Monday, April 21, 2014

Bipolar Disorder and Coexisting Disease



Coexisting Disease

As you may have noticed I haven’t been keeping up with my blog. Unfortunately I’ve been dealing with multiple hospitalizations for my bipolar disorder as well as my eating disorder. I was at John Hopkins from June-September 2013, and was at the Princeton Eating Disorder Unit in February of this year.

I’ve decided to focus on the topic of co-occurring/co-existing diseases that may occur with bipolar disorder, or may mimic symptom as well creating a foggy or inaccurate diagnosis. I picked the most common psychiatric co-occurring disorders and provide briefly a description as well at show the discrepancies which arise when making the determination of an accurate diagnosis.

Statistically individuals with bipolar disorder are more likely to be suffering from other psychiatric issues such as substance abuse, eating disorders, attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and personality disorders. People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses. So how does one deal with the coexisting (comorbid) psychiatric issues? And if so many disorders coexist, where is the overlap for distinguishing what’s what?

Obviously the first thing to tackle is anything that threatens an individual’s immediate safety. After that is achieved, trying to navigate through the minefields becomes the next focus. I’ve chosen to focus on a few psychiatric issues that seem to blur the picture when trying to obtain an accurate diagnosis of bipolar disorder.

Difference between bipolar and ADHD?

I’ve asked medical professionals this question multiple times, and have received a wide variety of answers. How does one determine the difference between bipolar and ADHD, and is it one or the other or both? The differences between the two especially the mania aspects can be difficult. Because ADHD is usually diagnosed as a child the characteristics are easier to tease out from bipolar disorder so I’ve provided descriptions. It’s also thought that medical professional’s may misdiagnosis. Sometimes ADHD is diagnosed when bipolar disorder was a more accurate diagnosis, and vice versa.

In young children distinct periods of mania tend to be rarer. Symptoms of irritability, rage, impulsivity, aggression, hyperactivity, mood swings, learning problems, and poor frustration tolerance are commonly seen. Temper tantrums or rages in children diagnosed with bipolar are seen as storms. Mood shifts come out of the blue, and destruction can occur at the blink of an eye. Stopping them requires patience and care. According to recent research five early childhood symptoms most likely to predict later bipolar are grandiosity, suicidal and rapid thoughts, irritability, and hyperactivity.  Factors such as irritability, hyperactivity, rapid speech, and distractibility co-exist with ADHD and bipolar disorder and when comparing the two don’t provide help for differentiating among them.

Considering 40% of bipolar preteens also have ADHD, which usually starts first, this makes it one of the most confusing issues for the medical community, in particularly psychiatrists, in establishing the diagnosis of childhood onset bipolar and its relationship to ADHD. What makes it confusing is the fact that symptoms of ADHD can include hyperactivity, agitation, impulsivity, distractibility, talkativeness and poor concentration, which is mentioned above, and appear commonly in bipolar disorder. Age of onset is utilized to determine a diagnosis. When making the diagnosis for adults, if ADHD symptoms were not present during childhood, then a diagnosis of bipolar disorder would be most accurate. ADHD is chronic and continuously present, bipolar moods alternate. Life events may also trigger ADHD individuals, but bipolar mood shifts have no connection to these types of events. Duration of moods are another factor, bipolar individuals have more rapid mood shift. While children with ADHD may sometimes feel sad for no reason, children with bipolar disorder may feel sad for weeks. Additionally, one thing that they do have in common is genetic components. Studies have shown that children diagnosed with ADHD will eventually receive a diagnosis of bipolar as well.

Children with untreated bipolar disorder have an increased risk of suicide, poorer school performances, relationship difficulties, increased rate for abuse of substances and risk for multiple hospitalizations.

I have received a diagnosis of both ADHD and bipolar disorder. Stimulant use for individuals with bipolar used to treat the co-existence of ADHD can exasperate the problem and cause individuals to go into a rapid-cycling mode. Psychiatrists may prescribe a stimulant once stability has been achieved over a period of time and bipolar symptoms have subsided.


Anxiety and Bipolar disorder

Anxiety commonly co-occurs with bipolar disorder as well. When someone is in the manic phase it’s not uncommon to occur. During the manic phase anxiety tends to be more extreme than regular generalized anxiety. And irritability and racing and disorganized thoughts can occur. Treatment of this anxiety is difficult because the line of drugs used for those without bipolar are SSRI’s. SSRI’s are risky to use with individuals with bipolar because they can exasperate symptoms and cause rapid cycling. In these instances a combination of medications are characteristically the best approaches.

Bipolar Disorder and Substance Abuse Issues

Mood disorders frequently co-exist with abuse of alcohol and other substances, and occur together at a higher rate. When an individual is in a manic phase, impulse control, and reckless behaviors may take place. Depression may precede substance use, with the hope of making an effort to feel better. Substances such as alcohol, PCP, heroin, cocaine, and marijuana have the possibility of causing severe mood swings which mimic bipolar disorder if not diagnosed properly.

Additionally, those dealing with addiction issues are at a higher risk of suicide, and have greater hospitalization rates. Of male and females, females have a higher rate in developing alcoholism than those without bipolar disorder, but up to 60% of individuals with bipolar disorder may have substance use or other addiction issues.

Having a professional onboard specializing in the treatment of individuals with substance abuse issues particularly co-existing bipolar, provides the most successful outcome possible. As well as development of a solid treatment plan.


Bipolar Disorder and Borderline Personality Disorder

Scientist for years has been trying to figure out a distinction between bipolar disorder and borderline personality disorder (BPD). Many of the symptoms concerning these two disorders overlap one another. BPD indicators include but are not limited to: abandonment issues, idealization and devaluation of individuals, impulsivity (spending, sex, substance abuse, binge eating), self-mutilation, recurrent suicidal behavior, affect instability, feeling of emptiness, severe anger issues, and loss of temper.

As you can see these symptoms are similar to hypomanic and manic phases. Personality traits are thought to be different than actual bipolar traits. One of the main differences is that bipolar patients characteristically have a stronger sense of self, when medicated properly. Mood liability and affect in BPD tends to lean more toward anger, anxiousness, and depression. Bipolar affect tends to lean more towards depression, elation and irritability. Many times, medicated BPD individuals won’t improve with psychiatric medications, whereas bipolar sufferers will. This is not to say that a patient can’t have both disorders, thus creating a co-occurring diagnosis.

There’s many other coexisting disease that may mimic bipolar disorder, these just summarize a few. As science and research advances, scientists are able to obtain a clearer picture and accurately diagnosis. With the continuous changes to the DSM, definitions are becoming more concrete, making the medical communities job more successful.







Saturday, September 14, 2013

Suicide

DISLOSURE 

STOP and read the following clearly. This article may be troubling to somebody thinking about suicide. This article is about personal and factual experiences regarding suicide. Please do not read if you are in a dark place and feeling suicidal. Suicide is never the answer, finding help and support IS. At the end of this article, I listed numerous resources, to obtain more information on this topic, as well as crisis hotline numbers for immediate support. Please utilize these fully.



Suicide:

I’m writing this from a room on one ofthe floors of John Hopkins Hospital’s Affective Mood Disorder clinic. I’mgetting help, for my severe bipolar disorder and these suicidal ideations andthoughts. I am still here in the hospital, it has been 11 weeks. Personally,for me, I get triggers when folks are talking about suicide. Whether it is adiscussion or action of somebody cutting and feeling triggered that way, orbeing triggered because someone is discussing how he or she want to killthemselves.  I have chosen to write thisarticle, so others may be helped and they know they are not alone.
 


Sowhat is exactly the definition of suicide: Suicide is defined at the “act oftaking one’s own life?” In addition, suicidal ideation is “thinking of endingone’s life.” Some view suicide as a cry for help. I view suicide as a way out,getting to the point where life is just too painful to live. Yes, part of mewants to live, but the other part has given up and cannot handle the highs andlows. I know my friends and family would miss me, but in the end, suicide is aselfish choice. However, most individuals who commit suicide really do not wantto die. Forfolks without a mental illness it is very hard for outsiders to understand whyone would choose to take their own lives. I have heard this comment many atime. “Somebody has cancer and is dying, don’t you think they would be angryknowing they could have lived and you killed yourself on purpose”? What folksdo not get is that it is an illness, and I am hurting. Yes, you are not seeingit, but it does not make it not there. People in the depths of feeling suicidalare in SO much pain, it actually hurts to live, and can see no other way out.

Therapyand medication can also help individuals that are feeling suicidal. While themedication can sometimes take a few weeks to get to therapeutic level, therapycan take place starting right away, and help reduce the thoughts of suicide. 


Statistics
Becausestatistics vary, the stats below are accurate according to various sources:
TheWorld Health Organization estimates that about 1 million deaths by suicideoccur each year, making it the 10th leading cause of deathworldwide. Of these the highest risk of suicide are white men. However, womenand teens have more suicide attempts. Of these about 30,000 or 2/3s arepatients with major depression or bipolar illness. In addition, even scarier,10-20 million non-fatal attempts are made each year.
  
Triggers and Risks
Sowhat factors contribute to the sad completion of a suicide or increase therisk?

Whatare the risk factors and triggers (I have chosen to name the predominant ones)?

  • Mental Illness (Depression, Bipolar disorder (especially mixed states, schizophrenia, substance abuse)
  • Means of suicide (i.e. pills, weapons, etc.)
  • Social situation (i.e. living alone, single, recent loss)
  • Severity of mood disorder (hallucinations, mixed states, moods and reasoning),
  • Employment (i.e. new job, job loss, new position)
  • Incarceration/Trouble with the Law (i.e. in jail or prison)
  • Previous attempt within 30 days or exposure to others suicidal behavior, peers, media, etc.
  • Family history of suicide attempts, and/or family history of mental disorder, or substance abuse
  • Physical illness (chronic pain, early on-set diabetes, stroke, epilepsy, multiple sclerosis, AIDS, and terminal illness)
  • Relationship Change (new marriage, divorce, break up)
  • History of trauma, abuse, or violence.

Mixedstate bipolar mental illness is the most dangerous of all. This is because depressionand mania are occurring simultaneously.  Somebody in a mixed state has the energy tocommit suicide, and the depression to want to. Being that they are depressedand manic at the same time.



Warning Signs

Whilethis may not entail all warning signs below captures a large amount of the mostcommon signs.

  • Discussing death, such as talking about wanting to die or that life is not worth living. Feeling like you have no purpose to live or no sense of purpose in life.
  • Threatening to hurt or kill oneself.
  • Feeling agitated and anxious.
  • Feeling hopeless about future and feeling there is nothing worth living for, wishing you‘d never been born.
  • Hating oneself, and feeling like you are a burden. Feelings of worthless or having low self-esteem.
  • Writing a suicide letter, saying goodbye to friends or family, writing about death or dying.
  • Start withdrawing from family and friends, also isolating and not wanting to leave the house, and deal with society.
  • Looking for lethal means to hurt oneself, such as guns, stock piling pills
  • Preoccupation with death, such as discussing death on a frequent basis.
  • Increase in alcohol and/or drug use.
  • Driving recklessly and obsession with killing oneself will attempt theses self-destructive behaviors.
  • Feeling rage or uncontrolled rage, or dramatic mood changes
  • Unable to sleep, or on the other end of the spectrum sleeping all the time.
  • A spurt of energy, allowing the person who is depressed to be able to enact the plan they have developed.1 (i.e. mixed states)
  • Depressed, psychosis, impulsive
  • Crying out for help in various ways
  • Philosophical reason to die (feelings it’s their destiny)



Prevention of Suicide

Howcan we prevent those considering suicide to turn their thoughts around andthink about the positive factors in their life that would, that would make lifeworth living?

Iunderstand how hard this is. While I am still a work in progress regardingreversing my thought and training my brain to see the positive and not thenegative. I am not saying it is easy, but as I am learning, it is possible.

Ipersonally find that when the seasons change, and the light outside get shortermy mood changes. In addition, as silly as this may sound, the full moon throwsoff my mood.

Ifsomebody brings up suicide, ALWAYS take it seriously, talking to the person whois suicidal cannot cause somebody to be worse off. For example, if anindividual seems to be suffering from depression, creating a casualconversation about suicide is not inappropriate. If the individuals reveal thatthey are indeed suicidal, they need all the support they can get. For starters,ask how long that they have felt suicidal, and ask if there was a particulartrigger or cause. Being attentive, as well as listening in a calm manner canhelp the suicidal individual.  

Anotherhelpful tip is to share with the individual any similar situations in which youhave felt depressed, manic, or suicidal as well. The individual will be able torelate which in turn will create an understandable dialog.



Evaluating Suicide Risk:
Sowhat do you do if the people you are discussing suicide with tell you they havea plan and they are going to kill themselves?

Ifthe individual has a plan and the means, the quickest suggestion is to call 911or take the person to an emergency room, or psychiatric facility. If the personwill not budge staying with the individual and calling, a suicide hotline isthe next best thing. Perhaps the hotline can convince them to hand over their“means” of suicide, or convince them to go to a hospital to be evaluated. NEVER leave them by themselves!


Being Supportive and Empathic:
Sohow do you help somebody whom of which is suicidal?  If somebody is suicidal but not in such a badplace that they need quick hospitalization, helping them to find supportwhether through a support group, or professional support and help. Set a safetyplan, for example, that the individual will call you every few hours to checkin. Another suggestion is to remove any means for committing suicide.

Additionallyhelp the person to create a suicide plan during which time they promise todelay suicide by 24hrs…then 48 hrs...etc. Help the individual call theirimmediately doctor, therapist, and/or psychiatrist. If needed go with theperson to the appointment.


Resources:
Suicide Hotline Information
NationalSuicide Prevention Hotline (available 24/7)
1-800-SUICIDE
(1-800-784-2433)

NationalSuicide Prevention Lifeline (available 24/7)
1-800-273-TALK
(1-800-273-8255)

NationalSuicide Hotline
888-999-9999

Additional Resources:
NationalInstitute of Mental Health
301-443-4513

AmericanFoundation for Suicide Prevention (AFSP)
888-333-2377

AmericanPsychiatric Association (APA)
202-682-6000

AmericanPsychological Association
800-374-3120

NationalAlliance for the Mentally Ill (NAMI)
800-950-NAMI

NationalDepressive and Manic Depressive Association (NDMDA)
800-826-3632

NationalMental Health Association (NMHA)
703-684-7722

SubstanceAbuse and Mental Health Services Administration (SAMHSA)
301-443-8956


***Ihave obtained much of this information from various sources available on theinternet. Much of the research I have done for this article is a compilation ofthesesources.