[raulsaul]

Not a finding of this particular study but I found this bit in the “Background” section interesting. It was hard for me to understand at first:

> In addition, a large-scale prospective epidemiological study of more than one million Swedish men found a “reversed–J” shaped association between intelligence and hospitalization for BD (the average follow-up period was 22.6 years, and the patients had no psychiatric comorbidities) [17]. Specifically, they found that the risk of hospitalization with any form of BD decreased as the intelligence increased; in the meantime, subjects with either the lowest IQ scores or the highest IQ scores (especially those who performed better in verbal or technical tests) had greater risk of hospitalization with pure BD [17].

because I’d never heard of “pure” vs mixed BPD before. I have a sibling who seems to be pure manic/hypomanic BPD, with high IQ, which according to this study seems to doom them to being hospitalized frequently; something that has tracked for the past few years since they were diagnosed.

Does anyone know of any research specific to sufferers of pure (manic) BPD, and how we can help them stick to treatment and medication?

[aatd86]

I don't think that helping them to "stick" to treatment and medication is the right solution especially long term.

The chemotherapy alleviates only some symptoms but can exacerbate if not create some other ailments. There is a great lack of knowledge in the causes and mechanisms of these mental illnesses.

Sometimes, such apparently harmless substances such as caffeine, can trigger psychosis in people. Repeated occurences of a psychotic break would lead people to be diagnosed as schizophrenic for instance when the simple solution would just be to review the diet.

Also, because there is no real way to study brain function (f-MRI is still nascent, and EEGs too noisy) in depth, neuroscientists do not necessarily understand what is wrong. Clinicians understand even less and are not always really motivated to understand or too remotely involved in research to keep up anyway.

If I were them, I would study the brain areas involved in creative thinking, internal visualization, and how they may link up CNS and PNS. Instead of just affecting neurotransmitters, it's the actual triggers that need to be examined but that's too fine-grained a work for today's tools perhaps. (and research in that area may need more funding)

By the way, ADHD would be studied under the same umbrella as well, then.

[raulsaul]

I’m not at all claiming to be an expert, but my understanding is that currently, the best treatment we have today is adherence to lithium and other medications used to treat BD (I used BPD earlier but realized that’s an acronym more regularly used for borderline personality disorder).

By the way I assume you were using chemotherapy figuratively, but in case not, I’ve never heard of chemotherapy being used to treat BD. All medications have side effects and it really does come down to a cost-benefit analysis, which I think is especially hard for mood disorders as the medicine can feel like it’s taking away someone’s sense of self.

I agree understanding and avoiding triggers are part of treatment. Some well known things like jet lag are known to make the condition worse, and I’m unsure if things like that are unavoidable for my brother.

A lot of what I was alluding to when asking about sticking to treatment and medication was anosognia, which is when someone is unaware that they have a condition. In the case of pure manic BD, I suspect a lot of people struggle to identify their condition as an issue because they rarely hit that depressive low, which results in refusal to treat their condition (even holistically, disregarding any medication), and ultimately, repeated hospitalization.

[aatd86]

Chemotherapy is actually a general term which means treatment by medicamentation as opposed to other kind of treatments.

I agree that nowadays it helps, and it can stabilize patients.

I was just explaining that it's not a cure nor a panacea and sometimes, the adherence has worst outcomes if it's forced despite the negative effects it can create on patients. The issue is that some effects of the medications are attributed wrongly to the illness by clinicians.

But yes, on the patient side, there can be a lack of awareness of the dangerosity of their altered behavior. Although I'd tend to believe there is (at least partial) awareness of the altered cognition.

The truth of the matter is that because the chemotherapy is too crude an attempt to control/tame the neuro-transmission, it can also affect mood and cognition in ways that make the treatment difficult to sustain for the patients or can lead to worse outcomes.

My point is that before medicamenting people suffering of such ailments to oblivion, there needs to be more research being done. Then again, in acute manic or psychotic phases, taming the CNS and PNS is of course the priority.

It's really a delicate balance.

There are a lot of psychoactive substances other than drugs that clinicians neglect mentioning (tea, coffee etc) that can in some cases be triggers. Also, it might sound a little too edgy (although it is part of some therapies) but properly conducted meditation (neutral observation at a distance of one's own thoughts, emotional state and sensations) can help. The rationale being that people tend to identify with their thoughts but the brain can be naturally chatty. It can help to take some distance from it as if it was someone else (not depersonalization which is something else).

[Teever]

I don't think you should be suggesting to strangers that they shouldn't 'stick' to treatment recommended by their healthcare providers.

What makes you think that this is appropriate to do?

[aatd86]

Don't misunderstand. I'm not advising them to not stick to it if they find the treatment appropriate.

I just don't think that it is wise to force a life-long treatment if the patient is aware that they have a problem but they also feel that the treatment is causing other issues. Especially if the treatment has adverse effects that can be erroneously thought as being caused by the illness itself.

Clinicians, self-admittedly, do not have the answers and unfortunately, some of them can be a little handwavy and forceful when it comes to cognitive ailments even though it's not a very understood area.

Before medicamenting people into oblivion because of a diagnosis that may not be the right one, in an area of science that is underfunded and not well understood, I think there is a need for better answers.

By any means, if the person is dangerous for themselves or others, and the chemotherapy stabilizes them, that's fine. That's not really that case that I was trying to address.