[AmaShel567]

I've been diagnosed with both bipolar disorder and gastroparesis. The last two times that I've had to be admitted to the hospital for my bipolar episodes my potassium levels were low. The second time I just had to take a huge vitamin but the first time they gave it to me through an IV. I've read that a patassium deficiency can can cause symptoms in different systems of the body. The specialist that I went to for the gastroparesis did a number of tests and couldn't determine the cause. Could there be a chance that I've been misdiagnose and that these three issues are related?

[Fresia]

I'm sorry to hear you are going through this. I would go for another opinion if you can afford to do it. From a friend who was also diagnosed with it, gastroparesis causes can be hard to pin down.

This website was helpful to her then, perhaps it might help you too:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001342/

They added a serotonin antagonist to her med regime, which also helped her depressive symptoms and the gastroparesis cleared; unfortunately I don't know what the cause was that they determined.

I hope you find the answers you seek and feel better soon!

[Atraeiouyu]

Misdiagnosing Bipolar Disorder

Bipolar Disorder is a widely recognized and legitimate mood disorder that affects approximately 6.4 percent of the general population and, depending on severity, can affect an individual’s ability to work, socialize, and/or care for them self and others. There is growing public concern, however that similar to more than one million cases of ADHD, the subjective diagnostic criteria, interpretation, application, and motivations of both patient and mental health professionals result in a large amount of misdiagnosis. With that in mind, we will explore common processes, contributing factors, and circumstances that result in the diagnosis and possible misdiagnosis of bipolar disorder and its effects.

The general procedure for diagnosing bipolar disorder, previously termed manic-depression until 1980, includes a physical examination, interview/mental health evaluation(s), and lab tests performed by medical and mental health professional(s). Upon ruling out ailments and traumas that can result in symptoms similar to a mental disorder, a mental health professional may conduct additional interviews of family, friends, and people close to the patient as well as detailed documentation of the heredity and history of related symptoms. The resultant findings are then applied to the widely accepted standards of criteria set forth by the Diagnostic and Statistical Manual of Mental Disorders version Four Text Revision (DSM-IV-TR) and a diagnosis is made, typically by committee.

As with any science the application and methodology can be flawed by various human elements and psychiatry, in particular it relies heavily on many intangible and less concrete observations for definition, diagnosis, and confirmation. The DSM itself is not entirely clear regarding the diagnostic criteria for bipolar and similar mood disorders. The DSM wording utilizes non specific and arbitrary language, unclear time references, and contradictory symptoms that indicate the same diagnosis. Additionally, the inclusion of bipolar not otherwise specified (NOS), which acts as a ‘catch-all’ diagnosis if the defined criteria cannot be met or properly evaluated and opens the door even wider for mental health professionals to categorize virtually any abnormal mood related behavior as bipolar. The future revision of the DSM, expected sometime in 2012, will likely expand on the already vaguely defined criteria by including the more severe Rapid Cycling Bipolar Disorder and the broader Severe Mood Dysregulation (SMD) and Temper Dysregulation Disorder with Dysphoria (TDD). Furthermore, it is expected to formally introduce the concept of the bipolar spectrum, which allows more room for diagnoses that do not clearly meet specific criteria.

While a diagnosis of any mental health disorder does not in itself specify a list of characteristics shared by all patients, its intent is to identify a starting point for effective treatment and recovery. The addition of several external factors, however greatly affects the diagnostic process and can result in additional complications as a result of misdiagnosis. Mental health providers are under intense pressure from insurance companies to provide speedy diagnoses, which can result in unclear and/or biased histories of the condition(s) and contributing factors. Further, in recognizing the validity and severity of mental health disorders, insurance companies, employers, and society may inadvertently offer incentives for individuals with such a diagnosis. Examples of this include the potential for long term disability, medical severance, priority employment status, etc. Adding to that is the lack of clarity in the identification of situational or ‘normal’ mood changes versus an ‘abnormal’ change in mood and behavior. With both patient and mental health professionals sufficiently motivated for a positive diagnosis in a muddied field of study, how can a truly unbiased and effective treatment plan begin?

Common treatments for bipolar disorder include medication, psychotherapy, and in some cases Electroconvulsive Therapy (ECT). The medications used to treat bipolar disorder typically alter the brain’s chemistry and pathways with regard to how an individual’s mood is controlled. The resultant use of mood stabilizers, anti-depressants, anti-psychotics, and focused chemical inhibitors cause highly subjective reactions and many times a laundry list of new or aggravated mental and physical side effects. Frequently a patient will undergo multiple medication changes until an acceptable balance of intended treatment versus inhibiting side effect is found. There exists also a high risk of dependency, toxicity, increased tolerance, and rebound from many commonly prescribed medications for the treatment of mood disorders. Cognitive Behavioral Therapy (CBT), Family-focused Therapy, Interpersonal and social rhythm therapy, and Psychoeducation are some recommended examples of psychotherapeutic treatment options that are intended for application in conjunction with medications (NIHM Handbook). Further, the inclusion of a well defined support network, daily journaling, and establishment of routine is a highly recommended common practice. For extreme unresponsive cases the use of ECT, previously referred to as electro-shock treatment, may be applied with a varying degree of positive results and even more subjective and intense side-effects, the most common being short term memory loss.

In conclusion, the tendency for the misdiagnosis of bipolar and other mental health disorders can result in drastic effects on an individual’s already deteriorated quality of life. Although some moderate successes in genetic testing can shorten the trial and error period of medicinal treatments, many medical insurance companies will not approve of the expensive procedures. Also, while the intention of the DSM is simply to provide diagnostic criteria for mental health professionals, the possible necessity of amplifying information regarding the standardization of the procedures used to diagnose, could help minimize the potential for misdiagnosis. From the patient and family perspective a quick diagnosis of a mental health disorder and resulting intrusive treatment options should include some elements of caution and extensive psychoeducation should be a large part of initial and continued treatment even in immediate cases. Lastly, however unlikely, something should be done with respect to the commonly encountered division of psychological therapy and psycho-pharmaceutical dispensaries (prescription writers). Whatever the end solution(s), the growing trend of a psycho-medicated population is approaching critical mass. There doesn’t seem to be enough psychiatric professionals to go around and the sarcastically referred to ‘religion’ of psychiatry continues to grow in size and public favor.

[Robsmith]

Sorry to hear about the Gastroparesis (GP). I will be having a food emptying study done in a few days to see if I have GP. Based off of the symptoms I can tell you that I believe I have had delayed stomach emptying since I was a kid. What I have found out is that GP does cause malabsorption. Malabsorption can cause vitamin, mineral and protein deficiencies which can cause all sorts of mood-mental disorders along with other physical illnesses. Example, I had pretty severe depression which I have never had before after moving from a dry sunny climate to a place that does not get much sun. I work indoors now where as before when I lived in a sunny climate I worked outside. Found out I was extremely low in Vitamin D. As soon as I started taking Vitamin D the depression when away. Over a decade ago I had about of extreme nausea, threw up very violently for over 6 hours till I finally passed out. The severe nausea returned every time I would try to eat. Went to a GI doctor back then and he said I was bulimic which I have never been. It took me over 3 years to be able to eat 3 square meals a day. Once I had that episode of extreme vomiting-it gave me my first panic attack. Since then my panic attacks 90% of the time are set off eating but I am hypoglycemic and I have to eat regularly.

I did run across this article about treatment of GP. ( unfortunately I can not post it as I am a new member) A lot of the medications that they list are what I have been on for years for panic disorder. . I am off of them now and now they suspect I have GP and is why I am being tested. The problem is and I even asked my pharmacist is what affect does GP have on the breakdown and absorption of Psych meds. He didn't know. Take Cymbalta or Effexor XR for example. They are extended release (break down slowly in the digestive tract) because the medication has a very short half life (4-9 hours) So imagine it sitting in your stomach for 4-8 hours before it goes into the intestine. I can think that if it sits in the stomach for that long its going to mostly break down before it gets into the intestine where its absorbed. Then your getting too much at once and before you go to bed its out of your system causing mild withdrawal symptoms. Now there is nothing to prove that this is what is happening if you have GP and take those meds but there isn't anything saying that what I described is not happening. But since GP in know to cause malabsorption of food I think that it would also affect meds as well? What I believe the main problem for me is with my anxiety and also GP is a weak Vagus nerve. The Vagus nerve is the main nerve of your parasympathetic nervous system AKA the "Rest and Digest" part of your autonomic nervous system.

Just my 2 cents here. I hope that once you get the GP under control, if you are able to see a Naturopath or find other resources to make sure your giving your body all of the nutrients it needs. Good luck with and keep us posted!