HELP PLEASE!!! Former diagnosis of bipolar/personality disorder

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    hello—i am a 23 year old nursing student interested primarily in psych nursing. i have been reading these boards for some time now, and it is apparent that you are all a well-informed group of nurses! that said, i am hoping that someone is able to help me out. you see, i was first diagnosed with major depression at the age of 12, and treated with a tricyclic antidepressant (nortriptilyn—spelling?). i responded to treatment quickly, and i do mean very quickly. within a month, my psychologist thought i was a smashing success story, despite the fact that i had very atypical results from the medication-- including a 40 lb wait loss. i stopped taking the medication after a year, and things quickly deteriorated for me. i sought treatment for a crippling depression off and on through high school, though i never stuck with one particular medication…or doctor. at the age of 17 and 18, i had what would seem to be a manic episode, one that still has had devastating impacts on my schooling (and credit) years later. at the age of 19, i was diagnosed with bipolar disorder and treated with depakote and lexapro. i stopped treatment ama within two weeks. my mother did not accept the diagnosis, and sent me to another doctor, who is treating me with paxil cr. (i am assuming that he has dx me with an anxiety disorder?) i am frustrated with the inconsistency in diagnosis and the litany of medications. so, my question is this. do you think that my diagnosis of bipolar disorder could be accurate? is it possible to have an isolated incident of mania without having bipolar disorder? how does one keep their “knowledge” of mental disorders from affecting their diagnosis. (i am particularly troubled because i did a report on bipolar disorder only three months before seeking help. did i accidentally, and incorrectly, diagnos myself?) i do not pretend to know more then the physician, but i do not want to take medication for something that i don’t have. my mind is racing…please help!

    p.s. i should mention that within the last two years, my fathers dx changed from bipolar to paranoid schizophrenia. yikes!!
    Last edit by finness on Jun 7, '04
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  4. 7 Comments so far...

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    Quote from finness
    my mother did not accept the diagnosis, and sent me to another doctor, who is treating me with paxil cr. (i am assuming that he has dx me with an anxiety disorder?) i am frustrated with the inconsistency in diagnosis and the litany of medications. so, my question is this. do you think that my diagnosis of bipolar disorder could be accurate? is it possible to have an isolated incident of mania without having bipolar disorder? how does one keep their “knowledge” of mental disorders from affecting their diagnosis. (i am particularly troubled because i did a report on bipolar disorder only three months before seeking help. did i accidentally, and incorrectly, diagnos myself?) i do not pretend to know more then the physician, but i do not want to take medication for something that i don’t have. my mind is racing…please help!
    some medications can actually trigger mania; paxil is one of them (not to scare you, but you should discuss it with your md).

    psych disorders don't fit into neat little boxes; you can have symptoms of several -- or have more than one disorder. and symptoms can change over time. makes it hard to diagnose in the few minutes the md sees you. of course, overspending is a classic manic symptom, but people also overspend when they're depressed or anxious.

    as long as your symptoms are controlled, the diagnosis may not be very important at this point.

    i wouldn't worry about the change in your dad's diagnosis as far as your diagnosis is concerned. some physicians try very hard to avoid diagnosing people with schizophrenia (because of the stigma), which may be what happened with your dad.

    i would let the md know about your racing thoughts.

    good luck!!
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    My mother, two out of three of my sisters, and my aunt have bi-polar disorder. I have done quite a bit of research and also have the first hand experience of being around family members with it, so if you have any questions you could PM me. I have read that most ppl with bi-polar are misdiagnosed almost 8 times before they recieve proper treatment. This is a disorder that without proper meds, unfortunately can bring heartache and havok to your life and destroy it. My mom and one of my sisters when they have a manic episode (usually occurs if they are not taking their meds), are sexually deviant, very loud and chattery. They are constantly on the go and have trouble sleeping at night and sometimes have trouble sleeping at all. They can also be very emtional and sometimes violent. My other sister is more depressive. Even with meds she tends to be moody and can get very quiet. She cannot keep a job, she is paranoid around others. Tends to get panick or anxiety attacks. When she has a manic episode she would get extremely angry or violent. Not sexually deviant.

    I hope this helps....
    Julee
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    You're 23 now. Your mother should no longer be involved in your decisions about your health care. If you have concerns about the treatment you are receiving, you should ask around for referrals to another psychiatrist. Unfortuately psychiatry is not an exact science and much depends on how the clinician interprets your symptoms and behaviors, so it is pretty common to try a variety of medications and to have different diagnoses. At the very least, talk with your current doctor about why you are on Paxil CR, especially given a history of a manic episode.

    good luck with this and with school
    luci
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    [B]seriously i was diagnosis with depression, PTSD, and a personitaly disorder.. so i know how the raceing thoughts are... maybe you should find someone with the same diagnosis as you because you can learn that you are not alone. also and talk to eachother what you've tried to make yourselfs feel better.. Have a nice day!! *smile*
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    Ditto what lucianne said ... My best advice, as a psych nurse of 20 years, would be to find a psychiatrist you feel comfortable with and confident in, and follow whatever treatment s/he recommends. I agree with hypnotic_nurse, it can take time and effort to accurately diagnose a person's unique, individual set of psychiatric symptoms. It can also take time and "trial and error" to arrive at the most effective medication regimen. You mention Paxil and say that you "are assuming" your doc has diagnosed you with an anxiety disorder -- does this mean that you and he haven't discussed his diagnosis and plans for you? How come?

    I also hope that you are actually seeing a psychiatrist, and not just a family doc who likes prescribing psych meds for people, because it is a complicated specialty ...

    lucianne is right, once you turned 18, your mother has nothing to say about your treatment or choice of physician (psychiatric, medical, or any other kind!)

    There are many, many possible presentations of bipolar disorder -- I once worked with a woman who was a successful professional who had a manic break once every ten years, regular as clockwork. The rest of the time she was perfectly fine ... There are also several possible dxs besides bipolar disorder that can account for "bipolar"-type symptoms (this is the case with most psychiatric diagnoses, and why, IMHO, family docs should stay out of psych for the most part ...)

    Best wishes --
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    It is often correct that folks are misdiagnosed during the early stages of the illness's development. Many folks often may meet criteria for several disorders at one time or may not present a neat clear cut picture unless it becomes blatant. Even so, often a person with bipolar mania with psychosis MAY look exactly the same as a person with acute schizoaffective with manic features....the chronicity or history of presentations of the illness often becomes the key to diffierentiate the two. A schizoaffective will present like a straight schiz when the mood disorder portion of the illness is not the issue. And a person may present with a severe depression with psychotic features and could present similar symptom pictures as well....psych is not a clear cut package deal. Never has been. This can be quite frustrating for the person with a disorder as well as the family. Again, here we often talk about the Axis I diagnoses. Often times, an Axis II (personality disorder) or tendencies may be present which can complicate the picture, but may not be diagnosed (or purposely not diagnosed because of stigma that may be attached). One thing seems to stand out here (in your story) is a potential risk in the family for "emotional" illness with symptom relief observed by medication...a strong indication of an Axis I illness, such as depression, bipolar, schizophrenia/schizoaffective disorder. When on your meds and symptoms are reduced, do not go off the medicine. You feel better because the meds help and serve a purpose, allowing you to function. Diabetes, migraines, high blood pressure and assorted other illnesses sort of present heavier in one family versus another. Emotional illness, maybe mental illness, may present in yours. You may want to look at your family tree to see if other family members have had difficulty. It may be difficult. People did not air their difficulties in the past, often out stigma or fear of losing face to others. You can never learn enough though. I also do not recommend a general MD, but a psychiatrist. Stay with one psychiatrist...DO NOT doctor shop. It may be very helpful for you and your dad to have the same psychiatrist in order to get an even better understanding and course of treatment. Quite often, one particular medication that is helpful for one family member may be helpful for another in the family due to the genetic portion of the illness. In answering one of your questions, one manic episode is all you need to meet the criteria of bipolar disorder, so don't kid yourself. Folks with bipolar AND schizophrenia often convince themselves that the disorder does not exist or it isn't that bad or do not need the medication. Do not make this mistake. As a nursing student and a future nurse, you are only as good to a person (patient) if you take care of yourself. So take care of yourself. In this respect, you have to be a little selfish and take care of #1...you. Good luck to you.
    Last edit by Thunderwolf on Oct 18, '04
    shotzynurse likes this.
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    Finness, Paxil CR has a very high incidence of causing mania like side effects. It also has a high incidence of increasing anxiety. It can cause psychosis. That said ,it sounds like no official diagnosis has been made.I'm not sure how old you are now, but if you were started on medication for "an isolated mania episode" I would be looking to get off medications and see what happens.To make a psychiatric diagnosis while altered on medication is irresponsible. Talk to your psych. Explain what you are feeling. To make a commitment to medications when your not sure if you need them is stressful in itself. High School behavior shouldn't be the map for your adult life.


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