I was doing research and interviews on
bipolar disorder when notices appeared in my
New York City neighborhood about a 21-year-old man
who had been missing for a week. He was described as “bipolar” and “may be
experiencing a manic episode.”
اضافة اعلان
It took me back nearly seven decades when the state police
in Texas called my father to say they had found his brother, my favorite uncle,
wandering on a highway. How he got there from New York we never learned. He had
apparently suffered a psychotic break and ended up in a New York state mental
hospital that administered electric shock treatments but did little else to
help him reenter society effectively.
Not until decades later did he receive a correct diagnosis
of manic depression, now known as bipolar disorder. Characterized by extreme
shifts in mood, “manic-depressive illness” was officially recognized by the
American Psychiatric Association in 1952. But it would be many years before an effective
treatment, the drug lithium, which acts on the brain to help stabilize
debilitating episodes of severe mania and depression, was available to help my
brilliant uncle resume a reasonably normal life.
Bipolar disorder typically runs in families, with different
members experiencing symptoms to a greater or lesser degree. If a parent has
the disorder, a child’s risk can rise to 10 percent. My uncle’s only child
displayed some minor behavioral characteristics of bipolar disorder, like very
rapid speech and frenetic activity, but was able to complete two advanced
degrees, marry, be a parent and succeed in an intellectually demanding career.
Bipolar disorder is most often diagnosed in the later teen
years or young adulthood, affecting some 4 percent of people at some point in
their lives. But in recent decades, diagnosis of the disorder has soared in
children and adolescents, although some experts believe the condition is
overdiagnosed or overtreated with potent psychiatric drugs.
Symptoms in children may initially be mistaken for other
conditions, such as
ADHD (attention deficit/hyperactivity disorder) or
oppositional defiant disorder, and young people may suffer serious distress at
home and in school for years. As David Miklowitz, professor of psychiatry at
UCLA School of Medicine, told me, there is still “an average lag of 10 years
between the onset of symptoms and getting proper treatment.”
Based on studies of patients’ histories, Dr. Boris Birmaher,
professor of psychiatry at the University of Pittsburgh School of Medicine,
reported, “In up to 60 percent of adults with bipolar disorder, onset of mood
symptoms occurred before age 20.
However, pediatric bipolar disorder is often
not recognized, and many youth with the disorder do not receive treatment or are
treated for comorbid conditions rather than bipolar disorder.”
Yet, Birmaher, who specializes in early onset bipolar
disease, argues: “Pediatric bipolar disorder severely affects normal
development and psychosocial functioning, and increases the risk for
behavioral, academic, social and legal problems, as well as psychosis,
substance abuse and suicide. The longer it takes to start appropriate
treatment, the worse the adult outcomes.”
With early detection, which is most likely to occur when
there is a family history of bipolar disorder, some affected young people may
respond well to family and behavioral therapy that obviates the need for
medication, Miklowitz suggested.
There is often resistance to treating children with drugs.
Terence A. Ketter, retired professor of psychiatry at Stanford University, said
one problem is that “faced with a bunch of badly behaved children, authorities
want to give them antipsychotics to make them behave, but if they’re
overtreated they can become like zombies.” In agreement with Miklowitz, he
said, “On average it takes about a decade and three different doctors to get
children the right diagnosis and treatment.”
Another challenge to proper diagnosis and treatment stems
from the boundless energy and extraordinary productivity and creativity that
can accompany bouts of mania. Not until the mania reverts to severe depression
or, as happened to my uncle, psychosis, might a young person with bipolar
disorder be likely to receive needed medical attention.
Ronald Braunstein, conductor of the
Me2 Orchestra he created with Caroline Whiddon to support talented people with
mental illness, recalled that he was riding a manic wave of artistic
achievement in his early 20s when a crippling depression caused a professional
and personal crash. Yet for decades he was not treated properly and experienced
repeated cycles of great successes as a conductor followed by major failures.
I asked Braunstein, now 65 and for
the last 14 years finally being treated effectively for bipolar disorder, what
he recalled about early signs of his mental illness.
“Everything seemed off in my early
teens — I didn’t feel emotionally balanced,” he said. “Things were weirder than
they should have been as a teenager. My father once took me to a psychiatrist
who diagnosed me as having ‘bad nerves.’”
As he described one early symptom of
mania, “I wanted to learn how to fly, and I thought if I ran down a hill fast
enough and tilted my hands in a certain angle I would have flown. In high
school I told fellow students I knew how to fly and I went to the top of a
building to demonstrate. Fortunately, they talked me down.”
He said, “I didn’t know what was
wrong or that it could be treated.” He added that for parents of teenagers, who
may have difficulty recognizing abnormal behavior in adolescents, “it’s
sometimes hard to distinguish what is illness and what is normal grandiosity or
normal sadness that might have been caused by a breakup with a girlfriend.”
Birmaher noted that young people with bipolar disorder
usually have recurring episodes of major depression, but that “depressive
episodes are not necessary for making the diagnosis.” For some, mania is the
primary symptom.
When depression is the symptom that brings patients to
professional attention, the correct diagnosis can be especially tricky. As
Ketter explained, depressed individuals may be unable to recall previous
episodes of mania that occurred when they were not depressed.
Miklowitz said one of the first signs of bipolar disorder is
“mood dysregulation — the child is angry or depressed one moment, then is
excited and happy and full of ideas moments later.”
He listed characteristics of mania that can help parents
distinguish them from normal teenage highs and lows. The symptoms, several of
which should be noticeable to other people, can include “grandiose thinking,
decreased need for sleep, rapid or pressured speech and/or flight of ideas,
racing thoughts, distractibility, excessive goal-driven activity, and impulsive
or reckless behavior,” Miklowitz said.
With depressive symptoms, he suggests looking for “an
impairment in functioning — suddenly not going to school or going late, not
finishing homework, sleeping through classes, a drop in grades, not wanting to
eat with anyone else, talking about suicide, self-cutting.”
Depending on the severity of a child’s impairment, if
nonlife-threatening symptoms are caught in the early teens, Miklowitz said it
may be possible to start with psychotherapy and avoid medication, which has
side effects.
“But if the child’s life is at risk, if he can’t function at
home or at school, medication may be the answer,” he said. “There are risks to
not medicating.”
When medication is necessary, he said, the dosage should be
just high enough to control symptoms and not be overly sedating.
Read more
Lifestyle
.jpg)
.jpg)
