Should the Topic of Bi-polar Disorder Be Made Into A Lighthearted Movie?

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The other day, (well now it has been a couple of months!  I am so not keeping up with this blog!)  some friends and I went to see the movie “Silver-Lining Playbook.”  It was a good movie.  The acting was excellent.  I assume that if Bradley Cooper had not been up against Abraham Lincoln, he would have won an Oscar for his portrayal of an individual with bi-polar disorder.

However, the story line itself was total fantasy and, as the movie proceeded,  it became more and more a fantasy.  Maybe the author of the book/movie entitled the story, “Silver-Lining Playbook” precisely to let the movie viewer know that we would be shown a fantasy. But any of us who have seen/lived with someone diagnosed with bi-polar disorder knows that this dis-ease (at least up until now) does not have a silver lining attached to it.  I found the fantasy that the movie portrayed a bit over the top.  Now I know that American movie goers tend to love the happy ending story and this was as fairy tale-ish  “…and they lived happily ever after” as it gets.  But I found it a little disturbing to approach the topic of an illness wherein there has been no cure found [as of yet] in such a fantasy like way.

Bipolar disorder has no single cause. It appears that certain people are genetically predisposed to bipolar disorder. Yet not everyone with an inherited vulnerability develops the illness, indicating that genes are not the only cause. Some brain imaging studies show physical changes in the brains of people with bipolar disorder. Other research points to neurotransmitter imbalances, abnormal thyroid function, circadian rhythm disturbances, and high levels of the stress hormone cortisol.  These imbalances purportedly can be modified with pharmaceuticals.  But pharmaceuticals have their side-effects, some of which can be pretty nasty.

External environmental and psychological factors can be involved in the development of bipolar disorder. These external factors are called triggers. Triggers can set off new episodes of mania or depression or make existing symptoms worse. However, many bipolar disorder episodes occur without an obvious trigger.

  • Stress – Stressful life events can trigger bipolar disorder in someone with a genetic vulnerability. These events tend to involve drastic or sudden changes–either good or bad–such as getting married, going away to college, losing a loved one, getting fired, or moving.
  • Substance Abuse – While substance abuse doesn’t cause bipolar disorder, it can bring on an episode and worsen the course of the disease. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression.
  • Medication – Certain medications, most notably antidepressant drugs, can trigger mania. Other drugs that can cause mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids, and thyroid medication.
  • Seasonal Changes – Episodes of mania and depression often follow a seasonal pattern. Manic episodes are more common during the summer, and depressive episodes more common during the fall, winter, and spring.
  • Sleep Deprivation – Loss of sleep—even as little as skipping a few hours of rest—can trigger an episode of mania.

Lithium is the oldest and most commonly used mood stabilizer. It is “highly effective” for treating mania. Lithium can also help bipolar depression. However, it is not as effective for mixed episodes or rapid cycling forms of bipolar disorder. Lithium takes from one to two weeks to reach its full effect.  But some of the side effects of lithium include:

weight gain, drowsiness, tremors, weakness and fatigue, memory and concentration problems, stomach pain, thyroid problems, nausea, vertigo.

Of course every doctor will tell you that not everyone develops these side effects, but if you happen to be one of the ones who does, would you willingly subject yourself to them?

In extreme cases, antipsychotics may be prescribed for bipolar disorder.

Antipsychotic medications used for bipolar disorder include:

  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Ariprazole (Abilify)
  • Ziprasidone (Geodon)
  • Clozapine (Clozaril)

The common side effects of antipsychotic drugs are similar to those of the mood stabilizers: Drowsiness, Weight gain, Sexual dysfunction; Dry mouth; Constipation; Blurred vision.

Often, antipsychotic medications are combined with a mood stabilizer such as lithium or valproic acid.  So you can imagine what someone on both antipsychotic drugs and mood stabilizers might look like.  This is why I put the words “highly effective” in quotes.  By whose definition?

My apologies to the readers: I seem to have lost the sources by which I got my details on symptoms and remedies.  However, a google search for bipolar disorder will bring up pages with which you can further educate yourself.  But please, please, do not think that the two individuals portrayed in “Silver-Lining Playbook” are representative.

© Yvonne Behrens, M.Ed  2013

 

 

 

 

Can Anti-Psychotic Abuses Be Stopped?

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Just as I think I have presented a fairly comprehensive picture about the abuses of anti-psychotic prescriptions and the elderly,  I come across another horror story. This time, the story appeared in the AARP Bulletin.

Apparently, in Florida, that golden state for retirees, a psychiatrist, Huberto Merayo,

“prescribed powerful drugs to thousands of patients at his Coral Gables, FLa., practice. In 2009 alone, he doled out more than 7,500 prescriptions to some 1,600 patients.  And that cost taxpayers big-time.  That year, Medicaid paid more than $1.9 million to fill scripts for antipsychotics written by Merayo.”

To add insult to injury, Merayo was earning $100,000 in consulting and speaking fees from the pharmaceuticals that manufactured these drugs.

Unfortunately, this story is not an isolated incident.  Lawmakers are apparently considering writing legislation that would address the misuse in administrations of these anti-psychotic drugs to the elderly.

Our elderly are frail and need protection.  The weakness inherent in creating laws by which to do this, of course, is the ability to manipulate the laws and/or the all too prevalent tendencies on the part of our lawmakers to be bought.

No.  The only way to protect the frail is to have a community, a village, if you will, or an extended family in which many people take responsibility for the care and protection of their nanas and grandpas.  Add to this picture doctors, general practitioners or geriatric, who know their patients and know what ailments may arise as one ages and, we might nip most of the abuses in prescribing anti-psychotic drugs that are prevalent today.  Oh, but then I guess I am talking about a society in which humans and not profits are the focus.  Hm.

[Next week: Why the dearth of geriatric practioners?]

 

 

Health Care or Mis-Care

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[Although I know that most people prefer to watch inspirational videos rather than harsh ones like the one I am showing in the next frame, how our society treats the elderly needs to be looked at in all of its harsh realities.  So for the next few weeks to parallel the blogs I have been writing about the elderly, the video will remain.  Please do view it, because in order to change things, one has to confront square in the face what is or can be unpleasant.  Bear with me.  I promise the next video will be inspirational. ]

In my last two blogs,  I have been exploring anti-psychotic drugs and the elderly.  According to a research done by the University of Florida in 2010,  70% of those entering nursing homes end up on psycho-active drugs within three months of entering the home in spite of having no prior history of psychotic problems. Although dementia may occur in old age, more often than not, the delirious or dementia like behaviors are most likely caused by medication or the interactions of several medications the elderly person may be taking.  Benzodiazepines, opiates and tricycic anti-depressants are the main culprits.  These pills come in very many variations and are extremely prevalent in our society.  Today’s blog is exploring the effects that these drugs can have on older users.

AFFECTS ON OLDER PEOPLE

As one ages, The body’s ability to clear drugs decreases often because of a normal age-related decrease in kidney and liver function. This results in a greater accumulation of drugs in the body.

Secondly, Older patients are often prescribed multiple drugs at the same time. Due to complicated interactions between different drugs, side effects can become more prominent.

Last, Some research have demonstrated that neurotransmitters become naturally imbalanced as people age, increasing the brain’s sensitivity to drugs that have activity in the central nervous system.

With the regular use of anti-psychotic drugs in nursing homes, it is no wonder that the Rovner, et al study concluded that nursing homes were “de facto psychiatric institutions.”

Let’s look at the above facts in more detail:

Number 1.  When doctor’s prescribe medication, they often prescribe the full dose without recognizing that in an older patient, “the body’s ability to clear drugs decreases with age.” For example the equivalent dose of diazepam (a short-acting Benzodiazepine) in an elderly individual on lorazepam (a long-acting Benzodiazepine) should be up to half of what would be expected in a younger individual.  Giving full doses of these medications are sure to cause the side effects to increase in severity the more the drug accumulates in the system.

Paradoxically, an overdose of Benzodiazepines can cause the effects it has been prescribed to diminish, ie, anxiety, delirium, combativeness, hallucinations, and aggression.[ (Wikipedia)

Number 2: “Older patients are often prescribed multiple drugs” many patients do not realize that they are taking too many drugs or taking drugs that might interact with the other drugs in an adverse way. Sometimes they may have two prescriptions for the same drug under two different names, thus inadvertently increasing the dosage.

With the fact that “Some research suggest that neurotransmitters” change as we age affecting the brain’s sensitivity to drugs continues the argument that prescribing drugs to older patients has to be done with extreme care.

With all these factors at play, it becomes of utmost importance, then, that in-depth evaluations are done if and/or when an elderly person begins to manifest dementia-like symptoms.

Public Citizens points out:

“Because cognitive impairment caused by drugs is so frequently overlooked, it is important that when symptoms of confusion, altered concentration or difficulty thinking occur that you and your physician review any medications you are taking to determine if any of them might be the cause.

Fortunately, if the cause is a medication, your symptoms should go away or become less severe after stopping the drug, even if it takes weeks or months. (http://www.worstpills.org/includes/page.cfm?op_id=459)”

And Dr. Gary Oberlender, a Specialist in Geriatric medicines,  points out that

“Dementia as the cause of a senior’s cognitive decline should only be considered after a thoughtful and thorough medical evaluation has excluded a potentially reversible cause. The list of common causes of dementia in seniors is short. It includes Alzheimer’s disease, vascular dementia (stroke), Parkinson’s disease, Lewy body dementia, and alcoholic dementia.”

In recent months, the overuse of anti-psychotic drugs is beginning to be noticed.  In an article that appeared in The Telegraph, doctors can get up to five years jail time in the British Isles for prescribing these drugs to the elderly.  Here in the U.S., nursing homes are being forced to reduce their use of anti-psychotic drugs 

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