Category: bipolar disorder

Double Trouble: A Dual Diagnosis

What is the relationship between drug abuse and mental illness?

Many chronic drug abusers–the individuals we commonly regard as addicts–often simultaneously suffer from a serious mental disorder. Drug treatment and medical professionals call this condition a co-occurring disorder or a dual diagnosis.

What is chronic drug abuse?

Chronic drug abuse is the habitual abuse of licit or illicit drugs to the extent that the abuse substantially injures a person’s health or substantially interferes with his or her social or economic functioning. Furthermore, any person who has lost the power of self-control over the use of drugs is considered a chronic drug abuser.

What are some serious mental disorders associated with chronic drug abuse?

Chronic drug abuse may occur in conjunction with any mental illness identified in the American Psychiatric Association (DSM-IV). Some common serious mental disorders associated with chronic drug abuse include schizophrenia, bipolar disorder, manic depression, attention deficit hyperactivity disorder (ADHD), generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, panic disorder, and antisocial personality disorder. Many of these disorders carry with them an increased risk of drug abuse.

Disorders With Increased Risk of Drug Abuse

  • Antisocial personality disorder 15.5%
  • Manic episode 14.5%
  • Schizophrenia 10.1%
  • Panic disorder 04. 3%
  • Major depressive episode 04.1%
  • Obsessive-compulsive disorder 03.4%
  • Phobias 02.1%

 Source: National Institute of Mental Health.

How prevalent are co-occurring disorders?

Co-occurring disorders are very common. In 2002 an estimated 4.0 million adults met the criteria for both serious mental illness and substance dependence or abuse in the past year.

Which occurs first–chronic drug abuse or serious mental illness?

It depends. In some cases, people suffering from serious mental disorders (often undiagnosed ones) take drugs to alleviate their symptoms–a practice known as self-medicating. According to the American Psychiatric Association, individuals with schizophrenia sometimes use substances such as marijuana to mitigate the disorder’s negative symptoms (depression, apathy, and social withdrawal), to combat auditory hallucinations and paranoid delusions, or to lessen the adverse effects of their medication, which can include depression and restlessness.

In other cases mental disorders are caused by drug abuse. For example, MDMA or Ecstasy, produces long-term deficits in serotonin function in the brain, leading to mental disorders such as depression and anxiety. Chronic drug abuse by adolescents during formative years is a particular concern because it can interfere with normal socialization and cognitive development and thus frequently contributes to the development of mental disorders.

Finally, chronic substance abuse and serious mental disorders may exist completely independently of one another.

Can people with co-occurring disorders be treated effectively?

Yes, chronic drug abusers who also suffer from mental illness can be treated. Researchers currently are investigating the most effective way to treat drug abusers with mental illness, and especially whether or not treating both conditions simultaneously leads to better recovery. Currently, the two conditions often are treated separately or without regard to each other. As a result, many individuals with co-occurring disorders are sent back and forth between substance abuse and mental health treatment settings.

Source: http://www.justice.gov/ndic/pubs7/7343/index.htm

For more info on the Dual Diagnosis see: http://bipolar.about.com/cs/dualdiag/a/0008_dual_diag.htm

Lithium: Help for the Afflicted

 

Lithium (brand names Eskalith, Lithobid, Lithonate, and Lithotabs) is the most widely used and studied medication for treating bipolar disorder. Lithium helps reduce the severity and frequency of mania. It may also help relieve bipolar depression. Studies show that lithium can significantly reduce suicide risk. Lithium also helps prevent future manic episodes. As a result, it ma y be prescribed for long periods of time (even between episodes) as maintenance therapy.

Lithium acts on a person’s central nervous system (brain and spinal cord). Doctors don’t know exactly how lithium works to stabilize a person’s mood. However, it helps people with bipolar disorder have more control over their emotions and reduce the extremes in behavior. It usually takes one to two weeks for lithium to begin working.

Your doctor will want to take regular blood tests during your treatment because lithium can affect kidney function. Lithium works best if the amount of the drug in your body is kept at a constant level. Your doctor will also probably suggest you drink eight to 12 glasses of water or fluid a day during treatment and use a normal amount of salt in your food. Both salt and fluid can affect the levels of lithium in your blood, so it’s important to consume a steady amount every day.

The dose of lithium varies among individuals and as phases of their illness change. Although bipolar disorder is often treated with more than one drug, some people can control their condition with lithium alone.

Lithium Side Effects About 75% of people who take lithium for bipolar disorder have some side effects, although they may be minor. They may become less troublesome after a few weeks as your body adjusts to the drug. Sometimes side effects of lithium can be relieved by tweaking the dose. However, never change your dose or drug schedule on your own. Do not change the brand of lithium without checking with your doctor or pharmacist first. If you are having any problems, talk to your doctor about your options.

Common side effects of lithium can include:

  • Hand tremor (If tremors are bothersome, an additional medication can help.)
  • Increased thirst
  • Increased urination
  • Diarrhea
  • Vomiting
  • Weight gain
  • Impaired memory
  • Poor concentration
  • Drowsiness
  • Muscle weakness
  • Hair loss
  • Acne
  • Decreased thyroid function (which can be treated with thyroid hormone)

Notify your doctor if you experience persistent symptoms from lithium or if you develop diarrhea, vomiting, fever, unsteady walking, fainting, confusion, slurred speech, or rapid heart rate. Tell your doctor about history of cancer, heart disease, kidney disease, epilepsy, and allergies. Make sure your doctor knows about all other drugs you are taking. Avoid products that contain sodium, such as certain antacids. While taking lithium, use caution when driving or using machinery and limit alcoholic beverages.

If you miss a dose of lithium, take it as soon as you remember it — unless the next scheduled dose is within two hours (or six hours for slow-release forms). If so, skip the missed dose and resume your usual dosing schedule. Do not “double up” the dose to catch up. There are a few serious risks to consider. Lithium may weaken bones in children. The drug has also been linked to birth defects and is not recommended for pregnant women, especially during the first three months. Breastfeeding isn’t recommended if you are taking lithium. Also, in a few people, long-term lithium treatment can interfere with kidney function.

A word of encouragement.  I’ve been taking 12oo mg of Lithium twice a day for over three years now, with just minor side effects.  (Mostly a bad hand tremor.)  Taking Lithium has stabilized me and protected me from my more bizarre behavior.

………………………………………………………………………………… 

Reviewed by the doctors at The Cleveland Clinic Department of Psychiatry and Psychology.

http://www.webmd.com/bipolar-disorder/bipolar-disorder-lithium

Hope in the Darkness

Winter can be a particularly trying time for those who struggle with depression and bipolar disorder. The increased darkness outside can begin to reflect in our hearts and so increase the darkness within.

I know Pr. Bryan has posted here before about the challenge of winters in Alaska where the days are extremely short. But even in the Pacific Northwest, Seasonal Affective Disorder is a big problem. When you drive to work in very little light and drive home again in pitch dark, which is even darker when it is raining, it is hard to remember the long days of summer.

It is during this dark season that we must cling even more to the Light of Christ so that the darkness does not overcome us. We must cling to the faithfulness of our God who brings the sun every morning and the seasons in their turn, so that we know spring and summer will follow the darkness.

Thinking about this one dark night earlier this week, I wrote a poem, which I posted on my blog, Linda Kruschke’s Blog, as a Thankful Thursday post. I hope you like my ode to God’s promise of hope and light that stands firm even in the darkness, and that it reminds you of the hope we have in Jesus.

Hope in the Darkness

Sun sinks below the horizon
Darkness envelopes all life in my view
Each night the darkness comes sooner
Each morning the sun arises anew

This season, winter, brings darkness
It seems to engulf the light of my soul
Sometimes the darkness is deeper
And blacker than the blackest mine of coal

But winter does not last forever
Spring and summer bring sun ever near
Hope of a Light everlasting
Is all that my darkened soul needs to hear

In him was life, and that life was the light of all mankind. The light shines in the darkness, and the darkness has not overcome it.

John 1:4-5 (NIV).

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Putting it Under a Microscope

Within our walks, as we attempt to follow Jesus, we need to be seriously evaluating our hearts–and the issues that affect them. If we make a short list, but the make-up would probably be justification, sanctification, glorification and deliverance.

Of this list, perhaps ‘justification’ takes the biggest hit.  Being declared ‘right with God‘ is targeted especially as the most significant .  But justification is quite potent, it will stand when all the other issues will stumble.  Justification is the starting point, and then it carries us quite a bit further. It stands when everything else crumbles.

We come to this place, it almost seems bizarre and garish as it comes to us.  But our simple faith in Jesus Christ has made us righteous.  But it seems, if we start to extrapolate it out, we start  thinking of realities and probabilities. These often confuse and darken our way, when they not really meant to.

“What if?” “But what might happen?” “Isn’t this a bit bizarre?” “Can’t I really make this ‘Christianity’ work?”  And yet at times, we won’t take a solid position, but we operate out of a miasma of thoughts that flit through our hearts.

In the courtroom of heaven, where God sits as a judge, we are given fair hearing. But simply put we aren’t so much as made righteous, but we are declared righteous.  The Greek word in the original is centered on this exclusive sense of “declaration.”

You have been declared righteous!  It is definitely not a feeling, or a sense of being just or righteous– because this changes 24x a day.  It seems I feel that I can never truly accumulate enough to save me.  And since I am always moving, I can never really figure it out.  And this makes me afraid. I become very disturbed. 

We are meant to walk out a sincere justification.  The enemy scrambles it before we can grasp it.  Satan‘s presence must be nullified in this.  There is something radical and decisive here.  And it is here he puts his crack troops.  This is a definite attempt to destroy your witness.

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