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Dr. Michael
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience:  Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
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What percent of bipolar patients are age of 55 at the time

Customer Question

What percent of bipolar patients are age of 55 at the time of diagnosis?
No family hx of bipolar disorder. No prior hx of depression. No medical problems except orthopedic due to MVA.

How short can manic episodes last. Is it possible to be rational and focused at one moment (ie look up the # XXXXX a pharmacy, call, pay bill with a credit card, then 20 minutes later have a manic episode? Is "word salad" seen during a manic episode?

I was on Neurontin/Lyrica, 1/2 Vicodin, Lidoderm Patches, Ambien prn. The insert for Neurontin says pressure to talk/mania, confusion, aggressive behavior.

I was diagnoses as having a bipolar disorder. I do not believe it.
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr. Michael replied 2 years ago.
Hello. I believe I can be of help to you with this issue.

Almost no cases of first-episode bipolar disorder are ever diagnosed after the age of 50 unless a long history of clinical depression has existed per se, and/or a strong family history of bipolar is also present. In fact, I've not seen an over-50 case of first-time onset, bona fide bipolar disorder ever, unless the person had a clinical history of depression.

You listed some medications you WERE on in the past. Exactly what were you being treated for with each of these meds? (I could guess but I'd rather not).

You say neither of the above histories are applicable to you. What you describe in your post would not appear to be a manic episode. First episode onset of true mania begins generally, slowly and persists for days or even weeks at a time. It doesn't last MINUTES or a couple of hours. RAPID SPEECH and very rapid flow of ideas is present, but not significantly disorganized speech (word salad).

My first hypothesis would be that the 'manic' episode as labeled, would probably bemore of a neurological state caused by something (injury, medication).
And you don't even sound as though you meet diagnostic criteria for hypomania, as would be the case in bipolar II disorder.

What you describe is something that could be medication or drug-induced. Now, one way to find out is to take a drug "holiday" ----taper back and then eliminate your medications for a time and see if the 'bipolar' symptoms disappear. They should of course, if they are medication induced. This is a far smarter thing to try than to put a person on lithium to see what effect it has. Are you on any other meds right now other than lithium? Were you ever medication free for a time to assess whether you where having drug side effects that were interpreted to be 'mania'?

I'm logging off for the evening so take your time responding. I'll be back in the morning.

Customer: replied 2 years ago.

Dear Dr. Michael,

Are you a psychiatrist or psychologist and where did you train?

 

I came to work. I had a conversation outside of my office with a man I had known for a long time, Marvin. I was having a lot of difficulties..separation, lazy staff, my father died and left me in charge with handling financial matter. Sister and I in legal battle. Night before, man who works in my office lost his temper and was shouting at me. I calmed him down and went into my office and closed the door. This man just opened the door and started shouting again. There was a volunteer in my office. I left and took the volunteer out to dinner the night prior to admission. I could not sleep despite taking Ambien. I was upset. So, on the morning of admission, I started to cry. I felt sorry for myself as I told this story to Marvin. This man's staff and called the paramedic. Marvin thought this man hit me.

I was forced out of my office by the paramedics. They would not tell me what this was all about. Taken to ER. Escorted to bathroom for urine specimen. I walked out of the ER to cafeteria in order to get something to eat. I had a brief conversation with a RN who I know. Taken back to ER. Clothes taken off. Bare upper ches in glass cubical. I pulled the covers over my head and asked for my clothes back. The next thing I know, IV Ativan and Haldol were given. I was never interviewed by the ER MD until after I was medicated. ER MD reports confused, speaking with pressured speech with marked flight of ideas. I said that it was 1999; the year was 2009. Has difficulty staying on tract with questions. "She does not recall her address on initial recall. I could not recall my address. I was upset. I thought, what in hell am I doing in the ER. No one would explain this to me. The Ativan knocked me out.

 

Neurologist came in to evaluate me approx. 2 hours after Ativan and Haldol. Was able to state name, mo, date, yr, city, state , place and president. Naming and repetition were intact. 3/3 on registration with 3/3 recall. Her speech did not seem particularly pressured. She easily recognized me and recognized other familar staff. Neurolgist partner came in the morning. I was still groggy from meds. "Does not want to open eyes." Dxd as being depressed and manic. Woke up in the afternoon. Had lunch with friend. Never took meds given to me. Let go 72 hrs later.

 

Never depressed. Sad about separation, but still worked out, got my hair done, bought tickets to music concert and invited friends. Friend came to office to assist with work. Did not think anything was wrong with me. So, was I manic, then depressed for two days, the ok again then manic one month later for two days, then ok as per psycholotherapist/J.D. who spoke to me for 2 hours?

 

Medications I was taking prior to admission were due to my car accident. Peripheral neuropathy.

 

Do not want to take Lithium. Cannot go off it as a condition for working.

 

 

 

 

Expert:  Dr. Michael replied 2 years ago.
Clinical Psychologist, Ph.D. BYU and Baylor College of Medicine

You started telling your story with the first sentence, "I came to work " Before this day you came to work, were you taking ANY medications of any kind and if so, what were they? I assume they did blood tests at the time of this psychiatric intervention with the Haldol. Did the blood tests show any drugs or medication in your bloodstream?
Customer: replied 2 years ago.

Doctors in and out of my room. Shrink told me that I need a mood stabilizer at 10:20 pm. No further discussion. Neurologist writes that I am depressed and manic on the second hospital day. I was at 2 holiday parties in December. I was at the movies on Christmas in the evening. My girlfriend came over and spent the night after the movie. I went out with friends 6 days prior to my first admission. She did not notice anything unusual. I was with my, friend again, 6 days prior to admissions. I was admitted on Jan 23rd, about one month later. 72 hour hold.

As per first email, I was on Lyrica 50 mg hs, 1/2 - 1/3 Vicodin ER, Lidoderm Patches, Naproxen, Ambien. Opiates positive due to Vicodin. All other test were normal.

 

Do bipolars have flight of ideas, pressured speech, memory lapses? I clearly recall getting ready for work. I dressed up in a suit. I looked up the name of a pharmacy where I had purchased some Lidoderm Patches. This was not my regular pharmacy. I called up, I asked to pay with my credit card. I read off all of the digits. I drove to work 15 minutes from home. I walked into the buiding where I work. I came in at the same time as this man I had known for years. I told Marvin what had happened the night before. This man in my office shouting at me for a minor problem. I started to cry. I felt sorry for my self. A separation, my staff taking advantage of me, this man in my office who I had helped. Marvin knew how hard I worked. Marvin was afraid that this man had assulted me. He had a staff who was with a bastard husband.

 

I am not a shrinking violet, but I have gone through a lot to achieve what I did. Marvin knows this. I had moved my office 5 times. I built out an office and was sued. I did not know what an estopel was. I did not have an attorney. I had terrible staff, but did not want to fire them. I did not want a affirmative action law suit. I was changing my own spools of toilet paper and watering my own orchids. They had my credit cards and but did not buy stamps or supplies. I paid my staff $5.00 to $9.00 more per hour than others. Let them use my credit card for lunch. Let them take days off when they wanted. I finally had a heart to heart discussion with one of my staff. Both walked out. I was happy.

 

 

I was very sleepy after 2 mg of IV Ativan and 2.5 mg of IV Haldol. I so sedated, but after I woke up, I could not sleep for 1 1/2 days. I had a sitter by my side. It was 68 degrees. I could not leave the room. Diagnosed with mania and depression after 2 days!! I have never been depressed. I have been sad. I was not my chipper self.

 

At baseline, I cry at funerals, I cry at movies, I cry when I see other people crying. I cry when I see people on Dancing With The Stars doing really well when they didn't think they could. I cry when I am surprised with a beautiful gift; touched.

 

Do bipolars have marked flight of ideas, pressured speech, tangential thinking, memory lapses?

 

I have read many accounts of individuals with bipolar disorders. They have shared their experiences online. They wanted to stay up all night and do projects. I wanted to sleep. I took Ambien and Benadry.

What is your opinion? Do you think that I am bipolar?

Thank you.

Expert:  Dr. Michael replied 2 years ago.
Do bi polars have flight of ideas, pressured speech, memory lapses, tangential thinking?

Yes, absolutely. I really do think your diagnosis is as yet, unclear. Actually, what you describe could also fit under the diagnostic category of what is called Schizoaffective Disorder. I'd like you to Google this topic and tell me what YOU think: DSM-IVTR Schizoaffective disorder. Read the diagnostic criteria and then look at a few more sites that come up from the search and read about this more generally and get back to me.

I think you would probably do very well to get a completely fresh evaluation and opinion from a clinical psychologist who is affiliated with a hospital or medical center in your area---not a 'therapist' or counselor or psychologist who has a private practice and never steps foot in a hospital. Can you get back to me about this Google search and tell me what you think?
Customer: replied 2 years ago.

Do not have delusions or hallucinations. I am not schizoaffective. I have never had any medical problems ever except for a car accident in 2006.

 

I am a pretty high-functioning person. Lived independently since age 16. 12 years of college.

 

I was placing ads for new staff. Calling around and trying to find a new office tenant. I paid out my payroll and all vendors. I had too many friends hearing about my hospitalization and trying to help. I filed 2 restraining orders. This required focused effort. Two trips to the court house. I needed to feel safe at home and at my office.

 

It's funny how the diagnosis shades the staff's observations. A woman was coughing on my dinner tray. I got up and left my tray for her to eat. There were other uneaten trays so I ate one of those instead. Staff thought that I was confused. Staff noted that I was anxious and walking around the room. I am not used to being confined in a small room. I am not used to laying in bed all day. I was on Premarin and I did not want clots in my legs. "patient is anxious" I was walking up and down the halls my first night in this psych facility. The informed me that I had a very high blood pressure. My blood pressure has always been very low, 95/60. I was forced to take a blood pressure medication. Was I going to pass out?

 

Am I bipolar at 55? Can a bipolar function well off meds, if he or she does not work?

 

How can a person be hospitalized and deemed incapable of self-care when I have credit card records demonstrating that I was taking care of myself. Massage, nails, hair, dinner out, concerts? No plan of action written over and over. I had 3 doctor visits scheduled for the week after my last admission.

 

Thanks.

 

JTM

Expert:  Dr. Michael replied 2 years ago.
It is quite rare to have a bipolar diagnosis at age 55 but you may meet criteria for it. I can tell you however, that mis-diagnoses are common in psychiatry and inter-judge reliability (having two doctors arrive at the same diagnosis when independently assessing the same patient) is not very high. I would seek a second or even a third opinion from another psychiatrist or clinical psychologist who would be wiling to visit with you 2-3 times before rendering an independent diagnosis. I would NOT tell them about your existing diagnosis, only that you have received an 'opinion' from a particular doctor and don't know if you agree with it, so you want another opinion. Armed with a 2nd or 3rd opinion, you might be able to drop your current medication.

If nothing else happens going forward, you could also gradually persuade your current physician to gradually taper your medication to a very, very low dose, or do so on your own until you are taking 'next to nothing', to see what happens across the coming 3-6 months. This could provide you with some evidence that the diagnosis was wrong in the first place. All that could be concluded is that because of an unknown metabolic anomaly that was temporary, you developed symptoms that were mistaken for a manic episode. The thing about bipolar disorder is that if you have one episode of mania, you are almost certain to have another one in the coming 2-3 years. It is not a 'single episode' disorder but is considered to be a chronic condition. In your case, the doctors are almost certainly calling this Bipolar I disorder, which means they think you had a full, true manic episode. I doubt have have bipolar disorder, based simply on your age and the odds of a first-time diagnosis at age 55, but I cannot tell you for certain unless I was able to work with you and do an assessment, across several visits, spaced a couple months apart. What do you think?
Customer: replied 2 years ago.

Thank you for your thoughtful consult.

 

I personally believe that my symptoms were due to the medications I was on, in addition to mutiple stressors and lack of sleep. Still would like to hear your opinion about Lyrica and manic. Neurotin label now specifically mentions mania, agressive behavior and even insomnia.

 

History is important. Independent thinking is important not only in psychiatry, but also in all fields of medicine.

 

My internal medicine practice and reputation has been destroyed.

 

JTM, MD

UTMB/UCLA

Expert:  Dr. Michael replied 2 years ago.
I have to agree with you. The odds are much higher this was a medication effect and not a first-onset episode of bipolar. Of course, time will tell----

Lyrica should not produce manic symptoms. It is of course primarily used for generalized pain such as fibromyalgia and it has some effects in reducing seizures. It is primarily sedating or helps cause drowsiness as a chief 'side effect' an can also cause confusion and dizziness and unsteady gait; it can cause some people to experience clouded thinking but no formal thought disorder, rapid speech etc.

Neurontin causes similar effects in most people as mentioned above for Lyrica; but mania IS a not-so-infrequent side effect as well. So if you were taking this prior to your 'bipolar' episode, this is probably the 'culprit'.

I hope this information is helpful. Let me know if I have overlooked any aspect of your original question. I do think that with the passage of time, your being symptom free of the meds and cutting back on lithium as indicated, you should be fine. You WILL also rebuild your practice if you are good at what you do. It does take 2-3 years for staff and colleagues to 'forget' that this was an issue and of course, if you do well going forward, they will begin to be able to reframe what happened in their mind---and will buy in to the notion that your episode was medication induced. Presently, most don't know what the heck to think. I say this based on episodes of psychological problems, misbehavior and mild malpractice that I've seen many time----people can recover professionally and socially but it simply takes time and they have to perform well going forward; again, I find it takes about 2-3 years with no new incidents. Please click on the green Accept button at the bottom of the screen. Thanks.

Please click on the green Accept button at the bottom of the screen.
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience: Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
Dr. Michael and 2 other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.

You mentioned that true mania begins slowly and persists for days or even weeks at a time. Please define what you mean by slowly. Slowly over the course of 6 months vs 1 month? What is the range? What is the range for the duration of mania? The shortest episode vs the longest and the average?

 

Optional Information:
Person's Gender: Female
Person's Age: 58

Already Tried:
On Lithium. Levels 0.4. Have been on Lithium monotherapy for about 10 months.

 

Detail Required: HIGH; Urgency: LOW
Expert:  Dr. Michael replied 2 years ago.
Oh, no. Mania onset occurs in short periods---a few days, maybe a week or so. Now some true manics have what is called rapid-cycling bipolar and they can move in and out of mood swings easily---every few days or a couple times per week. Now, a study of 219 patients with bipolar I disorder (the more serious kind of bipolar disorder), researchers asked patients to fill out an evaluation every 6 months for five years. The evaluation survey asked a number of questions to determine the length, type and severity of the person’s mood episodes. They discovered that for patients with Bipolar I disorder, the median duration for any type of mood episode — either mania or depression — was 13 weeks.

Patients on average, recover fully from a bipolar episode, if it is their first one, within one year. That is, a surprising number of patients (maybe 50% or more) don't have a recurrence of bipolar. If they have had a series of serious depressive episodes, their recurrence rate is quite high.

So if you have had just one manic episode, at this late stage of life (and I'm suspicious about your diagnosis, of course), then the chances are good that you will perhaps not have another one, if you have 'fully' recovered from it so far.

Let me know if I can be of further help. Please click on the green Accept button at the bottom of the screen. Thanks.
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience: Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
Dr. Michael and 2 other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.
So, regarding my "mania" and apparent memory impairment.. I remembered that I had an outstanding bill at the pharmacy. I called them before I left for work. I remembered how to drive to my office 7 miles away. I remembered the name of my first patient. I get hauled off to ER by paramedic. Recognized ER MD/staff. Forget about the 2mg IV Ativan and IV Haldol for a moment, I said that it was 1999, not 2009. "She does not recall her address on initial recall." "Has difficulty staying on tract." Approx. 2 - 3 hrs. later, neurologist exaimined me. "Was able to state name, mo, date, yr, city state, plance and president. Naming and repetition were intact. 3/3 registration and recall. I could barely keep my eyes open. I do not have a clear memory of speaking to this neurologist. Recall refusing a L.P. Clearly recall friend coming to ER with dinner approx 3 hrs. later. Then, 2 hours later, walking out of the cubical and walking in to the MD conference area. I asked the psychiatrist what was going on? He said he would come in to speak to me. He never did. Awoken about noon the next day by neuro. Still had hard time opening my eyes. Still very sedated. Said no to EEG; youre' not going to find anything. Neuro normal. Adm. Fri. Hospital staff came visit Sat. & Sun. Spent over 1 hr. with me. Knows me well. Definitely says I was not behaving abn. Discharged after 72 hrs. This same staff to my office to help me. Together for 2-3 hrs. Drove to my attorney's office. Normal. Asked to evict male MD from office. Please describel degree of memory lapses seen with bipolars. Is "memory loss" described c/w what's seem with bipolars. Can recall what an EEG, lumbar puncture is but can't recall year??
Expert:  Dr. Michael replied 2 years ago.
EEG is electroencephalogram. It measures brainwave activity. About all it can do is identify things like mini-seizures, changes in cortical electrical activity when one is resting or thinking. Not very useful for much, IMO. Persons with bipolar disorder don't have memory problems except during serious periods of depression and mania. Making a mistake in stating 1999 versus 2009 is not a big deal because this was one reasonable error and it appears you did fine on the rest of the questions. These questions are called the Mental Status Exam and they are simply a bunch of questions that help screen for gross mental impairments, memory, disorientation and confusion, psychotic speech and other symptoms of serious mental disorder. Nothing you reported in the your last post sounds at all abnormal.

I'm not sure what is meant here by lumbar puncture but perhaps they wanted to test your cerebral spinal fluid for some neurological problem.

You seem quite confident that the diagnosis of bipolar is in error and if this is so, you need to talk to your physician about a PLAN. That is, you may want to talk to your physician once again about tapering your medication to see if you remain stable. Then, you can get a medical clearance with your employer. This process will take a number of months and even, perhaps a year because regardless of what you want, those in 'authority' seem to think there is something wrong with you and therefore, you need a good track record of being symptom free, while medication free. What do you think?
Customer: replied 2 years ago.

I agree that stating that the year as 1999 vs 2009 and "not staying on tract", was not a big deal. In my opinion, Ativan was probably what caused my confusion. 2mg is a big dose. Ativan causes confusion,sedation and antegrade amnesia. Sometimes benzos can cause a paradoxical effect..hostility, aggression.

 

I have not completed my hx to you yet. I can see from some of the emails that I wrote that I communicated in a way that was not my norm. Long-winded. Jumping from topic to topic. Left out words in sentence. Ex, "I am going store." Typed some parts of emails in bolder larger font. Wrote and said things to people that I would have never said under normal circumstance. For ex, my friend, Janet, thought it took me too long to get ready to go out to eat. Janet, my former professor of med, dresses in jeans and t-shirts. I managed her stocks for years. She didn't want to learn how to do this. I emailed her to say that I cannot dress as "tacky" as she does..private practice, not county hospital..."Please get my name off her stock account immediately.""Stop emailing me"; Janet moved back to Hong Kong. Janet is my dear friend. I wear old gym clothes all the time at home. I blurt out to my friend/patient that he should not go to Dr. X in my absence because he could not pass the Boards afterXXXXX X and I worked together at our first job. I like him, but he is not well-trained. Does not answer page for hours. I introduced the pt/friend to this Dr. We socialized on several occ. Previously, I may have said, "Dr. X's office is so much further than Dr. Y next door to my office. I have worked alot with Dr. Y.and she is excellent.

 

Wrote 2 emails on night and at 5:00 am, on night prior to admissions. No sleep. Had taken Ambien, Neurontin or Lyrica, Lidoderm Patch, Vicodin, possibly Benadry. One email fairly well-written. 2nd, as described above.

 

Cannot go off meds as condition of lifting suspension. Have psychiatrist, small town. Have psychotherapist. Neither ask pertinent negatives or positives. No Lithium levels in 8 months!! No ques about compliance. Both know that I did not take meds given in the hospital. Put into food, trash, clothes. Previous psychiatrists affiliated with UCLA. Saw both on one day. Neither can recall I am on Lyrica after 2 visits. They both rx Lyrica. Great, I'll take Lyrica.

 

Have more hx, but would like your impression of above.

Expert:  Dr. Michael replied 2 years ago.
You cannot go off meds as a condition of lifting the suspension. However, it is certainly possible to discuss with the doctor the following: 1) take a lithium level; 2) begin decreasing lithium dose with the idea of gradually tapering it. While one is on lithium as a condition of lifting a suspension, there is probably no requirement about the dose. They simply want you on a therapeutic dose, which can be high or very low. Ditto with the Lyrica if this makes sense. If I thought medication was unnecessary and was actually impeding my health and psychological functioning, I'd want to taper it, personally.
Customer: replied 2 years ago.

I agree that stating that the year as 1999 vs 2009 and "not staying on tract", was not a big deal. In my opinion, Ativan was probably what caused my confusion. 2mg is a big dose. Ativan causes confusion,sedation and antegrade amnesia. Sometimes benzos can cause a paradoxical effect..hostility, aggression.

 

I have not completed my hx to you yet. I can see from some of the emails that I wrote that I communicated in a way that was not my norm. Long-winded. Jumping from topic to topic. Left out words in sentence. Ex, "I am going store." Typed some parts of emails in bolder larger font. Wrote and said things to people that I would have never said under normal circumstance. For ex, my friend, Janet, thought it took me too long to get ready to go out to eat. Janet, my former professor of med, dresses in jeans and t-shirts. I managed her stocks for years. She didn't want to learn how to do this. I emailed her to say that I cannot dress as "tacky" as she does..private practice, not county hospital..."Please get my name off her stock account immediately.""Stop emailing me"; Janet moved back to Hong Kong. Janet is my dear friend. I wear old gym clothes all the time at home. I blurt out to my friend/patient that he should not go to Dr. X in my absence because he could not pass the Boards afterXXXXX X and I worked together at our first job. I like him, but he is not well-trained. Does not answer page for hours. I introduced the pt/friend to this Dr. We socialized on several occ. Previously, I may have said, "Dr. X's office is so much further than Dr. Y next door to my office. I have worked alot with Dr. Y.and she is excellent.

 

Wrote 2 emails on night and at 5:00 am, on night prior to admissions. No sleep. Had taken Ambien, Neurontin or Lyrica, Lidoderm Patch, Vicodin, possibly Benadry. One email fairly well-written. 2nd, as described above.

 

Cannot go off meds as condition of lifting suspension. Have psychiatrist, small town. Have psychotherapist. Neither ask pertinent negatives or positives. No Lithium levels in 8 months!! No ques about compliance. Both know that I did not take meds given in the hospital. Put into food, trash, clothes. Previous psychiatrists affiliated with UCLA. Saw both on one day. Neither can recall I am on Lyrica after 2 visits. They both rx Lyrica. Great, I'll take Lyrica.

 

Have more hx, but would like your impression of above.

Customer: replied 2 years ago.
Would like your impression of the manner in which I wrote emails, and the lack of diplomacy when speaking about friends. I was sleep-deprived during this period and under a lot of pressure. Bipolar vs sleep-deeprived and loose lips.
Customer: replied 2 years ago.

Would like Dr. Michael's impression regarding the emails that I wrote prior to admission. Also, his impression of my lack of tact with my friends.

 

Bipolar vs lack of sleep and under trmendous pressure.

 

I am only taking Lithium.. Levels 0.4 - 0.6 for at least 1 year. If I am not bipolar, I would like to go off Lithium. Do not think that 3 UCLA faculty with private practices can evaluate my record objectively.

 

Thanks.

 

Expert:  Dr. Michael replied 2 years ago.
With regard to handling your friends. You should try to reflect on what you said to them that was unprofessional or out of character and then write them a letter of apology---be GENERAL in your statements. "It was uncharacteristic of me and inappropriate to make a comment about [ whatever it is]". I want to apologize to you for [ state the apology]". Going forward, with your friends, you should mostly stop talking and spend 90% of your time listening and paraphrasing back to them what you hear. You need to show that you are interested far more in them, than you are in you, your story, your needs, etc. This will help rebuild damaged relationships if you have them.

You are quite correct that for some people, severe stress and sleep deprivation can cause symptoms that 'look like' a manic phase of bipolar disorder. People's anxiety reactivity increases, their feelings of stress tolerance decreases, and they begin to think in fragments and seem incoherent.

As I mentioned in my last post to you (Hope you got it---wrote it yesterday), you should discuss with your prescribing physician whether you can TAPER back on the lithium on a graduated schedule, over the coming weeks and months. Your job situation requires you to be on lithium but I'm quite sure they leave it to your treating physician to determine what the proper therapeutic dosage is---so you could be compliant with the work order that you stay on meds, but at the same time, this could be very low blood levels of the meds, if you feel they generate side effects, are not working very well, etc. But this is something to discuss with your doctor in great detail.

let me know if I can be of further help. Please click on the green Accept button at the bottom of the screen.
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience: Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
Dr. Michael and 2 other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.

I would like to ask you questions regarding bipolar disorder. Recall, no hx of depression. Dxd at age 55 yo.

 

Onset Jan 23rd.mania. Dxd with depression by Stanford-educated neurologist after the 2nd hospital day. "Flat affect" "Does not want to open her eyes." I could not open eyes due to sedation with Ativan given the day before. 72 hrs later, discharged. Readmitted by man who I called to give me a car ride home. My coat had been stolen with car key. This man probably knew about 1st admission. Retired MD. Bizzare man fired from Kaiser. Taken to same ER. Same hx came up on computer. Not evaluated by ER MD. so Feb 16th, adm 72 hrs at psych facility. Did not take any meds given. I "seemed better". Psychiatrist knew I was not taking any meds; friend reported this to him. Saw psychotherapist/lawyer. Spent 2 hours with her. Spent about 2 hours with friend. Both felt I was functioning at my baseline. So, manic/depressed. 3 weeks later, manic and not depressed. One week later at baseline as per woman who worked as a litigator, then became a psychotherapist. Approx 3 weeks later, grabbed out of my home by ex who hears about my hx and hospitalizations. Taken to same ER. He has not seen me in over 3 months. Reports that I am not taking care of self. Home a mess. Great. Same hx on EMR. Taken to another psychiatry facility one month later. GAF of 35.

 

Is time course consistent with bipolar. Is it consistent with GAF 35 to buy groceries, have nails done, hair done, pay 10 vendors for my office, buy concert tickets and invite friends?

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  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
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  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
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  • http://ww2.justanswer.com/uploads/DR/Dr.Keane/2013-8-20_204325_drkeane.64x64.jpg Dr. Keane's Avatar

    Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
  • http://ww2.justanswer.com/uploads/RE/resolutions66/2011-1-17_05728_IMG8202smilingeditedforJustAnswer.64x64.jpg Elliott, LPCC, NCC's Avatar

    Elliott, LPCC, NCC

    Psychotherapist

    Satisfied Customers:

    5024
    35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
  • http://ww2.justanswer.com/uploads/formybunch/2010-12-06_191055_img_0975.jpg Kate McCoy, M.Ed, NBCC, LPC's Avatar

    Kate McCoy, M.Ed, NBCC, LPC

    Therapist

    Satisfied Customers:

    3733
    Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
  • http://ww2.justanswer.com/uploads/DR/DrAkiraOlsen/2012-2-20_746_AkiraADpicmain.64x64.jpg Dr. Olsen's Avatar

    Dr. Olsen

    Psychologist

    Satisfied Customers:

    2336
    PsyD Psychologist
  • http://ww2.justanswer.com/uploads/norriem/2009-5-27_134249_nm.jpg Norman M.'s Avatar

    Norman M.

    Psychotherapist

    Satisfied Customers:

    2193
    UK trained in hypnotherapy, counselling and psychotherapy and have been in private practice. ADHP(NC), DEHP(NC), UKCP Registered and ECP.
  • http://ww2.justanswer.com/uploads/PsychologyProf/2010-07-15_171248_logos060400409.jpg Dr. Michael's Avatar

    Dr. Michael

    Psychologist

    Satisfied Customers:

    2177
    Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
  • http://ww2.justanswer.com/uploads/KURTEMMERLING/2010-07-23_215531_just_ask_picture1.jpg Steven Olsen's Avatar

    Steven Olsen

    Therapist

    Satisfied Customers:

    1727
    More than twenty years of expertise in counseling, psychological diagnosis and education