Dec 08

Women treated for severe psychiatric conditions including major depression shortly after giving birth were more likely to be diagnosed as bipolar later in life compared to those whose first psychiatric episode happened at any other time, in a new study from Denmark.

Researchers said they didn’t know if some postpartum depression or schizophrenia-like episodes were actually misdiagnosed bipolar disorder — or if more women with those initial diagnoses developed bipolar disorder over time.

“We’re looking at severe psychiatric episodes,” said study author Trine Munk-Olsen, from Aarhus University. She noted that while “postpartum blues” are relatively common, severe depression and other acute psychiatric episodes requiring inpatient or outpatient clinic care only occur in about one in 1,000 new moms.

“The severe episodes are rare, but they are serious episodes and of course they should be taken seriously. You want these women to get help, no doubt,” she told Reuters Health.

Bipolar disorder is characterized by alternating swings between severe depression and “mania,” when a person is overly excited, happy and energized. It can be treated with medications including mood stabilizers and talk therapy.

The condition most often manifests in early adulthood, and the National Institute of Mental Health estimates six percent of the U.S. population has the disorder at some point in life. Previous studies have suggested giving birth may act as a trigger for a first overt episode of bipolar disorder. But few women are actually diagnosed as bipolar in the weeks after having a baby.

The researchers theorized that a severe psychiatric episode shortly after giving birth could be a signal of underlying bipolar disorder. So they tracked women in Denmark for 15 years after their first psychiatric episode to see whether the timing of that episode — shortly after childbirth or not — predicted who would later get a bipolar diagnosis. Using Danish registries, they found 120,000 women treated in an inpatient hospital or outpatient clinic for their first bout of severe depression or another psychiatric condition starting around 1970. Of those, 2,900 had those episodes within a year after giving birth to their first child. That didn’t include women with an initial diagnosis of bipolar disorder, since the researchers were interested in women with other psychoses that later became bipolar.

Over the next decade and a half, close to 3,100 of all women initially given a different diagnosis were ultimately diagnosed with bipolar disorder. Of women who had their initial psychiatric episode in the first month after giving birth, 14 percent were eventually diagnosed as bipolar. That compared to between four and five percent of women who were first treated in the rest of the year after giving birth or at any other time.

“It is likely that some of the women were misdiagnosed — we cannot rule that out — but it is likely that some of the women develop bipolar over time,” Munk-Olsen said.

The results translate to a four-fold increase in the probability that a severe psychiatric episode in the month after giving birth, versus one that happens at some other time, will ultimately lead to a bipolar diagnosis. Among those with such early postpartum episodes, the patients admitted for inpatient psychiatric treatment were also twice as likely as those treated as outpatients to later be diagnosed as bipolar.

“Clinically these findings make absolute sense,” said Dr. Verinder Sharma, an obstetrician and gynecologist who studies bipolar disorder at the University of Western Ontario in London, Canada. “We have seen that childbirth is a potent and specific trigger of bipolar disorder.” Sharma, who wasn’t involved in the new study, told Reuters Health that hormone changes that occur during this time, as well as sleep loss, might trigger some women to develop bipolar symptoms, which could be misdiagnosed as depression or an anxiety disorder.

However, he said, there are still many questions about the role that having a baby plays in a woman’s chance of becoming bipolar. “We don’t know whether these women have the illness because of childbirth, and if they didn’t have children they would have gone without any episode of bipolar whatsoever,” he said. The findings also can’t prove that postpartum depression, or giving birth itself, causes bipolar disorder, and the researchers didn’t measure whether less severe, more common postpartum blues are linked to bipolar symptoms.

Still, they wrote Monday in the Archives of General Psychiatry that severe psychiatric symptoms which first show up soon after a woman has a baby should be added to the list of features that could increase the risk of bipolar disorder.

Doctors, Munk-Olsen told Reuters Health, should “think about when women have their onset, and you might have an indication that there is an underlying bipolar disorder. We want these women to be diagnosed correctly, in order to help them in the best way.” In particular, Sharma added, doctors who are treating women with new psychiatric symptoms after childbirth should rule out bipolar disorder before they think about simply treating with antidepressants, which could make certain bipolar symptoms worse.

“It’s really important to think about the diagnosis of not just depression but of severe depression and definitely bipolar disorder in new moms who present with a sudden onset of mood symptoms,” agreed Dr. Dorothy Sit, who studies mood disorders in women, including postpartum psychoses, at the University of Pittsburgh and wasn’t involved in the new report.

(Sources: Reuters; Psychiatric Disorders With Postpartum Onset: Possible Early Manifestations of Bipolar Affective Disorders in: Arch Gen Psychiatry. Published online December 5, 2011. doi:10.1001/archgenpsychiatry.2011.157. Image credit: drop.ndtv.com)

Nov 18

Bipolar Disorder: Caught between depression and excitement

John always felt that his wife was ‘changeful’ – but it took both of them years to find out that she was in fact suffering from so-called ‘bipolar disorder’. People with what was formerly called ‘manic depressive disorder’ cycle between unusually intense emotional states that occur in distinct periods: ‘manic episodes’ are defined by overly joyful or overexcited states, and ‘depressive episodes’ by extremely sad or hopeless feelings. However, sometimes symptoms of one state may also occur during the other, depending on the variation of the disorder which has been estimated to afflict about one of every 45 adults, independent of sex, culture or ethnic group.

One of the most common problems of persons dealing with this disorder is that they have serious difficulty set ting and achieving goals and maintaining stable relationships in their lives. During their manic episodes, they often experience an increase in energy, set themselves highly ambitious goals and might break up their relationships with people they consider as inferior or slowing them down. They tend to self-medicate, often through substance abuse (particularly stimulants or depressants, alcohol, cocaine or sleeping pills). Some of them tend to gambling, others might become aggressive or violent or experience a break with reality. As soon as the depressive episode kicks in, almost nothing of that remains: now, feelings of sadness, anxiety and guilt are dominating, and the person might feel isolated and hopeless. The formerly high sexual drive now almost disappears, fatigue, apathy or even suicidal thoughts may occur: The rate of bipolar patients committing suicide at certain points in their lives is very high.

Today, we still know little about the causes for bipolar disorders, but studies have indicated a substantial genetic contribution, as well as environmental influence (like an unstable or traumatic childhood). It is also likely that certain triggers are required to cause an outbreak of the disorder in some people, particularly relationship issues, cultural or job-related stress or physical illness. The basis of treatment usually consists of medication (which especially for this kind of disorder should really only be prescribed by a psychiatrist!) and complimentary psychotherapy to work on environmental triggers and efficiently learn to deal with the symptoms. The prognosis for most individuals with bipolar disorder is a good one – provided that they were diagnosed accurately and received the correct treatment.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2010)

Sep 07

Talking about ‘sex addiction’ in certain Asian cities is like talking about alcoholism during the ‘Oktoberfest’ in Munich: a firework of dirty jokes and winking confessions (‘yes, I’m an addict, too!’) are standard elements of these conversations. However, few people seem to know what sex addiction really is or means.

Sexual addiction (sometimes also called sexual dependency or sexual compulsivity) means that a person is unable to manage her sexual behavior, which is described as ‘compulsive’ in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association. It is thus often also referred as ‘hypersexuality’ in many papers. Excessive sexual drive can cause distress or serious problems not only for the affected persons but also to persons associated with them. Usually they invest a lot of time and money to satisfy their obsession with various activities related to sex, and may risk losing their jobs, ruining their relationships, interfering with their social life, and putting themselves at risk for emotional and physical injury. While for many, their behavior won’t progress beyond compulsive masturbation or the extensive use of pornography or paid sex services, for others, the addiction can involve illegal activities such as exhibitionism, voyeurism, obscene phone calls, sexual harassment or abuse and especially here in Asia, violating various Asian laws like filming sexual activities or organizing sex parties. Many sex addicts spend high percentages of their money due to their lowered sexual inhibitions – basically, most of their money-making and thinking ultimately turns around satisfying their sex drive. However, sex addicts hardly gain lasting satisfaction from their sexual activities and rarely form emotional bonds with their sex partners. To many, it feels like constant hunting – without ever achieving the satisfaction of feeling full.

Unfortunately, it is also typical for sex addicts to engage in distorted thinking – justifying and rationalizing their behavior and blaming others for the problems that arise as a result of their actions. As long as possible, they will deny they have a problem and find excuses for their behavior. Thus, it usually takes a significant event like the loss of their job, the break-up of their marriage, an arrest or a health crisis, to force the addict to admit that there is indeed a problem.

While professionals are still struggling with the exact definition and diagnosis of hypersexuality / sex addiction, there is no doubt that this disorder exists. Hypersexuality is also a criterion symptom of mania in bipolar disorders and schizoaffective disorders and often linked to depression or other forms of addiction, like alcoholism or drug abuse. Treatment of sexual addiction focuses on controlling the addictive behavior and helping the person develop a healthy sexuality.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2010)

Nov 09

Die Bipolare St√∂rung ist eine ernsthafte psychische Erkrankung (fr√ľher bekannt als “manisch-depressive St√∂rung”), welche mit Ungleichgewichten im Hirnstoffwechsel in Verbindung steht.

Psychotherapie und die Kombination mit der Einnahme von Psychopharmaka können sehr gut dabei helfen, diese Störung besser in den Griff zu bekommen. Die American Academy for Family Physicians empfiehlt deshalb, auch im regulären Alltag folgende Dinge zu beachten:

  • beobachten Sie den Verlauf Ihrer psychischen Verfassung, und halten Sie Ihre N√§chsten dar√ľber auf dem Laufenden
  • gew√∂hnen Sie sich an einen bestimmten t√§glichen Zeitablauf f√ľr T√§tigkeiten wie Schlafen-gehen und Aufwachen, Essen, Sport und andere
  • nehmen Sie Ihnen verschriebene Medikamente m√∂glichst regelm√§√üig ein
  • vermeiden Sie Koffein und versuchen Sie, ohne Medikamente gegen Erk√§ltungskrankheiten und Allergien sowie Schmerzmittel auszukommen.
  • Fragen Sie Ihren Facharzt, ob Sie pers√∂nlich a) Alkohol eher vermeiden sollten sowie b) ob Sie eine spezielle andere Medikation ben√∂tigen
  • versuchen Sie, Stress oder andere psychischen Belastungen m√∂glichst zu reduzieren bzw. ganz zu vermeiden
  • halten Sie mit Ihrem Arzt und/oder Psychotherapeuten rechtzeitig R√ľcksprache, wenn Sie bemerken, da√ü sich Ihr Verhalten zu ver√§ndern beginnt oder Sie beginnen, anderwertige bipolare Symptome an sich festzustellen
  • suchen Sie eine lokale Selbsthilfegruppe, um sich mit anderen Betroffenen zu vernetzen.
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06.01.16