// Other goings-ons
| 09/03/2003 - 9:48 a.m. |

email to C.
Hiya woman,

So I know you're probably mad busy after the long weekend�just wondering if you having any thoughts to share when you get a chance re: the current status of the insurance/renfrew situation or "anything else" ;)

I did fax the form to McR. yesterday and confirmed he received it. Attached to it an outline of my mental "health" (haHAH)/treatment history going back to age 14. Oy vey, eh?

S. signed herself out of R. last night AMA. Yeah. Not really due to the freaking-out-over-eating-and-weight-stuff, well not only that anyways. For some "valid" reasons too I think. And as usual I *get* it�but am obviously quite worried as well. She crashed here with me last night as a--she hadn't exactly told anyone else yet, b--*I* wanted to be with her and support her with this, and c--I was reciprocally her safe haven. She already left here a short while ago, going to figure out where it is she's going to stay now (back to her aunt and uncle's or to the G.'s, who she has stayed with before too), make phone calls, etc., and then she already has an appt set up with K. for this afternoon (K.S. that is, the therapist she has worked with when she's been in Ph. in the past, and had already started with again before the R. admission finally went through). Soooo, *my* next task of the day is probably to do some journaling about all this�and I'm sure I'll end up copying it to ya later, heheh.

One other piece of interesting randomness. I finally got around to doing a little bit of my own research on topamax/topiramate, and came across an interesting article on "the 'Soft' Bipolar Spectrum"

(NOT that I'm looking for another label *eye-roll*. This petition-thing to have my coverage reinstated is titled "Application to continue coverage for handicapped dependent child.� And I'm like A--oh fabulous, another fucking label, AND B-I do believe the pc terminology is "disabled," thank you very little!!)

But anyways, heh. I nonetheless identified a bit with some things in the article, and am just copying one section of it below and bolding some particular parts. Like I said, just interesting�

Looking forward to hearing from you when you get a moment to breath--
M.

~~~~~

BIPOLAR SPECTRUM DISORDER:
A Practitioner's Overview of the Soft Bipolar Spectrum
By, Arnold L. Lieber, MD

Presenting Symptoms

* Episodic mood instability -
these patients manifest lifelong episodes of mood swings starting around adolescence. The mood shifts unpredictably among several distinct mood poles: brief depressions lasting hours to one or two days, brief euphorias, brief dysphoric or irritable episodes, brief paranoid episodes, episodes of rage or intense uncontrollable anger, episodic anxiety equivalents (panic attacks, phobias or obsessive ruminations ). This multiplicity of mood options begs the very issue of bipolarity. It appears that multipolar mood disorder might be a more accurate designation for the soft bipolar spectrum.

* Episodic atypical depression-
bipolar depressions can manifest the entire gamut of endogenous, nonendogenous and/or atypical depressive symptomatology, and they are always recurrent over time . Soft bipolar depressions usually show atypical depressive features. Patients are mood responsive, which means that they respond to favorable circumstances with a temporary lifting of the mood that can last hours to a day or two before returning to the depressed state. Other symptoms may include eating too much, sleeping too much, feeling worse towards evening and intense tiredness or lethargy. Anxiety and its subtypes (phobias, panic attacks, OCD ) frequently co-exist with atypical depression , as does episodic mood instability. There are a number of atypical depressive subtypes that are distinguished by special features. Since they are often episodic and associated with mood instability, they should be viewed as part of the soft bipolar spectrum. Included are the following: seasonal affective disorder - winter-onset atypical depressions; premenstrual dysphoric disorder - atypical depression associated with irritability, mood swings and dysphoria which occurs a week to ten days on either side of the menstrual period; hysteroid dysphoria - atypical depression mainly in women with histrionic personality features, whose episodes are precipitated by romantic rejection; abulic depression - atypical depression with a deficit syndrome ( apathy, amotivation, lack of will power, lack of energy, lack of pleasure in life, emotional blunting ).

* Hypomania -
hypomania is of two types, euphoric and dysphoric or irritable. It is also of two durations, episodic and protracted or characterologic. Bipolar spectrum patients usually show episodic dysphoric hypomania. Euphoric hypomania feels good and is sometimes productive, but dysphoric hypomania produces irritability, emotional discomfiture, impulsiveness, temper dyscontrol and impaired judgment. It tends to interfere with interpersonal relationships and to limit productivity at work. There is a sense of inner speeding combined with restless over activity and racing thoughts, which can lead to a state of desperation. The hypomania frequently alternates with episodes of depression, and mood instability is almost always present. Sometimes brief euphoric episodes are added to the mix. The triad of irritable episodes alternating with rage episodes and paranoid episodes is characteristic of dysphoric hypomania.

* Mixed states -
mixed bipolar disorder [ the simultaneous occurrence of both depressive symptoms and mania/ hypomania ] and rapid cycling bipolar disorder [ the patient experiences frequent switches from depression to mania/ hypomania and back ] often produce diagnostic confusion for treaters and treatment resistance for patients. These mixed states are found in bipolar I, bipolar II and bipolar spectrum disorders. They are more common in women and are often associated with thyroid abnormalities, lack of response to lithium (the standard treatment for bipolar I disorder) and antidepressant-induced worsening of symptoms. Outpatient diagnosis of these conditions is difficult at best, even after a detailed history is obtained. Diagnosis of mixed states is most likely to be made by a skilled diagnostician after a patient fails to respond to outpatient treatment or becomes worse on antidepressant medications and is subsequently admitted to the hospital for closer observation. Misdiagnosis of these conditions is all too common, leading to delays in effective treatment and a higher risk of suicide.