Diagnoses Articles

Article / Updated 05-03-2023

When you have bipolar disorder, you're encouraged to chart your moods, sleep, and energy levels daily to record patterns that may help you spot the early warning signs of a developing mood episode (mania or depression). In addition, this log provides valuable information to guide your doctor and therapist in their treatment decisions. Print this version of the mood chart and make as many copies as you need — or feel free to make your own, if you're spreadsheet-savvy. In the column for each day, record the following: Mood level: Place a check mark in the box that represents your overall mood for that day, which ranges from –5 (Depressed) to +5 (Manic). Hours sleep: Record the total number of hours you slept. Assigning sleep hours for a day can get tricky, because you're likely to fall asleep late one day and wake up early the next day. Consider assigning sleep hours to the night before. For example, if you slept from 10 p.m. Sunday to 6 a.m. Monday, assign those hours to Sunday (add in any nap time from during the day on Sunday). Energy level: Write a number from 0 (no energy) to 5 (supercharged) in the Energy level box. Notes: Jot down notes, such as a change in medication, exercise routine, or diet. Bring your mood charts to your doctor and therapy visits. Having this type of document to point back to and reflect on can be a powerful tool.

Article / Updated 05-03-2023

When choosing whether to take the name-brand or generic version of a medication for bipolar disorder, you and your doctor may want to consider the possible differences. Many people wonder whether name-brand medications are any better or even any different from their generic equivalents. Although the Food and Drug Administration (FDA) regulates both name-brand and generic medications, how those regulations apply to generic medications can lead to differences in how effective the medication is and in the side effects it causes, even when the generic has the same amount of the same active ingredient(s) as the name-brand version. The following sections provide the guidance you need to make well-informed choices between generics and name-brand medications. Consider the cost Most of the time for most people and with most medicines, generics are equivalent products and work just fine. The choice is usually straightforward: With the generic costing less, working just as well, and having the same or similar side effect profile, the more affordable generic is the better choice. However, in a minority of situations, the name-brand product is the better choice. In some cases, cost can be the determining factor in whether the person is able to obtain and take the medication. Being able to afford medications is critical for people to take the right amount of medication and to keep taking it. If the medicine is too expensive, people sometimes try to ration their medicines by lowering or skipping doses or even stopping a medicine entirely. Oddly, in certain situations, insurers cover the cost of a certain name-brand medication but not its generic. This is usually related to a financial arrangement between the insurance company and the pharmaceutical company that makes the name-brand product. Similarities between name-brand and generic medications According to the FDA, generic medications contain the same active ingredients as their name-brand counterparts, so theoretically, they should be equally effective, and in most cases they are. Here's how the two are similar: Same active ingredient(s): The vast majority of generic medications contain the same active chemical as in the name-brand version. Very similar bioequivalence: The generic version of the medication must be bioequivalent to the name brand. To be bioequivalent, the bioavailability of the generic must be very similar to that of the original medication. Bioavailability represents the amount of active chemical that gets into the system and the rate at which it does so. The bioavailability of the generic doesn't have to be identical to that of the original medication; it can be between 80 and 125 percent of the name brand. This may sound like a wide variation, but for most medications, in most people's bodies, the difference doesn't seriously affect how the generic works or the side effects it causes when compared to the name brand. Differences between name-brand and generic medications Although the generic is required by the FDA to deliver nearly the same amount of the same active ingredient(s) at about the same rate as the name-brand version, response to differences in the two can become more pronounced in the following areas: Individual response: How a person's body absorbs and then breaks down the medication can affect their response to a medication that's more or less bioavailable. If you change from a name brand to a generic, or vice versa, and you feel differently on it, let your doctor know. Medication class: Certain classes of medications have had some difficulties with these differences in bioavailability. For example, anticonvulsants (medicines for seizures, that are also often used to treat bipolar disorder) have a narrow therapeutic window, which means that getting control of seizures can require extremely tight management of doses and blood levels (within very narrow ranges). Studies have suggested that although patients who are started on a generic brand of an anticonvulsant may do well, changing from a previously well-managed dose of name brand to a similar dose of generic may cause reduced control of seizures. No specific studies show the same challenges with preventing mood cycles, but you and your doctor should consider and discuss the possibility. Extended-release versions: Long-acting versions of medications can be more difficult for generic companies to duplicate. In 2012, the FDA withdrew approval for a particular type and dose of a generic form of the long-acting antidepressant Wellbutrin XL. After patient and doctor complaints, the FDA tested and found that the generic version was only about 40 percent as bioavailable as the name brand. Other generic versions (by other manufacturers) were bioequivalent, but this one was withdrawn from the market. A similar incident happened recently with a generic version of the long-acting ADHD medication Concerta. Fillers: Medications include a variety of fillers and dyes that create the actual pill. Individuals may have more or less tolerance for these inactive ingredients (whether they're in the generic or name-brand version); they may even experience allergic reactions to them. Dealing with differences between generics of the same medication One downside to using a generic product is that a number of different manufacturers typically make the same product, and pharmacies may change suppliers to manage cost or supply levels. So, even though you may be stable on a generic version of your medicine, when you switch to a different generic, your response could change. With anti-seizure medications, this can be especially risky, but it could affect benefits or side effects in less dangerous but very important ways with other kinds of medicine, as well. Another concern is that the generic may look different depending on the manufacturer, which isn't usually a big problem, but it can cause challenges for certain populations, such as the elderly, who may experience confusion with that kind of change, or children, who may have difficulty swallowing a pill if it is much larger, for example.

Article / Updated 05-03-2023

Oppositional defiant disorder (ODD) is not just typical childhood rebellion. All children are oppositional at times; it's part of growing up and developing independence and personality. For most kids, rebellious behaviors respond fairly well to the usual carrot-and-stick parenting techniques, but oppositional kids exhibit a much more tenacious defiance. Parents describe the child as being stubborn, strong-willed, or simply a pain in the neck. When this pattern creates significant problems in function — at school, at home, with friends, or during activities — a doctor or therapist may suggest a diagnosis of ODD, which is described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, as: "A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months . . . and is not exclusively directed at siblings." ODD's irritable mood and behavioral difficulties — not doing as one's told — can overlap with mania. Although this is often a confusing area, the child with ODD demonstrates these symptoms chronically and not episodically. Furthermore, ODD doesn't include other manic symptoms such as energy changes and grandiosity. ODD is a problematic diagnosis in many regards, because its core symptoms are nonspecific. Irritable mood and defiant behavior can be associated with a wide range of developmental and psychiatric conditions. Your child needs a careful medical and psychiatric evaluation to help understand the mechanisms underlying these difficult symptoms. Bipolar disorder/mania is one possible explanation, but others can include unipolar depression, attention deficit hyperactivity disorder, language disorders, autism spectrum disorder, and trauma, among others.

Article / Updated 04-27-2023

If you’re battling with the idea that you are suffering from post-traumatic stress disorder (PTSD), there are signs that you — and your medical professional — can look for. Here’s an overview of symptoms that may point to a post-traumatic stress disorder diagnosis. Intrusive thoughts, emotions, or images: These may include vivid nightmares and/or flashbacks in which you feel as if the event is occurring all over again. Avoidance and/or numbing: For instance, you may avoid people or things that remind you of your trauma, feel emotionally detached from the people around you, or block out parts of your traumatic experience. Hyperarousal: Hyperarousal means being on red alert all the time, being jumpy or easily startled, having panic attacks, being very irritable, and/or being unable to sleep. You may also experience symptoms including body aches and pains, depression or other mental disorders, or problems with drugs or alcohol. If you have any or all of these symptoms, seek medical help — because if you do have PTSD, there’s help and hope!

Article / Updated 04-27-2023

Pinpointing the location of bipolar disorder in your brain is almost as difficult as finding affordable health insurance. Brain imaging studies have found few consistent changes when looking at large brain structures. They've had much more success looking at changes at the cellular level and, in particular, at functional changes in cells and groups of cells in different brain areas. Here is some basic brain anatomy and physiology that helps explain the research. Dissecting the brain Looking at a whole human brain from the outside, as shown, you see the cerebral hemispheres (the large sections, not labeled in the figure, that comprise most of the brain), the cerebellum (the small ball toward the back of the hemispheres), and the brain stem (a long, thin structure leaving the brain and connecting it to the spinal cord). The cerebral hemispheres are divided into four sections that serve broadly different functions — the frontal lobe, the parietal lobe, the temporal lobe, and the occipital lobe. When you open the brain up, pulling the two hemispheres apart into two equal parts, and look inside, you see a number of brain structures within the hemispheres. Within the outer layer, researchers have identified a number of cell areas related to different functions. Several of these areas appear frequently in studies of bipolar, including the prefrontal cortex and the anterior cingulate cortex. Below the large outer layer are a number of structures, some of which are quite important in bipolar disorder research, including the thalamus, hypothalamus, hippocampus, and amygdala. Exploring the functions of different areas of the brain Now that you have a bird's-eye view of the brain, consider the functions of some of these areas: Cerebral hemispheres: The cerebral hemispheres include most of the thinking and planning parts of the brain as well as areas important to sensory input and learning and memory. The areas are as follows: The frontal lobe is the executive of the brain, serving to coordinate and manage the many functions within the body and brain. The parietal lobe is involved in managing sensory experiences, in addition to playing a role in many other functions. The temporal lobe is involved in smell and auditory sensory input, speech and language, and memory and learning. The occipital lobe is the center for processing visual stimuli. All of these areas perform many other functions, as well, and functions may overlap between areas. Cerebellum: The cerebellum appears to manage the fine-tuning of complex movements and also seems to be involved in regulating thought, language, and mood responses. Brain stem: The brain stem manages basic survival mechanisms, such as breathing and the heartbeat, and is involved in the management of consciousness, alertness, and sleep/wake cycles. Cerebral cortex: The cerebral cortex is the outer layer of brain cells in the hemispheres. It's considered to be the site of higher level thinking, coordinating incoming information and generating movement, actions, and thoughts. It's broken down into a number of smaller areas associated with specific types of function. Prefrontal cortex: The prefrontal cortex is a section of the cerebral cortex that is highly developed and is involved in regulating complex thinking and behavior; it's considered a center of judgment and planning. Hippocampus: The hippocampus is located in the cortex (subcortical) and is especially important in learning and memory. Thalamus: The thalamus is a structure that sits below the cortex (subcortical) that serves as a relay station for sensorimotor input, conveying it to areas of the cortex. It also regulates sleep, consciousness, and levels of alertness. Hypothalamus: The hypothalamus is also subcortical and regulates many survival mechanisms such as hunger/thirst and sleep/wake and energy cycles, all components of circadian rhythms — physical, mental, and behavioral patterns that occur in approximately 24-hour cycles. Amygdala: The amygdala, another subcortical area, is a major player in the brain's reaction to emotions. Limbic system: The term limbic system is used to describe a number of brain areas important to emotional function. The list of areas can be different in different textbooks but the hippocampus, thalamus, hypothalamus, and amygdala are considered main components of this system. Anterior cingulate cortex: The anterior cingulate cortex is a part of the cortex that has strong associations between the prefrontal cortex and the limbic system and is thought to play an important role in regulation of strong emotions. Viewing the brain under a microscope The brain has several layers. The outer layer of the brain is called the cortex, often referred to as the gray matter. The layer beneath the cortex is a network of fibers that connect different areas of the brain, often referred to as the white matter. The fibers are protected and insulated by a layer called the myelin sheath. Within the brain is a system of cavities, including spaces called the ventricles, that make, circulate, and then reabsorb cerebrospinal fluid. This fluid serves as a mechanical shock absorber to the brain but also brings nutrients from and filters waste back into the blood stream. Another important component of brain anatomy is comprised of cells that make up all of these structures. Brain cells include neurons and glia. Neurons form the telecommunications system in the brain and body, dictating body functions by generating, sending, and reacting to electrochemical signals. Glial cells, once thought to be just a support network for neurons, play a major role in brain function and in the brain's communications and reaction systems. The gray matter of the cortex includes the cell bodies (central section) and dendrites (one of the connecting ends) of neurons, as well as glial cells. The white matter is made up of the axons (another type of connecting end) of neurons. Understanding how brain cells communicate Neurons communicate with one another in many different ways, but communication occurs primarily across the synapse — the space between neurons or between neurons and other cells, such as a gland or muscle cell. The most common type of communication occurs when one end of the neuron (often the axon, but not always) releases a chemical messenger into the synapse (as shown in the figure below). The next cell (often the dendrite of another neuron) receives the chemical messenger. Receptors on the outside of the second cell latch onto the chemical messenger. Cells have many different types of receptors for all of the chemical messengers; the type of receptor influences how the message is received and processed and how the instructions are transmitted to the second cell. After a chemical messenger occupies the receptor, it can generate many different responses in the receiving cell, depending on the chemical messenger and the receptor type. After the messenger has done its job, it's released from the receptor and then taken back into the first cell, a process called reuptake. In the brain, the chemical messengers are often referred to as neurotransmitters. Nervous system cells communicate in ways beyond the synapse. For example, chemicals called neuropeptides communicate between cells but not across synapses. Of great importance in the current research on bipolar disorder is the communication between glial cells and neurons. Disruptions in these communication systems may be at least as important as problems in neuron-to-neuron transmissions. Intracellular (within-cell) communication may also play a role.

Article / Updated 04-27-2023

When you love a person with bipolar disorder and want to support him or her, you will get a lot of suggestions from a lot of sources, some of which are more reliable than others. This article presents advice you can count on: seven ways to help a loved one with bipolar while retaining your own composure. These ideas have evolved from medical research and practice, along with personal stories and experience, and they can be powerful tools. Many of the suggestions are based on the few common principles covered here. With these in mind, you can begin to develop your own personal toolkit tailor-made for you and your loved one's needs. Don't take it personally. This principle is one of the hardest to put into action. Bipolar disorder symptoms include many behaviors that hurt your loved one and the people around him or her. It can seem clear to you that your loved one isn't trying hard enough or is just trying make things difficult. Don't give in to those thoughts. Blame the illness, not the person. What gets said or done to you isn't about you; it's about your loved one's distress and disrupted nervous system. Accept that you can't control your loved one or the illness. Your support is most effective when you let go of any ideas that you can force your loved one to do the things you think he or she needs to do. Empathizing rather than shaming, observing rather than criticizing, expressing feelings rather than demands, and trying to collaborate instead of control are some of the strategies that grow out of this principle. Keep cool. Bipolar disorder generates a lot of heat and high emotions. Responding with your own high emotions feeds the fire. Following this principle means figuring out how to refrain from yelling and screaming and how to walk away (disengage) from an interaction when necessary. You may want to explore ways to help you do this, such as mindfulness practices or regular exercise. Your lower tone can make a big difference for your loved one. Engage in discussion to create solutions. Effective communication is at the heart of helping your loved one. Listening attentively more than talking is one of your best tools in following this principle. Asking questions and really focusing on the answers opens up dialogue. Thoughts and feelings expressed clearly and compassionately are much more likely to yield positive outcomes than are blanket pronouncements and rambling lectures. Avoid the four big communication no-nos. Criticism, blame, judgment, and demand are likely to drive a wedge between you and your loved one. Work as a team to solve problems and address issues in ways that serve everyone's interests. Put safety first. Bipolar disorder can cause symptoms that are dangerous or even deadly. Being ready and able to call for help for your loved one is critical for everyone's safety and wellbeing. Your loved one may be unhappy, even angry, when you take action, but you can sort that out when they're feeling better. Planning ahead for crises — anticipating them, understanding that the risks are real, and being prepared to take action when needed — are strategies born out of this principle. Take care of yourself. You're in a better position to help others when you're physically and emotionally well. Discover how to leave a situation if you anticipate or observe danger. Care for your own health by paying attention to sleep, nutrition, and exercise, for example. This principle can feel hard to practice when you're exhausted by managing day-to-day crises, but caring for yourself alleviates the exhaustion and helps you maintain your role as a patient and effective caregiver.

Cheat Sheet / Updated 04-12-2023

To manage bipolar disorder effectively, you first need to know what it is. Then you can develop and follow a treatment plan, which usually includes a combination of medication, therapy, self-help, and support from a network of understanding and committed friends and family members. This Cheat Sheet can help you get up to speed on the basics of bipolar disorder in a hurry.

Cheat Sheet / Updated 10-24-2022

Living with obsessive-compulsive disorder, or OCD, poses challenges, not the least of which is making sure you don’t let your OCD define you. If OCD is part of your life, make the effort to focus on other health needs as well. Learn about what the disorder is and the many forms it takes so that you can start overcoming the disorder.

Cheat Sheet / Updated 04-12-2022

Symptoms of Post-Traumatic Stress Disorder (PTSD) give medical professionals clues to help make proper diagnosis of the disabling condition. The right medications, a good attitude, and positive affirmations can help to relieve the overwhelming signs of PTSD.

Cheat Sheet / Updated 03-23-2022

As you're learning more about autism, this Cheat Sheet can serve as a handy reference to the related acronyms and helpful websites. It also provides tips on how to communicate with a person who has autism, make sure they get the most from their education, and ensure they are properly prepared for emergencies.