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Bipolar Disorder Is Like Having Two Serious Illnesses at Once
Dr. Nichole Foubister gives a crash course on bipolar disorder and offers hope for the future of treating this difficult mental illness.
Dr. Nicole Foubister is a professional psychiatrist with a background in child, adolescent and adult psychiatry, as well as board certified forensic psychiatrist. She is currently on faculty at NYU School of Medicine and has been an attending psychiatrist at the NYU Medical Center, where she served three years as the Director of the Young Adult Unit. Dr. Foubister has extensive experience in the evaluation and treatment of many areas of concern including but not limited to anxiety, OCD, depression, attentional disorders, acting out behaviors as well as issues concerning relationships, career and identity.
Nicole Foubister: Bipolar disorder can have lots of effects on a person's day-to day functioning. So, for instance, again, in the middle of an episode of either mania or depression, people who are manic will often do things that are really impulsive and really out of character. And so issues of infidelity can come up, for instance, in a patient with mania who's having a sexual partner or sexual partners outside of the relationship in the midst of a manic episode. People will often spend money that they really can't afford to spend in the midst of a manic episode, which you can imagine will cause a lot of strain for them personally, but also in the context of their families. People in the midst of mania often don't appear to be logical and so they will go to work and will have lots of irritability. And you can imagine, again, that coworkers are confused; bosses are confused; and especially if they don't understand a lot about the illness it can affect their work relationships and their ability to maintain their employment.
You can imagine that if it's hard to get up out of bed and even go to the supermarket and get your groceries for the day that it can be very difficult to go to work and get all the things that you need to get done either in your work life or in your personal life. People will report guilt or sometimes feeling like they're worthless. People will also report that they feel like they're either kind of moving in slow motion, which is known as psychomotor retardation. And occasionally will people report that they actually feel jittery, which is known as psychomotor agitation. In addition, people will report disturbances in their sleep, which are most commonly insomnia. So either difficulty falling asleep, waking up in the middle of the night, or waking up earlier in the morning than one intends to. Occasionally this can be hypersomnia though where people are sleeping, for instance, 10, 12, 13, 14, or more hours per day.
Patients with bipolar disorder often are resistant to receiving treatment, especially during a manic episode. And this is really part of the illness in terms of not understanding that one is sick. Bipolar disorder cannot be cured, however people often find that they will go, you know, periods of time without having any illness or periods of euthymia. It really depends on the individual and how their clinical course goes as well as finding treatments that work. The mainstay of treatments are mood stabilizers. So these are medications that are used to keep somebody from having most notably a manic episode or a depressive episode. Finding the right treatment can sometimes be a little frustrating and patients really need to hang in there as their doctors try different medications to figure out what works best with their neurobiology.
In order to support a loved one who has bipolar disorder, it's really important to realize that this is an illness, like any other illness. A lot of times people think of mental illness as it's being something that's within the control of the individual and the individual will often think that as well feeling tremendous guilt when they do have episodes of either mania or depression. And so the first thing is realizing that people don't choose to have bipolar disorder and they would definitely choose to live with more mental wellness than having this illness. It's really important to be calm, present, and consistent with people with bipolar disorder, as well as supporting them and maintaining their treatment. In the next 10, 20, 30, 50 years I really see a lot more research being done to try to find treatments that are effective and have less side effects than some of the medications that we have currently available today. I really only see better things for the future.
Big Think and the Mental Health Channel are proud to present Big Thinkers on Mental Health, a new series dedicated to open discussion of anxiety, depression, and the many other psychological disorders that affect millions worldwide.
This week, psychiatrist Nicole Foubister delves into the world of bipolar disorder. Most people are casually familiar with bipolar disorder, although few understand the colossal strain it can have on the lives of sufferers and their loved ones. It's vital for people diagnosed as bipolar to open themselves up to treatment and for people close to them to be aware of the illness' ramifications. What's most important is to understand that no one chooses to be bipolar; you must learn to be calm and patient with people who suffer from it. It's not their fault that they lack mental wellness and their behavior during manic episodes is not reflective of who they really are.
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Gender and sexual minority populations are experiencing rising anxiety and depression rates during the pandemic.
- Anxiety and depression rates are spiking in the LGBTQ+ community, and especially in individuals who hadn't struggled with those issues in the past.
- Overall, depression increased by an average PHQ-9 score of 1.21 and anxiety increased by an average GAD-7 score of 3.11.
- The researchers recommended that health care providers check in with LGBTQ+ patients about stress and screen for mood and anxiety disorders—even among those with no prior history of anxiety or depression.
Study findings<p>For the study, <a href="https://link.springer.com/article/10.1007/s11606-020-05970-4" target="_blank">published in the Journal of General Internal Medicine</a><em>, </em>Flentje and her team evaluated survey responses from nearly 2,300 individuals who identified as being in the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community. Most of the participants were white, while nearly 19 percent identified as a racial or ethnic minority. Multiple genders were represented with cisgender women (27.2 percent) and men (24.6 percent) making up a majority of the participants. Sixty-three percent had been assigned female at birth. For the most part, participants identified their sexual orientations as queer (40.3 percent), gay (36.5 percent), and bisexual (30.3 percent).</p><p>The JGIM study participants were recruited from the 18,000-participant <a href="https://pridestudy.org/" target="_blank">PRIDE Study</a> (Population Research in Identity and Disparities for Equality), which is the first large-scale, long-term national study focusing on American adults who identify as LGBTQ+. It conducts annual questionnaires to understand factors related to health and disease in this population. </p><p>Participants filled out an annual questionnaire (starting in June 2019) and a COVID-19 impact survey this past spring. Flentje noted that on an individual level, some people may not have experienced a big change in anxiety or depression levels, but for others there was. Overall, depression increased by a <a href="https://patient.info/doctor/patient-health-questionnaire-phq-9" target="_blank">PHQ-9 score</a> of 1.21, putting it at 8.31 on average. Anxiety went up by a <a href="https://www.mdcalc.com/gad-7-general-anxiety-disorder-7" target="_blank">GAD-7</a> score of 3.11 to an average of 8.89. Interestingly, the average PHQ-9 scores for those who screened positive for depression at the first 2019 survey decreased by 1.08. Those who screened negative for depression saw their PHQ-9 scores increase by 2.17 on average. As for anxiety, researchers detected no GAD-7 change among the study participants who screened positive for anxiety in the first survey, but did see an overall increase of 3.93 among those who had initially been evaluated as negative for the disorder. </p>
Risks among gender and sexual minorities<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="fc3fd1ae68b77bbbf58a6995638d6d65"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/EnUqDjCqg0A?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>The LGBTQ+ community is a vulnerable population to mental health concerns because of their fear of stigmatization and previous discriminatory experiences.</p> <p>Previous research by the Human Rights Campaign has found "that LGBTQ Americans are more likely than the <a href="https://medicalxpress.com/tags/general+population/" target="_blank">general population</a> to live in poverty and lack access to adequate medical care, paid <a href="https://medicalxpress.com/tags/medical+leave/" target="_blank">medical leave</a>, and basic necessities during the pandemic," said researcher Tari Hanneman, director of the health and aging program at the campaign.</p> <p>"Therefore, it is not surprising to see this increase in anxiety and depression among this population," Hanneman said in the release. "This study highlights the need for <a href="https://medicalxpress.com/tags/health+care+professionals/" target="_blank">health care professionals</a> to support, affirm and provide <a href="https://medicalxpress.com/tags/critical+care/" target="_blank">critical care</a> for the LGBTQ community to manage and maintain their mental health, as well as their physical health, during this pandemic."</p>
What should health care providers do?<p>The authors of the study recommend that health care providers check in with LGBTQ+ patients about stress and screen for mood and anxiety disorders in members of that community—even among those with no prior history of anxiety or depression.</p><p>As cases of COVID-19 continue to mount, the sustained social distancing, potential isolation, economic precariousness, and personal illness, grief, and loss are bound to have increased and varied impacts on mental health. Effective treatments may include individual therapy and medications as well as more large-scale coronavirus support programs like peer-led groups and mindfulness practices. </p><p>"It will be important to find out what happens over time and to identify who is most at risk, so we can be sure to roll out public health interventions to support the mental health of our communities in the best and most effective ways," said Flentje.</p>
What we know about black holes is both fascinating and scary.
- When it comes to black holes, science simultaneously knows so much and so little, which is why they are so fascinating. Focusing on what we do know, this group of astronomers, educators, and physicists share some of the most incredible facts about the powerful and mysterious objects.
- A black hole is so massive that light (and anything else it swallows) can't escape, says Bill Nye. You can't see a black hole, theoretical physicists Michio Kaku and Christophe Galfard explain, because it is too dark. What you can see, however, is the distortion of light around it caused by its extreme gravity.
- Explaining one unsettling concept from astrophysics called spaghettification, astronomer Michelle Thaller says that "If you got close to a black hole there would be tides over your body that small that would rip you apart into basically a strand of spaghetti that would fall down the black hole."
The team caught a glimpse of a process that takes 18,000,000,000,000,000,000,000 years.
- In Italy, a team of scientists is using a highly sophisticated detector to hunt for dark matter.
- The team observed an ultra-rare particle interaction that reveals the half-life of a xenon-124 atom to be 18 sextillion years.
- The half-life of a process is how long it takes for half of the radioactive nuclei present in a sample to decay.
A new study looks at what would happen to human language on a long journey to other star systems.
- A new study proposes that language could change dramatically on long space voyages.
- Spacefaring people might lose the ability to understand the people of Earth.
- This scenario is of particular concern for potential "generation ships".