptoms of mania (or a manic episode) include:
- Increased energy, activity, and restlessness (yep had that)
- Excessively “high,” overly good, euphoric mood (sorta had that)
- Extreme irritability (never)
- Racing thoughts and talking very fast, jumping from one idea to another (once)
- Distractibility, can’t concentrate well (once when I took Aleve. It has a nasty impact on me)
- Little sleep needed (no, I GOT little sleep, I NEEDED much more)
- Unrealistic beliefs in one’s abilities and powers (never)
- Poor judgment (only in selecting boyfriends after my divorce)
- Spending sprees (yeppir big time)
- A lasting period of behavior that is different from usual (no)
- Increased sexual drive (ha ha I’m in MENOPAUSE, there is NO sex drive)
- Abuse of drugs, particularly cocaine, alcohol, and sleeping medications (never, well OK I take sleep meds to sleep)
- Provocative, intrusive, or aggressive behavior (no, I have the opposite problem)
- Denial that anything is wrong (no)
A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.
Signs and symptoms of depression (or a depressive episode) include:
- Lasting sad, anxious, or empty mood (yes)
- Feelings of hopelessness or pessimism (during my divorce, yes)
- Feelings of guilt, worthlessness, or helplessness (yes big time)
- Loss of interest or pleasure in activities once enjoyed, including sex (see menopause comment)
- Decreased energy, a feeling of fatigue or of being “slowed down” (big time)
- Difficulty concentrating, remembering, making decisions (during divorce)
- Restlessness or irritability (no)
- Sleeping too much, or can’t sleep (big time–again, menopause plays a role here)
- Change in appetite and/or unintended weight loss or gain (yep)
- Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury (no, I”m pretty good at legitimate injuries caused by complete inability in sports)
- Thoughts of death or suicide, or suicide attempts (at one time, not now)
A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.
A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.
Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person’s usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness. I’ve never ever experienced this.
It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call “the blues” when it is short-lived but is termed “dysthymia” when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.
In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized. Nope, this sounds very foreign.
Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment. Then how the heck can you tell exactly what issue the person has? This is pretty general, isn’t it?
The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When four or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.
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Hmm. Guess it’s bipolar II, but now I’m wondering if this is accurate at all (the diagnosis).
Will ask my GP for a referral so that I can get a second opinion. Last time we spoke, he too expressed doubts about this diagnosis.