Monday, April 21, 2014
Bipolar Disorder and 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.