Medication and Reduced IQ

April 4, 2009

The Maudsley Bipolar Disorder Project: the effect of medication, family history, and duration of illness on IQ and memory in bipolar I disorder.

This article presents evidence that psych meds make us sicker.

“Patients on treatment with antipsychotic drugs had a lower current full scale IQ, lower general memory scores, and lower working memory scores. A family history of affective disorders was associated with a higher full scale IQ, but not with either general or working memory measures. Duration of illness was negatively associated with general memory scores, but had no effect on either IQ or working memory measures.”

Mental Health Rules Put in Bailout

October 6, 2008

The above link is to the full text of the bailout bill, and I suggest that everybody read this bill. It was pushed through with only a couple of days debate by lawyers who have little understanding of the workings of Wall Street or The Fed. And they tacked a lot of pork barrel spending onto it to BRIBE Congress to agree to it. Unfortunately, mental health parity verbiage was tacked onto the bill with the pork. NAMI, of course, is celebrating the bill for its own sake without regard to what effect it will have, or when. Having appeased the mental health lobby, congress is off the hook as far as enacting any further legislation. Way to go!

“To amend section 712 of the Employee Retirement Income
Security Act of 1974, section 2705 of the Public Health
Service Act, section 9812 of the Internal Revenue Code
of 1986 to require equity in the provision of mental
health and substance-related disorder benefits under
group health plans, to prohibit discrimination on the
basis of genetic information with respect to health insurance
and employment, and for other purposes.”

This means that you only get parity if your employer provides your insurance AND that insurance already has mental health coverage. It doesn’t seem to require them to cover it in the first place. It also doesn’t appear to apply to private health insurance.

There is a cost exemption so to limit mental health coverage if it increases costs by some undetermined amount. The insurance companies can still deny claims bases on their definition of “medical necessity” or by their definition of “reasonable and customary” services.

6 ??(A) IN GENERAL.?With respect to a
7 group health plan (or health insurance coverage
8 offered in connection with such a plan), if the
9 application of this section to such plan (or cov
10 erage) results in an increase for the plan year
11 involved of the actual total costs of coverage
12 with respect to medical and surgical benefits
13 and mental health and substance use disorder
14 benefits under the plan (as determined and cer
15 tified under subparagraph (C)) by an amount
16 that exceeds the applicable percentage described
17 in subparagraph (B) of the actual total plan
18 costs, the provisions of this section shall not
19 apply to such plan (or coverage) during the fol
20 lowing plan year, and such exemption shall
21 apply to the plan (or coverage) for 1 plan year.”

Discrimination on the basis of genetic information only affects illnesses for which genetic tests have been developed. This bill ignores a lot of of the provisions of the ADA, while modifying ERISA quite a bit. I am concerned that this will weaken the ADA by tightening the definitions to exclude non-genetic diseases.

Specific diagnoses this bill applies to will be determined by the GAO, which has 3 years to study it and present a report. Once the beancounters are through will this bill, we’ll have no more than we had the day before the bill passed.

6 (1) IN GENERAL.?The Comptroller General of
7 the United States shall conduct a study that ana8
lyzes the specific rates, patterns, and trends in cov9
erage and exclusion of specific mental health and
10 substance use disorder diagnoses by health plans
11 and health insurance.”

I doubt this will change anything in the near future.

A few years from now you’re going to hear Congressdroids bitching because they didn’t have enough time to collect the facts before enacting this bill.

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.

How to Identify Mania

May 6, 2008

How to identify mania:

One way is to make a rough calculation of the percentage of support list email that is yours. Is half the email yours? That’s the support list equivalent of being at a party and running around in a frenzy trying to keep tabs on every conversation.

My personal favorite way to tell is to read my own posts and count how many times I begin a paragraph with the word “I”. If I write a post and every goddam sentence is about me, me, me, then I know that I should be talking to a therapist instead of taking energy from people whose boundaries are too soft for them to say or even think “no” or “you are a boring, self-involved twit.” When folks talk talk talk, it’s because there’s something that they want to say. Not the mush that comes tumbling out in idle chit-chat, but something important and maybe life-changing. OMFG, no, keep talking loud and fast so that you can’t hear it.

In case you aren’t aware of yourself enough to gauge when your thoughts are racing, you are emotionally labile, or you are feeling overly optimistic, grandiose, charitable, attractive, psychotic or whatever else might be part of your mania, then you have to focus on your behavior. Or more specifically to others’ reactions to your behavior.

I realize that gaining some awareness is the first step in being able to reduce your meds, get out and make new friends, do volunteer work or maybe even get job training, and eventually even stop hating yourself and your bipolar disorder. In a way, allowing yourself to be competent and independent is like sawing off the branch you’re sitting on if your continued access to medical care requires that you be sick enough to qualify for it.

Can you imagine being paid to stay sick?

The Invisible Plague

April 26, 2008

I’m not doing so well. I had a steroid-induced hypomania for about two weeks, and a subsequent crash. I was able to continue working through it, but I’m going to need a few days off to completely level out. Unfortunately I work for a company with only 5 people, and I do the testing so that we can ship product and bill the customers for all our hard work. It’s hard to get even one day off. I took off on Friday and had to take calls all day long. I might as well have gone in.

I really enjoy my work. Engineering is just as creative as any of the humanities. The main difference is that it attracts linear-sequential people and reductionists. That trait and that philosophy can be real creativity-killers.

Hypomania, or mild mania, can be socially and financially devastating. It’s the reason I sought treatment for the bipolar disorder. “Why do I get so stupid and unreasonably optimistic over and over again?” “Why do I keep making the same mistakes?” Hypomania by definition doesn’t include psychosis, so the impairment is completely due to over-optimism. As an engineer I have Mad Skilz at reality testing.

I usually avoid steroids for that reason, but my back is a mess from the accident last year and I got an epidural to have some relief from the pain. I also avoid painkillers because opioids are a guaranteed depression. There is a DSM-IV code for opioid-induced mood disorder.

Hypomania is exhilarating. Without an occasional hypomania, life is in shades of grey. Dorothy in Kansas. All bipolars have to accept that the price of avoiding hell is to give up heaven.

No meds stop mood swings completely but they make them tolerable and easier to manage. It takes a bit of effort to avoid triggers like lack of sleep, stress, etc. I do ok. A lot of folks on the list and the forum will never do ok. There but for the grace of God go I, eh?

I saw a book online while maintaining the forums this morning. I think you know the researcher EF Torrey? He has a new book called “The Invisible Plague: The Rise of Mental Illness from 1750 to the Present.”

I don’t feel like a deadly bacillus. Mental illness isn’t contagious! You can read everything I write, you can shake my hand and even drink from my glass, but you won’t catch get bipolar disorder from me. So why call it a plague? Why not focus on the triggers that cause a simple genetic propensity to become full-blown mental illness? Is that the point, to avoid implicating societal forces like the switch to strict industrial time constraints in the time frame Torrey’s book covers? Which, incidentally, was fueled by the shortage of workers in post-Plague Europe, but that’s another story. I’m a history buff and I really get into anthropology.

Refer to Edward T. Hall’s “The Dance of Life: The Other Side of Time” for a fascinating exploration of the perception of time as defined by our cultures.

And if you like rock, listen to Dire Straits “Industrial Disease.”

How does Torrey plan to eliminate mental illness? Does he want to go back to forced sterilization? Take biopsies of unborn children to identify and abort diseased DNA, thereby destroying even the unaffected siblings? Or is he content to make a good living calling us names? “Plague” indeed!

Pharmaceutical Chastity Belt

April 17, 2008

Pretty much any psych med by itself will affect sex drive. I see folks taking a half a dozen of them, and then another med or two to counteract the side effects. The pdocs tell us that they DON’T because they don’t want us to quit taking them.

Perhaps we should refer to our meds as a “pharmaceutical chastity belt.”

Anything that tweaks your dopamine down is going to get rid of the emotional spark required to have something resembling a sex life. And anything that tweaks UP serotonin receptors does so at the expense of dopamine receptors. See this article, Notes on Anhedonia and SAD.

For men, there’s also the problem of peripheral blood flow – a strictly mechanical problem. Can’t get the old hydraulics to run, eh? Viagra and Cialis work by improving blood flow. Heck, coffee dilates the blood vessels too, and if you brew it at home it’s way cheaper than an ED pill. Diabetes is common cause of ED, so antipsychotics that affect blood sugar (most of the atypicals) might contribute to it.

Maybe the whole idea is to give us drugs that prevent us from breeding lots of little bipolars.

Majnoon or Jinn?

April 8, 2008

Today I learned that the Arabic word for mental illness has the same etymology as the Arabic word for evil spirits. This has an unfortunate effect on how the mentally ill are perceived in the Middle East.

Language is an odd thing. It enables you to express your innermost thoughts and feelings. BUT it almost guarantees that the thoughts and feelings you express have been totally shaped by the language itself. In the words of comedian Lenny Bruce,

“Believe me, I’m not profound, this is something that I assume someone must have laid on me, because I do not have an original thought. I am screwed. I speak English. That’s it. I was not born in a vacuum. Every thought I have belongs to somebody else.”
— Lenny Bruce, quoted on Rakes Progress: Lenny Bruce is not afraid

So what’s happening is that as long as the doctors use that old-fashioned word to describe mental illness, demon-possessed the mentally ill will remain.

Arabs don’t have a monopoly on superstition though. The following TinyUrl will take you to a google search for “mental illness exorcism.”