Bipolar Disorder, a Mixed Blessing of Endowments and Risks




  • Here is a summary of the NAMI Marin meeting on Monday, 4/14/03, by Beverlee Kell and Joan Olsson.

    The April general meeting featured Dr. Michael Freeman, a Marin county psychiatrist and a psychologist Robert Reiser, Ph.D., who specialize in Bipolar Disorder. They will be offering 10-session psycho-educational therapy groups to help individuals with Bipolar Disorder build on their strengths and better manage moods. For more information, they can be reached at 415-378-6678 or 415-456-5256.

    Dr. Freeman described Bipolar Disorder as a constellation of special gifts and certain risks. Those gifts may include tremendous creativity, energy, stamina, vision, love of work, ability to think across conventional lines, innovative novel solutions, charisma and gregariousness associated with mania or hypomania (low-grade mania/euphoria.) Heightened creativity often is a hallmark of the bipolar individual as shown in such historical figures as Winston Churchill, Van Gogh, Hemingway, Jackson Pollack, T.S. Elliott, and Michelangelo. Research suggests that medication does not impair creativity and definitely improves productivity.

    Bipolar Disorder has now expanded to four subtypes. More than half of those with Bipolar Disorder have an onset before age 20, so there is a significant population of bipolar children. The most common ages of onset are age 5, 10, 15 and 17-21. In children with bipolar disorder, depression will manifest as social withdrawal. See the child mood chart at www.bpkids.org.

    Dr. Freeman discussed the differential diagnosis of Bipolar Disorder and ADHD(attention deficit disorder.) Recent data shows that about 30-40% of persons with Bipolar Disorder also have ADHD (attention deficit disorder) or learning disabilities. In children with Bipolar Disorder, about 70% are also ADHD. About 20-30% of persons with ADHD also have Bipolar disorder. Both disorders include symptoms of high energy, distractibility and impulsivity. The characteristics that seem to best differentiate Bipolar Disorder from ADHD are grandiosity, hyper-sexuality and reduced need for sleep. When Bipolar Disorder is treated the symptoms of distractibility and impulsivity usually improve. Neurostimulant medication used to treat ADHD can make Bipolar Disorder worse. When the two disorders co-occur, the physician must use extreme care to stabilize mood first before considering neurostimulants.

    Dr. Reiser described three specialized therapies that, along with medication, do work to prevent or reduce the severity and duration of relapse:

    1. “Family Focused treatment.” He highly recommended the Bipolar Disorder Survival Guide by David Miklowitz.
    2. “Interpersonal Social Rhythm therapy” developed by Ellen Frank, PhD (Univ. of Pittsburg) which teaches how to stabilize sleep and wake cycles and how to recognize mood shifts by mood graphing. He said that insomnia is an incredible path to mania.
    3. “Cognitive Behavioral therapy” which helps a person reframe how they think about things. Here Dr. Reiser recommended David Burn’s book Feeling Good. Also see his web sitewww.feelinggood.com. A good self-help web site for bipolar individuals is www.dbsalliance.org/

    An estimated 60-70% of bipolar individuals also misuse substances such as alcohol and illegal drugs. Some will use stimulating activity or drugs to stay manic or to activate themselves out of depression. The task of getting them to recognize they have a problem sometimes can be solved with “motivational interviewing” which elicits a plan from the client rather than imposing a plan on the client. For families dealing with medication non-compliance, the Kay Jamison book, An Unquiet Mind was recommended. Parents have a difficult role of trying to anticipate and prevent harm and at the same time allow a child to experience some consequences. A turning point does not occur for some unless they faced with very serious consequences.

    Dr Freeman said that medications require constant titration and for the client it becomes an art. Drugs used to treat Bipolar Disorder may include: 1) lithium, 2) mood stabilizers (anticonvulsants) such as tegretol, lamictal and topamax 3) atypical antipsychotics such as risperodone, Xyprexa, and clozapine, 4) anti-depressants, and 5) sleep medications. The only alternative therapy shown to provide possible benefits is Omega 3 fatty acids, 3 to 4 grams a day.