On Bipolar Spectrum

FreePsychArticles #1:    “DOCTOR, I’VE BEEN TOLD I’M BIPOLAR.  WHAT SHOULD I DO NOW?”

Recently a 20-year-old male asked me this question.   After a 30-minute interview I told him he does have many of the diagnostic signs & symptoms of “BIPOLAR SPECTRUM DISORDERS.”   This is the latest term used to classify disorders of the mood characterized mood swings, periods of depression or low emotional states with subsequent or coincident irritability and high energy commonly found whether or not there is depression.
The range of mood disorders that fall within the Bipolar Spectrum are full of variety and only the most severe forms display the long period of depression and withdrawal followed by a period of high energy, euphoria, leading to grandiose delusions often with hallucinations.  When clinicians define “bipolar disorder” with the classic cycle of clearly defined periods of depression and manic highs with periods of normal mood states they often miss the wider spectrum of bipolar disorders that are much more common.   So when a seemingly depressed person presents to the clinician there very well may be a manic underpinning.   This has significant relevance since the antidepressant usually offered may help briefly to elevate the mood but in the long run will either aggravate the mania, increase irritability or generally destabilize the moods.

So when the young man told me how his sleep was impaired, sleeping short hours at best, sudden flights from his work and responsibility, irritability and oversensitivity to perceived slights and criticism I had enough information to advise him to find a psychiatrist who was expert with Bipolar Disorders.

Medication would probably be the best and quickest way to normalize the extreme symptoms he experienced.   This advise was further bolstered by the fact his symptoms caused disturbance in one or more of the major areas of his life:

1. Ability to function well at school or work
2. Ability to maintain pleasant, harmonious social relationships                                                                                       3. Loving marital life                                                         4. Physical health
5. Avoidance of civil or criminal problems                               6. Financial matters                                                           7. Basic psychological balance

Besides advising profession help, I explained some things he might not hear elsewhere:
1.  Realize that true Bipolar Spectrum Disorders bring certain qualities not “enjoyed” by the general population.  Heightened mood, mania or hypomania, in some cases, can be experienced as exciting or even pleasurable.   It can be difficult to give up these mood states, even if they lead one into disruption of normal daily activities or relationships with others.   There are many accounts of a connection between these moods and increased creativity.   Although there may be some truth in this, it is advised one first attempt to stabilize the disorder.                                                                                               2.  What has been termed “manic” also means “hyperaroused, energetic, pressured, driven, and often with a higher capacity for risks and creativity.
3.  Psychiatric treatment would only succeed if working closely to a doctor and following prescription directions.
4.  Very likely there would come a time when it might feel medications were no longer necessary and to stop the treatment without talking with the doctors would be
a mistake.   Most mental hospital emergency admissions of Bipolar patients occurred after they discontinued treatment or medications without or against the advise of the doctor.
5.  Medication would be adjusted as often as necessary to maintain a good effect and comfort.   Major discomfort due to the med’s should not be tolerated and always discussed with the doctor.  Side effects should be kept to a minimum but often there is a tradeoff with some side effects accompanying major overall benefit of stable moods.
6. The main goal for Bipolar Disorders was stabilizing the mood.

Once the medications began to improve moods, sleep patterns, concentration and social functioning to real work of adjustment began.  The medications merely work to level the playing field by neutralizing the exaggerated biologic and genetic factors.

Now comes the major development of understanding the disorder and, really, becoming an expert in how it really effects your life.

The talking part of treatment, especially Bipolar Spectrum Disorder is called “Psycho-education.”  This is equally as important as the use of medications to modulate and stabilize the mood.    Psycho-education’s aim is to “personalize” the basic clinical, theoretical and research results into a specific method to maintain stability for the individual patient.   Since there are an infinite variety of clinical pictures for Bipolar Spectrum, one needs to share and relate details of their life and symptoms to assist the doctor to arrive of a personal understanding of how this disorder effects daily life.   In doing so one can develop a “language” to understand and use to recognize and gain more control over many types of problems.

The list of problems is long but manageable.   Medications efficacy and side effects, recognizing and managing symptoms, avoiding relapse, daily decisions, relating with others, utilizing helpers, and psychological turmoil are just a few of the issues talked about in Psycho-educational therapy.

Re-integrating back into one’s life activities is a major concern following episodes of mania or depressive withdrawal.   There is always a question of “when is the right time to return to a job, school or other activity?”

These are some of the issues to be discussed in future articles.

Gershon Freedman, MD

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