DIFFERENCES|COMORBIDITY: Borderline PD and BiPolar Disorder

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PotentiallyKevin:
Quote from: anker on June 28, 2010, 06:56:49 PM


Pwbpd don't often seek treatment on their own do they? Do people with bipolar (either kind)?



From Wikipedia: Quote


Egosyntonic is a psychological term referring to behaviors, values, feelings, which are in harmony with or acceptable to the needs and goals of the ego, or consistent with one's ideal self-image. It is studied in detail in abnormal psychology. Many personality disorders  are considered egosyntonic and are therefore difficult to treat. Anorexia Nervosa, a difficult-to-treat Axis I disorder, is also considered egosyntonic because many of its sufferers deny that they have a problem.

It is the opposite of egodystonic. Obsessive compulsive disorder is considered to be an egodystonic disorder, as the thoughts and compulsions experienced or expressed are not consistent with the individual's self-perception, meaning the patient realizes the obsessions are not reasonable. However obsessive compulsive personality disorder (OCPD) is egosyntonic, as it is consistent with the way the patient thinks.


Well, PDs are considered Egosyntonic, so usually the borderline doesn't believe they have a problem... and if they do, its more of a poor me, I am broken, deal with it, mentality.

To my understanding (barring a manic phase, which is probably egosyntonic) bipolar disorder is considered egodystonic. At a young age,  I realized and even wrote journal entries about my mood swings. I knew something was wrong with me. I desperately wanted to not have mood swings, and wanted to be like everyone else... constantly happy. When I was diagnosed as bipolar, at first, it felt like a death sentence, but later I was finally relieved to have a diagnosis that described exactly what I was going through. I sought help on my own, because I couldn't stand being controlled by my mood swings.

Skip:
Quote from: PotentiallyKevin on June 28, 2010, 06:47:36 PM

A good indication that her psychiatrist doesn't actually believe she is bipolar, is by prescribing Prozac. Prozac is the preferred staple drug for Borderline Personality Disorder. Prozac is also the worst nightmare for pwBipolar Disorder - if prescribed alone (without a mood stabilizer) it will induce mania faster than an alcoholic binge...



It is not unusual to prescribe antidepressants to someone with bipolar disorder and antidepressants are well accepted tools for helping manage the disorder.  In some people with bipolar disorder, antidepressants can trigger manic episodes (very true) but may be OK if taken along with a mood stabilizer. 

Many of the drugs used have potential negative outcomes - it is why we want to stay close to the clinician and report any concerns promptly.

Quote from: PotentiallyKevin on June 28, 2010, 06:47:36 PM

Psychiatrists prefer to "officially" diagnose a patient as bipolar rather than borderline for three main reasons.

#1 No drama with the insurance company. Bipolar is considered highly treatable - and usually fully supported by insurance companies.

#2 Many psychiatrists feel that if they diagnose as borderline - the patient will be "shunned" by future therapist/psychiatrists. They consider it almost "blacklisting" the patient. I had a therapist admit to me that she almost always diagnoses bipolar rather than borderline - because if she diagnoses borderline, the person won't get the help they need.

#3 Many psychiatrists aren't familiar enough to properly distinguish between Bipolar Disorder and Borderline Personality Disorder. Unfortunately, this seems to be the #1 problem. Bipolar disorder and Borderline Personality Disorder have a lot of the same characteristics (Grandiose/Magical Thinking, Impulsiveness, Hyper-sexuality, Recklessness on the "high" side, Extreme Depression, Anxiety, Panic attacks, Loss of interest/appetite on the Low Side), The root of the problem, however, is very different.



These are all valid points. 

But it is also important to consider that psychiatrists, whom don't have the equivalent of low cost technical tools like blood tests and x-rays to diagnose patients, are limited to what the patient tells them.  This communication is a function of time (appointments are under an hour), communication skills of the patient (remember, people often see a therapists when they are in crisis), patient self awareness and honesty, and patient follow up (coming in for additional appointments, reporting progress).

My understanding is that many clinicians work through a process of elimination - treating the more episodic, pharmaceutical responsive, and lower cost conditions first.  Many of the Axis I disorders fall into this category.  The process is a little like pealing back an onion and dealing with each new layer.  If the patients stop coming in, the pealing process stops.

Axis II disorders are far more expensive, complex treatments for conditions that are often buried below other comorbid conditions.

In a hospital setting, there is more time to analyze and diagnose a patient.  Outpatient treatment, however, is often very time limited.




http://www.mayoclinic.com/health/bipolar-disorder/DS00356/DSECTION=treatments-and-drugs
Medications
A number of medications are used to treat bipolar disorder. If one doesn't work well for you, there are a number of others to try. Your doctor may suggest combining medications for maximum effect. Medications for bipolar disorder include those that prevent the extreme highs and lows that can occur with bipolar disorder (mood stabilizers) and medications that help with depression or anxiety.

Medications for bipolar disorder include:

Lithium. Lithium (Lithobid, others) is effective at stabilizing mood and preventing the extreme highs and lows of certain categories of bipolar disorder and has been used for many years. Periodic blood tests are required, since lithium can cause thyroid and kidney problems. Common side effects include restlessness, dry mouth and digestive issues.

Anticonvulsants. These mood-stabilizing medications include valproic acid (Depakene, Stavzor), divalproex (Depakote) and lamotrigine (Lamictal). The medication asenapine (Saphris) may be helpful in treating mixed episodes. Depending on the medication you take, side effects can vary. Common side effects include weight gain, dizziness and drowsiness. Rarely, certain anticonvulsants cause more serious problems, such as skin rashes, blood disorders or liver problems.

Antipsychotics. Certain antipsychotic medications, such as aripiprazole (Abilify), olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel), may help people who don't benefit from anticonvulsants. The only antipsychotic that's specifically approved by the U.S. Food and Drug Administration (FDA) for treating bipolar disorder is quetiapine. However, doctors can still prescribe other medications for bipolar disorder. This is known as off-label use. Side effects depend on the medication, but can include weight gain, sleepiness, tremors, blurred vision and rapid heartbeat. Weight gain in children is a significant concern. Antipsychotic use may also affect memory and attention and cause involuntary facial or body movements.

Antidepressants. Depending on your symptoms, your doctor may recommend you take an antidepressant. In some people with bipolar disorder, antidepressants can trigger manic episodes, but may be OK if taken along with a mood stabilizer. The most common antidepressant side effects include reduced sexual desire and problems reaching orgasm. Older antidepressants, which include tricyclics and MAO inhibitors, can cause a number of potentially dangerous side effects and require careful monitoring.

Symbyax. This medication combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer. Symbyax is approved by the FDA specifically for the treatment of bipolar disorder. Side effects can include weight gain, drowsiness and increased appetite. This medication may also cause sexual problems similar to those caused by antidepressants.

Benzodiazepines. These anti-anxiety medications may help with anxiety and improve sleep. Examples include clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Niravam, Xanax). Benzodiazepines are generally used for relieving anxiety only on a short-term basis. Side effects can include drowsiness, reduced muscle coordination, and problems with balance and memory.

Finding the right medication

Finding the right medication or medications for you will likely take some trial and error. This requires patience, as some medications need weeks to months to take full effect. Generally only one medication is changed at a time so your doctor can identify which medications work to relieve your symptoms with the least bothersome side effects. This can take months or longer, and medications may need to be adjusted as your symptoms change. Side effects improve as you find the right medications and doses that work for you, and your body adjusts to the medications.

Medications and pregnancy

A number of medications for bipolar disorder can be associated with birth defects.

Psychotherapy

Psychotherapy is another vital part of bipolar disorder treatment. Several types of therapy may be helpful. These include:

Cognitive behavioral therapy. This is a common form of individual therapy for bipolar disorder. The focus of cognitive behavioral therapy is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. It can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.

Psychoeducation. Counseling to help you learn about bipolar disorder (psychoeducation) can help you and your loved ones understand bipolar disorder. Knowing what's going on can help you get the best support and treatment, and help you and your loved ones recognize warning signs of mood swings.

Family therapy. Family therapy involves seeing a psychologist or other mental health provider along with your family members. Family therapy can help identify and reduce stress within your family. It can help your family learn how to communicate better, solve problems and resolve conflicts.

Group therapy. Group therapy provides a forum to communicate with and learn from others in a similar situation. It may also help build better relationship skills.

Other therapies. Other therapies that have been studied with some evidence of success include early identification and therapy for worsening symptoms (prodrome detection) and therapy to identify and resolve problems with your daily routine and interpersonal relationships (interpersonal and social rhythm therapy). Ask your doctor if any of these options may be appropriate for you.

Transcranial magnetic stimulation

This treatment applies rapid pulses of a magnetic field to the head. It's not clear exactly how this helps, but it appears to have an antidepressant effect. However, not everyone is helped by this therapy, and it's not yet clear who is a good candidate for this type of treatment. More research is needed. The most serious potential side effect is a seizure.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy can be effective for people who have episodes of severe depression or feel suicidal or people who haven't seen improvements in their symptoms despite other treatment. With ECT, electrical currents are passed through your brain. Researchers don't fully understand how ECT works. But it's thought that the electric shock causes changes in brain chemistry that leads to improvements in your mood. ECT may be an option if you have mania or severe depression when you're pregnant and cannot take your regular medications. ECT can cause temporary memory loss and confusion.

Hospitalization

In some cases, people with bipolar disorder benefit from hospitalization. Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you're having a manic episode or a deep depression. Partial hospitalization or day treatment programs also are options to consider. These programs provide the support and counseling you need while you get symptoms under control.

Abigail:
Quote from: anker on June 28, 2010, 07:32:58 PM

That was what she said. Like the high anxiety and sadness along with plenty of energy...

That's how their disregulation feels. She told me to look up "dysphoria"; I haven't had time yet.


Borderlines experience dysphoria which is a combination of anxiety, rage, depression and despair.  It does not include the endless energy or grandiose thinking associated with bipolar disorder.  But it is a horrible, awful feeling.  The opposite of euphoria.  Many times, after a rage, or when extremely dysphoric, they will simply go to bed and stay there. 

One therapist told me she thought my husband was bipolar because of the rages.  I told her that he never once had mania the entire 23 years I had been married to him at the time.  When dysphoric, he could sleep 24/7.  If he didn't get enough sleep, it was due to insomnia, not endless energy.

Abigail:
Quote from: Mobocracy on June 28, 2010, 06:47:36 PM


From what I have read, Borderlines seem to do OK on mood stabilizers - but I have read that Zyprexa has poor results - and Xanax seems to be a borderlines Kryptonite...I have read several accounts of Xanax having horrible results with BPD.  My ex was on Xanax and her rages increased 10 fold while she was on it - same with her dissociation...


Several studies have shown that those with BPD do worse on Xanax.  Interestingly, some types of epilepsy that have a behavioral dyscontrol syndrome as well, have epileptic fits of rage that are triggerred or worsened by Xanax.

anker:
Mania is only part of a bpI diagnosis, people with bpII don't get manic.

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