Is there SUCH a MASSIVE difference in the BP spectrum?

I know this might be a silly question- but how different is this spectrum from one end to the other. I have a friend who is on the spectrum and he seems to get manic and aggressive to the point of hospitalization every few months. I seem to suffer from depression most of the time, with the odd bout of mania/ hypomania which doesn't last more than a week!! I have been in hospital about 4 times last year, with psychosis, but I'm wondering whether my diagnosis of Bipolar Affective Psychosis is wrong!? How can I be so difference to my friend??????

I think the spectrum is huge. I've heard that some researchings think the spectrum is

ADD/ADHD > Depresion > Bipolar II > Bipolar I > Schizoaffective > Schizophrenia

There is a huge difference between ADD and schizophrenia.... o.O

Plus not everyone has all the symptoms. I'm not such a huge risk taker, for example. I've never been in the hospital although I think there are times I should have been. My psychologist told me that some people only have one manic episode in their lifetime and the rest is depression. So.... yeah, there is a huge difference and although we're all the same we're all extremely different. I think that's why it is so hard to treat.

I don't know if I agree with ADD/ADHD being on the spectrum, although I've seen people with Bipolar use stimulants for depression. I don't exactly agree because it isn't a mood disorder.

I kind of agree that Schizophrenia is on the spectrum because it's essentially a person who is always in psychosis or experiences psychosis frequently. (Which can be a byproduct of mania in bipolar/schizoaffective) However, they say schizoaffective is a mood disorder + schizophrenia...so does that mean schizophrenia is without any mood issues? So they have a relatively stable mood? As they do more research they will be able to clear up questions like this.

I was only hospitalized once when I was diagnosed and may get *light* psychosis, but it has never been bad enough where I wasn't aware enough of my surroundings and I could differentiate most of my issues. I also rarely if ever get depression. I have hypomania that has bordered manic and mixed episodes when I do not take medication right. I happened to luck out and lithium keeps me fairly stable.

You are right Confusedinomicon, schizophrenia does not include mood disorders and isn't listed under mood disorders.

The spectrum is:

Bipolar NOS > Cyclothemia > Bipolar II > Bipolar I

I'm not quite sure about which is first NOS or Cyclothemia... but Bipolar I is the top of the spectrum.

Cyclothymia is the mildest, I think Bipolar NOS would be a bit more severe than that. The spectrum does top out at Bipolar I, schizoaffective is kind of a mixed bag and schizophrenia is not a mood disorder.

As a BP II I'd have to say there is a significant difference between the types, most people with are pretty functional, typically unmedicated BP I's end up inpatient or in trouble with the law when they hit a manic episode. That's been my experience working in the field anyways.

http://en.wikipedia.org/wiki/DSM-IV_Codes
Control + F Bipolar or click on it (This is what the insurance companies see as part of the bipolar spectrum if you're curious)

I'm diagnosed as 296.80 which means I'm considered BP NOS. According to wiki (i've seen it elsewhere) most people fit the description for this rather than fully fitting into either BP I or BP II. It's basically a catch-all for people who have a mood disorder that isn't depression. NOS can vary in severity. (There is also mood disorder NOS which I was diagnosed before hospitalization)

It shows that they only really have a rudimentary understanding of the disorder because it shows itself in many different ways that are met by elevated and lowered mood. (Which is probably the only thing that is definite about bipolar disorder)

The thing is that with every psychiatric condition, there are different groups of people who have that condition. Each group has characteristic clinical features and underyling pathology. One person may have a problem with dopamine, while another has a problem with GABA, and so on...

That's why it's so difficult to treat. Because my 'bipolar' may have a completely different biological basis than your 'bipolar'.

They have some hard data on this with OCD and trichotilloamania. That's why some people with OCD respond well to SSRIs, and others (like me) don't. Because only some people with OCD have a serotonin issue. The rest have issues with other neurotransmitters.

I think a more useful thing than a linear spectrum is organizing it by comorbidities. A venn diagram would be more useful.

what I think are different categories of bipolar:
- people who are predominantly depressed/have 'BP II'
- comorbid bipolar/ADHD (+/-OCD)
- bipolar with psychotic features
- bipolar that is predominantly manic or hypomanic, with little depression
- true 'cyclic' bipolar with regular, distinct cycles of severe mania-severe depression ('classic' bipolar)
- people who predominantly have mixed states/agitated depression

I think I'm in the category of comorbid bipolar/ADHD+OCD. As in, I have an issue with impulse control and compulsion control.

Sometimes I can relate to other bipolars on here, sometimes barely, sometimes not at all. I'm dx with bipolar 1 with psychosis NOS. That's what my pdoc put down, he put psychosis NOS because he isn't sure whether or not I have schizoaffective, I have psychosis at times with no mood episode present. Doesn't matter to me anymore.

I have a friend who was dx as Bipolar NOS, her and I couldn't be more different. She tends to usually be depressed, and only slight hypomania that is short lived. I am about half and half, slightly leaning to the manic or mixed side more. My mania can lasts months. She doesn't experience psychosis, I experience it almost every manic or mixed episode. We can relate to each other a bit, but we're pretty far apart.

I have a hard time relating mania to fun, good times. Mania is more like terror for me, not so fun.

You've gotta remember that the diagnostic categories and the disorders themselves are an artificial construct, and not infallible by far.

In my case the closest the shrink got to a real diagnosis was 'bipolar spectrum', she couldn't even decide on the cop out answer on NOS.

I feel as if I got to see something I wasn't supposed to. hee hee hee

Thanks so much for this. Of course by the time I'd worked my way through the maze field called "codes," I was understanding why insurance companies figured if you went to a T or pdoc you'd be too f*'d-up to question their billing.

Can't remember if my most recent "official" diagnosis was bipolar I or II. Doesn't really matter to me. I'm usually depressed. Just came off a major 3-4 month manic episode with a huge crash at the end back into depression. I'm currently way at the low end of depressed, leaning heavily toward self injury and suicide. Throw in the rest of my "multiple diagnosis" crap and all that matters is I'm a mess and I have to figure out a way to live with it somehow.

They actually keep it NOS because the insurance companies coverage is more than if they say outright that you are BPI or BPII. (According to my Pdoc) The way I interpreted it is that if you're NOS, they don't have a clear picture of what to expect so they'll cover more. Once you are defined as BPI or BPII they expect you to fit a certain model which determines what they are and aren't willing to cover...but having bipolar in general can't help you much. xD

But what if you are in a country that relies heavily on public health care, honest question, I'm actually curious

Bow,

You're a BP I if you've ever had a Mania or a mixed episode. BP II never goes beyond hypomania, and no psychosis.

It will be interesting to see what changes with the DSM V when it comes out.

Not sure. I don't have any experience with public healthcare...but I might look it up in a second.
http://ideas.repec.org/p/hpa/wpaper/200706.html

zbmom, you can have psychosis with depression too. :P
http://en.wikipedia.org/wiki/Psychotic_depression

One of the main things that through my shrink off was that she couldn't decide if she thought I was hypo or full manic, don't know how that could apply to Bowhunt but it does happen.

Yeah, I'm waiting with baited breath to see if bipoler goes the way of pyomania.

I'm pretty sure that if psychotic features are present and they don't diagnose you as a BP I you go into BP NOS.

Yeah the distinction can be hard for some people, usually they say if you can hold down a job, not get into trouble with the law, reckless driving, that sort of thing you're probably hypo. Thankfully I don't get pressured speech when I'm hypo so to most people I just appear really energetic and in a really good mood, but my husband can always tell.

http://www.ncbi.nlm.nih.gov/pubmed/20457470
Not true, zbmom. It didn't take me long to find this article on google. It even states that psychotic features are not rare! The finding (which is two sentences on here) suggest that the psychotic feature and non-psychotic feature could be two different phenotypes but still considered Bipolar II.

I also forgot that the psychotic features can only occur during depression.

For me the problem is I've got really extreme self control (courtesy of some incredible painful medical conditions when I was younger), so definitions like that one don't really apply.

If that's the criteria then maybe BP II and a really long hypomania? Can sort of hold down a job, having trouble at work (currently off on disability again) due to problems with fatigue, mood, concentration. I was semi-forcibly "retired" from firefighting because the results of my city ordered psychological evaluation scared the fire department so bad they couldn't get rid of me fast enough. Latest episode involved a lot of of elevated mood, sleeplessness, rapidly making poor decisions without considering the consequences. No legal trouble except for getting pulled over because I was too fuzzy and fatigued to drive straight. Wrecked my marriage by leaving my wife and family to get back with an old lover who eventually left me, leading to the crash. Don't know if you want to call that manic or hypomanic.

That's what psychiatrists and mood journaling are for alcinus and bow!!

That's interesting! Maybe that's why my insurance company is so generous in giving me unlimited mental health visits....I'm BP NOS and nobody really knows yet where I fit on the spectrum. I have had a mixed episode, but I've never lost contact with reality and the only time I've ever had full-blown mania was when I went on Wellbutrin. So I don't really qualify for BP I, but II doesn't describe my version of it either. My internist calls me "tripolar"---he said, "You've got the depression, you've got some mania, and, well......you're f'ed up." THAT describes me perfectly, lol.

ETA: Whatever the category, bipolar SUCKS!!

So I guess that's why I'm BP I? Because I didn't go to work last summer, and lost my job?

I always thought I'm BP I because of the grand of coke I flushed down the toilet and the whole having sex with strangers off the internet thing.

Thanks so much guys for responding. It really is such a massive field!!! Maybe I don't need to question my dx!? I certainly experience all the different episodes to one stream or another!! I just wish I could help my friend- I feel so useless!!

Thx again xx