There are a number of challenges that the identification of bipolar spectrum disease can pose, and that’s exactly why the following information is indeed vital to mental health professionals as well as patients and their families. Bipolar spectrum disorders are clearly defined within the DSM-IV, or Diagnostic and Statistical Manual of Mental Disorders, also consist of:
1. Bipolar I disorder: a manic depressive disease that can exist either with and without psychotic episodes
2. Bipolar II disorder: consists of depressive and manic episodes that alternate and are normally less intense and do not inhibit the function
Cyclothymic disorder: a cyclic disorder that causes brief episodes of hypo-mania and depression
These conditions together affect approximately three to four percent of the population, although recent research and clinical observations seem to imply that bipolar spectrum disorders may affect a bigger percentage of the population to a lesser level. These patients suffer from a sub-threshold bipolar disorder and therefore are often less willing to receive medical treatments such as antidepressants.
Continued efforts are being made to properly sub type the bipolar spectrum, but those individuals who have sub-threshold bipolar disorder are now diagnosed with bipolar disorder NOS, or not otherwise specified. When these people are included in the overall, the prevalence of bipolar disorder increases to around five to eight percent. This goes far beyond the only one percent prevalence currently credited to manic depressive disorders by important surveys and studies.
Diagnoses that Move Beyond the DSM-IV
Any mental health professionals who’ve dealt with those with bipolar spectrum disorder will certainly agree that there are a range of patients who are suffering from anxiety, depression, and other symptoms that don’t exactly fall within the DSM classifications. In most cases, the symptoms experienced by people such as these are more erratic and change over time. Both depression and anxiety symptoms are irregular and some other present hypo mania tends to be dysphoric than is rigorously defined in the DSM.
Many patients with these characteristics have been previously prescribed anxiolytic medications or antidepressants by their general practitioner or psychiatrist. They often don’t possess the desirable response to these drugs, with some only experiencing partial relief and others actually regressing to more extreme episodes of depression and/or hypo mania.
All of these patients that appear to resist your typical bipolar identification are lumped into a group that is known as”soft bipolar”. Until appropriate sub-typing of bipolar spectrum disorders is accepted and used across the board, psychiatrists that are mindful of this none-too-rare subgroup are required to go outside the DSM to diagnose those folks.
The Challenges Related to Co-Morbidity
The definition of co-morbidity is the simultaneous existence of a couple of conditions in one patient. Roughly 50 percent of people with bipolar disorders are co-morbid and therefore are residing with other psychiatric or medical conditions. Unfortunately, this can frequently make proper identification and/or therapy harder. The following are some conditions that can impact the diagnosis and treatment for bipolar illness:
Thyroid conditions: Both hypothyroidism and hyperthyroidism can complicate psychiatric ailments. On the flip side, hypothyroidism can frequently resemble depression and may cause antidepressants ineffectual and aggravate symptoms of this disorder.
Substance abuse: Alcohol and drug abuse are equally common among those with bipolar disorder. Actually, about 50 percent of patients with a bipolar spectrum disorder will struggle with significant substance abuse throughout their lifetime. This can be a large issue, as addictive and intoxicating substances will nearly always worsen symptoms of this disease. Not only do illicit substances and alcohol affect those with bipolar disorder, but smoking and excessive caffeine have been known to do so as well. Drugs and alcohol may mimic both hypomania and depression. However, it is impossible for them to cause bipolar disorder.
Attention deficit hyperactivity disorder (ADHD): While ADHD is generally correlated with small children who struggle to pay appropriate attention in school, it should be mentioned that the signs of ADHD frequently carry on into adulthood and can merge with all the symptoms normally associated with adults with a bipolar spectrum disorder. However, bipolar symptoms are seldom constant whereas symptoms of ADHD are nearly always present in 1 form or another
Borderline personality disorder (BPD): Patients with BPD often have symptoms of each one the different personality disorders discussed from the DSM-IV. This will make daily life difficult and unstable. These individuals are often dramatic and vulnerable to feelings of sensitivity and abandonment. They also often place far too much stress on loved ones and frequently have unrealistic requirements for their own families and friends. They tend to be self-destructive, and suicidal ideations are not uncommon.
Other Character Disorders: During periods of disturbance, it’s typical for those with bipolar disorder to experience symptoms of numerous different personality disorders. Typically, once the bipolar disorder is treated, the symptoms of the various personality disorders will be alleviated as well. However, in circumstances where the symptoms are acute, therapy can become complicated. Patients who have personality disorders can often be manipulative, self-destructive, and reluctant to seek out the proper therapy. While they see that the treatment may be advantageous, they often put up obstacles and neglect to choose suitable proactive steps. It should also be mentioned that bipolar disorders are quite common among individuals who are incarcerated.
Oftentimes, individuals who suffer from bipolar spectrum disease have failed to respond to standard treatment at the same point or another. For those who haven’t found relief from their symptoms utilizing regular anxiolytic or antidepressant drugs, an alternative is seen within an in-depth interview and assessment to better understand their anxiety and mood disorders. A catalog of all their symptoms is listed together with their severity. This, in conjunction with a quantitative EEG and TRH test, can be very useful at determining whether a person is in reality on the bipolar spectrum.
If the individual has previously been prescribed a benzodiazepine or a different medication that hasn’t had the desired result, the individual can be weaned from this drug before the following treatment starts. If the individual has a substance abuse problem, the person will be required to get and stay sober for a period of thirty days to ensure more successful treatment. In case a complicating illness is present, the individual is thought to have a mixed state bipolar disorder, or even a high-dose benzodiazepine was prescribed before, it could be beneficial for the patient to become stabilized at an inpatient, hospital setting that is dedicated to providing rapid detox.
During treatment, all of us will be carefully counseled and informed of the value of sticking with their medication instructions to the letter. They’ll also be informed about the value of long-term follow-ups and monitoring. Depending upon each individual’s needs and situation, individual or group psychotherapy may be necessary. However, this determination likely won’t be made until the individual has been stabilized. In many cases, patients need to be constantly reassured and encouraged to keep in their therapy, particularly if they have been previously dependent on drugs.
People who have bipolar spectrum disorder that is primarily plagued with depression and stress symptoms will probably be set on SSRIs like Zoloft, Lexapro, or Prozac. These medicines are absolutely efficient in many cases at both alleviating depression and usually stabilizing the individual’s mood. Patients need to be closely monitored until they have been fully coated.
In cases where hypo mania emerges during treatment, it may be necessary for a stabilizer like Lamictal, Tegretol, or Topamax to be introduced as well. These include antidepressants like Welbutrin and Cymbalta. Once a solution has been discovered and has been shown to be effective at managing the disorder, the clinician will probably advise that the drug be kept at the exact same dosage until some change necessitates an alteration in treatment.
Those people who seek treatment originally for dysphoric or euphoric hypo mania or who have a history of violence or anger will almost certainly be set on mood stabilizers before any other treatment can be started. Once the uncontrollable anger and outbursts have been reined in, antidepressants could be added to their routine.
Patients who have been diagnosed with rapid cycling or mixed state bipolar disorder or who have a history of recent substance abuse or dependence on anti-anxiety medications will nearly always require treatment at a hospital setting. In instances such as these, combination therapy that is made up of antidepressants and mood stabilizers is frequently the very best.
Patients who have co-morbid bipolar disorder and BPD will also typically require combination treatment with mood stabilizers, antidepressants, and anti-psychotics like Geodon or Zyprexa. Once their mood disorder has been correctly addressed, psychotherapy is a lot more likely to be effective. With long-term treatment and permanent medication, the prognosis is greatly improved.
Those with personality disorders pose a challenge as they are often hesitant or downright refuse to take treatment. Some will follow the process to please the clinician. But this rarely continues for the length of the treatment, making it hard to treat this group of sufferers.
In rare instances where this doesn’t supply the desired effects, a stimulant like Ritalin or Adderall may be prescribed together with the mood stabilizer.
People who have substance or alcohol abuse issues will, as previously mentioned, be required to detox and be substance-free for at least a month before treatment starts. After free of medication and correctly treated for their bipolar range symptoms, approximately 50 percent of people will remain free and clear of alcohol and drugs.
Individuals with other health conditions frequently have a successful treatment provided that their medical issues are addressed. Any issue of a metabolic character, like diabetes, fever, thyroid conditions, disease, or pain can disrupt the efficacy of mood stabilizers making a flare-up of bipolar disease symptoms more prevalent.
Sometimes, patients won’t have the desirable answer to newer antidepressant drugs. Due to the hypertensive effects, they had been later demonstrated to possess one of the patients that consumed certain foods took particular medicines, they largely fell into disuse.
Antidepressants in Children and Adolescents: A Definite Dilemma
It’s no secret that children and teens can occasionally have a different and oftentimes negative response to antidepressant medications, most especially serotonin re uptake inhibitors or SSRIs. For this reason, packaging for all these drugs now contains warnings suggesting the possible dangers these medications might pose to miserable children.
It’s certainly disconcerting that a lot of these teens responsible for school shootings have been actually taking SSRIs at the time of the offenses. Certainly, these abusive outbursts brought up the question of whether these drugs might be doing more damage than good. In cases such as these, it is likely that the identification of these troubled youths was in which the problems started.
Ever since SSRIs were created and promoted, clinicians have had to take care of the fallout of the occasional individual who not only didn’t respond correctly to the medication, but had extreme, violent, and sometimes suicidal reactions to the drugs. In most cases, these issues were quickly solved by stopping or altering the medication given. Suicide was uncommon in such scenarios, but there wasn’t any doubt that the medication did create an intense reaction in some younger patients. The presence of bipolar spectrum disease in these individuals may really have been a contributing factor.
Psychiatrists who focus on working with children and teens are starting to be aware that a few of the patients, many especially those who appear exceptionally explosive, may really be suffering from a bipolar spectrum disorder. According to the data accumulated by The Spectrum Project, it appears like more than 50 percent of individuals diagnosed with depression may go on to develop symptoms of bipolar illness as well. In instances like these, antidepressants might not be appropriate therapy and medications like these may really aggravate the signs. This may certainly account for the violence, anger, and suicidal behavior of these individuals.
If there’s something that this research indicates, it’s that more research should be conducted and more info gathered about how to properly diagnose individuals, both young and old, that are living with psychiatric ailments. The search should continue for objective parameters in which to properly diagnose the disease and appropriate care has to be given to educating future clinicians from the subtleties of the status.