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Your Mental Health

Untreated bipolar disorder

Bipolar disorder can be difficult to diagnose. Hallmark symptoms of moodiness and irritability are common to many other conditions and it is rare for the disorder to present in an immediately obvious manner.

Occasionally, an individual with bipolar disorder will present with psychotic symptoms or mania early in their illness – when this happens, an accurate diagnosis can happen quickly, but otherwise the process often takes years.

Researchers in France have studied more than 400 individuals with bipolar disorder to determine how long it took for them to accurately be diagnosed and properly treated.

Results showed it generally takes almost 10 years from the start of symptoms to the initiation of appropriate treatment of bipolar disorder.

In this group of patients, the mean age for symptoms to begin was 25.3 while the mean age for psychiatric treatment of any kind was 28.6. Appropriate treatment took much longer with the mean age being 34.9 years.

Children with bipolar disorder are often not recognized and, indeed, some people still believe, incorrectly, that children cannot be bipolar. They can present as attention deficit, oppositional, depressed or anxious. Adults can present as depressed, anxious or irritable. They are often diagnosed as having Borderline Personality Disorder.

Bipolar disorder is difficult to diagnose and also difficult to treat. When it is undiagnosed for many years, individuals suffer many adverse consequences such as substance abuse problems, legal problems, marital failure, educational and vocational failures.

By the time treatment begins, most patients and those around them will have come up with other explanations for all of these problems. These other explanations are often not very flattering and may lead to poor self-esteem, hopelessness and frustration.

A diagnosis, as serious as it is, may be accompanied by a sense of relief in finally having an explanation for a myriad of problems that previously seemed unrelated. A chaotic life comes into perspective and there is now at least hope for solutions.

It may also be a relief for loved ones who have been coping with (and sometimes blamed for) difficult, irrational behaviour for years without an understanding of what is happening.

I wish I could tell you a simple strategy to shorten the duration of this undiagnosed and untreated period. There is no simple way. The diagnosis requires skill and interest. If one doesn’t ask the right questions the diagnosis will not be made except in the most extreme cases.

I do believe the chances for an accurate and timely diagnosis are improved for those who see a psychiatrist. As trained specialists in mental illness, psychiatrists have the most experience with this group of patients. Nevertheless, it is not uncommon even for psychiatrists to miss this diagnosis or to make the wrong diagnosis. The two most common wrong diagnoses will be unipolar depression and Borderline Personality Disorder.

Wrong diagnoses do more than delay appropriate treatment. Incorrect treatment can make things worse. For example, treatment for depression or attention deficit disorder can induce mania or a mixed state if mistakenly given to someone with bipolar disorder.

Counseling is always recommended for everything and there is no doubt that most people feel better having someone who will listen and be supportive. This, however, can be mistaken for effective treatment and they may spend years exploring issues that are not really as important as they believe. This is both time consuming and expensive. Counseling can also cause harm when it is misdirected.

Keep an open mind, read, ask lots of questions, seek other opinions and hopefully you will get appropriate diagnosis and treatment early.



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Character leads to success

Do you remember being disappointed about something as a kid and having a well-meaning adult tell you not to worry – that disappointments build character?

Those words of wisdom are not always welcomed when in the throes of some childish catastrophe, but they are wise nonetheless.

Author and speaker Paul Tough published a book on the subject – How Children Succeed: Grit, Curiosity and the Hidden Power of Character.

According to Tough, it is character more than IQ and standardized test scores that determines an individual’s success - and I agree with him.

Character is made up of a variety of non-cognitive qualities including perseverance, curiosity, conscientiousness, optimism and self-control. They have to do with a person’s ability to adapt, to work through disappointment and failure and to set and reach goals.

In today’s world it often seems as though these skills are overlooked in favour of teaching children to master the more easily measured abilities prized in the school setting – reading, writing, math and science. Ask any parent of a pre-school or school aged child and you will no doubt get an ear-full about their child’s progress in mastering language, reading and numbers. To be sure, these academic pursuits are important, but they do not define a person’s overall ability to succeed in the world.

Research indicates that although IQ and cognitive ability are part of the package, temperament or character traits are also critical and we ought to be spending more time thinking about how to develop these skills in our children.

In Tough’s book, he highlights the research by several American and Canadian scientists in the field and also follows the stories of children and the educators helping them.

He points out that one of the primary ways we develop skills like persistence is through failure – something from which we go to great lengths to shield our children.

Recently there has been much media attention surrounding the ‘no-zero’ policies within school systems in different parts of our country. These well-intentioned policies aim to give everyone the chance to succeed but they have stirred up controversy partly because they don’t reflect the way things work in the rest of life.

It is inevitable that we will not always get what we want – that we won’t be good at everything we try – that disappointment is part of the human experience.

An absolutely vital part of parenting, teaching and coaching is to teach our children how to manage negative experiences, to take away the lessons when they need to and put things behind them when necessary.

Although it is right to want to protect our kids from too much disappointment, there are times when we need to stand back a little and let them fall down so they can learn to pick themselves back up.



Brain myths

In spite of our easy access to information in this technological age - or perhaps partly because of it – myths about the human brain abound.

You have undoubtedly heard people say that we use just a fraction of our brain. Imagine how much smarter we would be if we were only able to figure out a way to unlock the 90 percent of our brain’s potential that simply sits idle as we muddle through our lives.

This, of course, is false. Contrary to this widely held myth, we actually do use our entire brain. Different areas in the brain serve different functions and certain places are more active at times than others, but brain cells that are inactive will die.

Although I am not certain where this myth originated, it may be in part because when we look at brain images we often see just a small area ‘lit up’. Depending on what is being imaged, this does not mean that only one area is active or being used while the rest of the brain lies dormant.

Another very popular idea about the way our brains learn is the notion that providing a lot of rich stimulation to preschoolers will improve their brain or learning capabilities.

If you go into a toy store today you will be bombarded with myriad educational toys and products designed with this in mind.

It is true that studies in animals have found that rats kept in isolation fare worse than those in more stimulating cages with other rats for company or an exercise wheel. However, this study would translate better to a comparison between a severely neglected child and children exposed to the amount and types of stimulation one could expect in a normal household with human interaction.

Although educational toys and videos are just fine to use, it does not follow from existing scientific research that children without these latest fads will fail to keep up with their peers at school or in life.

Another commonly held belief about the human brain is that children learn better when they receive information in their preferred learning style.

While people certainly do prefer different kinds of instruction - whether auditory, visual or kinesthetic, these preferences actually have little to do with how effectively we learn. Several studies have shown there is little to no correlation between these preferences and learning performance. In spite of the published data on this topic, a staggering 94 percent of teachers still believe students perform better when taught in their preferred style.

Of course this is not to say that a good teacher should not try to make learning more appealing to students by adjusting lessons to suit various preferences. This practice undoubtedly leads to more engaged learners who will appreciate their educational experience and pursue it further.

These were just a few of the almost ubiquitous myths about the human brain and the way we learn. There are many more out there.



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Psychosis

When we see news stories involving very bizarre or inexplicable behaviour, it is common to pause and think, “that person is psychotic.” I hear this comment frequently from people when talking about strange or unsettling behaviour.

The statement may indeed be correct, but there are a lot of misconceptions out there about what constitutes psychosis and what it means for someone to be psychotic.

Psychosis is actually a symptom rather than an illness in itself. Psychotic episodes are experienced in several psychiatric disorders as well as some general medical conditions and as a result of substance use.

So what does psychosis entail? It is derived from the Greek words “psyche” for mind and “osis” for abnormal condition – and that is truly what it is - an abnormal condition of the mind. It is used in connection with a disconnection with reality as with hallucinations and delusions. When people are hearing or seeing things that others around them cannot hear or see we say they are hallucinating and are psychotic.

Hallucinations involve perceiving things that are not there or are unreal. Hearing voices is one of the more commonly portrayed types of hallucinations, especially in schizophrenia. There are also olfactory hallucinations when a person smells something that is not there or tactile hallucinations when someone, feels something that is not there such as insects or parasites crawling in their skin.

Delusions are fixed beliefs that are out of keeping with those in one’s social circle. Paranoid delusions are among the most common. These may involve the belief that that another person or organization is conspiring against one.

As mentioned above, psychosis can occur as a symptom in schizophrenia. It can also occur in bipolar disorder, severe depression, post partum depression, Alzheimer’s disease, Parkinson’s, multiple sclerosis and some other medical conditions. Some prescription medications can also cause psychotic side effects and psychotic symptoms can also occur from the use of street drugs.

Psychosis is more common than you might think – affecting more than one in every 100 people. A psychotic episode can occur only once in a person’s life or as a recurring symptom.

Since psychosis is by definition an abnormal brain state involving a disconnection with reality, they can be dangerous. People sometimes act on their false beliefs and/or perceptions to the detriment of themselves and those around them.

Treatment for psychosis depends to some degree on what is causing the symptom. Often, hospital admission is necessary in the midst of a psychotic episode for the safety of the patient and others. There are a number of antipsychotic medications such as quetiapine, risperidone, olanzapine, and aripiprazole to name a few. These will provide symptomatic relief in most situations.

Psychosis is a serious symptom and a physician should always be consulted as quickly as possible if the cause and appropriate treatment are unknown.



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About the author...

Paul Latimer has over 25 years experience in clinical practice, research and administration. After obtaining his medical degree from Queen's University in Kingston, Ontario, he did psychiatric training at Queen's, Oxford and Temple Universities. After his residency he did a doctorate in medical science at McMaster University where he was also a Medical Research Council of Canada Scholar. Since 1983 he has been practicing psychiatry in Kelowna, BC where he has held many administrative positions and has done numerous clinical trials. He has published many scientific papers and one book on the psychophysiology of the functional bowel disorders. He is an avid photographer, skier and outdoorsman.

 

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The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet presents its columns "as is" and does not warrant the contents.


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