Bipolar Diagnosis Rules Have Been Changed
Well, that might be a bit of an overstatement. But that's journalism, right?
Here's what really happened. The International Society for Bipolar Disorders (ISBD) is a group of researchers and clinicians interested in bipolar disorder, with members from all around the world. The leadership of this organization decided several years ago that we needed an update on the DSM (Diagnostic and Statistical Manual), because the next edition of that official rulebook won't come out for another three or four years.
The current DSM was written about 15 years ago. You would hope that by now we might have some additional insight into the nature of bipolar disorder and how it should be diagnosed.
So the ISBD commissioned 25 mood specialists to look at the existing literature on bipolar disorder and make recommendations in a different areas of controversy: mixed states, Bipolar II, bipolar depression (how is it different, if at all, from unipolar depression?), rapid cycling, children and adolescents, and the "bipolar spectrum" perspective.
For intrepid interested readers, I have posted a summary of these guidelines, with the relevant links, on my PsychEducation website. The bottom line, from my point of view: virtually all of the papers prepared by this committee of bipolar specialists acknowledge that the DSM system of discrete categories -- in which one either has unipolar depression, for example, or bipolar depression, but nothing in between -- is causing some trouble. While switching over to a "spectrum" perspective, as reflected on my website, is not a solution either (all sorts of logistic problems would follow), the validity of that way of thinking is supported by the work of these experts.
Dr. Phelps
So although the official rules for bipolar diagnosis have not literally changed, an important update on those rules has been issued. Anyone who depends on the rule system -- which hopefully includes a broad array of patients and practitioners -- should be interested in further details on the work of the ISBD Committee on Diagnosis. Here is the summary link again.
posted by PsychEducation | This post's link
9 Comments:
Can you discuss what you know/think about bipolars I & II and use of the smoking cessation drug Chantix? How does Chantix work physiologically in the brain and how might that affect the way that other psychotropic drugs work? I've read both horror and success stories. I am bipolar II/GAD presently on lamictal, vistaril and zoloft.
Regarding Chantix in people with bipolar disorder --
Well, as you summarized, both horror and success stories. And unfortunately, that's about it: "stories". In our business we call them "case reports" if they get published but I'll bet there are plenty of personal reports on blogs out there.
Even in my own practice I've seen the successes and the problems. Indeed, here's a *very* informal number: about half of my patients who have bipolar disorder have had some sort of symptom problem when they tried Chantix. These symptoms include depression, anxiety, and hallucinations.
So for now, I'm very wary of it and I try to make sure it is not used when I'm trying something else at the time. But because smoking is such a huge health risk, and so hard to quit for some people, I've not been telling my patients (yet?) that they shouldn't try it. I tell them that the odds are uncomfortably high, as near as I can tell at this point, that they'll have a negative reaction in terms of their bipolar disorder worsening somehow.
JP
oh that was a good work by Dr.phelps and keep the good work phelps .thank you.
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ragavendra
sreevysh corp
I appreciate the update on the continuing efforts to diagnose bipolar disorder more accurately. Our daughter had bipolar and died by suicide in 2003. One of the activities of our family foundation in her memory (http://KarlaSmithFoundation.org) is a support group for the family and friends of anyone with a mental illness. Group members continually ask questions about bipolar, its symptoms, and treatment. While we are not psychologists or licensed counselors, we are knowledgeable about mental illness in general. Your site is helpful in translating the more technical research into terms that are helpful to us as we educate our group members about mental illness. Your update and the corresponding link to a summary of the current research provide a service to us so we can be more supportive of the people in our group.
Tom Smith
Author of "A Balanced Life" and Co-Founder of the Karla Smith Foundation
http://karlasmithfoundation.org/
Dr. Phelps....yesterday I was dx with Bipolar II and my doc recommended I get your book. It was really helpful....beyond words. I am also relieved to know why I feel the way I feel. I have been on antidepressants for 4 years now and have a plan to go off them under my doc's supervision.
I've also been reading your web site and want to let you know that steroid nasal sprays make me nuts! I know you said that there isn't conclusive evidence on this, but go with me, I'll give you evidence!
Thanks again for your great work.... Barb
Barb' --
thank you for your comments, your enthusiasm and your experience is most appreciated. I also appreciate your noting what happens to you with nasal steroid spray. I have been waiting for such a report to get more serious about trying help people get off of those when their bipolar disorder is not well controlled. Very helpful, thank you. Good luck with the process --
Dr. Phelps
Dr. Phelps,
Hello, it's Dr. Margaret again. How slowly would you typically wean someone off an antidepressant if it had helped partially with bipolar II symptoms? Assuming I try more of these people on Lamictal, for example, how many do you think would be able to stop antidepressants? Also, do trazadone and amitriptyline, when used for sleep, chronic pain, etc., tend to effect pts with bipolar I or II?
Thank you again for all you do.
Dr. Margaret in Virginia
Dr. Margaret --
The very short answer is "four months". But that is so much longer than almost everyone else recommends (usually you might hear 2-4 weeks), there should be a reference. Until recently, I had nothing but an expert's recommendation. Finally, an article from a distantly related field suggests that indeed for months might be not only rational but warranted. Here's my webpage about that: http://www.psycheducation.org/bipolar/AntidepressantWithdrawal.htm
Cheers --
Jim P.
Thank you so much for all you have published! Lifesaver and the help I am looking for. Bless you!
Kate.
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