No More Pediatric Bipolar Disorder!

December 7, 2012

The DSM-V will be dropping the diagnosis of pediatric bipolar disorder. It took YEARS for the shrinks to admit that some children were experiencing psychotic manias from the stimulants given to children with ADHD because they didn’t have ADHD! The seminal book on the topic is The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder, Third Edition

Another thing that is STILL missing is an anosognosia specifier. It is my nightmare to be trying to convince some evil bastard that I am not insane.

Anosognosia means you are unaware that you are exhibiting the symptoms of your illness. Self-awareness, i.e. the ability to be objective about yourself, isn’t a guaranteed just because you’re human, but when a mentally ill person doesn’t have it, they can get in extra trouble.

The DSM-IV has specifiers for “last episode depressive” or “with psychosis” but there isn’t one for “painfully aware that she is batshit insane.”

It’s not enough to stay calm and not talk about space aliens. The powers-that-be ASSUME you’ll be on your best behavior. Once on a psych ward even a sane person would be hard-pressed to get back out. There was an experiment a few years ago in which psych grad students feigned hearing voices to be admitted to a psychiatric hospital. Once in, they behaved normally and tried to be released. In all cases the students had to submit to the will of their captors and admit they were mentally ill before being allowed to leave.

“The uniform failure to recognize sanity cannot be attributed to the quality of the hospitals, for, although there were considerable variations among them, several are considered excellent. Nor can it be alleged that there was simply not enough time to observe the pseudopatients. Length of hospitalization ranged from 7 to 52 days, with an average of 19 days. The pseudopatients were not, in fact, carefully observed, but this failure speaks more to traditions within psychiatric hospitals than to lack of opportunity.”


Online list of DSM-IV diagnoses.

September 28, 2008

PSYweb DSM-IV Diagnoses and Codes.

PSYweb has a list of the DSM-IV Diagnosis Codes. Notice that there are a lot of psychiatric diagnoses caused by psych meds. This makes it totally clear that your meds can make you sicker, a good argument for doing the minimum meds to make you functional vs. medicating yourself into oblivion.

The following are a few examples of iatrogenic (physician-caused) psychiatric disorders:

Opioid-Induced Mood Disorder
Yes, pain meds can make you look like a bipolar.
Neuroleptic-Induced Acute Akathisia
He’s agitated, let’s give him more neuroleptic. Neuroleptics are old-fashioned antipsychotics such as Haldol.
Amphetamine-Induced Psychotic Disorder, With Hallucinations
Some of the ADHD meds they give to kids, including Ritalin and Adderall, are amphetamines. Can you imagine turning your kid into a Speed Freak?
Sedative-, Hypnotic-, or Anxiolytic-Induced Anxiety Disorder
Anxiety from anti-anxiety pills? Some of the benzodiazepines can even induce hypomania, however there doesn’t seem to be a diagnosis code for it. Maybe in the DSM-V. Or maybe not. I hear it’s being written by Big Pharma.

Another cool thing on psyweb is a Mood Disorder Flow Chart that is able to distinguish bipolar disorder from the other mood disorders. A real kick in the head is the question “Symptoms Psychotic in nature, occur at times other then during Manic or Mixed Episodes?”

This seems to imply that bipolars don’t have psychotic depressions, but other mood disorders do. Note that the only the 296 numbers are mood disorders, and only a few of those are called bipolar disorder. Been there, done that, bought the t-shirt.

A couple of years ago I did a decision tree for the bipolar disorders based on the DSM-III. It’s a little different from the DSM-IV-based version.

Psyweb also has a decision tree for differential diagnosis, and that’s a better choice than the mood disorders tree, even for diagnosed bipolars. This tree helps you figure out whether you have another psych diagnosis masquerading as bipolar, something that a 15-minute psych eval will definately miss. That would be truly disastrous, being treated for life for bipolar instead of dealing with something less severe. Have fun!

I think I’m going to invent Seroquel jimmies for ice cream.

Bipolar or ADD?

March 20, 2008

A reminder: I’m an engineer. This is all my opinion based on readings in a field that is not my own. I request that as you read my posts, you also check my references.

Cigarettes are powerful anti-anxiety drugs. It’s my opinion that may smokers are self-medicating an anxiety disorder.

Nicotine has calming effects on stress-induced mood changes in females, but enhances aggressive mood in males

“Exposure to moderate stress significantly increased ratings of anxiety, discontent and aggression and nicotine blocked these mood changes in females, but enhanced them in males. This suggests that young women may start regular smoking as a form of stress self-medication, which implies that preventative and smoking cessation programmes would be more successful in women if they addressed issues of stress and anxiety, which may be core factors underlying initiation and maintenance of regular smoking.”

A bipolar most certainly will get a high score on an ADD screening test like the Copeland symptom checklist. The symptoms of ADD overlap with the symptoms of bipolar. A bipolar child scores higher on the ADD screening test that a child with ADD. Your GP isn’t qualified to make a differential diagnosis, and in fact is likely to misdiagnose you and make your illness worse.

I’m going to quote from articles about children because misdiagnosis kills so many of them. It applies to adults too, but we don’t have parents to FORCE us to continue taking ritalin when it is obviously tearing us to pieces.

Diagnosing Bipolar VS. ADHD: Similarities

“There is concern that ADHD is being overdiagnosed and bipolar disorder underdiagnosed in the population of children.”

That being said, yes, I have ADHD combined type. My psychiatrist diagnosed it after I’d been seeing him for 10 years and after an evaluation that DIDN’T included taking an ADD screening test. Screening tests are useless for bipolars. You have to be cautious.

I have been through the entire pharmacopia, or it seems that way. Every ADD med I’ve taken makes me hypomanic within a week. So how I work it is that on days I really REALLY need to focus I take it. I have tried:
Ritalin (methyphenidate) – this is the one they give our children. Somebody please explain to me why 40% of American children need psych meds?
Strattera – this was the absolute worst for me. It interferes with metabolism in the liver of SSRIs, resulting in a huge buildup of both drugs. I was up there in 3 days and in a nasty mixed state in a week.
Provigil – similar to Strattera, but takes longer to build up. YMMV! 🙂
Adderall – amphetamine. SPEED FREAK! Three days in a row and I’m have “racoon eyes” and am well on my way to psychosis.

Strattera Risks May Widen
FDA,s warning about Eli Lilly’s drug Strattera causing suicidal thinking in children used for ADHD caught many parents and doctors by surprise.

“Dr. Laughren says the agency also plans to ask Lilly to include a stronger caution on Strattera’s label about its risk of inducing mania and similar mood destabilization, along with the new “black box” warning out this week. The new warning will focus on the drug’s risks for kids with undiagnosed bipolar illness, according to Dr. Laughren. In fact, “very often bipolar illness is not recognized until you [give] patients a drug like Strattera,” he says.”

Bipolar Disorder, Co-occurring Conditions, and the Need for Extreme Caution Before Initiating Drug Treatment

“Now understanding that early-onset bipolar disorder is frequently co-morbid with other childhood psychiatric conditions, doctors and parents should be concerned that a medication used to treat these other conditions may “flush out” a previously quiescent bipolar gene that can significantly worsen the course of illness and potentially wreak havoc with that child’s life. It is therefore vitally important that parents learn everything they can about their family histories, and if mood disorders (depression or manic-depression), suicide, or alcoholism come to light, treatment should proceed very cautiously. Mood stabilizers should perhaps be the first line of treatment (and it may take two such medications to stabilize the child), and attentional, obsessional, or depressive symptoms be treated only after a therapeutic dose of the mood stabilizer is achieved.”

The Overlap With ADHD

Perhaps the greatest source of diagnostic confusion in childhood bipolar disorder is that its symptoms overlap with many of the symptoms of attention-deficit disorder with hyperactivity. At first glance, any child who can’t sit still, who is fidgety, impulsive, easily distracted or emotionally labile is more likely to receive a diagnosis of ADHD than bipolar disorder. However, since over 80 percent of children with a bipolar disorder will meet full criteria for attention-deficit disorder with hyperactivity, ADHD should be diagnosed only after bipolar disorder is ruled out. While these two conditions seem highly co-morbid, stimulants unopposed by a mood stabilizer can have an adverse effect on the bipolar condition. 65 percent of the children in our study had hypomanic, manic and aggressive reactions to stimulant medications. Parents wrote to us and described some of their children’s reactions to stimulants. They said things like: “He got sky-high on Ritalin and then violent”; “Ritalin caused physical aggression”; “She got psychotic on stimulants”; “He got suicidal and tried to get run over by a car”; “He went bonkers…”

Don’t let a GP play with screening tests. See a psychiatrist.