In Bipolar Disorder For Dummies, we point out that as part of the initial work up for bipolar disorder you really should have a complete physical first to rule out any potential medical issues. Other possible diagnoses that may be considered by your doctor include the following:

• Thyroid malfunction
• Hormone imbalances
• Diabetes
• Mononucleosis
• Chronic Fatigue Syndrome (CFS)
• Lupus
• Cancer
• Cushing’s Syndrome
• Hepatitis
• HIV/AIDS
• Rheumatoid arthritis
• Medication or other substances that could have triggered symptoms

Sometimes we wonder whether doctors, including psychiatrists, follow the proper protocol in diagnosing bipolar disorder. Before diagnosing you and prescribing any medication, did your doctor perform a physical exam or refer you to an internist/specialist and/or order various tests to rule out medical issues that may have been causing symptoms of mania or depression?

What was the diagnostic process like for you?

Doctor image available from Shutterstock.

Chris asks…

Can long term (decade+) acute pain from an artery joining a vein directly in the spine that causes legs to not work very well lead to bipolar? Person has master degree in Mech Engineering and a MBA. Started to make poorer decisions which led to job loss, went on disability, divorce, severe ruminating, depression, possible suicidal thoughts, inability to think things through, sense of being lost and blaming one’s self for all that has gone wrong, fear or what is going to happen and impulsive behavior that cost his life savings.

He knew what to do but didn’t do it to prevent such a large loss of savings. He is seeing a therapist for mental health reasons and a regular doctor for his physical impairments. A lot of his symptoms I’ve seen in several bipolar individuals who I am familiar with. He asked me if he could be bipolar. Therapist thinks pain.

Dr. Fink Answers…

In a recent study entitled “Postural Control in Bipolar Disorder: Increased Sway Area and Decreased Dynamical Complexity,” Indiana University researchers measured and compared the magnitude of postural sway between study participants with and without bipolar disorder. The study involved 32 participants, 16 of whom carried the bipolar diagnosis. The control group was made up of 16 age-matched non-psychiatric healthy participants. Participants were asked to stand as still as possible on a force platform for 2 minutes under 4 conditions: (1) eyes open-open base (feet apart); (2) eyes closed-open base; (3) eyes open-closed base (feet together); and (4) eyes closed-closed base.

The researchers postulated that because many of the structural, neurochemical, and functional abnormalities identified in the brains of those with bipolar disorder are also implicated in postural control, people with bipolar disorder would have less postural control and hence a greater magnitude of sway than those without a brain disorder. In other words, there’s a connection between motor and mood disorders. The results supported their hypothesis:

Kelly Asks…

About a month ago, I was taken off my Lamictal, lithium, Seroquel, and Zoloft. I have a new Dr. who has prescribed me 150mg of Wellbutrin SR and 600mg of Neurontin. I became very depressed, had sleeping problems, and then as the third week hit, I became suicidal.

She increased my Wellbutrin SR to 150 mg twice a day and Neurontin up to 900mg (300mg morning and 600mg in the evening). I feel she is not treating me for my rapid-cycling Bipolar. I am either up or real real down, more down moments than my manic high, which often occurs.

Is she helping me or going to hurt me? I do not want to visit any more hospitals as a result of a doctor not giving me the right doses or too little or, as it is now, I have no antipsychotic meds, which is worrying me. Is this why I feel so depressed and suicidal thinking?

Please help. I am 43. I am not a child with Bipolar. Is this weak for my case? I have been hospitalized twice with Bipolar and I really wish to stay out of them. HELP PLEASE!!!!

Dr. Fink Answers…

Hi, Kelly. I am so sorry to hear that you are struggling like this right now. Most importantly, you should continue to express to your new doctor how badly you are feeling and insist that she explain to you what she is doing and why.

Psych Central’s Senior News Editor Rick Nauert recently posted a piece entitled “Genetic Variant Heightens Risk for Bipolar Disorder.” In it, he calls attention to a recent study published in the American Journal of Human Genetics that’s “based on a relatively new technique for the study of the genetics of bipolar disorder” termed genome-wide association studies (GWAS).

We invite you to check out the post, especially if you’re interested in keeping up on the latest breakthroughs in identifying the genetic component of bipolar disorder. Although it may be years before these genetic studies translate into any sort of gene therapy, if that’s even possible, they deliver an immediate benefit in three important ways:

A big challenge in diagnosing bipolar disorder or attention deficit hyperactivity disorder (ADHD), especially in children, is that the two disorders share behavioral symptoms, including impulsivity, irritability, and attention problems.

Unfortunately, they don’t share treatment protocols; if the diagnosis is wrong, treatment may be counterproductive. Stimulants, like Ritalin, which are effective in treating ADHD can make a child with bipolar disorder more manic. Giving a mood stabilizer, like Tegretol, to a child with ADHD may result in little or no improvement or severe side effects. Getting the diagnosis right is the key to effective treatment.

In Wednesday’s post, “Childhood Trauma Linked to Psychosis: Maybe Not,” I introduced a few terms and concepts that many people seem to wrestle with. In this post, I try to clarify the terminology and explain some of the concepts related to psychosis, hallucinations, and delusions.

Psychosis

Psychosis is defined as an abnormality of thoughts (content) or thinking (process). Psychosis is not a diagnosis in itself but a type of psychiatric symptom that occurs in a variety of diagnoses, including schizophrenia and bipolar disorder.

Schizophrenia is primarily a disorder of thinking – psychotic symptoms are the main presenting symptoms. Depressive or manic episodes sometimes include psychotic symptoms, but not always. Certain drugs such as LSD, mushrooms, and other psychedelics can also cause psychotic symptoms.

Continue reading… »

We often discuss the stressors that play a role in triggering bipolar disorder in adults who have a genetic susceptibility to it, but what about stressors in childhood?

Results of a study published in the January 2011 edition of the American Journal of Psychiatry entitled “Childhood trauma and children’s emerging psychotic symptoms: A genetically sensitive longitudinal cohort study,” claim to show that childhood trauma from maltreatment and bullying is associated with children’s reports of psychotic symptoms.

While the report serves an important role in calling attention to the serious psychological and psychiatric damage that intentional abuse and bullying can cause, it also raises the question of what is and is not psychosis, especially in children.

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????

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.