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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
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Experience:  Dr. Mark is a PhD in psychology in private practice
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By the type of manic episode my son had with psychosis, his

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By the type of manic episode my son had with psychosis, his diagnosis would seem to be bipolar 1, however he is cycling a week depressed and today manic although he is just on the second day of Seroquel. Does this still indicate bipolar1?
It might just help in knowing how to deal with this situation
BD1 does not exclude frequent cycling. Let me explain.

Today, we have had now so much history to review and research that has been done on Bipolar Disorder (BD) that we discuss it in more and more refined terms. We recognize because of all the history that has been documented and research done that there are many forms of mood cycling, or mood swings.

At first, we thought until the late 1980s that BD meant a full manic episode that was followed, after the mania crashed down, into depression. Then the person would have a full manic episode again. This was portrayed incredibly well by Kay Redfield Jamison in her book An Unquiet Mind and her subsequent books. Because she was/is a psychologist who herself had BD. I recommend you read her books. I think she's wonderful for the public to gain an understanding of the classic BD. Here is an Amazon search on her books I made for you. YOu'll see that the reviews are mostly positive and I agree with them:

But then with research we saw that there were other forms of mood swings/cycling that people were experiencing. That these mood swings weren't quite as extreme and dramatic but were also debilitating because they happened more frequently. The less extreme state was called hypomania instead of mania. And this was characterized by weekly and sometimes daily swings back and forth. Whereas manic states were fully extreme, hypomanic states tended to be irritable, more energetic, aggressively angry states but not fully manic. This was called BD2

We then learned that some people were cycling many times every day. In my office I've seen people go through 4-6 mood swings in a one hour therapy session! These mood swings aren't as extreme as even the classic hypomanic states, but they are happening so quickly that the person feels tremendous anxiety and finds functioning difficult. This was called BD2 with rapid cycling.

Now, the important part is that your son may be experiencing both the classic BD1 manic symptoms and also BD2 symptoms. That can occur. And it is important then for you to alert his doctors.

I'd like to add something: if he is cycling more, it would be very worthwhile to start keeping track of his moods. That will help in establishing if the "swings" are happening.

Here are three resources: the first are computer programs for tracking moods:

They are both popular; Moodtracker is perhaps more well known, at least here in the US. Here, though, is a simple printout with charts that you can copy and fill in by hand and that may be enough:

The idea here is for him to track his mood changes for a week or 10 days minimum. Then when he will go to his doctor to discuss the problems, he'll have some data that the doctor can look at so that you can discuss your son's entire range that the mood chart may bring up. Okay?

I wish you the very best!

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