My wife experienced a manic episode on Christmas Eve and ended up in the hospital near my home town of Chicago. Every day, she has been getting better.

Current plans are to pick her up tomorrow and bring her back home to Indiana. Please send positive energy and prayers her way. Me and the rest of my family could use them, too.

Wishing you all the best.

MAY CONTAIN A SPOILER

I recently had the pleasure of seeing the new film Black Swan. It is the best movie I have seen this year, and I believe is the best artistic depiction of a psychotic break that I have ever witnessed.

I do NOT recommend it for those who are currently in a fragile mental state or those who are easily upset. The film is VERY intense. It contains some elements that are more characteristic of a horror flick, although I’ve seen a couple reviewers mistakenly refer to it as a “horror movie.”

I would like to know what you think of the film. For those of you who haven’t yet seen the movie, be warned that the comments that follow this post may contain spoilers, so you may want to see the movie first and then come back to read the comments.

The December 20 issue of TIME magazine has ten questions with writer-actress Carrie Fisher, author of Wishful Drinking. One of the questions, from Gary Bebout of Los Angeles, asks:

What is the biggest misconception about bipolar disorder?

Fisher responds:

The big thing happening now that seems bizarre is that they’re diagnosing everyone with it. Anyone with a mood: Oh, they’re bipolar. We’re probably the most medicated society in the world. But misconceptions, I don’t know. We’re good dancers. All of us.

How would you answer this same question? What do you think is the biggest misconception about bipolar disorder?

Carla asks…

My son was in nursing school, age 27, and working as a graduate assistant at the same time. He was going without sleep, but feeling sleep deprived, so he was drinking caffeine energy drinks. He passed a big test, went out with the guys, and overdid the drinking. The next day, he played in a flag football game and got a head injury that required stitches. After the injury, he was sleeping maybe 2 hours a night, and felt terrible. Two days later he has a psychotic break!!!!!

I swear he never exhibited bipolar symptoms growing up. He did have test anxiety and some attention issues in school, but overall was a good student, etc. He did not have extreme mood swings.

As a result of the psychotic break, he was hospitalized, and came out of it, on Seroquel. He has managed ok, but has terrible self-esteem issues because of it. The doctor at the mental health center has now switched him to Abilify.

How can we be sure he needs these meds?? Does he have bipolar or was it just a combination of crap that produced the perfect storm????

As we have noted in several posts, the depressive pole of bipolar disorder is often the more challenging to treat. In most cases, conventional antidepressants may require three to four weeks or even longer to become effective. In addition, most if not all of the most effective antidepressants may push a person with bipolar disorder from a depressive cycle into a mania.

For these reasons and others, researchers are constantly on the lookout for new treatments for depression that provide faster relief and have a more neutral side effect profile. Some medications that show promise are already in use in other medical applications. Back in August of this year, we wrote about one of these promising medications, Ketamine – originally used as an anesthetic.

Another medication that has shown some promise is scopolamine, which traditionally has been used to prevent nausea and vomiting caused by motion sickness.

It is well known that some people with bipolar disorder experience a variety of neuro-cognitive deficits (problems in areas such as attention, learning, and memory) in addition to their emotional and behavioral symptoms.

Because many of the medications used to treat bipolar disorder can cause cognitive problems as a side effect, psychiatrists have often debated whether these problems with learning and thinking are due to medications or are related to the underlying brain changes found in bipolar disorder. It seems likely that both factors are at play.

Some ongoing studies are looking at a medication called galantamine (Razadyne is the trade name), which is FDA approved for treating the cognitive deficits in Alzheimer’s disease.

On Tuesday, November 30, NIMH posted a Science Update entitled “Most Children with Rapidly Shifting Moods Don’t Have Bipolar Disorder.” The update references an NIMH-funded study published online ahead of print in the Journal of Clinical Psychiatry on October 5, 2010.

Based on results from the study, researchers concluded that “Relatively few children with rapidly shifting moods and high energy have bipolar disorder, though such symptoms are commonly associated with the disorder. Instead, most of these children have other types of mental disorders.”

I first wrote about my concerns surrounding this issue in 2007 in a post on my Bipolar Blog entitled “Bipolar Disorder Overdiagnosed in Children?” Back then, Benedict Carey of The New York Times wrote a piece calling attention to the 40-fold increase in the diagnoses of bipolar disorder in children between 1994 and 2003, climbing from 20,000 cases in 1994 to 800,000 cases in 2003.