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!!
Oct 18, '04
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