My 20 year old cousin was just diagnosed with Bipolar II disorder last month and I have a few questions.
A little background info:
She has always been such a loving and outgoing person, no signs of depression or unusual mood swings ever in her life. She was in her 2nd year of college and has been holding down a job for about 2 years as well. She is not impulsive and she has always been very responsible.
She was engaged to be married and was making wedding plans then found out her fiance was a thief. I won't go into those details but she did break up with him. She seemed to be dealing well with everything then 2 months later she just suddenly had a psychotic episode.
During this episode she said she felt confused and didn't know who she was. She was sure something bad was going to happen to someone she loved. She thought she was in a movie, thought she was pregnant and was going to give birth to Jesus Christ, she would pace back and forth, didn't sleep for several days.
She ended up in the psych ward for about 10 days. Was put on depakote and Zyprexa. After about 6 days on the meds she finally started showing signs of improvement and was eventually released with the diagnosis of bipolar. Dr. had her drop out of school and quit her job.
Ok so now it has been 1 month from the date of her 1st episode, she has been almost back to normal except for some grogginess from meds. Then just this last Saturday she suddenly started acting psychotic again out of the blue.
There were no warning signs or anything. The only link that I can find is that she was on her period during the previous episode and during this episode and she did have an ovarian cysts a few months ago (unknown whether she still has this or not). She is now back in a different psych hospital being treated by a diff DR. who took her off of the depakote and put her on lithium. So far no improvement in her condition.
So here is my question, does this sound like bipolar disorder to you?
Are manic episodes worsen during your menstrual cycle or do you see a link in that respect?
How long does a psychotic manic episode tend to last?
Is it common to have a manic episode so soon?
I know this is a long post, but i really appreciate any insight you can give me. Our family has never dealt with anything like this and we are struggling to find answers. I have ordered the book An Unquiet Mind, trying to learn everything I can about this disorder but I am having my doubts if it is in fact bipolar.
ummm...I'm confused BiPolar II's don't have manic or psychotic states. Are you sure they didn't diagnose her as BP I? Here's a pretty good definition off BPII that I just looked up, hope it helps.
Bipolar II is a psychiatric disorder that involves mood swings from depressed to hypomanic states. Unlike bipolar I, also called manic depression, bipolar II does not involve manic states. However, like bipolar I, the person afflicted suffers from varying degrees of mood. Bipolar II may create depression or anxiety so great that risk of suicide is increased over those who suffer from Bipolar I.
In order to properly diagnose Bipolar II, patients and their doctors must be able to recognize what constitutes hypomania. People in a hypomanic state may experience increased anxiety, sleeplessness, good mood, or irritability. The hypomanic state can last for four days or longer, and patients will note a significant difference in feelings from when they are in a depressed state.
Hypomania may also cause people to feel more talkative, result in inflated self-esteem, make people feel as though their thoughts are racing, and in some cases result in rash choices, such as indiscriminate sexual activity or inappropriate spending sprees. Often, the person who feels anxious or irritable and also has bouts of depression is diagnosed with anxiety disorder with depression, or merely anxiety disorder. As such, they do not receive the proper treatment, because if given an anti-depressant alone, the hypomanic state can progress to a manic state, or periods of rapid cycling of mood can occur and cause further emotional disturbance.
Manic states differ from hypomania because perception of self is generally so deluded as to cause a person to act unsafely and take actions potentially permanently destructive to one’s relationships. Additionally, the manic person may be either paranoid or delusional. Those with mania may feel they are invincible. High manic states often require hospitalization to protect the patient from hurting himself or others.
As to whether a womans' monthly cycle can make things worse I seem to remember someone saying that it could due to the hormone levels changing, but I can't swear to that. Is there a reason why your cousin went to a diff. hospital with a diff. pdoc?
I'm confused BiPolar II's don't have manic or psychotic states.
People with BPII don't experience mania, but they can experience psychosis. This is what is known as BPII with psychotic features. A person with this diagnosis hears voices when they are depressed.
A person can also be diagnosed with bipolar NOS (not otherwise specified) but in this case, bipolar is not the primary cause of symptoms and psychosis is due to a secondary disorder like schizophrenia.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN
Last edited by dreams in neon; 04-21-2009 at 01:24 PM.
Bipolar II may create depression or anxiety so great that risk of suicide is increased over those who suffer from Bipolar I.
According to my pdoc, mania is less common than depression even for people who have BPI.
Furthermore, men experience manic episodes far more than women although there are exceptions. I happen to be one of them since 95% of my symptoms revolve around mania.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN
The length of a psychotic episode varies and also depends on the time meds are given to treat it. The sooner meds are given, the faster it can be controlled. My last manic/psychotic episode lasted a little over a month. I was given high doses of mood stabilizers and antipsychotics. I now take Depakote for mania and Risperdal for my voices, delusions and paranoia. I've just started taking Risperdal a little over 2 weeks ago and so far, it's working great.
By the way, if Depakote was working well, why did the new pdoc take her off of it and put her on Lithium instead?
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN
Last edited by dreams in neon; 04-21-2009 at 01:19 PM.
Maybe she is really good at hiding it but she has never in any way acted depressed. We are close family and no one has noticed any depression. She's very even tempered and upbeat. Can you just become bipolar overnight? I didn't think it worked that way.
Her first psychiatrist said he would do a brain scan before she left the hospital to rule out anything like tumors and such but decided that since she finally got better on the meds the scan wasn't necessary.
But also he did not want to know any details of what we thought may have caused this episode. You see,we originally thought that all of the stress of dealing with her boyfriends deception had caused her to have a mental breakdown.
Maybe she is really good at hiding it but she has never in any way acted depressed. We are close family and no one has noticed any depression. She's very even tempered and upbeat. Can you just become bipolar overnight? I didn't think it worked that way.
Her first psychiatrist said he would do a brain scan before she left the hospital to rule out anything like tumors and such but decided that since she finally got better on the meds the scan wasn't necessary.
But also he did not want to know any details of what we thought may have caused this episode. You see,we originally thought that all of the stress of dealing with her boyfriends deception had caused her to have a mental breakdown.
I wonder why her pdoc didn't want to know about possible stressors? When I was IP for my first manic/psychotic episode, the attending pdoc asked my sister all kinds of questions about events that may have been responsible for triggering my episode. As it turned out, the pdoc said that the death of my mother as well as other factors were responsible in causing my mania and psychosis.
People can experience bipolar symptoms overnight. I started hearing voices and became manic after I had cochlear implant surgery. According to what the pdoc who oversaw my treatment when I was IP said, my mania was induced by anesthesia as well as other factors.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN
Last edited by dreams in neon; 04-21-2009 at 01:28 PM.
He said he didn't want to know anything that would influence his diagnosis and treatment.
That's strange because in most cases, the more information a pdoc can receive about a person's symptoms (i.e. cause), the more it helps them arrive at a correct diagnosis.
By the way, I would still ask her pdoc if she can be switched back to Depakote. If she isn't doing well on Lithium, there is no reason to continue taking that med.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN
Last edited by dreams in neon; 04-21-2009 at 01:45 PM.
Something sounds a bit iffy here....a diagnosis of BP II just doesn't seem to fit, and a pdoc not wanting any info. that a close family member can give him about how she's acting is kind of strange.
another thing is...if she's on Lithium then she has to very careful and med compliant in regards to taking her meds...it's not like just popping a pill each day, you have to stay within a certain level, so it's a bit more involved.
Something sounds a bit iffy here....a diagnosis of BP II just doesn't seem to fit, and a pdoc not wanting any info. that a close family member can give him about how she's acting is kind of strange.
another thing is...if she's on Lithium then she has to very careful and med compliant in regards to taking her meds...it's not like just popping a pill each day, you have to stay within a certain level, so it's a bit more involved.
k
That's true Kat. Another thing to remember is that Depakote is a strong mood stabilizer and works much faster than Lithium. When someone takes Depakote, they can expect their symptoms to improve (provided this med is right for them) in a few days compared to Lithium.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN
Last edited by dreams in neon; 04-21-2009 at 04:10 PM.
Now that you say that it sounds more likely to fit the symptoms doesn't it....
The BPII just doesn't fit in anyway. What about BPI??
Of course this is all speculation.
k
Kat,
It very well could be BPI -- especially if she experiences more mania than depression.
As you know, this is the case for me. I have more manic episodes than depressive episodes except during the autumn/winter months.
If she does have BPI, it sounds like her diagnosis would be BPI with psychotic features.
It's also possible that she could have schizoaffective bipolar type as well, but that would depend on whether or not she also hears voices while she is in a normal mood. If she doesn't, then she would have BPI with psychotic features.
On a final note, as you know, some people with BP only experience mania, so that makes the possibility of having BPI even more likely.
There has to be a reason why her pdoc diagnosed BP. She must be experiencing clear signs of mania even if they are disguised as psychotic episodes since people with BPI do have manic/psychotic episodes.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN
I went to see her in the hospital last night and she is not very well at all. I found out that her diagnosis was not BPII, but BPI I guess they have changed it. Anyhow they did do an MRI yesterday but we don't know the results yet. She can't even carry on a conversation and she has been vomiting, I guess from the lithium? Plus, she is seeing things that aren't there. It is so sad to see her like this.
I'm just worried that she won't get the proper help, where she is at. Because she is an adult and checked herself in do you know if her mom & dad can request she be transferred to a diff hospital? She is in no state to make this decision herself.
I went to see her in the hospital last night and she is not very well at all. I found out that her diagnosis was not BPII, but BPI I guess they have changed it. Anyhow they did do an MRI yesterday but we don't know the results yet. She can't even carry on a conversation and she has been vomiting, I guess from the lithium? Plus, she is seeing things that aren't there. It is so sad to see her like this.
I'm just worried that she won't get the proper help, where she is at. Because she is an adult and checked herself in do you know if her mom & dad can request she be transferred to a diff hospital? She is in no state to make this decision herself.
If her parents feel that she is receiving inadequate care, she can be transferred to a different facility.
As far as her psychosis is concerned, that should subside in a few weeks, if not sooner. When I had my first manic/psychotic episode, I heard voices for 3.5 weeks. Once the high dose of mood stabilizers and antipsychotics kicked in, my voices completely disappeared.
By the way, is she on an antipsychotic? If not, you may want to ask about her being put on one since they are designed to address visual and auditory hallucinations.
When I was IP in 2006 for my first manic/psychotic episode, I was given Haldol and later, Geodon.
One final point. Her diagnosis may have been changed from BPII to BPI due to the fact that she is experiencing a full blown manic episode as opposed to severe depression or hypomania.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN
Last edited by dreams in neon; 04-22-2009 at 09:37 AM.
The DX change is actually one good thing that has come out of this hospital because it definitely is more accurate with what you've told us is going on. If I were her parents I would get her to a different hospital posthaste, because it really sounds like she is not getting any type of care there. They should have her on diff. meds and a diff. treatment regimen if she is not reacting to the current one.
I am so sorry that you and your family have to go through this, I know it can be a terrible experience. Well actually this is more Dreams expertise, all of my hospitalizations are for severe depression or suicidality as i am BPII.
Please don't give up, hopefully her parents will transfer her and they'll get her some proper care.
Keep coming here and let us know what's going on, and better yet, how you are doing and holding up, we will continue to be here to support for you.
