A new clue to the genetics of bipolar disorder: Piccolo

Philadelphia, PA, 23 February 2011 – Understanding the genetics of bipolar disorder could lead to new treatments, but identifying specific genetic variations associated with this disorder has been challenging.

A new study in Biological Psychiatry implicates a brain protein called Piccolo in the risk for inheriting bipolar disorder. In the orchestra of neuronal proteins, Piccolo is a member of a protein family that includes another protein called Bassoon. Piccolo is located at the endings of nerve cells, where it contributes to the ability of nerve cells to release their chemical messengers.

http://www.eurekalert.org/pub_releases/2011-02/e-anc022311.php

Temper Tantrums, Mental disorder, and DSM-5: The Case for Caution – Psychiatric Times

At the same time, throughout psychiatry, there has been a continuing debate over the status of aggressive behavior in children and in relation to other disorders. Lee and Galynker³ reported that “just under 50% of people with bipolar disorder have some history of violent behavior.” Violence can occur in manic or in depressive states, or even in euthymic moods. They saw a close and compounding relationship between childhood trauma and violence in adult Bipolar Affective Disorder (BAD): “A history of 2 or more types of trauma has been associated with a 3-fold increased risk of bipolar disorder, as well as a worse clinical course that includes early onset, faster cycling, and increased rates of suicide.” Early trauma complicates adult affective disorder by predisposing to substance abuse, criminality, and personality disorder. In general, early onset of aggressive behavior indicates a poorer prognosis, and not just for the affective disorder. So what is the disorder, and what should be treated?

via Temper Tantrums, Mental disorder, and DSM-5: The Case for Caution – Psychiatric Times.

Me vs. My Therapist: An Identity Crisis

Had my weekly session with my therapist last night.  First, I have to say that she is the best therapist I’ve ever seen.  She’s compassionate, insightful and I have to solely credit her with finally arriving at the correct diagnosis.

As in any relationship, there are times in this one when we don’t see eye to eye.  We’ve had an ongoing dialogue about what a bipolar diagnosis does to one’s identity.  I’m afraid this time, we’re going to have to agree to disagree.

My therapist keeps trying to tell me that I am no different than I was before the bipolar diagnosis.  I keep trying to tell her that I am, because now my entire world is forever colored by these BP diagnosis glasses I can never take off.  True, I have been BP most of my life and I cannot really remember what it is like to be free from wondering if a day will be good or bad based on the mood-of-the-moment.

Since the diagnosis,  there is no denying I do see and experience the world differently. I never used to wonder if the pharmacist was having unprofessional thoughts when picking up my migraine med.  But I sure do now that I’m signing for antipsychotics.  I never used to wonder what shopkeepers’ experiences with me were.  But, now I wonder if my interactions with others are perceived as ‘normal.’  And, because last summer’s hypomania resulted in some really dumb behavior, these days, every time I make a decision, I am always questioning my judgment.

Personally, I think living in a perpetual state of behavior questioning is one of the hardest parts of living with this affliction.  It just takes so much energy.

There is an upside to BP, too. I’ve accomplished many things in my life that make people say, ‘wow!’  Could I have been such a blatant overachiever if I weren’t hypomanic at the time?  Probably not.  Being Touched with Fire has certainly served me well over the years.  So, today, when I am being productive the question becomes, “Am I being productive or hypomanic?”  Indeed, there’s lots of energy spent questioning.

For someone who is not bipolar, I don’t think they can ever fully appreciate how self-conscious and sometimes paranoid a BD diagnosis can make a person. Really, all I’m trying to bring to light with this post is we BPs need a bit of empathy and understanding.  Because from the moment one learns they have an incurable ‘disease,’ the world is changed forever.

Does needing a handful of pills to survive make me less of a person?  No.  But it sure does make me a different person than I was before being taken hostage by a daily handful of antipsychotic / antidepressant medication.

 

Return of the Light

For those in the Northern Hemisphere, the last two weeks have gifted us with noticeably longer days.  Here in the PNW we’re gaining around 4 minutes per day, which is pretty significant to my bipolar eye.  Also, the last two days have been absolutely stunning – crystal blue skies and sun from dawn until dusk.

Personally, I have had two outstanding, back to back  days this weekend.  I spent some wonderful time with my husband – we went out and about, driving and shopping.   I was in a good mood before we left the house, had positive exchanges with store clerks and even forgot (for a few hours, anyway) about my bipolarity.  I’ve also noticed this trend among several of the other bipolar bloggers whom I follow.

And, I believe I can attribute them in part to both the longer daylight hours and sunshine.

During my mini-hypomanic research on Seasonal Affective Disorder and bipolarity, I discovered that 60% of people with any type of depressive symptoms have an elevation in depression symptoms during the winter months.   But, does the return of the light also mean we need to watch out for mania?  We probably need look no further than studies done on bipolar patients who also use light box therapy, a form of mood therapy whereby one sits in front of a full-spectrum light for at least 30 minutes per day.  Apparently, we should, “…Be careful if your diagnosis is Bipolar Disorder. You can still use a light box, and probably should, but there is some risk that you could go into a hypomanic or manic phase. The best time for Bipolar folks to use the light box is in the mid-afternoon. It is also strongly suggested that you stay on, or use a mood stabilizer medication in combination with the light box.“

So, it really isn’t all in my head, is it?  The return of the light can spark a return of the light.  (OK, not very poetic, but you get the idea.)

I believe the trick from here out is to monitor my good days closely.  A bit of hypomania is good.  However, I cannot go to the same place I was last summer.  Light may bring back the spark, but the fire burned too hot and too bright (and much too destructive) late last spring.

Oh, why can’t there just be a few quiet, normal months?  Sometimes I really hate all of this bipolar stuff.

Employers: To Tell or Not to Tell

Yes, I know.  This subject has been beat to death.

After four weeks of LOA, as my return to work date draws near, of course whether or not to tell my employer I am bipolar is a topic I must revisit.  And, I’m sorry to say my opinion on the subject hasn’t changed one iota. Here’s why…

Being on LOA means I am, of course, home.  My husband does work from home for a large chunk of his 40 hour-plus work weeks.  These past weeks have really driven home for me what my husband has to suffer through at work and why.  He reported to a man who is bipolar for the first three of his five years with the company.  Now, you’re probably thinking, “Hooray!  A high-ranking executive in a major corp comes clean about our condition!  WOOT!”

Not so much.

This man, let’s call him John, went through a period where he was shouting through the rooftop about his bipolarity to anyone daring to stop long enough to listen.  Yes, this is a courageous thing to do.  Except this self-awareness campaign was part of the larger manic campaign during which John stopped taking his meds.  HUGE red flag, right?  John wreaked so much havoc in the six months he was off meds, although not officially ‘fired,’ he was asked to leave the company.

Fast forward to today, and two years after John’s departure, fallout is still occurring from actions taken and decisions made while he was manic / off meds.  The more depressing part of this not-so-fairy-tale ending is those who survived his manic wake are still lambasting him for his bipolarity, blaming the illness and perpetuating the stigma.  For benefit of my DH, I should make it clear that many things John was allowed to get away with were just plain wrong, and I am not suggesting for one second he should have been given amnesty due to his illness.  Management and HR should have stepped in long before they did.  Hell, I, too, have been the victim of crap managers who were not bipolar or mentally ill and the effects and fallout were eerily similar.  What I am saying is admitting to your employer and colleagues you are bipolar still makes people perceive your actions in a different way.  If John were ‘just a crap manager’ and not admitted he is bipolar, would that have changed how the staff sees the present drama?  Would they still be uttering his name under their breath and joining it with swear words and mental illness slurs?  I am not sure.  But, probably not.  Two years is a long time to harbor resentment against an ex-boss.  So, there’s got to be more to the story.

I am still extremely sensitive about mental illness stigma.  As I plan my exit strategy from my current job, it has occurred to me should I out myself and then leave the company, the same thing will probably happen to me that happened to John, just on a lesser scale.

“She left the company?”

“Yes she did.  Did you know she was bipolar?

“Really!?!”

“I bet that’s what drove her to it.  Just couldn’t hack the job.”

And you know, they would be right.  But just imagining that dialogue in my head is hurtful.  And that is only one of the reasons why I will never reveal my condition to my employer.  Stigma is not only alive and well, but it’s longevity rivals that of an elephant’s memory.

Interesting Canadian Mental Illness Stats

Fighting mental illness one nickel at a time.

20 per cent of Canadians will experience [mental illness] in their lifetime

Men are 2.6 times more likely meet the criteria for substance dependence, while women are 1.5 times more likely to meet the criteria for mood and anxiety disorders.

70 per cent of mental health problems have their onset during childhood or adolescence, and young people between the ages of 15 and 24 are most likely to report experiencing problems with mental health and substance abuse.

In Canada, [mental illness] is the No. 1 cause of disability, accounting for nearly 30 per cent of disability claims and 70 per cent of the total costs of disability. And each day, 500,000 Canadians are absent from work due to psychiatric problems. According to the Centre for Addiction and Mental Health, the total estimated cost of mental illness, in terms of health care and lost productivity, is $51 billion.

Despite the prevalence of mental illness, [mental illness] receives only 5.5 per cent of our health care dollars

Bipolar Boarding

Being a bipolar person presents a unique set of challenges when traveling.  I’ve already tackled the joys of packing. Now, let’s address boarding the aircraft.

The single most stressful time at the airport for yours truly is getting in line for the all-important ‘boarding  shuffle.’ Why? The bane of my existence: securing optimum overhead compartment space.

If I travel for business, it is a requirement of my company my laptop never be out of immediate reach or the compartment it is stowed in out of my line of sight. Over the years, along with the escalating severity of my condition, this rule has made me downright paranoid.  Not only during business travel, but securing optimal overhead space during personal travel has become an anxious nightmare as well.

I’m sure some of you are laughing by now (and rightfully so), but I’m also sure some are nodding in solemn agreement.  Bipolarity aside, over the last few years, securing the compartment immediately above your seat has become a blood sport.  Especially for those who insist on stretching to the absolute limit the allowable number and size of carry on items.  Thankfully, my Dear Husband has a frequent flier standing that allows us to pre-board, so yes, as I write this post, my articles are stowed directly above my exit row seat [score!] and within my line of sight. However, the couple with the 5 month old infant who boarded almost-too-late for the transcontinental flight?  Wow. The daggers Mom was throwing when her overhead compartment was already occupied were the stuff of which legends are made. I feel very sorry for her.  Having once been in her position, I truly do.  However, I can say with conviction that the soul crushing anxiety I feel as a bipolar person without their optimum overhead space is nothing compared to what I felt as a new Mom (many years ago) when my diaper bag had to be stowed 3 seats behind me.

Sigh. Such is life as a bipolar traveler.  Time to close the cabin doors & get this flight underway. Thank goodness I have Xanax already on board.