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Dr G (or others) differences between diagnoses? TRIGGER?
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psychkt posted:
Dr G (or others),

Please bear with me as I'm very new to the Bipolar world. I'm getting very confused with all the diagnoses I have been given. The first pdoc said it was unipolar depression after the first 5 minutes he saw me, (3 of which were him on his cell phone talking to his child about a baseball game that night). The next pdoc I saw had input from notes from the Partial Hospital Program i was in at the same clinic and never told me what he thought it was. I found out from my insurance papers he was labeling it Bipolar NOS. Due to transportation issues I had to leave him, and the newest pdoc I'm seeing is very well respected in my community. He started with unipolar depression but then got to see my "fun" cycles and told me possibly cyclothymia,after seeing more cycles he began using the term rapid cycling. He had put me on 450mg of lithium (along with cymbalta, and trazodone for sleep) and things seemed to level off with slight swings. Due to a verbal sparring with a coworker at work in front of my boss, I lost it (crying in the corner for an hour) my pdoc agreed to me taking time off work (since that is a huge stress for me) and I was doing great. I finally saw "me" for the first time in 2 years. As I'm preparing to go back to work after 6weeks off, with new coping skills and some much needed "me time", he said he believes that work may have been the cause of the roller coaster and has tapered me off lithium. Since my return to work is next week I know I'm stressing a bit about it, but my mood has dramatically shifted. I'm so angry (at everyone) I'm cursing them out and just in a B*tchy attitude. Plus all I want is sleep, but my mind won't shut off long enough to get real sleep. Now I've been reading up on BPD and it sounds so familiar to me too.

Wow that was long....sorry about that.

I guess my question is this: with all the diagnoses thrown my way, are there any tell-tale signs for each (unipolar, bipolar II, cyclothymia, BPD) that tend to lead pdocs (or whoever) to lean one way or another. I've seen the Wikipedia definitions of these but in terms of signs and symptoms what's the difference in these?

Also, one other question, with the lithium, he mentioned over and over (and over) that its such a low dose (we tried much higher, I got too sick from it) is it possible/likely that it wasn't doing anything for me since its so low? (No blood tests ever done)I believe it wasn't and that it just took the cycle a bit to happen because I wasn't under as much stress while being off work. I know everyone responds differently but in general can lower doses still work? Hope this has made sense. Thanks in advance!

Would love any others thoughts on this as well as Dr. G. So glad I found this site!
Reply
 
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Joseph F Goldberg, MD responded:
Dear Psychkt,

Most if not all psychiatric diagnoses are based on clinical criteria -- symptom constellations -- and have no laboratory tests to "confirm" a diagnosis, so debate about the diagnoses you mention really comes down to how thoroughly and carefully the evaluator has gobe through a detailed assessment of individual symptoms. The diagnosis of bipolar disorder requires that someone has had at least one discrete manic or hypomanic episode, defined not just by a change from usual mood but also a distinct increase in energy, activity, speed of thought, rapid speech, and needing little sleep. (The "mood" part per se of bipolar disorder is just one small piece of making the diagnosis, and mood swings in and of themselves are not very diagnostically specific.)
Cyclothymia, technically, means that someone has had hypomanic episodes but the depressive phases never last for at least 2 weeks. Bipolar disorder by definition involves distinct episodes that are a departure from someone's usual state...whereas personality disorders such as borderline personality disorder are (by definition) someone' usual state...and the mood changes are usually driven by situational factors (such as interpersonal affronts).

Medicines such as lithium are not specific to any diagnosis (just like Tylenol isn't specific to pain relief caused only by tension headaches)...in frank mania (bipolar I mania...where someone's functioning is compromised by their high energy and overactivity [eg, spending sprees>, lithium levels above about 0.6-0.8 are generally thought to be more helpful than lower lithium levels. Lithium levels are less well-established in hypomania, or bipolar depression, or for mood problems other than mania.

Florid mania takes about 5 seconds to diagnose. Differentiating bipolar II from unipolar depression from borderline personality disorder from a myriad of other types of problems can take a lot of time -- I often spend several hours over several visits with patients along with family members or other historians -- to make such determinations when things are not simple and straightforward.

Hope this helps.

Dr. G.
 
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psychkt replied to Joseph F Goldberg, MD's response:
Thanks for the reply Dr. G! I guess there isn't one specific thing that makes someone say "a-ha that's bipolar"(BPD, etc). Your information was very helpful. I appreciate you taking the time to respond so quickly.
 
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emily5887 replied to Joseph F Goldberg, MD's response:
This was really helpful for me also thank you


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