Bipolar Disorder and Autism

Bipolar disorder (previously called manic-depression) is a mental condition characterized by mood swings that vary between the “high” episodes of mania and the “low” periods of depression. Research studies suggest that bipolar disorder may be relatively common among autistic individuals. According to Jessica Hellings and Andrea Witwer some studies have found that as many as 27% of individuals diagnosed with autism have symptoms of bipolar disorder (http://bit.ly/1LRIkiV). These investigators believe that the high prevalence rate may represent an over diagnosis due to an overlap or commonality between the symptoms of both conditions; other researchers believe that the cited figure under represents this comorbidity as affected patients may find it difficult to express some of their symptomatology due to language and/or intellectual impairment.

Although we are uncertain as to the cause of bipolar disorder (both genetic and environmental factors seem to play a role) treatment protocols for it have been well established and are effective in a majority of cases. This makes it imperative to appropriately diagnose those autistic individuals who may have bipolar disorder.

Rates for bipolar disorders appear to be similar for both men and women with a prevalence in the general population of 1-2%. Mean age of onset for symptoms is 19 to 25 years. In about one third of patients the diagnosis is obtained after more than 10 years of symptom onset. Diagnostic delay in the latter cases may be attributed to some existing comorbidities (e.g., drug abuse, ADHD) that may serve to divert the attention away from a diagnosis of bipolar disorder. Note: A problem with comorbidities, especially ADHD, is that you would not like to give a stimulant to a bipolar patient as response to this therapy is unpredictable. In some susceptible bipolar individuals stimulants may precipitate full blown manic symptoms.

Many people use the word bipolar disorder with different meanings. There is a general tendency to self-diagnose as bipolar because of perceived anxiousness, feelings of hostility or because of poor concentration. I believe that if you think you have mania but somebody else has not noticed it, it is not mania. True manic symptoms include markedly decreased need for sleep, inflated self-esteem, talkativeness, and distractability. If untreated it will last some 9 months and has a 15% mortality rate. Although the increased mortality rate is attributed in many cases to suicide other deaths are cardiac related probably due to the stress of the condition. In addition to those symptoms mentioned above, manic symptom may include racing thoughts (i.e., you can’t keep on with your thoughts), increased psychomotor activity (as in ADHD), promiscuity, and unrestrainined spending sprees. Some manic patients may manifest hypergraphia (ie., a rambling style of writing without punctuation).

There are different types of bipolar disorders. Bipolar 1 has manias or both manias and depression. Bipolar II has hypomanias and depression while cyclothymia has hypomania and depressive symptoms. (Note: symptoms of hypomania are similar to those of mania but last fewer days and patients may remain functional and productive during this period of time). Substance abuse, some prescribed medications and medical condition can lead to or precipitate symptoms of bipolar disorder, e.g. asthma medication, stimulants, interferon, corticosteroids.

The basic screening tool for bipolar disorders is the MDQ (Mood Disorder Questionnaire). The questionnaire probes whether reported symptoms have occurred during the same period of time (i.e., simultaneously), whether symptoms caused moderate to severe problems with work, family, money or legal troubles, arguments or fighting. The questionnaire provides for many false positives; however, it tends to weed out the negatives.

Prevalence prior to adolescence is low, likely less than 1%. In these cases, for a bipolar 1 diagnosis, a patient must meet all criteria for mania, just like an adult. Irritability alone does not mean the presence of a bipolar disorder. When confronted with a child with a presumed diagnosis of bipolar disorder the diagnostician should consider disruptive mood dysregulation disorder. According to the American Academy of Child and Adolescent Psychiatry: “Disruptive Mood Dysregulation Disorder (DMDD) is a relatively new diagnosis in the field of mental health. Children with DMDD have severe and frequent temper tantrums that interfere with their ability to function at home, in school or with their friends. Some of these children were previously diagnosed with bipolar disorder, even though they often did not have all the signs and symptoms. Research has also demonstrated that children with DMDD usually do not go on to have a bipolar disorder in adulthood. They are more likely to develop problems with depression or anxiety” (http://bit.ly/1kWc5oD).

Before starting treatment ask the patient on what medication are they on. Are they on stimulants? If so, you will have to take them off from the same. Also withdraw any tricyclics and any serotonin norepinephrine reuptake inhibitors. Are there any other medical issues? If manic, before starting medication, see if you can get them to sleep as it will start calming down. For pediatric patients lithium, olanzepine (Note: astronomical weight gain, sedation can be very strong, no initial lab, diabetes and cholesterol risk), risperidone, quetiapine (note: has a good sedative effect, weight gain is a big deal but it does not have much in terms of involuntary movement disorder), aripiprazone, asenapine have been approved for use in children. For depression some prefer treatment with olanzepine (down to 4 years of age). For maintenance, lithium is the only available medication although there is no safety data under 12 years of age. Lithium is fairly safe, a lot of data has accumulated in regards to its use for different age groups, but has many side effects, e.g., diarrhea, acne, weight gain, tremor, hypothyroidism, hyperparathyroidism, and diabetes. Lithium is inexpensive but proves inconvenient to some patients as it needs follow-up laboratory work. Depakote has been around for a long time. It is effective for mania but not for depression. Depakote requires lab monitoring and has many side effects: hair loss, nausea, vomiting, weight gain. Use in women of child bearing age may be difficult because of teratogenic effects.

Note: As with autism, members of the Neurodiversity movement claim that bipolar disorder is the result of normal variability within the human genome. They believe that bipolars posses an alternate cognitive style within society that should be preserved and accepted rather than treated. In this regard they cite historical accounts of figures like Wolfgang Amadeus Mozart and Vincent Van Gogh as possible bipolars who greatly contributed to society.

Although manic states may be associated in some individuals with increased creativity, in other cases the individual may be deluded as to the significance of his/her own efforts and achievements. A thousand page manuscript meant as a manifesto by a bipolar during his/her manic phase will almost always show gibberish verbiage of little intellectual significance. The truth is that for many bipolar individuals the disorder is a painful condition, in the physical sense, that bears a 15% mortality rate. Although many of those who die do so because of suicide others die of cardiac problems apparently precipitated by stress. Furthermore, offsprings of parents with bipolar disorder may inherit a susceptibility to affective disorders (Note: this relationship may appear more important that thought at first instance. It may help explain some of the pathology and the so-called “genetics” of autism see Stevens et al, 2013 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3532962/). Contrary to claims by the Neurodiversity movement medical treatment in bipolar disorder can greatly benefit the affected individual.

5 responses to “Bipolar Disorder and Autism

  1. My sister was diagnosed with bipolar at ten years old,before she was diagnosed with autism.She has many of the features of DMDD as well as bipolar and autism.The comorbidity factor must be very strong.Her mental health state is as complex as I am medically,and genetically.My sister attempted suicide yet again this year,and she was reevaluated for bipolar and autism again,much as I was reevaluated for autism after my last acute regression in 2008.

    I was not aware the neurodiversity movement had reached out to lure those with bipolar disorder into their evil clutches,but I am not surprised.These people are despicable.Are any of those who spout this garbage either profoundly bipolar themselves,or have lived with close family members who are?Have they witnessed the numerous suicide attempts,or had to take a family member to the emergency room,after a suicide attempt went wrong? Have they been on the receiving end of the rages,or “temper tantrums”,as you put it,that people with both bipolar disorder and DMDD can have?Have they had to financially bail out a family member,who has gone on one of the spending sprees you describe?I hate these people with every fiber of my being.The lies spread by the neurodiversity movement cause more suffering and death than they will ever know.

    Like

    • They have gone after all mental conditions, e,g, dyslexia, ADHD, bipolar disorders, schizophrenia. I once wrote that Neurodiversity had some of its roots in the antipsychiatry movement. Steve Silberman in our exchange said this was not the case, but spent a good amount of time in his book bashing Psychiatry and extolling Thomas Szasz. Many of them have no personal experience with any of these conditions. Unfortunately they are receiving a lot of praise and attention with major changes coming for funding from the federal government, Autism Speaks, etc catering to their point of view.

      Like

    • I’m not familiar with the Neurodiversity group but I have questioned the psychology and medical industries practice of diagnosis and management of many issues that directly correlate to societies increase of overstimulation from media, technology, diversifying futures, financial/job stressors and families breaking apart. Not identifying many of these external factors as the route cause that triggers an episode and the lack of support systems to mitigate or correct those factors for better management before administering drugs that are not well tested is a huge problem. Because of that there are many more people that don’t trust the medical communities advice and look for alternatives, some of which can be harmful because they are looking to capitalize off their misfortune or don’t have the resources in place to handle all cases or certain cases.

      Like

  2. Roger Kevin Lietch who was the founder of Left brain right brain blog and created the autism hub was a member of neurodiversity and had a bipolar disorder. Autism speaks funded Laurent Mottron going back to 2008, so catering to neurodiversity is nothing new for them.

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s