Is Bipolar an excuse for bad behavior?

[harper]

Originally Posted by BillyTheMountain

you missed the title, and Buster tells me it's because U R psychotic

Oh, no, I didn't miss the title. It seemed even more disconnected that the cut-and-pasted text with no accompanying explanation. In fact, your title was my first clue that you were posting in the wrong thread or the wrong forum.

[harper]

Originally Posted by BillyTheMountain

Excuse means to lessen the blame attaching to (a fault or offense); seek to defend or justify; or a reason or explanation put forward to defend or justify a fault or offense.

Here's a short list of excuses:

Bipolar
My dog ate my homework
Drank too much
Didn't see you
Collateral damage
I thought you were someone else
I'm only 5 years old
You created an irresistible impulse in me (Women tell this to you much?)

You seemed to have left out, "my paste buffer was full of god-knows-what and I accidentally dumped it into this discussion."

[BillyTheMountain]

Originally Posted by harper

You seemed to have left out, "my paste buffer was full of god-knows-what and I accidentally dumped it into this discussion."

Homer, your boss at the nuclear power plant says he tired of you offering that excuse. Please select an excuse from the list above.

[MuniAddict]

Originally Posted by BillyTheMountain

Excuse means to lessen the blame attaching to (a fault or offense); seek to defend or justify; or a reason or explanation put forward to defend or justify a fault or offense.

Here's a short list of excuses:

Bipolar
My dog ate my homework
Drank too much
Didn't see you
Collateral damage
I thought you were someone else
I'm only 5 years old
You created an irresistible impulse in me (Women tell this to you much?)
It's still all Bush's fault

Added one more.

[Nurse Ben]

-I can't help thinking this his a HUGE market and many people would be really p*ssed off if those meds were discredited/banned/boycoted.

Can the same be said for medications that treat diabetes, hypertension, seizurea, etc...

As well, if something helps you function, does that make it addictive? Take for instance eye glasses, hearing aids, medication for a wide range of illnesses.

It us not ncommon for people to confuse addictive substances with addiction from using these substances. If this was the case, would all be adictive to opiates.

What I have struggled with as a pychiatric provider is the disparity between how people look at mental health and physical health. Imagine if you well, you are being treated for allergies. Prior to your allergy treatment you had asthma attacks which limited your time outside exercising. Since treatment you feel better and you have more freedom to be outside. Is this an addiction or are we just using medications to achieve a normal state.

There is a heritary basis to most things, but it is possible to reduce the occurence of an illness, mental or physical by minimizing stressors/insults to the body. There was an adopted twins study done in Scandanvia, they were looking at the emergence of schizophrenia in twins raised in different households. They found that the children raised in a higher energy/higher stress environment were more likely to become schizophrenic.

Stress is a tigger for many illnesses, stress can be a result of social interactions, abuse, lifestyle, etc...

In general, people who have mental illnees that is treatable with medications are less likely to seek treatment or accept tratment when it available, in part due to the stigma of mental health, which tells us that we aren't normal if we take medication in order to be normal.

This is no more evident than in two populations I see: schizophrenics and hyperactive teens, both populations avoid medicataion because they don't want to have to take them "in order to be normal". I had this conversation with a schizophrenic and his case manager, the case manager didn't understand why the patient didn't take his medications. To me it makes perfect sense, but it is sad nonethless that society criticizes a person for taking psychiatirc medications, even if the medications help.

All I can say is don't throw out the baby with the bathwater. If medications help, then they help, take em. If medications don't help, then you need to look elsewhere, ie behaviral change.

One of my favorite things to talk with parents about is how they manage attention deficit. Even when treated, attention deficit people are still attention deficit, so what about a parent who is punishing a child for not paying attention?I find it bizarre that, even though the parent is aware of the child's problems with attention, they cont to insist the child pay attention. Well how about this: if Sally only has one leg, is it fair to expect Sally to run as fast as the kids with two legs? Sure you should encourage the child to be as good as they can be, but their is a limit to what each person can achieve, why punish a child for not being as good as you want them to be?

Most of my clients have problems with impusle control, which cause inattention, hyperativity, and poor decision making. I write a lot of scripts for stimulants, yup. I also have a lot of conversations with parents about their own impulse control issues which their children inherited, but they insist they can manage...as long as Johny gets his adderal

[wobbling bear]

Originally Posted by Nurse Ben

Stress is a tigger for many illnesses, stress can be a result of social interactions, abuse, lifestyle, etc...

Stress can be inherited too. I can stress without any reasonnable reason.
it also depends of the direction of the stress: though there is a psy ailment inherited in my family, a psy doctor told me that I succeeded in overcoming this inheritance using music, sport (unicycling!) , day dreaming and ... daily stress.
so .....

[Nurse Ben]

@mrboogiejuice:

It is untrue that difficult children are diagnosed with ADH/ADD. Diagnoses go with the medictaions, so if a child is not receiving treatment for ADHD/ADD, then they would not have that diagnosis. Instead they might be diagnosed as Adjustment, Oppositional Defiant, Impulse Control, or Conduct.

A child who is not able to manage themselves in a typical social environment, this is a problem for the child as well as the others in thier environment. Though it would be nice to have a situation that will work for all people, that just isn't the case.

Children do not act in an oppositional manner for the same reasons as an adult, in part due to differences in brain development as well as thinking processes. For this reason children are not labeled as a conduct disorder until their teens and personality disordeers are not given until early adult years; I don't use personality disorders as they are the purvey of psycholgists

[BillyTheMountain]

Originally Posted by Nurse Ben

I don't use personality disorders as they are the purvey of psycholgists

Do you use Bipolar Disorder? For what?

Is Bipolar an excuse for bad behavior? (back on topic)

[BillyTheMountain]

Originally Posted by wobbling bear

day dreaming

[Byc]

Originally Posted by Samstoney

They probably don't "have" ADHD in China. They also don't commonly treat basic illnesses like Chronic obstructive pulmonary disease, in spite of the fact that probably more people suffer from COPD than anywhere else in the world, thanks to lots of air pollution and a high smoking rate. Perhaps holding China up as an example isn't so good.

Both my son and I "suffer" from ADHD, so I have some opinions on the topic. My son was diagnosed when we took him to a psychiatrist, against our better judgement but on the recommendation of his 2nd grade teacher. I knew he would be diagnosed with ADHD, as I have a particularly dysfunctional family and there is a hereditary component to this condition. Sure enough he was diagnosed as having "textbook" ADHD and the psychiatrist then recommended we put him Adderal, the most common ADHD medication prescribed to kids

My response to the psychiatrist was: "you're implying that there is a hereditary root to his condition - does that mean you'd diagnose me as having same thing?" after he affirmed, I suggested he evaluate me, and if I did indeed have the same condition, start me on meds first. He agreed.

After a couple of visits to the psychiatrist on my own, the diagnosis was positive, and I was put on Concerta, a time released form of Ritalin. It is a very interesting drug - sort of like having all the positive effects of coffee with none of the negatives. I found I was more alert, able to focus and stay on task better, and noticed an improvement in my short term memory. I didn't see any negative side effects at all.

I kept taking this for a couple of months before giving it to my (then) 8 year old. It had the same effect on him, and watching him he seemed...calmer when he was on the drug. But I started noticing that I was beginning to feel like this drug was *really* helping me - how could I ever have functioned without it? This seemed to hint of addiction, so I stopped. When I saw that I could function perfectly well without it, I also stopped giving it to my son.

So - here are some of my thoughts and conclusions on ADHD and drugs in *my* family:

ADHD is a real condition, and people with ADHD have a unique set of issues to deal with. But, like many psychological conditions, there are varying degrees ranging from having a minor focusing issue to extremes; my brother has relatively severe Asbergers, which I believe is related to the ADHD diagnoses in the rest of our family. Explaining to my son how to deal with the ways he thinks differently from others using ADHD as a frame has been very useful; he (and I) see is as a way of understanding our relationship with the world, not as an excuse to misbehave.Modern medication definitely has a positive effect on many of the ..err..characteristics of ADHD. In our cases they did not "dull" us, make us obedient, or stunt our creative ability in any way. The *only* negative I noticed after several months of use was a level of addiction akin to what I have with coffee. Many people with more severe ADHD really need these drugs to function well in modern society, particularly in modern public school classrooms. But these drugs are also performance enhancing drugs - they make pretty much anyone who takes them more focused and improve memory, though maybe not to the same extent as they do with an ADHD patient. The question for me was: where do we draw the line between addressing a problem and enhancing performance?
In our case I made the decision that my son and I both could function w/o the drugs. We have since moved my son into a small private school and he excels there; for us this was a better way to address the academic and social issues that started us down this path. But if he were still in his old school there's a good chance he'd still be on ADHD meds - like, incidentally, over 20% of his male classmates were! Bottom line is they work and it's a good tool to have in reserve, but both my son and I choose to deal with our issues on our own.

Here's a

nice video

, okay it's about schooling systems but ADHD and the rise of diagnosis of ADHD are menioned in it.


Greetings

Dru

[MrBoogiejuice]

Originally Posted by Nurse Ben

@mrboogiejuice:

It is untrue that difficult children are diagnosed with ADH/ADD. Diagnoses go with the medictaions, so if a child is not receiving treatment for ADHD/ADD, then they would not have that diagnosis. Instead they might be diagnosed as Adjustment, Oppositional Defiant, Impulse Control, or Conduct.

It's somewhat tautological though isn't it? X child's on ritalin/adderall because they have ADD - they're diagnosed as ADD because they're prescribed ritalin/adderall. I think it's interesting to think about the subjective reality of not just the person being diagnosed, but also the person doing the diagnosing, something the article I linked to earlier explores.

Originally Posted by Nurse Ben

A child who is not able to manage themselves in a typical social environment, this is a problem for the child as well as the others in thier environment. Though it would be nice to have a situation that will work for all people, that just isn't the case.

What is a typical social environment and how typical is it compared to the majority of our evolutionary history? For most of human history, certainly pre-agricultural history, humans have by and large lived in very tightly knit social groups with parenting responsibilities taken on by the whole group. Compare that to today where if kids are lucky enough to have two parents in the home at least one of them will be working. One or two people trying to do the job that for the greatest chunk of our existence has been done by a larger group are always going to struggle to provide the requisite attention and affection a child needs. With this in mind I'm distrustful of labeling children as having a medical condition when the issues seem to be to do with how they fit in with their social circumstances, or unaddressed emotional trauma.

I don't think it's a coincidence that ADD diagnoses have risen in post-industrial countries as working hours, stress levels and single parent/both-parent-working households have increased whilst kinship networks have become more fractured.

Originally Posted by Nurse Ben

Children do not act in an oppositional manner for the same reasons as an adult, in part due to differences in brain development as well as thinking processes. For this reason children are not labeled as a conduct disorder until their teens and personality disordeers are not given until early adult years; I don't use personality disorders as they are the purvey of psycholgists

Patients with PD diagnoses were often rather derided by the staff on the wards I worked on, particularly by the more old school nurses. They weren't deemed properly "ill". Sometimes it did seem like the diagnosis of last resort for some consultants once they'd tried a few others that didn't fit.

[Nurse Ben]

Okay, I see what's confusing...the meds go with a diagnosis, sorta like when you go to the auto repair, you get charged for what you do, so I can't prescribe a mood stabalizer for ADHD unless I also give that person a mood disorder diagnosis. It keeps things consistent.

And yes, as society has become more structured, the norms are narrowing, but at the same time cultural norms are expannding in other ways, so I'm not sure you can blame the change in society for increasing problems with social relationships.

I have a pet peave, it has to do with technology and society, you see I believe that the further we get from direct human to human interaction, the further wae get from understanding each other, ourselves, and as a result we lose our social skills. Now imagine how this affects our youth, growing up in an impersonal world, all media at home, more media at school, kids choosig to stay in the house vs be outside. I have seen a huge change in just the past decade, kinda scary for me esp as it seems to mirror theincrease in problems in the schools and home.

So Billy, you aksed when do I give a bi polar diagnosis? Well, first the client has to have some mood lability at which point they get a Mood Disorder NOS. Then, if they don't have unipolR depression (read as straight depression), but distinct cyles of ups and downs, AND most importantly they have see some improvement from medication, if that all comes together, then I will move them from Mood Disorder NOS to Bi Polar specified with whatever fits.

For perspective, though 90% of my clients are kids, I have seen a fair number of adults on and off over teh years, and in that time I have had very few cases of mania, less than ten that could not be explained by something else (drugs, hyperactivity, insomnia, psychoses, personality). This is a key point in why I brought up whether bi polar was being overused, "excusing" bad behavior, because it is really quite rare and yet I have bi polar patients coming out of the woodwork!

The most commom "bi polar" case that comes through the door is the child or adult with "anger issues". The anger is causing the client a degree of difficulty, either at home, school, work, or legally, so they are either seeing me at someone else's insistence or because they finally see the need for help. We have a comprehensive clinic, so case mgmt and therapy are available to all clients; though far more want medications than want therapy.

Since becoming a prescriber I have felt a lot of animosity from lay people who criticize prescribers for over using medications, but what I don't hear is those same people criticizing the folks taking the medications. The prescriber can not be the only one at blame for misprescribing of medication. In the case of mental health, we literally have no factual tests that can be performed to help us rule out a diagnosis, it is all about what we see or think we see. Which means, if someone tells me a story, that is what they telll me, so then I have look through my special filters, and see what I can see...in other words there is a lot of guessing, granted it's educated guessing, but it's still guessing.

Now this may piss some people off, but just hear me out:

I you take a medication, then you are choosing to take that medication, so it is your responsibility to ask questions until you get the answers you need to feel right. If a person is not competent to ask these questions, then they should have a friend or family member attend appts with them. If a prescriber "does the ugly" and tells you that he/she is the doctor and you should take them because they say so, well then that should be your signal for the door.

Anyway, it is an interesting area to be working in right now, not a whole lot going in terms of new medications, but I'd expect to see more black box warnings as the FDA catches up big pharma

[MuniAddict]

Originally Posted by Nurse Ben

...90% of my clients are kids...

Ok, I'm confused. Are you a male nurse, as your username implies, or an M.D.? If you are a doctor, why not "Dr Ben" for example, or better yet, "PsychoBen"!

[BillyTheMountain]

Originally Posted by MuniAddict

Ok, I'm confused. Are you a male nurse, as your username implies, or an M.D.? If you are a doctor, why not "Dr Ben" for example, or better yet, "PsychoBen"!

Nurse Practitioners prescribe meds.

Despite research demonstrating that ADHD drugs ("speed" or amphetamines) enhance everyone's performance, attention, and concentration. Like many other drugs of this nature, there is a tolerance such that after 6 weeks, you need more to get the same effect.

They help ADHD kids fit in, because they mostly help the teachers. These kids are far more likely to develop drug dependencies in adulthood too, for some reason.

Under the law, ADHD is not likely to be an excuse for illegal behavior, but psychotic diagnoses sometimes are.

[Nurse Ben]

Ok, I'm confused. Are you a male nurse, as your username implies, or an M.D.? If you are a doctor, why not "Dr Ben" for example, or better yet, "PsychoBen"!

PsychoBen, it has a certain ring to it

Family Mental Health Nurse Practitioner, or psychiatrist on the cheap

I prescribe medications, do a little song and dance, show the kids that unicycles aren't just for clowns any more.

So a lot of folks think I'm crazt for seeing kidsm, and maybe I am "psycho", but kids are a really wonderful population:

They are energetic, always trying to think ahead of you (parents, teacher, PO's, me), never think they "need" medications, are quick to know it all, and more often than not are fixed with an ample application of time.

I get a lot of satisfaction from treating kids because in many ways they are the perfect patients, but of course they all come with parents (baggage)

Stimulants like adderall, ritalin, etc.. are a great tool, I write a ton of them, they are one of two medication groups that are guaranteed to help more than 50% of the time; the other group is benzos, such as Xanax, Ativan, Klonopin, Valium...

I have seen immediate turn arounds in a child's behaviors and school performance with a single dose, parents and teachers have even commented that it's a "miracle". Now of course I know better, there have been times when I stopped a stimulant because it caused more problems than it solved.
But seriously, don't take my work for it, ask your doctor how many "miracles" s/he has witnessed.

I had one today, the foster M was surley going to send a foster kid packing for aggressive outbursts, so I changed the methylphenidate to adderall, this was two weeks ago, today foster M comes in and says "I think we are getting close"; and not a word about disrupting the placement.

I witness these miracles "all the days"

Like many other drugs of this nature, there is a tolerance such that after 6 weeks, you need more to get the same effect.

Not true, in fact many kids start low, go high, then go back to low. I had one today, he had taken up to Adderall XR 50mg, but then two summers ago M agreed to reduce his dose to help him gain weight, then when summer ended we continued the lower dose of Adderall XR 25mg, he continues to do well and at today's appt we discussed future decreases as he works his way through high school.

It is not a drug if it is prescribed. Tolerance is real, but the tolerance you're describing is very different from the efficacy which is the basis for the prescribing of stimulant medications. I'm not prescribing for a "high", I am prescribing for improved impulse control. In generall, tolerance increases more with some rx than others, and in many cases the need for an increase is due to the growth of the child vs any tolerance they develop. It helps that kids rarely take the stimulants on a daily basis.

Baby and bathwater...