Chances are you have met someone who has been diagnosed with Bipolar Disorder. In fact, the judgment is pronounced as freely as lollipops are handed out at a local bank.
This catch-all phrase for an illness which bears a questionable etiology is thrown around as often as SIDS. So why are these two terms so prevalent? The answer is simple—we’re not getting the full story.
The term SIDS, short for Sudden Infant Death Syndrome, is not actually a medical diagnosis in and of itself. It is an acronym used to describe a lethal event of unknown cause.
So, a neonate who dies suddenly in the night does not technically suffer from SIDS, but rather an idiopathic mystery illness that a medical examiner has not identified.
There is a plethora of genetic mutations and pediatric afflictions that cause apneic or hypoxic events that can lead to infantile death, but that is a topic for another day. Suffice it to say, bipolar depression may be overly diagnosed.
Has this become another generic term for a mysterious illness that most doctors and psychiatrists are unwilling to unravel? Bipolar Disorder may in fact be the Great Pretender.
Bipolar disorder is a clinical diagnosis, one in which a mental health care professional will consider a set of symptoms and connect those to a set of guidelines established by the powers that be…but is there more to the picture?
To uncover the truth about bipolar disease, one must consider the phrase, “altered mental status” and the clue that it provides. If one were to view bipolar depression from an organic view or a biological perspective, naturally the term encephalopathy comes to mind. Encephalopathy refers to any malfunction in the brain that can cause a broad set of symptoms.
Ever thought of bipolar disease or schizophrenia as an encephalopathy? Perhaps you have heard of the term encephalitis such as the West Nile variety. Undoubtedly, a person suffering from such an illness will have an altered mental status due to the inflammation in the brain.
Some researchers have even suggested that schizophrenia could result from a mosquito-borne infection that triggers encephalitis. This is certainly a logical assertion that begs further attention.
To further inspect and delve into the root cause of bipolar illness, one must consider the cyclical nature of the condition. Why the ups and downs? Consider what happens to the unfortunate patient experiencing one of the known symptoms of mania—delusions of grandeur.
This exhibition is strikingly reminiscent of a dementia patient suffering from an episode of delirium. Distinguishing between delirium and psychosis is academic more than anything else. Most doctors warn their delirium patients they are likely to experience a depression once they break free from their altered state. Sound familiar?
The investigation into what causes, or what masquerades as bipolar disorder should begin not in the depression, because it is expected, but rather in the mania. Consider a man who is in a delusional state and believes he is the King of France. Once he returns to reality and realizes he is just an ordinary person, why wouldn’t he be depressed? No, the key is not in the depression, but in the cause of the mania. If the agitated state is triggered by an encephalopathy, that is where the investigation begins.
So, you may be wondering, what elicits encephalopathy? The list is vast and there are a host of culprits that cause an altered mental status. Something as simple as a vitamin deficiency can cause neurological symptoms.
Take pernicious anemia, for example, in which a patient cannot properly absorb the vitamin, B12. Did you know such an individual can succumb to a full-blown dementia from the lack of such vitamin? In fact, there are many forms of treatable dementias, but these are often not publicized or made widely known. Ever wonder why?
Another common illness that can cause personality changes and neurological disability is stroke. Whilst doctors will consider such an event in an elderly individual, they may not often entertain the notion in a young person.
Strokes can occur even in infants and adolescents causing a range of symptoms from paranoia to apathy. If the obvious signs of an infarct or stroke such as ptosis, (a drooping eyelid) and/or an uneven smile are absent, the chances are greater a diagnosis will be missed.
Unbeknownst to many, there are countless inborn errors of metabolism such as multiple carboxylase deficiency and methylmalonic acidemiamasquerading as mental disorders. While individually these inborn errors are considered rare, collectively they are not.
Plus, most of these metabolic derangements were not even discovered until the late 1960’s, so even if their occurrences are currently considered outside of the bell-curve, the probability that these conditions are underestimated is exceedingly high.
Many of these metabolic anomalies involve complex enzymatic pathways, which once disturbed, result in the body’s inability to process or metabolize certain vitamins, amino acids, and fats just to mention a few.
The neuropsychiatric manifestations of such ailments include confusion, delirium, psychosis, and the like. Sadly, these are frequently missed but can if diagnosed properly, could be easily treated with high doses of proper and specific types of vitamins.
Imagine…how many poor souls institutionalized over the years just needed a simple vitamin to ease their symptoms. It is a horrific thought.
Furthermore, these conditions occur with variable presentations and different ages of onset. While some patients are symptomatic in the neonatal period, others do not exhibit symptoms until adolescence or even adulthood.
Could those suffering from Alzheimer’s or other forms of dementia actually be exhibiting an even later onset of an inborn error of metabolism? Certainly, this hypothesis warrants further research as these afflictions are so easily and inexpensively treated.
There is also a seemingly endless list of infectious agents and toxins that cause neurological symptoms. If there are so many known causes of an altered mental status, why is a specific diagnosis not given and a generic one such as Bipolar Disorder so often used? Unfortunately, it comes down to time and money.
Consider if one of your family members exhibits signs of “mental illness” such as experiencing hallucinations out of the blue. Even if you opt to take your loved one to the family doctor, the likelihood of a psychiatric referral is high, if not a guarantee.
The probability that a medical or organic cause for an altered mental status will even be considered is low. Once at the office, the first order of business will typically be a predictable prescription for an antipsychotic.
Your family member is sent home with a bottle of pills, that once taken, may offer more harm than help. Ever see one of those commercials for a psychotropic drug? It is enough to scare any consumer away. Bottom line though, sometimes no intervention is preferable to a harmful one. Premium non nocere. (First, do no harm.)
So, why hide behind the cloak of bipolar disorder? Simple. Reimbursement is often a high priority, and time is sadly limited due to overbooked practices. Doctors and psychiatrists do not have the luxury to investigate each case of altered mental status on a case-by-case basis, and to do so, would be impractical.
Unfortunately, other than those who can afford boutique-style medicine, the days of house calls are over. While the doctors collect their fees and the pharmaceutical companies’ shareholders accumulate more wealth, where does that leave the consumers who are suffering with “mental illness?”
This is where the patient or the patient’s family, almost by necessity, is left with the burden. Many laypersons, whether advocating for themselves or others, have become medical detectives without ever even intending to do so. If you want something done right, do it yourself…yes?
Perhaps it is time for a paradigm shift in our approach to mental illness. The technological advances in other areas of medicine are impressive, yet our mental health industry lags behind, lingering in the dark ages. As consumers, it is time to demand more.
So, if your elderly father thinks he’s the President, or your husband tries to purchase a yacht on a painter’s salary, all hope is not lost. In addition to calling the psychiatrist or filling that script, you may want to put on your sleuthing cap and conduct your own investigation. Remember…a vitamin a day may keep the doctor away.
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