Category Archives: mental illness

Subthreshold (Hypo)Mania As A Precursor To Bipolar Disorder

The new Bipolar Spectrum.

“There is growing clinical and epidemiologic evidence that major mood disorders form a spectrum from major depressive disorder to pure mania.”

Subthreshold mania can be seen as a precursor to Bipolar Disorder, subthreshold Bipolar Disorder is defined as “recurrent hypomania without a major depressive episode or with fewer symptoms than required for threshold hypomania” (Merikangas et al, 2007). Bipolar disorder should be suspected if prominent behavior problems, anxiety, and substance abuse were present during childhood in someone with recurrent depression and a family history of affective disorders. For example, the prevalence of anxiety in children may be prominent in early-onset Bipolar Disorder and may predate affective symptoms. Children with a parent with Bipolar Disorder are more likely to be at risk for early-onset Bipolar Disorder, along with anxiety, depression and other disorders.

Studies have shown that offspring of people with Bipolar Disorder are at high risk for developing Bipolar Disorder because they have a parent with the disorder and generally have significantly higher rates of subthreshold mania or hypomania (13.3% versus 1.2%) or what is known as bipolar disorder not otherwise specified (BP-NOS); manic, mixed, or hypomanic episodes (9.2% versus 0.8%); major depressive episodes (32.0% versus 14.9%); and anxiety disorders (39.9% versus 21.8%) than offspring of parents without the disorder. Subthreshold episodes of mania or hypomania (those that resemble but do not meet the full requirements for bipolar disorder in terms of duration) were the best predictor of later manic episodes.

It should be noted that the American Journal of Psychiatry has a multitude of studies that suggest that people who suffer from Major Depressive Disorder (MDD) have a higher susceptibility to Bipolar Disorder and that subthreshold hypomanic symptoms that are found in people suffering from MDD should be taken into consideration when diagnosing. Placing these people instead on a bipolar spectrum, hence altering their treatment plan by incorporating a mood stabiliser which can also assist with the present MDD.

 

 

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The ‘Poster Patient’ of Bipolar Disorder.

When you’re considered the ‘poster patient’ of Bipolar disorder…

I see all my doctors at regular intervals and I take medication daily. That’s the simple side of things, the easy routine and foundations that you are required to build. Depression and hypomania have accompanied me at different interludes, always waiting backstage for the next show to begin. I see myself as so dysfunctional. So haphazard and incapable of maintaining all the demons in check. I’m writing this post because I see myself as all those things, maintaining complete control of my emotions and rhythm is beyond my control, yet my psychologist insists that I’m a ‘poster patient’ for Bipolar Disorder, my ability to be functional when everything has turned on its head. I was so confused when she originally said this. I know my dysfunction, mismanagement and self-sabotage run deep, hence my confusion to the compliment. She referred to how she used me as an example to other patients about what can be achieved. The facts that she presented were right: I have completed a university degree and I am half way through another, I do have a full time job (I work full time as a secondary teacher), exercise, eat regularly and maintain some semblance of social interactions with friends. It hadn’t hit me that this is what is considered to make me less dysfunctional. My moods don’t generally have repercussions on my life, they are damn high mountains to climb over in order to find solace again, but the hike and lightheadedness of the ‘mood mountain’ doesn’t necessarily interfere with my outer world.

I don’t see these facts as things which make me more managed. I am dysfunctional. My ability to manage my life doesn’t make me any less so. As my depression deepened a few weeks ago, I started to have regular suicidal ideations again. Obviously the recognition that the severity of my depression was getting worse, I acted. I wanted to flip the switch. Anything had to be better than those tendencies, those ideations. I have done a lot of research into the vitamin 5-HTP, simply put it can potentially alter the levels of serotonin in your brain which can result in a hypomanic episode. High is much better than being low. Until you’re high….

Then it’s hell, again.

Without going into specific details of my episode, 5-HTP worked by flipping the switch. The worst part about flipping the switch is when you remember how horrible it is to actually be hypomanic at times. My memory had conveniently let myself forget. My mind has the useful ability to allow me to forget how bad things have been at both ends of my imaginary scale, the thermostat of my mind. It’s a protection mechanism, allowing me to move on and forget the consequences of all my subsequent moods. I took 5-HTP for three days before stopping when my head started to *whoosh*. I find everyone’s interpretation of ‘racing thoughts’ to be different, but then again, each episode I have had resulted in ‘racing thoughts’ which were different from previous occurrences. I see these in the following categories: Actual racing thoughts, when you have too many ideas at once – excitement usually accompanies this variation. Then there is the static or *white noise* head background pressure ‘racing thoughts’ which is usually accompanied by irritation and finally there is *whooshing*, when there isn’t an exact thought but your mind is just doing the simple cycle of the washing machine with your ears blocked, accompanied by a bit of depersonalization. It sounds absolutely nuts. Which it is.

I was never meant to be this broken, popping pills, waiting for the next mountain to climb.

At least I know that I can climb and conquer.

The Morning After I Killed Myself, I Woke Up.

*Thought this was a pretty epic story by Meggie Royer – for anyone who has thought about the day after it’s all over. 

I made myself breakfast in bed. I added salt and pepper to my eggs and used my toast for a cheese and bacon sandwich. I squeezed a grapefruit into a juice glass. I scraped the ashes from the frying pan and rinsed the butter off the counter. I washed the dishes and folded the towels.

The morning after I killed myself, I fell in love. Not with the boy down the street or the middle school principal. Not with the everyday jogger or the grocer who always left the avocados out of the bag. I fell in love with my mother and the way she sat on the floor of my room holding each rock from my collection in her palms until they grew dark with sweat. I fell in love with my father down at the river as he placed my note into a bottle and sent it into the current. With my brother who once believed in unicorns but who now sat in his desk at school trying desperately to believe I still existed.

The morning after I killed myself, I walked the dog. I watched the way her tail twitched when a bird flew by or how her pace quickened at the sight of a cat. I saw the empty space in her eyes when she reached a stick and turned around to greet me so we could play catch but saw nothing but sky in my place. I stood by as strangers stroked her muzzle and she wilted beneath their touch like she did once for mine.

The morning after I killed myself, I went back to the neighbors’ yard where I left my footprints in concrete as a two year old and examined how they were already fading. I picked a few daylilies and pulled a few weeds and watched the elderly woman through her window as she read the paper with the news of my death. I saw her husband spit tobacco into the kitchen sink and bring her her daily medication.

The morning after I killed myself, I watched the sun come up. Each orange tree opened like a hand and the kid down the street pointed out a single red cloud to his mother.

The morning after I killed myself, I went back to that body in the morgue and tried to talk some sense into her. I told her about the avocados and the stepping stones, the river and her parents. I told her about the sunsets and the dog and the beach.

The morning after I killed myself, I tried to unkill myself, but couldn’t finish what I started.
By Meggie Royer

Three Months of Freedom. I’m Back.

It’s been three months without thinking about Bipolar Disorder. Three months ago my psychiatrist started to think that I could potentially be Borderline Personality Disorder comorbid with Bipolar Disorder, it’s taken me two months to even acknowledge this. Borderline Personality Disorder can often co-occur with Bipolar disorder, having numerous overlapping symptoms. My psychiatrist sees the disorders linked in some people, existing on a mood spectrum where they interconnect. I’m against this analysis, I was mad, I’m still a bit mad. I slowly began to take myself off my medication. I cancelled all my other upcoming appointments, in my mind it was a big f*** off to mental health. I was good, I was on university holidays, no stress, nothing to trigger mood instabilities, and it was nice. University went back 4weeks ago, so I took myself back to the doctors, my psychologist, in contrast to my psychiatrist she doesn’t believe I’m BPD, but reaffirmed her belief that I need to monitor my moods and stay on top of my emotions. My psychologist forced the importance of Bipolar Disorder awareness back into the forefront of my mind. I’m still medication free, but the reality of mental illness is scary.

For anyone else who is or potentially has both Bipolar Disorder & Borderline Personality Disorder.

Development/Nature of the Illness:

Borderline personality disorder is a type of “personality disorder” which essentially means that it is a developmental condition – something that has evolved through the entire development of a person’s emotional/behavioural infrastructure.

Bipolar disorder is an illness that presents acutely or sub acutely (less than acute) sometime in a person’s life and is not, at least as we define it now, a condition that is part of a person’s core personality structure.

Course/Presentation of Symptoms:

Borderline symptoms are present as a person’s baseline– their difficulties with mood regulation and impulsivity, their ups and downs, are part of their life all the time. They are always up and down.

Bipolar symptoms present in episodes that must be a change from the person’s baseline – that is part of the diagnostic definition. Their episodes of depression or mania are a change from who they are when they are feeling well.

So the most annoying part of all of this: HOW CAN I BE BOTH! Uh… Having to exist on a spectrum with both, I don’t exhibit all symptoms of either.

Would love to hear from other people’s experiences.

Hope everyone has been well and happy. Love Alice.

*image by ahermin

The Rise Of Psychiatry Has Augmented The Rise Of Madness Through Medicalization

When psychiatry is ‘curing’ the deviants of society and is invested in the restoration of normality.

It’s been a long while since I’ve last written, I’m not exactly sure why. Maybe, just maybe it’s because I’m not feeling too high or too low, the lows always lasting longer than the highs. Psychiatry has been playing on my mind lately, pills and potions; we’re overdosing, sick, sick, sick, I hear them say it. The pills fail to fill the void, has the void always been there or are the pills’ telling me that something needs to be fixed.

I was never meant to fix myself, the bruises on my thighs are like my fingertips, eerily matching the darkness that I feel. The darkness is like beautiful cherry blossoms that are always about to bloom, they are always so pretty, but they are always gone too soon. 

An attack on psychiatry: The original rise of asylums has allowed the confinement of madness to be ‘treated’, reclassifying a non-medical problem as a medical problem. Medicalization is the defining of non-medical problems in medical terms, usually as an illness or disorder, and usually with the implication that a medical intervention or treatment is appropriate (Zola, 1972). Medicalization leads to “normal” human behaviour and experience being “re-badged” as medical conditions. Rebadging “deviance” as a series of medical disorders, the engines driving medicalization have been identified as biotechnology (especially the pharmaceutical industry and genetics), consumers, and managed care. The hubris of psychiatry, believing originally that they could cure all psychological problems with psychoanalysis, psychiatry still failing to improve the average levels of happiness and well-being in the general population. Psychiatry is able to pump out psychotropic drugs, not save mankind, attempting to alleviate our ‘age of disenchantment’.

We are treated, analysed and regulated scientifically, living by a manual which fails to understand the sociological impacts and failings of society. Have we potentially been manufacturing our own madness? Postmodern psychiatry seems to have become a tailor-made diagnosis for an age of disenchantment. Are these psychiatrists potentially manufacturing madness? Is the medicalisation of madness reducing creativity, the creative aspects of people commonly misinterpreted as deviants? Centuries of creative people from all modalities have suffered from mental illnesses, resisting treatments which could potentially ease their conditions, fearing that it could cloud or alter their mind, drugging them into submission, proceeding to quash their inner creative impulses.

Edvard Munch: “I want to keep my sufferings. They are part of me and my art.”

Van Gogh: “Men have called me mad; but the question is not yet settled, whether madness is or is not the loftiest intelligence, whether much that is glorious, whether all that is profound, does not spring from disease of thought, from moods of mind exalted at the expense of the general intellect.”

Psychologist Maureen Neihart: associates the shared characteristics amongst creative production and mental illness, which include mood disturbance, a tolerance for irrationality, greater openness to sensory stimuli, restlessness, speed of thinking, and obsessiveness of thought.

Marcel Proust: “everything great in the world is created by neurotics;”

Seneca quoted Aristotle as having said, “No great genius was without a mixture of insanity.”

Many psychologists believe that artists use their work to heal and soothe their minds. But if drugs heal artist’s minds for them, is their work still needed, or would it even be produced, would their work even be needed? I always found that my over-sensitive and stimulated mind would always find so much more beauty in the world, glimpsing the magical and maniacal way of being present. Sometimes the pills keep me from spiralling into the abyss of the rabbit hole, the terror, but also the creative language which comes from seeing both sides, the place that is sometimes so warm and comforting but at the same time cold and hard. We’re definitely a pill popping society, whether it be vitamins or hard core anti-psychotic sedatives (Haloperidol…I’m talking about you, you’re such an exhausting and all-consuming prick). I’m not writing off psychiatry as a professional form of medicine, I just believe that they are infested with conflicts of interest, most commonly the extensive influence of the pharmaceutical industries over modern medicine.

End note: I do not mean the use of the word “madness” to be taken in any offensive way; it is used in the same way that sociology and psychology have referenced it in academic journals.

Playing Devil’s Advocate With Key Religious Figures And Mental Illness Correlations.

Disclaimer: Not my own thoughts, the research is from the Journal of Neuropsychiatry – The Role of Psychotic Disorders in Religious History Considered. This blog entry is me playing devil’s advocate to provoke debate; I’m not in any way trying to undermine a person’s religious beliefs, simply trying to encourage discourse underlying subconscious preconceptions of mental illness within religion.  


Thoughts to be considered before reading:
-Why would it be so bad if the inspirational figures in religious history experienced mental illness?
-Why do we subconsciously reject the thought that God wouldn’t work through people who have mental illnesses?
-Does being mentally ill make you exempt from God’s work and unable to meaningfully participate in worship when one in four people have been statistically proven to suffer from mental illness at some point in their lives.

The awkward moment when it becomes plausible that Jesus suffered from Schizophrenia (Just to clarify: this wouldn’t in anyway take away from his religious position, history and achievements).

A study was conducted by psychiatrists when they were presented with a concept by a paranoid schizophrenic patient, who claimed that he could read minds and was selected by God to provide guidance for mankind. The patient refused to take the medication because they stopped the voices, presenting his doctors with the question: “How do you know the voices aren’t real…How do you know I am not The Messiah…God and angels talked to people in the Bible”. The patient raised interesting questions, how does one distinguish between people with mental health disorders and those of religious figures in history?

One of the examples the doctors used in their journal article was Jesus, by examining passages within the bible they located specific areas that presented symptoms of mental illness:
Paranoid-type (PS subtype) thought content: Matthew 10:34–39, 16: 21–23, 24:4–27; Mark 13:5–6; Luke 10:19; John 3:18; John 14:6–11

Auditory and visual hallucinations: Matthew 3:16–17, 4:3–11; Luke 10:18; John 6:46, 8:26, 8:38–40, 12:28–29

Referential thought processes: Mark 4:38–40 (Figure 3); Luke 18:31

Within the New Testament Jesus exhibits behaviours that closely resemble the DSM-IV-TR– Auditory hallucinations, Visual Hallucinations, delusions, referential thinking, paranoid-type, (PS subtype) thought content, and hyper-religiosity. Through the text Jesus also displays signs of disorganization, negative psychiatric symptoms, cognitive impairment, or debilitating mood disorder symptoms. The article poses the question about whether starvation and metabolic derangements caused some of the behaviours as Jesus experienced hallucinatory-like visions whilst he fasted for 40days in the desert (Luke 4:1–13).

Jesus’ experiences appear to have occurred over the course of at least the year before his death. There is a notable lack of physical maladies which suggest psychiatric aetiologies as more plausible. There is a 5%–10% lifetime risk of suicide in persons with schizophrenia.  Suicide is defined as a self-inflicted death that has intention to end one’s life. The New Testament recounts that Jesus was aware that people intended to kill him.  Jesus took the steps to ensure that his followers were aware that his death was necessary for his return (Matthew 16:21–28; Mark 8:31; John 16:16–28). These passages appear to present Jesus to deliberately place himself in a situation wherein he anticipated his execution. Schizophrenia is often associated with increased risk of suicide.

There is a term called ‘suicide-by-proxy’, any incident whereby a suicidal individual causes their own death to be carried out by another person.  Jesus’ behaviour before his death has parallels with someone who premeditates a form of suicide-by-proxy. In the passage Mark 3: 21: Jesus was on occasion viewed as mad or “beside himself.” People from Jesus’ hometown and the religious authorities of the day also did not accept his message. Subsets of individuals who have psychotic symptoms appear to be able to form intense social bonds and communities, despite having distorted views of reality. The study analysed the religious figures from a behavioural, neurologic, and neuropsychiatric perspective. The research indicates that the experiences of the individuals coincide with psychotic symptoms, suggesting that manifestations of their experiences had a primary or mood disorder-associated psychotic disorder basis.

The_God_Delusion_by_BlackMagic26

A main goal of this research was to evaluate the influence of individuals with mental illness and their effects on shaping the Western civilization, hoping that the findings will help to increase compassion and understanding in relation to mental illness. Within the research it should be noted that they did use explicit passages from the bible, but each passage should be examined in its own context. It is generally acknowledged that biblical scholars are not unanimous about the literality of the scriptures nor are psychiatrists completely unanimous about the DSM (basically the bible of psychiatry). The research conducted a form of psychological profiling by people that aren’t saddled with the preconceived notions and biases that encumber those that have studied their field in depth, allowing a fresh take on ideas that have been overanalysed by people in the same area of study.

Only by joining multiple areas of study can any true concept of history be interpreted, attempting to remove the elitist theories that dominate popular thought. It needs to also be acknowledged that historians aren’t the sole area of study that can interpret history, other fields of study have valuable insights that historians can lack.  The article didn’t stipulate and designate that religion was the cause for psychological symptoms, neither did it go into the scientific explanation, but it still needs to be acknowledged that religion does play a dominating role for some psychoses, especially with delusions. Does the motivating factor of religion in mental illness make it a definable feature??

I’m increasingly intrigued by the article when it encourages speculation on our inability to disprove that a person who is schizophrenic is a mouthpiece of God or is suffering from psychoses. The opposing opinions from both sides need to be taken into consideration; biases from long term studies ultimately detract from the viability of the research. The study showed the correlations that religious historical figures had with the current DSM, they acknowledged their limitations, like either psychological or biblical should do, my main question is this: why would it be wrong if they had suffered from a mental illness, it doesn’t detract from their accomplishments or their religious foundations, each person’s beliefs will always be grounded, who’s to say that God didn’t use psychoses to achieve his end.

I didn’t want to post this all week, didn’t want to ruffle anyone’s feathers. I came across this article, it really interested me, I understand its controversial, I am in no way promoting and detracting from either side and hope my post won’t be interpreted as such. Thank you.

Author and Article Information

From the Dept. of Neurology, McLean Hospital, Harvard Medical School, Belmont, MA (EDM, BHP); Dept. of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA (MGC); Dept. of Neurology, Massachusetts General Hospital, Harvard Medical School, Belmont, MA (EDM, BHP).

Murray, E., Cunningham, M. and Price, B. (2012). The Role of Psychotic Disorders in Religious History Considered. JNP, 24(4), pp.410-426.

Is Early Onset Bipolar Disorder a Myth?

I’ve always been curious about a child’s ability to exhibit all the required symptoms of Bipolar to meet the criteria. The other possibility involves the symptoms developing over time to eventuate into Bipolar disorder with the component of environmental factors and the individual traits of the child. My own personal example is severe childhood insomnia and anxiety, aided by my genetic predisposition to the disorder (biological father had BP1). I then question whether the insomnia was merely a symptom that demonstrated that Bipolar disorder was present during my childhood but in varying degrees. As a child I was a very clean individual that would cry at people not washing their hands or leaving a mess, I would also go into a ‘seek mode’ to find particular objects with an obsessive stubbornness that didn’t abate until I had found what I had been searching for, during these times I would also have head and neck aching pain – which was a generalised discomfort or pressure in those areas. Looking back at these times as an adult they highly correspond to my symptoms I currently exhibit during an episode of hypomania.

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The psychiatrist who wrote this abstract (40years experience in clinical child psychiatry) believes that prepubescent Bipolar disorder is a misdiagnosis, ascertaining that the children diagnosed with Bipolar Disorder are predominantly based on violent outbursts which are produced by chaotic home life (Kaplin, 2011). The critique by Stuart Kaplin promotes the argument that there is no conclusive biological test for any psychiatric diagnosis. Kaplin further argues that paediatric Bipolar Disorder doesn’t even meet the DSM-IV criteria, stating that children don’t exhibit the appropriate levels of mania and depression that define Bipolar Disorder, bipolar is characterised by extreme contrasting mood poles. Kaplin does recognise that the DSM-IV largely ignores different symptoms that should be based on age and their psychological development, instead the DSM-IV takes a simplistic approach to all ages of development and has one set of criteria, a very ‘one size fits all’ approach.

Children that are diagnosed with Bipolar Disorder don’t seem to display the clear-cut episodes that the disorder is primarily based on. Etiology of psychiatry is always based on the psychiatrist’s perception of the symptoms, presenting ambiguous diagnoses based on areas of ‘grey’ within science. Children that are diagnosed with Bipolar disorder additionally display constant symptoms, episodes not deviating from their usual behaviour. Even with children meeting the manic criteria through their irritable mood, the irritable mood usually isn’t from a distinct period of time, not different from their normal functioning. Children displaying bipolar-like symptoms can also be categorised under a series of other disorders, fitting each accordingly. If a child also exhibits grandiose behaviour or euphoria it can also be attributed to the ability for the majority of children to present ‘grandiose’ orientated behaviour through their games and high imaginative ability.

Overall no objective science can adequately diagnose children to have early onset Bipolar disorder even if they have some symptom indicators, usually in my opinion it’s the environment factors that enhance the childhood symptoms to further develop into the classic Bipolar Disorder standards that are recognised by the DSM-IV.

This is just my opinion. 🙂