In my 35 y. long experience, real bipolar disease i.e. alternating phases of severe depression, normality and real mania is erroneoulsly extended to include banal fluctuations of unipolar endogenous depression. Do you agree ?
Some of the observations in Eiko Fried's working paper on major depression heterogeneity and its conceptualization/study likely have some tangential relevance here, i.e. focusing on the study of individual symptoms, their causal interactions, and paying attention to differences among patients.
I partially agree with that. I think that many people diagnosed with bipolar disease are just depressive in their deep nature, experiencing that kind of symptoms as a way to scape from fear, horror, tragedy, suicide attempts and even strong feelings of emptyness, I mean, as a way to cope with life. So, mania can be seen here as a cope strategy erroneusly seen as fluctuations in an usually assumed low mood in that particular person.
Yes, I strongly agree. We need to start again diagnosing accurately and not quasi-so.
In this case we can use the ....- like conditions.
Thank you
Absolutely. This insight gets to the heart of the consistently rising number of bi-polarity diagnoses. We need to be very careful in our assessment of the constituent facets of true manic symptoms. More than tangentially related, this also includes properly diagnosing the presence of anxiety disorders that present concurrently with depressive symptomology and may, in fact, be the underpinnings of the depressive response as a coping mechanism; thus, our prescriptions and treatment modalities. All supported by recent research in the neuroscience of loneliness and our assessments of the true impact of the digital age environment. This is an important and timely question with significant ramifications.
I don't see what is wrong with DSM 5, which recognises several subtypes of what is a complex disease.
It seems to me that the opposite is true. Many bipolar disorder patients are initially diagnosed as depressives, but when they begin to experience mania as high elation they are not unhappy about such episodes and thus are not likely to report them to their psychiatrists. The idea that depression is adaptive is a mistake (see Gonzalo Munevar and Donna Irvan, “Neuroscientific Evidence against Depression as an Evolutionary Adaptation,” Psychology Research, Vol. 3, No. 6, June 2013, pp. 358-363). Ditto for mania.
I agree with you.
In case of Bipolar disorder I, the manic episodes are well established with definite symptoms and signs of manic episodes.
Whereas in case of Bipolar disorder II an elaborate history is needed from the patients and the family members to establish the hypomanic episodes to differentiate them from the patient's very own personality.
If the disorder starts very early in life of the patient even before the basic personality of the patient is established, then the diagnosis of bipolar disorder II with the dubious diagnosis of an episode of hypomania versus the patient's personality itself becomes difficult.
I think there is always a gray area when it comes to Bipolar II as compared to unipolar depressive disorder.
"Whereas in case of Bipolar disorder II an elaborate history is needed from the patients and the family members to establish the hypomanic episodes"
My late wife suffered from chronic depression, but nor for one minute did I witness any hypomania or consider she was bipolar. But then I recalled that before I met her she had an acute episode of depression. She was never enthusiastic about housework, but when she started ironing paper bags in the middle of the night, she was admitted into a mental hospital.
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