tag:blogger.com,1999:blog-21605329.post3782976634016913331..comments2024-03-19T02:52:27.788-07:00Comments on The Neurocritic: Akiskal and the Bipolar SpectrumThe Neurocritichttp://www.blogger.com/profile/08010555869208208621noreply@blogger.comBlogger14125tag:blogger.com,1999:blog-21605329.post-1134467406541866042022-03-10T12:22:14.170-08:002022-03-10T12:22:14.170-08:00The distinctions between Bipolar 2 and Cyclothymic...The distinctions between Bipolar 2 and Cyclothymic Disorder is not helpful, because depression is very serious, even if if seems mild.<br /><br /><br />My prolonged mania is a mystery.<br /><br /><br />After severe mania with history of severe delusions, at the age of 15, after I started to take medications, my manic episode became milder, and felt like a narcissist for five years until I became very depressed, all of that feelings was gone. I still functioned very all those years and still do. My symptoms of Bipolar Disorder looks like Cyclothymic Disorder, because I am on medications, but even then, depression is very serious.Oren Franz2https://www.blogger.com/profile/06414688542921223789noreply@blogger.comtag:blogger.com,1999:blog-21605329.post-62849192188677782162020-12-24T11:46:45.154-08:002020-12-24T11:46:45.154-08:00I think the diagnostic criteria for Bipolar and re...I think the diagnostic criteria for Bipolar and related Disorder should be called “Manic<br />Spectrum Disorder”.<br /><br /><br /><br />Bipolar Disorder:<br /><br />Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental<br />disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the<br />ability to carry out day-to-day tasks.<br /><br /><br />Types of Bipolar and related disorders:<br /><br />● Bipolar I Disorder— defined by manic episodes that last at least 7 days, or<br />by manic symptoms that are so severe that the person needs immediate<br />hospital care. Usually, depressive episodes occur as well, typically lasting at<br />least 2 weeks. Episodes of depression with mixed features (having<br />depressive symptoms and manic symptoms at the same time) are also<br />possible.<br /><br />● Bipolar II Disorder— defined by a pattern of depressive episodes and<br />hypomanic episodes, but not the full-blown manic episodes that are typical<br />of Bipolar I Disorder.<br /><br />● Cyclothymic Disorder (also called Cyclothymia)— defined by periods of<br />hypomanic symptoms as well as periods of depressive symptoms lasting<br />for at least 2 years (1 year in children and adolescents). However, the<br />symptoms do not meet the diagnostic requirements for a hypomanic<br />episode and a depressive episode.<br /><br />● Substance/Medication-Induced Bipolar and Related Disorder- This<br />condition occurs when the mood disturbance symptoms occur during or<br />soon after taking a substance or stopping use of a substance that is<br />capable of producing the bipolar symptoms. These symptoms can include<br />an elevated or irritable mood, or depressed mood that may or may not occur<br />with a loss of interest in or pleasure from activities.<br /><br />● Bipolar and Related Disorder Due to Another Medical Condition - This<br />diagnosis is used when symptoms are produced by a medical condition<br />(not another mental health condition). There must be evidence from a<br />health history, physical examination or lab tests that the symptoms are<br />directly related to another medical condition. The mood symptoms cannot<br />be the result of another mental health condition, only a medical one. They<br />must also be causing a lot of stress or problems with school, work,<br />relationships with others, or daily activities<br /><br />● Other Specified Bipolar and Related Disorder - This category applies when<br />symptoms cause significant distress or impairment, but do not meet the full<br />criteria for any of the other disorders in this category. This is used when the<br />clinician specifies the reasons that criteria are not meet (for example, not<br />quite enough days or symptoms displayed to trigger the full diagnosis).<br /><br />● Unspecified Bipolar and Related Disorder - This diagnosis is used to<br />describe situations where the clinician chooses not to specify the reason<br />that the criteria for one of the other types are met or when there is not<br />enough information available to make a more specific diagnosis.<br /><br /><br /><br />I don’t think that Bipolar I, Bipolar II, Cyclothymic Disorder, Other Specified Bipolar and<br />Related Disorder and Unspecified Bipolar and Related Disorder is very helpful.<br /><br />Not everyone is going to have all the symptoms of Bipolar Disorder or related disorders. Another problem is that<br />there are disorders that includes symptoms of mania, but are not Bipolar Disorders and<br />there are disorders that includes mania without depressions.<br /><br />The symptoms of Bipolar and related disorders can be profound and all the way to mild to<br />the point where you can have Bipolar or related disorders and nor you or anyone will find out that you<br />or they have it.<br /><br /><br /><br />That is why I think it should be called “Manic Spectrum Disorder”<br /><br /><br />Manic Disorder:<br /><br />Extremely elevated and excitable mood usually associated with bipolar disorder.Oren Franz2https://www.blogger.com/profile/06414688542921223789noreply@blogger.comtag:blogger.com,1999:blog-21605329.post-86012470319913124772017-09-10T12:16:20.537-07:002017-09-10T12:16:20.537-07:00There is some misunderstanding of Akiskal's pa...There is some misunderstanding of Akiskal's papers here. Most of them argue that psychiatric medications should be minimized for the affective temperaments (also called bipolar spectrum or soft bipolarity). He consistently advocates for psychotherapy as the best approach to temperament, and makes humanistic arguments that psychiatrists should "respect" the patients temperament to avoid "aggressive" over-medication.<br /><br />He does suggest that temperament can help inform the choice of medication if it is used, but most of his papers focus on psychosocial areas like career counseling for people with affective temperaments rather than medication. His view is that affective temperaments can help doctors understand the person behind the diagnosis, as well as the genetics behind bipolar and depression. <br /><br />Most academic psychiatrists have relationships with the pharmaceutical industry, and Hagop Akiskal is one of the few among them who has not traveled extensively to give paid talks for the pharmaceutical industry.Chris Aiken, M.D.http://www.moodtreatmentcenter.com/noreply@blogger.comtag:blogger.com,1999:blog-21605329.post-42674844009224040232014-08-15T08:52:33.813-07:002014-08-15T08:52:33.813-07:00What if industry invites Akiskal because of his wr...What if industry invites Akiskal because of his writings and not otherwise?<br />Please consider that any field in human medicine nowadays has industry support and i'm not saying that's a good thing or the only way but that's the American way. Don't forget although that URSS reached space first.John Cenasnoreply@blogger.comtag:blogger.com,1999:blog-21605329.post-47134288997900196542013-01-31T01:39:43.964-08:002013-01-31T01:39:43.964-08:00I havae rapid cycling bipolar I. IMHO drugs as Zyp...I havae rapid cycling bipolar I. IMHO drugs as Zyprexa should only be given to patients that are actually psychotic or at least bordering mania.<br /><br />Living with these drugs is not easy and there are serious side effects for most patients. There must be a serious problem before these drugs are even considered and there must be strong benefits to keep using them. That said, Zyprexa etc, has been a life saver for me. It is truly an amazing drug.<br /><br />Furthermore, I strongly dislike that young people with relatively normal problems in life are diagnosed at all with anything but "find a grownup to talk to". Giving them anti-psychotics is very, very wrong.<br /><br />Doctors that prescribe anti-psychotics should be forced to try them to see the effects they have on normal people, or indeed bipolar patients that are low.<br /><br />Ask anybody with true bipolar disorder and they can explain the difference. When manic these meds make you virtually normal. When normal these meds make you a zombie.<br />bipolarnoreply@blogger.comtag:blogger.com,1999:blog-21605329.post-56166979668836499372011-06-17T13:11:01.413-07:002011-06-17T13:11:01.413-07:00Thanks for weighing in, Don. I agree with you on t...Thanks for weighing in, Don. I agree with you on the heterogeneity of clinical depressions, and I should have made it clear that the D and d concept that I picked up from Jules Angst applies to the endogenomorphic domain.Bernard Carrollhttps://www.blogger.com/profile/16203083806436919715noreply@blogger.comtag:blogger.com,1999:blog-21605329.post-88473474123959819942011-06-17T12:44:03.142-07:002011-06-17T12:44:03.142-07:00I almost always agree with Carroll and Angst but h...I almost always agree with Carroll and Angst but here think they may be over simplifying in that D is dividable into Endogenomorphic (SSRI,TCA,ECT) responsive and Atypical(MAOI responsive--not SSRI,TCA,ECT responsive--if adolescent onset--as I think Barney has contemplated previously--and probably Mania comes in discrete forms<br />Where classic Bipolar I (lithium responsive) vs others with a whole variety of complex partial seizure symptom <br />manifestations often do better on anti-convulsants--though this is personal opinion and not well documented.<br />This certainly agrees with Barney's point about independent regulators re mood,energy,appetitive and consummatory hedonics.<br />Cordially<br />Don KleinDon Kleinnoreply@blogger.comtag:blogger.com,1999:blog-21605329.post-46266051738812032382011-06-15T11:25:44.394-07:002011-06-15T11:25:44.394-07:00is one's proliferation of papers in one's ...is one's proliferation of papers in one's own journal a sign of Bipolar I perhaps?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-21605329.post-54627610829937466502011-06-15T06:48:17.838-07:002011-06-15T06:48:17.838-07:00Surely anyone familiar with the psychological char...Surely anyone familiar with the psychological characteristics of human beings would have observed that most traits or mental disturbances occur on continua. Rarely is an individual so simple that they have just one aspect to any unusual thinking or behaviour, but likely a combination of differing strengths of several from the possible spectrum. My preference is to have just one category: 'Mood disorder' with everything else, whether mania, depression or psychotic aspects, added as 'features'. Then we can cut down on labeling (and writing about the labels with examples) and concentrate on individuals suffering their own species of mood disorder, so we can work out strategies to deal with the symptoms which are most disabling.Murfomurfhttp://healthforhumans.blogspot.comnoreply@blogger.comtag:blogger.com,1999:blog-21605329.post-49429028593173788602011-06-14T22:27:27.687-07:002011-06-14T22:27:27.687-07:00Dr. Carroll - Thanks for your comment. The part ab...Dr. Carroll - Thanks for your comment. The part about "latent sociopathy" was very amusing...The Neurocritichttps://www.blogger.com/profile/08010555869208208621noreply@blogger.comtag:blogger.com,1999:blog-21605329.post-70490458398504715382011-06-14T22:23:16.803-07:002011-06-14T22:23:16.803-07:00I believe that last comment was from someone affil...I believe that last comment was from someone affiliated with Bipolar Advantage, which is located in Tiburon, CA {the IP address was from neighboring Mill Valley, CA}.The Neurocritichttps://www.blogger.com/profile/08010555869208208621noreply@blogger.comtag:blogger.com,1999:blog-21605329.post-12634254336580644412011-06-14T22:06:38.578-07:002011-06-14T22:06:38.578-07:00You should go to the Presidio library tomorrow nig...You should go to the Presidio library tomorrow night to hear about Bipolar IN Order<br /><br />http://www.bipolaradvantage.com/NewsEvents/Events/2011-07-09_Marin/EventsMarin.phpAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-21605329.post-62365140753350582372011-06-13T10:17:56.183-07:002011-06-13T10:17:56.183-07:00I think Anonymous takes too strong a position. I h...I think Anonymous takes too strong a position. I have long been partial to Jules Angst’s proposal – that there is severe or mild depression (D or d) as well as severe or mild mania (M or m) and that any given patient may display some combination of these, i.e. DM (bipolar I) or dM (another form of bipolar I) or Dm (bipolar II) or dm (cyclothymia). Then there are a few patients with just M (so-called unipolar mania) and a lot of patients with just D (unipolar depression). I leave it to others to decide about cases that display just d or m. As Kraepelin said, the manifestations of manic depressive illness show infinite gradations, merging imperceptibly from clinical episodes into temperament.<br /><br />Keep in mind that the commonest psychiatric disorder in the families of bipolar probands is D, unipolar depression. And, as Kraepelin taught us a century ago, there are also mixed manic-depressive states. One of my memorable mixed MD patients, pacing the ward and wringing his hands in agitation asked me didn’t I think his depression was the absolute worst depression in the entire history of the world! The admixture of painful depressed mood with grandiosity was striking.<br /><br />The very existence of mixed states tells us that separate circuits mediate distinct components of affective disturbance, and that these components are orthogonal. A neurodegenerative process may release depressive or manic symptoms and behaviors by knocking out the modulation of these circuits, but Occam’s razor requires that we refrain from metaphysical speculations like Ng et al’s suggestion that the dementia “released latent bipolarity.” You might just as well say that when patients with early dementia start shoplifting and swearing and hitting people they are displaying latent sociopathy.<br /><br />Here is more on the topic of brain mechanisms in manic-depression. http://www.ncbi.nlm.nih.gov/pubmed/8313611Bernard Carrollhttps://www.blogger.com/profile/16203083806436919715noreply@blogger.comtag:blogger.com,1999:blog-21605329.post-64438382778947651012011-06-13T05:37:12.381-07:002011-06-13T05:37:12.381-07:00There is really only one true bipolar disorder and...There is really only one true bipolar disorder and that is Bipolar I. The rest of the "bipolar spectrum" nonsense is complete BULLSHIT.Anonymousnoreply@blogger.com