Bipolar Disorder

Explaining the Realities of Mental Illnesses. The ongoing campaign against stigma and discrimination attempts to promote an attitudinal shift from misunderstanding and fear to knowledge and compassion. Unfortunately, mental illnesses only grab the public's attention when high-profile tragedies become front-page news.

In more than two dozen programs throughout the United States, telepsychiatry is ushering in a new way of bringing mental health services to thousands of individuals who, in the past, may have gone without. More often than not, however, they are pilot projects or grant-supported endeavors, meaning that these prototypes of the psychiatrist's office of the future have yet to prove themselves in the medical marketplace.

The psychiatrists' apparent interest in natural medicinals may be driven by the rising popularity and widespread use of the products among the public. At the annual meeting of the American Psychiatric Association, a symposium considered the hazards and benefits of herbal medicines, and, perhaps for the first time since the 1960s era of psychedelic experimentation, reconsidered the therapeutic and research potential of hallucinogenic substances.

While there is broad-ranging support for increased resources for the mentally ill, the degree to which innovations should include mandated care has re-ignited a long-standing debate over whose civil rights are actually being trampled-those individuals who are forced to receive care, or those who are denied care even though they desperately need it.

Every year, more than half of newly approved drugs and biologics considered likely to be prescribed for children lack labeling information on safe and effective use. Seeking to rectify this situation, the FDA recently issued final regulations requiring new drugs and biologics that are therapeutically important for children or will be commonly used in children to have labeling information on safe pediatric use.

The increasing complexity and specificity of clinical trials, widely publicized research scandals and major advances in psychopharmacology have created a dilemma for academic institutions and private research organizations alike--how to find appropriate volunteers to participate in clinical drug trials. A major obstacle to patient recruitment is finding patients who are protocol-appropriate, said Nancy Hashim, affiliated with the Feighner Research Institute in San Diego.

After a teenager's suicide attempt, her desperate and bewildered parents dragged her to a mental health clinic. The 16-year-old admitted to drinking nearly every day and using an assortment of other illicit drugs. Only after a month in treatment did the clinician learn that the teenager had been molested when she was 8 years old by an uncle and threatened with death if she ever told her parents.

Nelson Kull, executive director of Pathways, sees an additional benefit to consumer employment: it provides patients with a first-hand look inside the system, and this can help defuse the sometimes antagonistic relationship between consumers and caregivers. "Some people criticize doctors and pharmaceutical companies for making a lot of money," says Kull, "but they gave me back my life. I once told meeting [attendees] that yes, psychiatry and medical care cost a lot, but your car costs a lot. I can't drive my car without my medications, so which comes first?"

The goals of National Coalition for Mental Health Professionals and Consumers are to educate the public about the problems of managed mental health care and to develop alternative health delivery models. I think greater media coverage has spawned greater awareness of the difficulties with managed care and has provided legislators with vital information. Certainly sharing their stories has made many people feel less alone and isolated within a system they find frustrating and depriving. I think media advocacy has helped doctors find support for their right to stand up to these abuses and band together in greater numbers to fight for integrity and quality in mental health care delivery.

Is the rising use of psychotropic medication to treat anxiety and mood disorders incompatible with the psychoanalytic approach? As a psychopharmacologist and psychoanalyst who frequently provides consultation to analysts regarding medication for their patients, Steven P. Roose, M.D., has studied this question and presented his findings and opinions in various scientific papers, books and meetings.

The guidance answers the most commonly asked questions about how ADA affects persons with psychiatric disabilities, said EEOC chairman Gilbert F. Casellas. "It provides practical instruction to employers and persons with psychiatric disabilities on their respective rights and responsibilities."

We believe that TMAP [The Texas Medication Algorithm Project] is the first large-scale use of medication algorithms, Rush said, "certainly in a community mental health setting. A project like this may help to lay the groundwork for improved public mental health treatment here and in other states as well." Medication algorithms, according to the project directors, consist of "a series of treatment steps, each of which is defined in turn by the clinical response of the patient to the preceding step."

As a practicing psychiatrist, I have watched with growing dismay and outrage the rise and triumph of the hegemony known as biologic psychiatry. Within the general field of modern psychiatry, biologism now completely dominates the discourse on the causes and treatment of mental illness, and in my view this has been a catastrophe with far-reaching effects on individual patients and the cultural psyche at large. It has occurred to me with forcible irony that psychiatry has quite literally lost its mind, and along with it the minds of the patients they are presumably supposed to care for. Even a cursory glance at any major psychiatric journal is enough to convince me that the field has gone far down the road into a kind of delusion, whose main tenets consist of a particularly pernicious biologic determinism and a pseudo-scientific understanding of human nature and mental illness.

The past decade witnessed major strides in our understanding and treatment of affective disorders in adults, children and adolescents. One of the baffling problems in child and adolescent psychiatry was the question of psychiatric illness spanning a lifetime. The existence of depressive disorders in prepubertal children has been generally recognized and acknowledged since the 1960s; however, only in the last decade did evidence become available that supports the notion that depression in different ages represents the same entity, albeit manifesting different clinical symptoms in each developmental period (Cytryn and others 1986).

Since 1980, criteria for diagnosing bipolar disorder in adults have also been used to diagnose mania in children, with some modifications to adjust for age.

At this time, both patients and professionals seem to have an unprecedented interest in circadian rhythms. We now know that the body's clock is located in the suprachiasmatic nucleus (SCN) of the hypothalamus, and that the SCN regulates the pineal gland's secretion of the hormone melatonin.