Posted by Scott L. Schofield on March 14, 2000, at 10:41:23
In reply to Re: Cam W...the world must be round, posted by Mark H. on March 13, 2000, at 20:32:40
> I feel like a real outsider in this conversation, but what about those of us who are bipolar II? This designation didn't even exist that long ago.
I guess everything is relative. “Bipolar II” as a subtype has been recognized for over a decade.
> Like grammar and usage, diagnosis can be both descriptive and prescriptive. Prescriptive diagnosis becomes dangerous when the absence of a label causes certain professionals to pretend the condition doesn't exist.
I sure hope few researchers think this way. I guess you gotta start somewhere, though. When I was first treated in the early 80’s by the research department of Columbia Presbyterian in New York, it seemed that diagnosis was sometimes based upon response to medication. But at least they used this information to identify clinical profiles. This would eventually lead to constructing consistent diagnostic criteria. Of course, one of the goals is to determine whether or not these different clinical profiles represent discreet biological etiologies. However, I’m not sure that understanding such distinctions is so important for the average local practitioner, as long as he follows the recipes.
> Mania has traditionally been classed as a psychosis separate from schizophrenia, and for good reason, since it looks quite different and seems quite different in the descriptions of those experiencing it.
They also respond quite differently to various treatments. At this point, I feel it is obvious that they are indeed different.
Someone here described attending a lecture in which the lecturer considered bipolar disorder and schizophrenia to be different presentations along a continuum of the same illness. I found this concept to be a bit unnerving.
> Those of us with Bipolar II are never psychotically manic; however, we do experience cyclic depression relieved by periods of hypomania.
There are many who present the inverse. They are continuously hypomanic, except for infrequent episodes of depression. Also, they never seem to enter a state of euthymia. It is either one or the other.
> The cyclicity seems to be the main determinant, not the appearance of hypomania (which I call my delusions of adequacy).
What do you mean by “cyclicity”?
This is an interesting notion. I have not yet encountered it elsewhere regarding bipolar II. I see the terms “cyclicity” and “rapid-cyclicity” used here often, but I wonder how people define these. “Rapid-cyclicity” has a prescribed diagnostic definition, although it may be somewhat arbitrary. I think the DSM IV manual defines it as being the occurrence of at least 4 episodes of either depression or mania within a year. There are even guidelines used by some investigators that describe “ultra rapid-cycling” and “ultra ultra rapid cycling”. I don’t recall how they are defined, but we’re talking about cycles occurring every 48 hours, and sometimes several cycles within a single day.
> I'm suspicious of the motivation and research of those who believe the depression experienced by cyclic depressives, including Bipolar IIs, is qualitatively different than depression that is considered unipolar. Experientially, at least, it doesn't add up.
I don’t think any research has determined the presentation of bipolar depression to be immutably consistent. However, I believe it is generally characterized as resembling the so-called “atypical-depression”. It tends to be anergic. It would be interesting to compare the depressive phases of bipolar I and bipolar II to see if there are any statistical differences in symptomology between them. I have not come across any literature addressing this.
One must be careful when trying to extrapolate their own experiences to the general. I’ve made this mistake.
> Also, "schizophrenic" is one of the LEAST understood and MOST erroneously applied descriptors in mental health. There are those who think a child acting out at school is "schizophrenic." Whew! No Social Worker should be allowed to use the term at all. ;-)
Man, I had hoped we were past all that. To hear someone speaking of schizophrenia in these terms seems anachronistic – even comical. This is a tragedy, because it involves real people.
See ya’ later.
- Scott
poster:Scott L. Schofield
thread:26511
URL: http://www.dr-bob.org/babble/20000312/msgs/26974.html