Comments on: Bipolar, Cobra and ADHD: Are We Killing a Hognose Snake?

By: Dr Charles Parker

Dr Charles Parker — Thu, 22 Oct 2009 10:37:37 +0000

Kristine,
Thanks so much for your thoughtful and insightful reply… completely agree! The earlier comments by Lorre also addressed this issue over on the ‘other, ADHD side.’

So much of what we do in our offices does require a profound measure of humility in the face of our own ideas not working. If we aren’t ‘getting it’ with a good response to the interventions strategies on the table, we clearly must fall back and regroup. Most important in all of these comments for any of us is the development of thoughtful feedback loops as you have with your patient.

And one further ‘anti-reductionistic’ point, germane to both sides of the question, seen in my own office if I am off the mark: It could be that dreaded multi-headed Medusa Snake – also recognized as Both-and-Then-Some. I have many folks who suffer with comorbid ADHD and Bipolar, and significant metabolic/immune/endocrine issues. Any of the comorbid challenges from gluten sensitivity to estrogen dominance can completely corrupt any informed psych intervention strategy.

Excellent points Kristine, – thanks for your comments.
cp

By: Kristine

Kristine — Wed, 21 Oct 2009 18:27:05 +0000

I have found that the mislabeling goes both ways. I was treating a young man for substance dependence and was very cognizant of his behaviors in group and individual therapy. He had been diagnosed with ADHD since childhood and couldn’t maintain abstinence, even on his ADHD meds, he was looking for a way to calm or excite. I explained to him that I believed he was misdiagnosed all these years, not having ADHD, but having Bi-Polar. He was actually relieved because he felt that none of the ADD meds he had been on all his life worked and he was ruining his relationship w/ his significant other and his little girl. He ended up getting incarcerated, but I received a call from his mother, who informed me that he was seen by a psychiatrist who concurred with my diagnostic change and that he was finally getting the help he needed. The symptoms of these disorders can overlap and appear at times quite similar. I think that it is important that diagnostic tools are utilized correctly w/o an immediate label, that colleagues are involved in assisting as offering a second opinion when so many disorders can be this or that. Nothing is clear cut in the world of mental health and that of substance abuse. As providers we must always look at history, current and past behaviors, symptoms, chemical usage,trauma etc.

By: Dr Charles Parker

Dr Charles Parker — Wed, 21 Oct 2009 11:16:15 +0000

Would love to do this one, looks like a great series. We could invite Clint and have him talk about the character and type-casting. He’s a great guy, don’t have time at this moment to link to a previous CorePsych Blog post talking about my brief meeting with Clint… he is a great guy, gets it, and would probably love to hang out on this subject.
cp

By: Dr Charles Parker

Dr Charles Parker — Wed, 21 Oct 2009 11:11:01 +0000

Hormones and cognition, oddly enough, are sub sub specializations with no certification!
cp

By: Dr Charles Parker

Dr Charles Parker — Wed, 21 Oct 2009 11:05:20 +0000

Sorry on this one David, was writing away, and didn’t say it precisely.

She suffered from the cognitive anxiety all the way back into our first recognition of it [in her case] in 7th grade. The presentation of the cognitive abundance, the cognitive anxiety, the relentless worrying, the refractory depression is the symptom picture that so often is misidentified as the bipolar cobra. If you have a racy mind in this country it = bipolar. The characteristics of that racy presentation, the history, the context, and the mind activity outside the crisis are all often overlooked in the acuity of the moment. That hood and hissing make it a cobra. Pull out the gun, momma.

Over time, the cobra alert is sounded from doc to doc, and without a detailed background that looks at brain function vs appearances, it is so completely easy to err on the side of not adding to the patients problem by making her worse with stimulant meds. Many of the docs in the trenches with ADHD are strong on these matters, and at the meetings also get pretty hot about this problem.

I may be writing about it, but the other line officers see it as well. The problem is with the docs who aren’t accustomed to this frequently seen manifestation, and the ‘public safety’ becomes the issue. I do hope this dialogue changes the field guide for these observations. Many good folks suffer downstream for *years* with misidentifications.
cp

By: David H

David H — Wed, 21 Oct 2009 06:56:58 +0000

Maybe we can get Clint (and/or Willy) and you on this program next year. http://www.framesofmind.ca/blog/

They have had almost nothing relating directly to ADHD in 8 years.

You come up, do a compulsive brain day, conference, some professional training etc., evening screening, you and a panel..maybe some great fly fishing on the side……..

I’m at least half serious…

By: David H

David H — Wed, 21 Oct 2009 06:37:25 +0000

I am curious about the “since the first hospitalization” qualifier. Are you implying that the severe episode, which I presume led to the hospitalization was a demarcation point or even the cause for a sudden emergence of the “classic Thinking ADHD” (i.e. brain damage)?

I am think,think, thinking of more to say on this…..

By: Dr Charles Parker

Dr Charles Parker — Wed, 21 Oct 2009 01:32:03 +0000

You guys are too kind, – it’s a deep pleasure to have the opportunity to share my time with folks who truly get it!
cp

By: Lorre Hopkins

Lorre Hopkins — Tue, 20 Oct 2009 21:19:16 +0000

I agree, and I am fortunate to have him for my doctor since I’ve seen a few comorbidities!! Thanks again!

By: Gina Pera

Gina Pera — Tue, 20 Oct 2009 20:17:41 +0000

If you “stumbled upon this blog,” you have very good instincts, Lorre!
I had to search assiduously to find an expert as knowledgeable Dr. Parker on so many aspects of brain health and function.