The many faces of bipolar disorder — (Digital Journal)

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Digital Journal

By Lisa duTrieuille

Aug 2, 2013 in Health

Christine Adewunmi, a 37-year-old stay-at-home mom and a former physical education teacher from Missouri, was struggling with bipolar disorder, depression, including researching suicide methods online.
On March 16, 2012, Christine Adewunmi, fatally shot her three young daughters in the head and then killed herself. The next day, a guest of Blue Springs Ranch, 80 miles south west of St. Louis found the bodies on a gravel road with a handgun nearby.

Leonard Adewunmi, husband of the former physical education teacher, is suing Mercy Hospital in St. Louis, West County physicians and an on-call psychiatrist, Dr. Saad Khan of negligence. According to the widower, a day before the tragic incident, his wife had come to the hospital seeking treatment. An assessment of Adewunnmi’s former wife had been done and revealed that his wife had been suicidal and had not taken her anti-depressants for two days. Furthermore, a hospital employee, indented as Joan Bova, had determined that the former stay at home mom was a danger to herself, that she had refused treatment.

According to the widower, had the hospital staff bothered to communicate with him directly, March 15, 2012, he would have explained that his wife’s therapist had referred her for inpatient care, that Christine had previously taken their daughters on unsupervised trips and had expressed her desire to die. Mr. Adewunmi, claims that had his wife been hospitalized March 15, 2012, she wouldn’t have shot her daughters in the head, ending their young lives, and then killed herself with a handgun.

Holly Osment, a Licensed Marriage and Family Therapist, who specializes in bipolar disorder, says that those with bipolar disorder have a fifteen fold increased risk of suicide than the general population.  Osment says generally the statistic is one third of people with bipolar disorder have suicidal intent or act on their suicidal intent. As was the case with Christine Adewunmi, who was battling bipolar disorder. Osment says there’s often resistance to medications among those with bipolar disorder. Patients are at risk for stopping their medications. She says often they’re okay with taking medication when they’re depressed, because they want relief. However, once they become stable, then they think, “I don’t need it anymore.” Osment adds that they may subsequently swing into mania, which they may enjoy (unless it is dysphoric mania). The therapist says it is sometimes difficult to keep them taking their medications consistently. The care provider may try to help by framing bipolar disorder similar to any other chronic medical condition that needs medication management. “You have a chronic, medical disease, its kind of like hypertension or diabetes. You may always need to be on medication.” That can be a hard sell, but that’s often the best course for most patients.

According to Osment, manic episodes may include paranoia as well as psychosis, which is technically losing touch with reality (such as visual or auditory hallucinations). Osment adds that the mania is the more harmful aspect of bipolar disorder to the brain, and that patients should be helped to actively take steps to prevent it from occurring. Furthermore, suicidal thinking combined with untreated mania or depression puts the patient at very high risk. Most likely had Christine Adewumni been hospitalized as an inpatient the day before she shot her three daughters in the head and then killed herself, the priority of the psychiatrist treating her in the hospital would have been to get her stabilized on medications to treat the bipolar, depression and suicidal ideation.

According to Dr. Dorson Liss, who has been a psychiatrist for over 40 years, and had been treating many clients who have mood disorders, including bipolar disorder, about 40 percent of patients with bipolar disorder have some kind of substance abuse problem. And, the most common explanation is that they are trying to use drugs and alcohol as a way of treating their severe mood shifts.

Dr. Liss says that bipolar is marked by a number of severe depressive episodes and often by sever manic episodes- moods that are marked by increased levels in energy, increased repeatability of thought, difficulty focusing thoughts, distractibility, elevated mood, instability and cognitive distortions in thinking.

Liss states that that the diagnostic systems divide bipolar disorder into bipolar I and bipolar II. Bipolar I is marked by both depressions and a series of manic episodes, usually necessitating some dramatic treatment, either use of medication and/or hospitalizations, or severe restrictions in a person’s lifestyle. He adds that in bipolar II, the manic episodes are less dramatic, do not involve hospitalizations or marked alternative lifestyle. Furthermore Dr. Liss says they can be incapacitating and sometimes life threatening depressive episodes.

Cyclothymia is another diagnosis where the depressive symptoms don’t reach the level of Major Depression, nor the manic symptoms reach the level of true mania. Sometimes when one sees cyclothymia, it’s a precursor to actual bipolar disorder, but not always.

Liss says that the manic episodes tend to last no more than seven months. The depressive episodes last several months and sometimes years. In addition, the depressive episodes far out number the manic episodes by five to one. Furthermore, he says there’s the existence of what’s called a mixed manic state( also known as dysphoric mania) that people don’t associate with mania. Many people when they think of mania they think its all euphoric. That isn’t always the case with dysphoric mania ( also know by some clients- as the painful mania) which by some estimates account for as much as 30% of mood shifts in one with bipolar. Liss emphasizes that these mood shifts can be so severe that they require hospitalization because of intense anger and violence or, potential for violence.

The Licensed Marriage and Family Therapist says that signs of bipolar, the illness has a genetic component in addition to environmental factors and the kind of stressors one has. In addition, she adds that it appears that bipolar disorder is sort of genetic cousins with schizophrenia, Obsessive Compulsive Disorder( OCD) and ADHD, sometimes sharing some genes with these other disorders.

The Licensed Marriage and Family Therapist says that signs of bipolar can be seen in childhood, or early twenties. It sometimes takes many years for someone to get correctly diagnosed, while meanwhile the bipolar symptoms are left untreated properly.

According to a study Liss read, about five to ten percent of people who had one bipolar parent, become bipolar. There’s no doubt that the existence of bipolar in one’s parents, dramatically increases the possibility of a person developing bipolar disorder.

Osment and Dr. Liss seem to disagree about the link between bipolar and creativity. Osment says from the abundance of current information that supports the fact that many with bipolar have lots of creativity, the artistic kind like Van Gogh. Whereas Dr. Liss doesn’t think having bipolar disorder predisposes one to become more creative. Although, he says that creative people seem to have bipolar disorder, but he says it is not known for sure what the relationship is.

Osment strongly believes that someone with bipolar disorder has to become an expert on the illness as well as their family. She firmly believes that the therapeutic relationship is extremely helpful. For example, Osment says therapies such as cognitive behavioral or existential therapy are very helpful because the therapist is really intervening. Osment believes that a strong therapeutic connection can be part of the healing process as well as helping with compliance with treatment. Educating the patient ( and his or her family, if possible) on the importance of sleep, stressors and medication, and working with the patient to cope with the emotional impact of living with bipolar disorder may help increase quality of life and add deeper meaning to one’s own existence.

In order to get a diagnosis of bipolar I, bipolar II or cyclothymia, the main criteria is that one has to have a history or some evidence of having a manic or hypomanic episode before it can be diagnosed, according to Osment.

Whereas Osment strongly believes that genetics, the environment and stressors in a bipolar person’s life are all factors in terms of triggering episodes of mania, dysphoric mania and/or hypomania. Dr. Liss disagrees somewhat with Osment. Liss says that things such as deficiencies in parenting, traumatic events, disadvantaged situations fostering a whole set of faulty cognitive approaches to life. An important part of the non-somatic treatment of bipolar incorporates cognitive behavioral therapy according to Liss which helps people re-frame the way they deal with and conceptualize things that are happening in their lives.

Dr. Liss firmly believes when medication and/or anything else doesn’t work for a client who is severely depressed, the use of Electroconvulsive Therapy (ECT) treatments usually are given to the patient. Liss says that ECT remains the gold standard against which all treatments for any depression has to be measured, including bipolar depression. [The truth is that this “gold standard” causes brain damage, evidenced by typical severe memory loss – SSRI Ed.]

Not many therapists such as Osment specialize in bipolar disorder because many therapists think of bipolar as based on a medical modality. In the ever expanding field on bipolar disorder, she feels ethically compelled to keep on top of all the latest research on bipolar disorder, including being well-versed in all the medications that are out there to treat the illness, which usually makes some psychiatrists give her a bit more respect. If Osment really knows what she’s talking about, its better for the client because they can both have a better conversation advocating for the client.

Getting stabilized from a depressive or manic episode includes establishing a regular sleep cycle. When depressed, patients often sleep excessively while when manic they may feel a need for very little. Osment recommends getting eight to ten hours of sleep, and establishing a regular sleep/wake rhythm to the day. Waking up at the same time and going to sleep at the same time every day is often recommended for those with bipolar disorder. Exercise can be a tremendous way to manage depression. Of course most importantly is the client taking their medications as prescribed by their psychiatrist.

In conclusion, Osment says, “The good thing about bipolar disorder is that once someone finds the right medications for them, they may be able to stay fairly stable. Being watchful for stressors tipping them toward depression or mania and intervening immediately can help maintain stability more quickly. It is a chronic condition and can cause a lot of disruption and harm if not treated properly.