Best Differential Diagnosis Book


Seems that everybody nowadays knows someone (or certainly knows someone who knows someone) who has bipolar disorder (BD).
So you’d have thought that information about the illness would be clear, easily-accessible, and well-known.
Well, you’d have thought wrong.
Of course misconceptions still abound, but, beyond that, there are some important facts about BD that remain obscure to so many of those without the disorder–and, surprisingly, even to some of those with it.
Here are 10 facts everyone should know about BD:
1. BD is the sixth leading cause of disability in the world, according to the World Health Organization.
That puts it behind tuberculosis (can you imagine?) and road traffic accidents, but ahead of war. It is, additionally, the most expensive mental healthcare diagnosis in the United States, hands-down.
2. A shocking 1 in 4 bipolar sufferers receives an accurate diagnosis in less than 3 years.
Often mis-diagnosed as anxiety, depression, thyroid condition–you name it–it takes an unacceptably long time for doctors to finally pinpoint the real problem. During that time, more mood cycling occurs, which in turn leads to more mood cycling, which contributes to the severity of the condition.
3. Lifetimes suicide rates are higher for those with BD than for any other mental illness.
In fact, higher by far.
For major depressive disorder the suicide rate is 9%, which increases to 10% for schizophrenia. But the rate of suicide is double that in BD, with an estimated 20% of those with the illness taking their own lives.
4. Three times more days in a bipolar person’s life are spent in a depressive state than in a manic or hypomanic state.
So many people are attached to their mania, and the energy and creativity it can bring. But as surely as devastating night follows day, depression rides on the heels of the manic pole. There is an inevitable plunge, and people will pay the price--in triplicate–for their elevated moods.
5. A full 50% of those with BD have co-occurring substance abuse issues.
Often in an attempt to self-medicate, people with BD will turn to drugs and alcohol. These in turn exacerbate the condition, and can wreak havoc on prescribed medication regimes.
6. When the first bipolar episode occurs, it is most likely to be a manic episode in males, while the first episode for females is more likely to be a depressive one.
7. Even after the first episode, BD can present quite differently for men and women.
Women more commonly experience rapid cycling, mixed states, and cyclothymia. Men, by contrast, more frequently experience early-onset bipolar disorder (which can lead to a more severe condition). Men also have higher rates of substance abuse [A.D.A.M., Inc., 2012].
8. The average age of onset for BD is 25.
The first occurrence is usually between the ages of 15-30. However, it can occur at any age, including in children (although that diagnosis has recently received much skepticism. See “Bipolar Disorder In Children–A Diagnosis in the Doghouse” for some of the latest research on the existence of the illness at young ages).
PsychCentral points out that an earlier age of onset doesn’t bode well. Their article on age of onset notes:
“On average, the earlier the age at which symptoms appeared, the longer it took for the patients to be diagnosed.  In addition, the longer the delay in diagnosis, the more time patients spent depressed, the more episodes of depression they had, the worse the episodes were, and the more rapid the cycling of episodes.”
9. Rates of bipolar differ among countries.
Although one would think the illness would occur at the same rate, whether in Dubai, Israel, Zimbabwe, Brazil–you name it, it turns out that a CNN study of 11 countries found wide variance.
The winner (if it counts as winning, I suppose), hands-down, was–who else?–the U.S., with the  highest lifetime rate of bipolar disorder at 4.4%, and overall wealthier countries had higher rates.
Just as a point of interest: Japan, which should have had higher statistics, had a lifetime prevalence of only 0.7%, while Columbia, a lower-income nation, turned out to have a relative high prevalence at 2.6%.
The loser (winner?)? India, the absolute lowest, with 0.1%.
10. The highest risk factor is something you can do nothing about. . . it’s having a relative who has BD.
More than age, stress, and drug abuse (all potential risk factors for developing BD), genetics is the single biggest risk factor by far.
Those who have a parent or sibling with bipolar disorder are four to six times more likelyto develop the illness, compared with controls. (see Nurnberger & Foroud, 2000).
Look, realizing that you’ve got the worst risk factor going, and that you’re in a country where your diagnosis is most common can’t really help you treat your illness. But just knowing the facts of your disorder give you some semblance of control over it.
Since knowledge is power, as per Frances Bacon, the more you know, the more power you have to manage your illness.
And making sure that you manage BD, instead of it managing you, well, that’s the name of the game. So 10 points to you for reading this post; bipolar–none.

 

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