Tag Archives: diagnosis

SSDI Prep – A Doctor’s Testimony

I got a call from my SSDI lawyer this week. Basically he wants to add the testimonies of at least one doctor to my case files, preferably the psychiatrist I’m currently seeing, if not another as well.

The trouble with this is that 99% of doctors will not do this for free. And when I say not for free, I mean it costs several hundreds of dollars for each doctor.

My lawyer assumed (correctly) that I have virtually nothing in terms of money but told me my chance of being awarded a favorable verdict will require more proof from a doctor. 

Obviously, I believe him, and though I often scrape by doing whatever it takes to survive, this is a situation where I need to do whatever I can to win. At this point I’ve put over a year of my life into this process, and it is important for me to feel like I’ve done everything I could do to increase my chances of coming through it on top.

(Ok, so I’ve been watching too much survivor, and clearly that doesn’t mean things like lying or cheating or stealing, just the general sort of MacGyvering I do to figure out how to solve the (there isn’t enough) money problem.)

As of right now, I am waiting to hear back from the attorney about how much it would cost for my doctor to do the review I need, and then I will figure out from there weather I can make that work or need to find another solution.

Ultimately the answer will probably be another form of deprecation. Giving up my phone to save what I need to, or not eating out for the next six months, or whatever. Realistically, this is the sort of thing that comes standard with my life, and it isn’t something I’m complaining about, just stating. Of course, if I can figure out a way to have my cake and eat it too, I will.

I think the point of all of this is really to convey how much our current social security disability system requires one to give up before offering them a chance to be taken care of. I mean, I would gladly give the doctor everything I have if it guaranteed me a social security award, but that isn’t the case. When applying for social security means living for over a year without any income and relying on the people around you to take care of you simply for a chance to make your case to the government, I must say it is a very hard road to go down.

I realize that people say that if it wasn’t hard, everyone would do it… but is this system causing the people with the most need extra unnecessary hardship?

In any case, I knew this was what I would be getting into when I started this process a year ago, and that is why I waited for so long to give it a go. I wanted to be sure that this was the right road to be going down, and despite the hardships I am still sure. Still pressing forward, figuring it out as I go.

Brain Scans Might Identify Bipolar in Youth

Australian researchers were recently using MRI to view the brain activity of young people who were shown pictures of faces with a variety of expressions on them.

“We found that the young people who had a parent or sibling with bipolar disorder had reduced brain responses to emotive faces, particularly a fearful face. This is an extremely promising breakthrough,” study leader Philip Mitchell, of the University of New South Wales, said in a university news release.

The article over on US News Health says that the brain imaging technique may be used to identify young people who are at risk (genetically pre-disposed, etc.) but who do not yet have bipolar symptoms. By identifying the risk as soon as possible, intervention and treatment can begin much earlier.

There are more details in the article here, it is an interesting concept!

The thing that interests me the most about this breakthrough it what it means for young people, and what it might have meant for me if this technique was employed when I was a teenager.

I know many people have expressed that they almost wouldn’t want an early detection of bipolar disorder, and that living in something of an ignorant bliss before symptoms hit was a chance to live life to the fullest before things came to a grinding halt.

From my own experiences though, I can say that it would have been really beneficial for me to have known early on that bipolar disorder was something I was predisposed to, as my symptoms came on quite swiftly after being given an antidepressant (the wrong treatment) and I had to be hospitalized. Could that hospitalization have been prevented? With the technology and knowledge we have today, the answer is a potential yes. 

What do you think? Would you rather have known earlier that you were predisposed to bipolar disorder, or do you think it would have made a difference in your life and recovery?

DSM-V Preliminarily Approved by Psychiatric Association

So, some pretty big news about the latest version of the Diagnostic and Statistical Manual of Mental Disorders (or simply “DSM” -this will be version 5). On Saturday it was announced that the American Psychiatric Association has preliminarily approved the major changes in the latest edition.

The DSM is the standard for the criteria for mental disorders in the United States, and generally determines what most insurance companies will cover. The manual has been considered somewhat outdated for several years, which is why this newest edition has been compiled. Revisions have been happening for over a decade, so the news that changes in the new DSM-V have been approved is definitely long-awaited.

I think I can safely say that any changes to a disorder people have been diagnosed with, or the total removal of a disorder is unnerving at best, and there are several changes in the new DSM that many people are getting worked up about. Generally, people are opposed to change, so even though the changes in the DSM (made by many of the leading doctors in the nation) have been made with the best intentions, you can expect to be hearing that some people are upset about the way the latest edition has panned out.

Personally, I’m not a doctor or a scientist, so I don’t really understand the implications that some of these changes have. Will it help more people? Will it help less people? I don’t know. I am already wary about the diagnostic process in America and often wonder whether a diagnosis helps more often than not… but there are several conflicting schools of thought on this subject, none of which I find myself subscribing to whole-heartedly.

So, here are a few of the bigger changes (that I’ve seen many people becoming upset over or overjoyed about) for better or worse:

Gender Identity Disorder has been removed from the DSM, with the new phrase gender dysphoria” being used to describe emotional distress over

“a marked incongruence between one’s experienced/expressed gender and assigned gender.”

Many people in the GLBT community are heralding this as a welcome (and groundbreaking) change, because it separates the issues of gender identity and disorders, suggesting that gender identity issues are not the product of having a disorder of some kind.

Autism Spectrum Disorder is the new umbrella term for a number of previous diagnoses, including autism, Asperger’s syndrome, pervasive developmental disorder – not otherwise specified (PDD-NOS) and childhood disintegrative disorder. With this new spectrum diagnosis, all previous individual diagnoses no longer exist.

Many people are extremely concerned about this change out of fear that their insurance coverage will change, and intense confusion with feelings of loss around these old diagnoses and what the new diagnosis means.

From what I understand, this new model has many benefits -they simply have not fully been explained at this point. But, by using a spectrum model, doctors will be able to diagnose based on the severity of symptoms, rather than by using a checklist. Also, according to a number of websites I found, patients will not be losing their current diagnosis unless there is some reason to re-diagnose them. Granted, as I said, I can imagine how it must be difficult to hear a diagnosis someone may have worked long and hard to identify and clarify is no longer going to given to others, so all we can really do at this point is wait and see what happens.

No More “Bereavement Exclusion” for MDD means that if a patient has symptoms of depression after two weeks after the death of a loved one, they can be diagnosed with major depression. Previously, symptoms (that would normally be considered depression) would not be labeled as depression if they were related to the death of a loved one.

More additions and changes are included for binge eating disorder, disruptive mood dysregulation disorder, excoriation (skin-picking) disorder, hoarding disorder, pedophilic disorder, post traumatic stress disorder, and substance use disorder.

Currently, only major changes are being released, so I am patiently awaiting when we can find out about more minor changes. I’m curious to see if any of the changes that were proposed for bipolar disorder will have made it into the new edition. The long awaited DSM-V will be published in May, 2013.

Here are links to a couple of the articles with more details about the approval.

Study Finds Bipolar Disorder Prevalent in Panic Disorder Patients

This morning’s sweep of the internet turned up a new study by the University of Tokyo, Japan suggesting bipolar disorder is common among Japanese patients who were being treated for panic disorder.

Panic disorder is an anxiety disorder marked by repeated attacks of intense fear that something bad will happen. This is often accompanied by repeated panic attacks, generally peaking between 10-20 minutes at a time.

It seems like people have been drawing conclusions between bipolar disorder and anxiety disorders for a while now, and I find this study particularly interesting because of how interwoven anxiety is with the bipolar symptoms in my own life.

The study by the University of Tokyo, Japan (and colleagues) found that:

22.3% of 649 patients (434 women) with panic disorder met criteria for, or had a previous diagnosis of, bipolar I (BD I) or II (BD II) disorder.

That is nearly a quarter of the panic disorder patients studied, which is huge considering that they figured the prevalence of bipolar disorder in the general population was only estimated at about 0.2%.

The study, which was published in the Journal of Affective Disorders, said 17.1% of total patients had bipolar type II, while 5.2% had bipolar type I.

The conclusion that such a high rate of bipolar disorder was found in panic disorder patients is important because the first line of treatment for anxiety disorders is usually antidepressants (which can quickly worsen bipolar symptoms). Knowing that those with panic disorder are more likely to have bipolar disorder than the general population can help doctors when considering treatment options for those with panic disorder across the board.

For more details on the study, you can find the whole article here.

Celebrities; Coming Out or Outed?

Lately, the influx of news on celebrities with bipolar disorder has been exploding. 

Doing a google news search of the word “bipolar” leads to sloughs of articles like this one claiming to have news on handfuls of everyone from hollywood celebrities to athletes, and even folks working in politics who have bipolar disorder.

Now, I have some real mixed feelings about all of this, because I’ve often considered these articles a place for little more than gossip. The word gossip, to me, suggests sharing information that might not be true, and information that isn’t consented by those who are being talked about.

Knowing that a successful celebrity is experiencing similar symptoms as us can really run home that mental illness can affect anyone, and in a sense I believe these articles are beginning to help people become more familiar with illnesses like bipolar disorder -which helps lessen the stigma for all of us.

But, I can’t help but wonder how detrimental it can be to those who are in the public eye and facing bipolar disorder. Can you imagine if one of these newspapers or websites printed an article about you having bipolar disorder before you were ready to talk about it with anyone outside of your family or friends? What if someone told your co-workers, the people at your gym, and essentially the entire nation about the state of your mental health without asking you about it first?

These folks are essentially being outed, and once everyone knows (or even believes) that you have something like bipolar disorder, there isn’t really any way to go backwards and let it remain a private matter.

Can you think of any other situations where people have been weeded out, and then thrust into the public eye? How about the McCarthy era? Or even homosexuality, as it became more prominent and accepted in our society? Personally, I just see this as extreme bullying.

I realize that I am someone who is out, I tell people both privately and publicly about my experiences with bipolar disorder, but my real point here is that I made the decision on my own. It is one thing to feel strong enough and ready to take on what people might throw back at you for being open about mental illness, and another matter completely to have someone pull the rug out from under you and do it without your consent or before you are ready.

As I said, I think being able to look up to celebrities or our own personal heros (mine being Carrie Fisher who has been out about having bipolar disorder for quite some time) is important, and a wonderful growing addition to help America understand that mental illness may not mean we are unsuccessful, or hard to work with, or… well, evil or anything. But, it is important that people are ready to deal with the waves of questions, and the uncertainty that may come with being open about mental illness, and being pushed into that arena too soon can be extremely detrimental to what might be an already unstable situation.

The next time you see an article or a news segment on someone like a previous teen star who has recently been diagnosed with bipolar disorder, I hope you will consider the notion that the information may not have been something they expected to share. In that sense, celebrities are just like everyone else.

Though it is my own personal dream that people can talk openly about mental illness in any situation, with anyone, and feel comfortable doing it, I think it is important to realize that some people aren’t comfortable yet. And if celebrities are the ones paving the way for this dream to be realized, I think it is important to understand that it may not have been entirely willingly.

I would say that what most would consider the “sacrifice” of losing my-life-where-I-was-hiding-having-bipolar-disorder in exchange for one where my mental health is an open topic for conversation doesn’t feel like a sacrifice anymore.

In fact, I’ve found that the water is much warmer, the fish are much friendlier, and the ocean current isn’t as strong as it was when I was trying to swim it alone.

In conclusion, I do not plan to pass on any celebrity gossip, only accounts on mental health that are being put forward by the person in question themselves. I want to encourage people to be open about what they think and feel and believe, but I believe that can happen without bullying anyone into doing it or talking behind anyone’s back. I believe being open can inspire others, and that inspiration wont need any pushing or gossip because it’ll do the work for us. 

I do hope the other bloggers here on wordpress will consider making a similar pledge.

When the Doctor is Away

Many people I know who experience symptoms of mental illness have partnered up with a therapist, psychiatrist, prescribing nurse, or general doctor to aid in their care. These kinds of relationships may take a lot of time and effort to grow, and from my own experience I can say that things like trust and understanding don’t come immediately, they generally take some time to form.

That said, it can be a harrowing experience when you have built this kind of relationship and lose access to it when your professional partner in care is sick, experiencing an emergency, or taking time off.

I know I’ve talked a little bit about this before, but my recent circumstances (basically experiencing intense symptoms and being unable to work while my psychiatrist is out of town) have been something of a reminder that it is never a bad time to create a plan in case of future emergency -and know what you need to do in case that emergency occurs when your professional support person is not available.

Now that the weather in Seattle has finally started to turn and it is obvious that fall is upon us, I thought this might be a good time to bring this up again as well. Winter can be a particularly difficult time for people who experience depression or mood swings, particularly in the Pacific Northwest.

So, here are some suggestions that could help you avoid unnecessary risk and potentially make a difficult situation much easier.

1. Talk to your professional support people about what to do in the event of an emergency in their absence. Your therapist or doctor may have special instructions on who to contact if you are having an emergency and they are gone, so speaking with them before and emergency occurs is a great way to start setting up an emergency plan for yourself. At the same time, you may want to request that your support person give you notice if they will be going out of town so you can be well prepared in the event of an emergency.

2. Consider the needs you might have in an episodic emergency and discuss with your doctor if having an emergency medication (such as an antipsychotic you can take as needed) is a possibility in your situation. If an emergency medication is not a possibility, at the very least I would suggest making sure you have enough refills to last the duration of your doctor’s absence.

3. As discussed in In Case of Emergency, I would highly suggest taking the time to create a card or sheet of paper you can carry in your wallet/purse with the following information on it:

  • Your primary care doctor’s name and contact information
  • Your therapist’s name and contact information
  • Any diagnoses you may have
  • Your current medications and dosage information
  • Your medication allergies, if any
  • Any previous hospitalizations
  • And if I am in a situation where I might be given a new medication to try, I like to include previous medications I’ve taken, dosages, and what effects they had (namely the reason I am no longer taking them).

This information can be extremely helpful to have in an emergency when the professionals attempting to help are unfamiliar with your particular situation. It might even be wise to add notes on things like, “do not give antidepressants” in the medication allergies section if you have a history of switching to mania when given an antidepressant. Just last week I had to wrestle with my general physician because the seemingly obvious thing to do (in his opinion) was to give me an antidepressant for my current situation of depression. My psychiatrist absolutely knows better, but my physician isn’t familiar with my history -which is why it is important to be able to relay this information to someone new.

4. Create a plan with someone close to you that defines exactly what an emergency situation is, and when emergency procedures need to take place (such as the emergency room or potential psychiatric hospitalization). It might be helpful to consider the following questions to help define what an emergency looks like to you:

  • Are you someone who is more likely to seek emergency care because of a depressive episode, a manic episode, or a mixed episode?
  • Have you sought emergency treatment before? What symptoms made it an emergency? (Ex., suicidality, homicidality, psychosis, self harm, etc.)
  • Have you experienced a range of severity levels in these emergency symptoms?

For example, I have a 0-3 rating scale for suicidality. If it is at 0, it is not occurring. At level 1, new suicidal thoughts begin occurring in a fleeting way. At level 2, I begin flirting with the suicidal thoughts, and that is where suicidal ideation begins (imaging different acts of suicide). Level 3 denotes a place where I feel convinced suicide is the correct course of action.

So even though “suicidality” might be my emergency symptom, I often feel stages one or two without feeling concerned enough for hospitalization. If I reach a stage 3, I have a contract with myself and my doctors to seek hospitalization immediately.

For issues of psychosis I generally consider severity and length of psychotic period. If you are someone who typically has long psychotic episodes, I would suggest considering any psychotic symptom a cause for emergency.

The idea here is to consider what is the worst you can foresee, based on what you have experienced. I would take those symptoms and make a checklist, and perhaps fill out that checklist twice a day, once your mood begins going into a more intense area.

Talk with someone about what you would consider an emergency, and share the scores you get from the emergency checklist with that person. This way, if you reach a point where you can no longer discern what is an emergency and what isn’t, your friend/family member can make that judgement call for you. And the checklist is a great tool if you do go to the emergency room, they can look and see exactly what the emergency is about.

5. Maybe you don’t have access to a friend or relative that you feel comfortable sharing this kind of information with, and that is ok. I would still recommend coming to conclusions about what you would consider an emergency, and if you ever find yourself at a loss for someone to talk to, contact the Crisis Line. 

I am pretty sure the number varies from region to region, but I am under the impression that most states have one, so it may be worth your while to google it and jot the number down on a card in your wallet/purse. The people on the other end of the line are used to receiving calls from people who are in crisis, so in lieu of a physical person who is present and able to help give direction in an emergency, I would highly suggest this route. These folks are level-headed, and if they are under the impression that your or someone else is in danger (which really trumps whatever your definition of emergency is in the case of most medical professionals), they will suggest going to the emergency room.

Ok, so those are a few ideas on how to handle emergencies in the absence of our professional support team, and I would suggest taking a look at In Case of Emergency as well where I talk a bit about mapping out emergency rooms and hospitals in your area to be prepared in the event of a psychiatric emergency.

For all of this, and for all emergencies, it is much more helpful to begin working on a plan of action when feeling fairly stable, as opposed to waiting for an emergency to happen first. By having a plan worked out, knowing that your psychiatrist or therapist or whomever is out of the office will be a lot less stressful, and less risky in the event an episode does occur.

“Bipolar Disorder” or Typical Human Behavior?

I’ve been seeing a recurring theme lately.

I told someone I’ve known for a while (but who has somehow escaped the knowledge of what has really gone down the last year or two) that I have bipolar disorder.

She asked me, “ok, so what does that mean?”

“Mood swings,” I said, “overreactions to things, stuff like that.”

I may have been much too general because her response made me pause for a moment,

“Isn’t that everyone?”

Rather than go on a long rant trying to explain further, I laughed.

Likewise, I was recently at my third visit with my new therapist and she was analyzing one of the horrible days I had last week with an abrupt mixed manic episode at work where I had to leave early.

“You were in a bad mood because you were still sick, which anyone can do,” she started, “you were frustrated with your boss about how you were being treated, you were anxious about coming back to work after having been sick for the last few days,” she grinned wildly, “are any of these things that anyone else (bipolar diagnosis aside) might experience?”

Frankly, this long speech pissed me off because, though I hope to have a therapist who can tell it like it is, I’d rather them do it in a nurturing, enlightening way rather than a smarmy, shit-eating-grin sort of way. After taking so long to come to terms with the notion of having bipolar disorder, having your “support person” question it really drives me bananas. 

“Which part,” I asked, “of the following is also typical of ‘normal’ human behavior? You forget, I do not presume to know what is typical and what isn’t, as the only experience I have to base my conclusions on is my own. But having paranoia that leaves one simply terrified of their co-workers, is that typical? How about having the overwhelming urge to attack and/or destroy the people around me? Maybe overwhelming feelings of suicidally that crop up in that situation -surely that is ‘normal’ as well?”

I’ve been thinking about this the last few days and it makes me think about what a few people have said to me, regarding jumping to the conclusion after receiving a diagnosis that any subsequent activity is linked to that diagnosis.

For example, someone with bipolar disorder grieving over a loss assuming they are having a depressive episode associated with bipolar disorder.

Or, (and I expect this is what that therapist meant to say, though she did so in a terrible way) becoming legitimately angry about something but calling it a manic episode.

At first, part of me got concerned that this is something I might be doing too. Am I attributing the regular moods of life with bipolar disorder? Do I lump all of my emotions into one category?

The conclusion I came to is no.

The whole concept behind bipolar disorder (as I see it anyway) is that people experience a wide range of emotions. Up to a point, these emotions are totally normal, everyday occurrences for people. Becoming furious is not singularly a bipolar experience.

But, there is a point where these emotions can do a number of different things that are what relate them to the notion of bipolar disorder.

1. The emotion could be a response to something that has happened (like a normal reaction) but is not a proportional response -either in magnitude or duration. 

i.e, wanting to kill the co-worker who borrowed your pen without asking, or being depressed for a week because you know you bought stamps but can’t find them in your house.

2. The emotion could be occurring independently of outside events. 

i.e, walking down the street and then bursting into tears for no apparent reason.

3. The emotional response could include abnormal sorts of elements.

i.e, delusions, hallucinations, suicidally, homicidality, etc.

When sitting down and looking at it, these were the things that stood out to me as defining factors of what makes my emotional responses different than those of (what I’ve heard) is the typical human response.

The fact that I have these sorts of responses doesn’t mean I am somehow being controlled by something called bipolar disorder. In fact, the reality is the opposite. Bipolar disorder is merely a description of what I have already been experiencing.

And, unfortunately for me, these incidences happen fairly frequently.

I feel pretty confident that I am able to discern an “episode” (meaning, an occurrence of one or more of those elements -I don’t usually require a specific duration of my symptoms to personally identify these elements, even though I recognize that most doctors do) after the amount of mood charting I’ve been doing, and I find it pretty straightforward when there is a big difference between feeling bummed out about something and feeling depressed and suicidal.

I think it can be common, though, for people with bipolar disorder to either begin tagging all negative emotion as bipolar disorder and expecting that to be something that can be simply eradicated. It can be easy for me, sometimes, to forget that it is normal to feel a bit of misery every once in a while, or loneliness, or anger. As long as it isn’t the killer sort, I consider it a welcome change.