Friday, July 31, 2009

Good Read

I know that when testing my elementary students for special needs, it is very hard to describe exactly what kind of syndrome these young kids actually have. This is the same thing here with the adults.

If Bipolar Disorder Is Over-Diagnosed, What Are The Actual Diagnoses?

A year ago, a study by Rhode Island Hospital and Brown University researchers reported that fewer than half the patients previously diagnosed with bipolar disorder received an actual diagnosis of bipolar disorder after using a comprehensive, psychiatric diagnostic interview tool -- the Structured Clinical Interview for DSM-IV (SCID). In this follow-up study, the researchers have determined the actual diagnoses of those patients. Their study is published in the July 28 ahead of print online edition of The Journal of Clinical Psychiatry.

Under the direction of lead author Mark Zimmerman, MD, director of outpatient psychiatry at Rhode Island Hospital, the researchers' findings indicate that patients who received a previous diagnosis of bipolar disorder that was not confirmed by a SCID, they were significantly more likely to be diagnosed with borderline personality disorder as well as impulse control disorders.

Their research involved the study of 82 psychiatric outpatients who reported that they received a previous diagnosis of bipolar disorder that was not later confirmed through the use of the SCID. The diagnoses in these patients were compared to 528 patients who were not previously diagnosed with bipolar disorder. The study was conducted between May 2001 and March 2005.

Zimmerman, who is also an associate professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University, says, "In our study, one quarter of the patients over-diagnosed with bipolar disorder met DSM-IV criteria for borderline personality disorder. Looking at these results another way, nearly 40 percent (20 of 52) of patients diagnosed with DSM-IV borderline personality disorder had been over-diagnosed with bipolar disorder."

The results of the study also indicate that patients who had been over-diagnosed with bipolar disorder were more frequently diagnosed with major depressive disorder, antisocial personality disorder, posttraumatic stress disorder and eating and impulse disorders.

Zimmerman and colleagues note that "we hypothesize that in patients with mood instability, physicians are inclined to diagnose a potentially medication-responsive disorder such as bipolar disorder rather than a disorder such as borderline personality disorder that is less medication-responsive."

In their previously published study that concluded bipolar disorder was over-diagnosed, they studied 700 patients. Of the 700 patients, 145 reported they had been previously diagnosed as having bipolar disorder; however, fewer than half of the 145 patients (43.4 percent) were diagnosed with bipolar disorder based on the SCID. The authors state that the over-diagnosis of bipolar disorder can have serious consequences, because while bipolar disorder is treated with mood stabilizers, no medications have been approved for the treatment of borderline personality disorder. As a result, over-diagnosing bipolar disorder can unnecessarily expose patients to serious medication side effects, including possible impact to renal, endocrine, hepatic, immunologic and metabolic functions.

Zimmerman concludes, "Because evidence continues to emerge establishing the efficacy of certain forms of psychotherapy for borderline personality disorder, over-diagnosing bipolar disorder in patients with borderline personality disorder can result in the failure to recommend the most appropriate forms of treatment."

The report is from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project, for which Zimmerman is the principal investigator. Zimmerman said, "The MIDAS project is unique in its integration of research quality diagnostic methods into a community-based outpatient practice affiliated with an academic medical center."

Along with Zimmerman, other researchers involved in the study include Camile Ruggero, PhD; Iwona Chelminski, PhD and Diane Young, PhD, all of Rhode Island Hospital and Brown University.

Founded in 1863, Rhode Island Hospital ( in Providence, RI, is a private, not-for-profit hospital and is the largest teaching hospital of the Warren Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. Many of its physicians are recognized as leaders in their respective fields of cancer, cardiology, diabetes, emergency medicine and trauma, neuroscience, orthopedics, pediatrics, radiation oncology and surgery. Rhode Island Hospital receives nearly $50 million each year in external research funding. It is home to Hasbro Children's Hospital, the state's only facility dedicated to pediatric care, which is ranked among the top 30 children's hospitals in the country by Parents magazine. Rhode Island Hospital is a founding member of the Lifespan health system.

Saturday, July 25, 2009

Found on my Bipolar News

GOP: Democrats Censoring Mail on Health Care
Capitol Briefing
House Republicans have been prohibited from mailing out this diagram of Democrats' health-care reform plan.

By Ben Pershing
The partisan debate over health-care reform has trickled down into one of the more arcane corners of the House -- the committee on free mail, otherwise known as the Franking Commission.

One of the perks of being a member of Congress is that each lawmaker is allowed to send "franked" -- or free -- mail, as long as it is related to official business. Members use that ability to send newsletters and legislative updates to their constituents. To ensure that privilege is not used inappropriately, a majority of the bipartisan six-member Franking Commission must approve each piece to ensure it meets some basic guidelines. Mail is blocked only on rare occasions.

But now the commission has gotten involved in the health-care fight, prohibiting several Republican lawmakers from mailing out reproductions of a colorful, labyrinthine chart that purports to diagram Democrats' reform plan. The controversy was first reported by Roll Call.

The chart was produced by the Republican staff of the Joint Economic Committee and has become a popular visual aide on the minority side of the aisle, as the GOP attempts to convince the public that the majority's plan will be a confusing disaster. But Democrats have argued that the chart is an inaccurate representation of their health-care efforts, and for that reason, the three Democrats on the Franking Commission say the GOP can't use it in official mail. House guidelines say that in franked mail, "Comments critical of policy or legislation should not be partisan, politicized or personalized." But what about information that's inaccurate, or -- arguably -- just misleading?

"We have never before censored anybody's presentation of facts this way," Rep. Dan Lungren (R-Calif.) complained in an interview Friday.

Lungren, the top Republican on both the Franking Commission and the House Administration Committee, said the commission has never traditionally played a fact-checking role. He pointed out that Democrats this year have sent out numerous pieces of franked mail touting the number of jobs created by the economic stimulus package, and while Republicans might disagree with those numbers, they've never moved to block the mail from being sent out.

"We let those things go by, even though we don't think it's true," Lungren said, adding that he knows of at least 15 Republicans who have asked to mail out copies of the health-care chart in question. (For some context, Rep. Kevin Brady (R-Texas) explains the chart's purpose here. Ezra Klein mocked the chart here, and includes a chart of Republicans' own health-care "plan." )

The controversy extends beyond the colorful chart. Salley Collins, a spokeswoman for House Administration panel Republicans, said GOP members were also being told by the Franking Commission that they could not refer to "government-run health care" in their mailings, and had to dub it "the public option" instead.

Democrats, led by Franking Commission Chairwoman Susan Davis (Calif.), say they are trying in good faith to negotiate a compromise with Republicans on this subject. If the impasse isn't resolved, watch for the GOP to turn up the volume on the controversy next week.

Thursday, July 16, 2009

Equality on the Brain

Amen to all of the following: I always ask, when someone tells me that another person does not have health care, Why? Why does that person not have healthcare? Sometimes the reason is no job and why is there no job? Sometimes the answer is they don't want to work hard, don't want to get an education, etc? Let the three trinity in charge of our great nation right now, step up to the plate and give up their wonderful government healthcare and join us all with what they are proposing to pass. Let them go first. Give up what you have and see how you like the socialized medicine dole-outs.

You're going to be healthy — whether you like it or not. The Obama administration is pushing for a national healthcare bill this summer and Democrats in the Senate are responding, with a Health, Education, Labor and Pensions committee measure that would make healthcare both a right and a responsibility.

Writes the San Francisco Chronicle, "The health panel's $600-billion measure would require individuals to get health insurance and employers to contribute to the cost. The bill calls for the government to provide financial assistance with premiums for individuals and families making up to four times the federal poverty level, or about $88,000 for a family of four, a broad cross-section of the middle class." The bill passed by a 13-10 margin, with all the Republicans on the committee voting nay.

So now the federal government is taking a leaf out of Mitt Romney's Massachusetts book, with its intention to force citizens to obtain health insurance at the end of a gun. Many support this, too, with a poll last year showing that even 52 percent of Republicans find this kind of coercion palatable. (Although we should always take the findings of one poll with a grain of salt. That is, until the health czars prohibit that sort of thing.) Of course, their reasoning isn't hard to grasp. They figure that the uninsured cost the system money, so they should be forced to step up to the plate. But the point many seem to ignore is that this isn't a problem of the free market — it's a problem of socialism. It arises when you force people to be responsible for the consequences of others' decisions.

Now, many think this is only just, and this brings us to the Senate proposal to make healthcare a "right." Should it be?

It certainly sounds good. But it also sounds good to have a right to live to be 120 or not develop cancer. The question is, is it realistic and is it the government's role to try to secure it?

We first must understand the difference between moral and legal rights. For example, I think every person has a moral right to be treated with dignity, but do we want the government to try to enforce such a thing? Likewise, I do think that people in need should receive help, but who should administer it? Moreover, when we say there is a "right" to healthcare, it's rather ambiguous. What level of care? Will people have the right to play the hypochondriac and clog hospitals for frivolous reasons? Will the elderly have the right to extreme measures designed to prolong life to the tune of millions of dollars per person? Will people have the right to psychological counseling for the latest "condition" invented by head shrinkers, such as "Oppositional Defiant Disorder" or "Sibling Rivalry Disorder"?

These are not minor questions. And when deciding what kind of healthcare is a "right," we must add some perspective. Remember that for most of man's history healthcare was cheap, true enough — but life was also short. Without the miracles of modern medicine, doctors could do relatively little. Women didn't live as long as men, the infant mortality rate was high, and making it to adulthood was a dubious proposition. In fact, I once read that the average lifespan in the Roman Empire was only 22 years. (Yes, many Romans did live to be very old, but so many people died in infancy or youth, that the "average" was very low.)

So, yes, healthcare is infinitely more expensive today, but isn't it just a case of getting what you pay for? Can our unparalelled level of care be delivered "on the cheap"? And is it realistic to think that everyone could have precisely equal access to cutting edge technology and innovations? Bear in mind that an MRI machine costs approximately $2 million to buy and $800,000 per year to run, and it costs the better part of $1 billion to research, develop, and bring a new medication to market. And what happens when you remove profit from the system? Well, note that the whole nation of Canada, with its much touted socialized medicine, has fewer MRI machines than the city of Pittsburgh.

The above fact illustrates well why we have heard horror stories about healthcare rationing in Canada, Britain, and elsewhere. It also brings us to a hard, cold fact and an immutable law of economics. The fact is that no amount of good intentions will grant us a special dispensation from the laws of economics. And one of those laws is that price caps ever and always lead to rationing. Always.

This is why we had gas lines in the 1970s. It's why 20 percent of curable lung cancer patients in Britain die because of long waiting lists. It's why that nation's prostate cancer survival rate is only 44 percent while ours is 80. Still want to be more like Europe?

The fact is that socialist systems don't work. And as a great example as to why, consider what author Daniel Gavron tells us about the problems encountered in a certain Jewish commune. In his book The Kibbutz: Awakening from Utopia, he writes, "There were also several endemic weaknesses in communal life, one of which was wastage. Food was 'free,' so members took more than they needed. Huge quantities were thrown away, and expensive items were fed to domestic animals. Electricity was paid for by the collective, so members left their air conditioning on all day in the summer and their heaters on all day in winter."

This story teaches a valuable lesson: price caps and profit loss within the medical system will mean less incentive to provide healthcare and less disincentive against using it wastefully. Collectivism would only ensure that the people collectively have worse healthcare. This is a fact.

Part of the reason so many today have trouble accepting this is immaturity. What do I mean? Well, when I was a boy, I often heard my father say, "Money doesn't grow on trees." He was old school, meaning, he understood reality. In contrast, too many of us — specifically, those of the leftist persuasion — are rather childish regarding money matters. So many Americans have a buy-today-pay-tomorrow mindset; this manifests itself in the liberal use of credit, both on the individual level with credit-card debt and on the collective level when we fund social programs with posterity's pocketbook. Many of us are also raised with a style-over-substance philosophy. That is to say, we seem to behave as if good intentions are all that matter; just institute the programs and worry about the details later. I mean, eat, drink, and be merry, for tomorrow we die — and maybe there is a money tree.

The reality is quite different. We can pretend as if medical care is a right all we want, but doing the hopey-changey won't grant us that special dispensation from the laws of economics. Any which way you slice it, modern healthcare is an expensive proposition just as is modern transportation. Yet there is one difference: while we all expect that we should have a car, we don't expect it to be cheap. We will pay $450 a month for a neat set of wheels, but many are taken aback when life-saving medication costs one quarter that much.

Unfortunately, reality doesn't matter to the radical egalitarians who are marching us toward healthcare oblivion. They want everyone to have equal healthcare — even if that means it will be equally bad. And if this sounds like a radical statement, just read the following story Walter Williams relates about Sweden's healthcare system:

Sven R. Larson tells about some of Sweden's problems in "Lesson from Sweden's Universal Health System: Tales from the Health-care Crypt," published in the Journal of American Physicians and Surgeons (Spring 2008). Mr. D., a Gothenburg multiple sclerosis patient, was prescribed a new drug. His doctor's request was denied because the drug was 33 percent more expensive than the older medicine. Mr. D. offered to pay for the medicine himself but was prevented from doing so. The bureaucrats said it would set a bad precedent and lead to unequal access to medicine.

Hard to believe, I know. It's like saying that instead of doing the good you can and feeding a large number of starving people, you won't feed any if you can't feed them all. It's what happens when you have equality-on-the-brain, that type of destructive zealotry that should itself be labeled mental illness.

The "right" to healthcare will ultimately mean the right to the kind of care we can already get for free. We should also note that members of Congress won't avail themselves of this right. They'll still have their special health plan.

Well, at least someone will still be getting the best healthcare.

Wednesday, July 15, 2009

Not New but worth re-reading

This is not new news, but the topic is always worth re-visiting.

People With Schizophrenia Say Bias Is Part of Their Lives

WEDNESDAY, Jan. 21 (HealthDay News) -- People with schizophrenia often expect to be discriminated against, and are, in various aspects of their life, new research finds.

The study, which included 732 people with schizophrenia in the United States and 26 other countries, found that 47 percent reported discrimination in making or keeping friends, 43 percent from family members, and 27 percent in intimate or sexual relationships. Also, 29 percent of the participants said they experienced discrimination while trying to find or keep a job.

What the study referred to as positive discrimination was reported by less than 5 percent of the participants.

The researchers also found that 64 percent of the participants didn't bother applying for work, training or education because they expected to fail or to face discrimination, and 55 percent anticipated discrimination when seeking a close relationship. However, more than a third of participants who expected these types of discrimination did not actually experience it.

Most participants, 72 percent, also told the researchers that they felt they needed to conceal their diagnosis of schizophrenia.

The findings appear online and in an upcoming print issue of The Lancet.


"This study opens a new arena of research characterizing the nature and extent of discrimination against people with mental illness," study author Graham Thornicroft, a professor at the Institute of Psychiatry, King's College London, and his colleagues wrote in a news release issued by the journal. "Rates of both anticipated and experienced discrimination are consistently high across countries among people with mental illness. Measures such as disability discrimination laws might, therefore, not be effective without interventions to improve self-esteem of people with mental illness."

"Even allowing for the possible effect of anticipated discrimination influencing patients' views of their experiences, negative experienced discrimination in many domains of life might be related to prior coercive mental-health service intervention," the authors continued. "If confirmed by further studies, this finding might guide mental-health services to promote social inclusion and to rely less upon compulsory treatment in the future."

The study points to the kind of research required to improve understanding of stigma and discrimination, according to an accompanying editorial by Beate Schulze of the Research Unit for Clinical and Social Psychiatry at the Center for Disaster and Military Psychiatry in Zurich, Switzerland.

"By investigating actual discrimination and self-stigma, the study brings together the structural and cognitive perspectives that have not previously been combined," she wrote. "However, what remains to be done is to determine the effect of discrimination on health and social outcomes and translate these findings into effective public-health strategies."

Saturday, July 11, 2009

Need more of this

I would like to see these open house forums in every state.

Stanford To Offer Bipolar Education Day On July 25

Bipolar Disorders
Find Causes, Symptoms & Treatments Research Depression Options
Current Article Ratings:

The Stanford University School of Medicine will host its fifth annual Bipolar Education Day on July 25. Individuals with bipolar disorder, their families, caregivers, friends and interested community members are invited to attend.

The free event will be held at the William R. Hewlett Teaching Center at 370 Serra St., located on the main campus.

More than 5.7 million Americans have bipolar disorder, a psychiatric illness that causes unusually intense shifts in mood, energy and behavior. Bipolar Education Day gives scientists and clinicians an opportunity to discuss the previous year's research findings with individuals and families affected by the disorder.

This year's speakers include Terence Ketter, MD, professor of psychiatry and behavioral sciences and chief of Stanford's Bipolar Disorders Clinic; Po Wang, MD, and Jenifer Culver, PhD, from the Stanford Bipolar Disorders Clinic; Manpreet Singh, MD, from the Stanford Pediatric Bipolar Disorders Program; and representatives from the National Alliance on Mental Illness and the Depression and Bipolar Support Alliance. Speakers will discuss treatment options that can help patients manage their symptoms. An afternoon question-and-answer session will follow the talks.

"I'm looking forward to a chance to share some of the latest advances in research at this year's Education Day," said Ketter.

The program runs from 8:30 a.m. to 2:30 p.m. and includes complimentary morning beverages and an afternoon snack. Pre-registration is required. For more information or to register, please visit or contact Meredith Childers at

The Stanford University School of Medicine

Wednesday, July 1, 2009

Anger or Irritability doesn't really matter

This is another good article about diagnosing young children with bipolar. This addressed the symptom of being irritable for no reason. We know that pure anger is a huge symptom of bipolar in adults so it would only make sense that is a very young child like 7 years old, that instead of anger it could be seen as severe irritability. I do see this in my special ed. students and one in particular who is entering the 2nd grade this year and has already been diagnosed as bipolar. He has a family history, can't focus, and most days if very irritable. Makes sense to me.

Irritability Should Be Considered When Diagnosing Bipolar Disorder In Children
Main Category: Bipolar
Also Included In: Pediatrics / Children's Health; Depression
Article Date: 26 Jun 2009 - 0:00 PDT

A new study from Bradley Hospital and The Warren Alpert Medical School of Brown University, as well as two other institutions, adds to mounting evidence that clinicians consider irritability as a symptom when diagnosing pediatric bipolar disorder.

Reporting in the July issue of the Journal of the American Academy of Child and Adolescent Psychiatry, researchers say a small percentage of children with bipolar disorder experience manic episodes without extreme elation - one of the hallmarks of the disorder - and are diagnosed based on irritable mood alone.

"Diagnosing children with bipolar disorder is challenging. One of the chief controversies is whether irritability should be included among the criteria for this diagnosis because it can also overlap with a number of other psychiatric disorders, such as attention deficit hyperactivity disorder," says lead author Jeffrey Hunt, MD, a child psychiatrist and training director at Bradley Hospital. "Our findings confirm that while irritable-only mania is uncommon, it does exist - particularly in younger children - and should be considered in a bipolar diagnosis."

Bipolar disorder is characterized by dramatic mood swings from euphoria, elation and irritability - the manic phase of the disorder - to severe depression. Bipolar disorder often begins in late adolescence or early adulthood, although it can develop as early as the preschool years. Recent studies have shown that the number of children and teens being treated for bipolar disorder has grown dramatically in the last decade. Although it is unclear what has caused this increase, experts believe it may be due in part to more aggressive diagnoses by physicians and a greater awareness of pediatric bipolar disorder in the medical community.

Hunt and colleagues studied 361 children between the ages of 7 and 17 with bipolar disorder participating in the multi-site Course and Outcome of Bipolar Illness in Youth (COBY) study at Bradley Hospital and Alpert Medical School, the University of Pittsburgh and the University of California-Los Angeles. COBY is the largest and most comprehensive study of children and adolescents with bipolar disorder to date.

Researchers quantified the frequency and severity of manic symptoms of each participant, including whether irritability and elation were present. Based on this data, the group was then reclassified into three subgroups: elation-only, irritable-only and both elated and irritable.

Approximately 10 percent of children fell into the irritable-only category, while elated-only constituted about 15 percent. Nearly three-quarters experienced both elation and irritability. The irritable-only participants were significantly younger in age than the other two groups; however, there were no other sociodemographic differences between the groups. There were also no significant differences in terms of bipolar subtype, rate of psychiatric comorbidities, severity and duration of illness, and family history of mania and other psychiatric disorders. However, depression and alcohol abuse in second-degree relatives occurred more frequently in the irritable-only subgroup.

"The fact that the irritable-only and elation-only subgroup had similar clinical characteristics and family histories of bipolar disorder provides support for continuing to consider episodic irritability in the diagnosis of pediatric bipolar disorder," says Hunt, who is an assistant professor of psychiatry and human behavior at Alpert Medical School. Hunt is also training director of the child and adolescent fellowship and triple board residency programs.

The authors say continual, long-term follow-up of this study sample will help clarify whether the presence or predominance of elation or irritability at baseline will predict future clinical outcomes.

The research was funded by a grant from the National Institute of Mental Health. Study co-authors include Jennifer Dyl and the late Henrietta Leonard from Bradley Hospital and Alpert Medical School; Christianne Esposito-Smythers, Martin Keller, Lance Swenson and Robert Stout from Alpert Medical School; Boris Birmaher, David Axelson, Neal Ryan, Benjamin Goldstein, Tina Goldstein, MaryKay Gill and Mei Yang from the University of Pittsburgh Medical Center; and Michael Strober from the David Geffen School of Medicine, University of California at Los Angeles.