Archives for September, 2011
If a loved one with mental illness or suspected mental illness is arrested, the goal is to transition the person as quickly as possible from the legal system to the healthcare system. The Los Angeles NAMI Criminal Justice Committee has posted a very thorough seven-step guide to help families navigate the criminal justice system in Los Angeles County when a family member who suffers from a brain disorder (mental illness) is arrested. It's called "Mental Illness Arrest: What do I do?" This post changes the process a bit, removes details related to the Los Angeles jail, includes some additional notes and tips, and presents everything in more of a checklist format.
Recently, a patient's mom asked me why I was prescribing an antidepressant, fluoxetine (the generic form of Prozac), for her son's anxiety disorder. Jeremy had started on this medication in the past few weeks. When I first prescribed it, I carefully outlined the target symptom of anxiety and explained how the medicine would help treat the anxiety through the serotonin system. Since starting the medicine, Jeremy's anxiety levels were declining – he was getting better. But mom became concerned when her own mother and some friends of hers asked her why the doctor prescribed an antidepressant for anxiety. They thought he should also be on something "for his anxiety" – an anxiolytic.
Mental illness carries a stigma, no doubt about it. Recently, however, I began to wonder just how deep this stigma really is and how much of it is self-imposed. In other words, do we feel stigmatized mostly because people stigmatize us or because we fear that they would if they knew we were living with mental illness? (And when I say "we" I mean members of the bipolar community, including people who have loved ones with mental illness.) Two events triggered my thoughts on this.
Many people who experience a serious mood episode with psychosis often have cognitive impairments that continue long after they recover from the mood episode. The actual percentages vary from study to study, but approximately 50% of those with mania and 15% of those with major depression experience mood episodes with psychotic features, so recovery from cognitive impairment is a serious concern for those with bipolar disorder. A study published in the American Journal of Psychiatry entitled "Two-Year Syndromal and Functional Recovery in 219 Cases of First-Episode Major Affective Disorder With Psychotic Features," found that while most patients recovered from symptoms soon after hospitalization, only about one third with psychotic affective disorders recovered functionality by 24 months. Medication is effective in treating acute bipolar mood episodes. Medication and psychoeducation are both effective in reducing recurrences in euthymic periods (when symptoms are not present). Unfortunately, neither treatment option has much effect on restoring cognitive facilities or one's ability to function as they did prior to the episode. But there may be hope on the horizon.
In a recent article published in Current Psychiatry Online, entitled "Treating bipolar disorder during pregnancy," assistant clinical professors of psychiatry at Stanford University Mytilee Vemuri, MD, MBA and Katherine Williams, MD provide an excellent summary of the risks and benefits associated with bipolar disorder and its treatment during women's reproductive years, particularly during pregnancy and the postpartum period. Their article offers detailed information about the relative risks of the most commonly prescribed medications, and provides clear recommendations regarding working with young women with bipolar disorder before, during, and after pregnancy.