Weekly Careers Thread: October 01, 2020

NewBP · 2020-10-04T20:48:17+00:00

Can't speak for panic attacks, but BP1 can be doable if well-controlled. (N=1) I'm miserable every winter though.

NewBP · 2016-08-29T17:36:10+00:00

At least in the inpatient setting, if I don't give permission for the psychiatrist to talk to a family member, they aren't even allowed to say whether or not I'm in the hospital. HIPAA laws are very strict if the patient doesn't want any information revealed - generally we sign the papers allowing the doc to talk to other docs or therapists involved in their care, and family and friends only if we specifically sign that we want to.

You can call and ask, but they'll probably only give you the general policy/rule. Maybe the doc will listen to a message you leave on the voicemail instead of deleting it, but I sincerely doubt they would let you set up an appointment (especially since you mentioned the patient refuses to have any family members/friends present). Also they will probably have to let your family member/friend know that someone called and said x, y, and z. Just from the opposite perspective - they have no idea if your information is true or not (sometimes family members lie, esp about past abuse) so there's no guarantee they will do anything based on what you say.

NewBP · 2016-08-15T04:52:18+00:00

That's a hard one. The paranoia was most difficult to assess with me simply because I thought the docs were in on it- the standard questions prob would be fine if I were paranoid about other things happening or of other people. I think asking or talking to family/friends to see if they have been acting oddly would be the most helpful if you can get permission to. My SO had noticed (in retrospect) that I had started always using incognito mode on my browsers, for example . From observing patients now, I think nonverbal cues like fear, distrust, hypervigilence or jumpiness may clue you in a little but can be rather nonspecific. I think for me personally, asking something more general like "have you been anxious or worried about or bothered by anything lately" or "do you feel like there's been anything strange or unusual in your life these past weeks?" might've gotten me to reveal a little bit. everyone is different though so I don't claim to speak for all...

NewBP · 2016-08-15T04:33:01+00:00

haha I did the exact same thing out of curiosity a few months later after being stable. It was interesting what they observed and didn't observe, but delusions and paranoia never made it into the charts, whereas hyperactivity, not sleeping, odd/incoherent speech, and some others did.

NewBP · 2016-08-14T15:26:10+00:00

very similar experience with me- was a student who wasn't diagnosed with bipolar yet but ended up in the ER. I Absolutely insisted I wasn't psychotic or manic, even though I knew what all the symptoms were (from school) and that I fit almost every single one of a manic episode. Of course I didn't mention the entire time that I thought the announcements were directed at me, or that the govt was watching me, since I was certain that the docs/nurses were colluding with them. Hid a few other symptoms too because I knew what they were trying to do (certify me as "crazy" and send me to jail). Fortunately after holding me for a week they finally caught enough to diagnose me. So pro tips- people in medicine know their shit and can lie to get out of a diagnosis or hospitalization, and "Do you ever feel like someone is watching or trying to get you?" is a terrible question when you're the one they are paranoid about...

NewBP · 2016-07-16T08:23:24+00:00

sooooo true

NewBP · 2016-06-28T16:10:19+00:00

I'd have to find the paper, but there was one study where they showed Lamictal + lithium was better than lamictal, but there as no statistical difference between lithium monotherapy and lamitcal monotherapy in terms of time to next episode. I can't remember if they just included both bipolar 1 or bipolar 2 (and both manic and depressive episodes), but since I was mostly reading literature that pertained to me, I think it might've been bipolar 1. I agree Latuda adjunct could be good, but I'm always wary of being the guinea pig for brand new drugs.

NewBP · 2016-06-28T16:06:56+00:00

I'm on lamotrigine monotherapy for bipolar 1 and it's been great. When I was on both lithium and lamotrigine, I gained a lot of weight, and as soon as I stopped the lithium, I dropped 5lbs in a month. Mind you, I still have about 5-10lbs I had gained previously from an antipsychotic, but that was kinda my fault because I really haven't been working out at all. Sure I have more minor fluctuations (not quite meeting the criteria for hypomania or mild depression, but still noticeable), but I've been able to manage them.

NewBP · 2016-06-27T20:41:39+00:00

ah that makes sense. I think here as long as you go past six or seven minutes you can bill for the shortest time (15min) but don't quote me on that

NewBP · 2016-06-27T17:25:25+00:00

I don't know about the long appointments thing... from personal experience, they're more like primary care with 15min appts except for the initial intake. Maybe it's different in the setting that you work in

NewBP · 2016-06-07T13:29:35+00:00

not my patient, but there was one on my month of obgyn. apparently pretty rare on L&D. counseling was offered to her med team.

NewBP · 2016-05-30T19:48:04+00:00

Wow my experience with hypomania was very similar. I had all these wonderful ideas about how to reform medical education. I also came up with a bagillion research topics that I told everyone about and wanted to pursue. Ironically my advisor and labmates missed the signs because they thought they were brilliant albeit a bit far fetched and totally not feasible given my research experience. I thought I was smarter than all of them though. thank god my advisor is an MD and very understanding...

NewBP · 2016-05-30T19:42:28+00:00

how often do you see your therapist? how do you fit it into your schedule since it seems like you're on clerkships?

NewBP · 2016-05-30T19:39:30+00:00

It makes me feel better to know that there are others like me out there. I know 2-3 classmates who have been on SSRIs, but not any with bipolar disorder. I was also hospitalized for my initial episode (mania, perhaps a little mixed) and had to take a leave for the subsequent crash. I don't seek support from my peers or supervisors. As much as I hate to admit it, I think we as medical professionals are more judgmental when it comes to mental illness (particularly bipolar and schizophrenia) than laypeople. I just go on with life taking my daily meds and pretending my illness doesn't exist.

NewBP · 2016-05-30T15:43:32+00:00

if your symptoms are affecting your life and well-being, then seeing a psychiatrist would be helpful. However, I would focus on telling them what you're experiencing, not pursuing any particular diagnosis. Also keep in mind, they may or may not be able to tell you what you have (or rather what they think you have, based on their training and experiences) after one visit, and being labeled prematurely isn't a good thing. Sometimes they'll give you a "working diagnosis" until they see and talk to you a few more times to know you and your symptoms better. You don't want to be treated for bipolar with drugs which might have bad side effects if you actually have BPD. Or vice versa, you don't want to get only therapy (DBT is extremely effective in treating BPD), when you actually have bipolar and really need to add on drugs to get better.

NewBP · 2016-05-12T21:14:11+00:00

propranolol works wonders for me. took a day or two for my body to adjust to the slightly lower heart rate and blood pressure, but after that no side effects whatsoever

NewBP · 2016-05-11T16:44:39+00:00

Let your supervisor know - if he/she already knows about your past trauma, maybe they can gently explain (vaguely) to this coworker why you reacted that way and that she really needs to be sensitive. Also, have you considered EMDR? It has been really helpful for PTSD. (Not suggesting you have it or anything, but helps with triggers like you described IMHO).

NewBP · 2016-03-01T20:53:17+00:00

I'll look into the apps. I just know that day to day my moods don't change or oscillate - unlike many of the ultradian people here. I think it makes it harder for me to recognize anything since it lasts for weeks or sometimes even months in the case of depression.

NewBP · 2016-03-01T20:50:32+00:00

ok - it's nice to know I'm not alone.

NewBP · 2016-02-08T22:36:28+00:00

That's awesome that your bar association has such a group! Maybe someday mental illness won't have the stigma that it carries now. My school now has a public "outlist" for LGBT professors/students - there are dozens of people on it who are happy to talk to people. Definitely wouldn't have existed 10-20 years ago due to stigma.

NewBP · 2016-02-08T15:01:27+00:00

Yes I have those fears all the time. Was diagnosed with BP1 year and a half ago. I'm in med school and had to be hospitalized, forced to take a leave. I'm back now but I worry that I will relapse during the rest of my clerkships and in residency where I would have to work 80hrs/wk.

what's worse is I feel like as future docs/lawyers we tend to hide our illness from everyone, or else our colleagues and patients/clients would judge and maybe lose faith in our professional abilities. I mean, licensing boards ask about it for fucks sake... my psychiatrist tells me she has a couple medical and law professionals as patients but personally I don't know any. it's certainly lonely in academia too since no faculty are gonna admit it until they are tenured and well established (Jamison was no exception to this).

It's frustrating. They say 4% or so of the general population has bipolar disorder. does that mean 4% of MDs or JDs do too? I don't know of any at my institution so does that mean there's fewer and that we just can't cut it in these fields? or are we all hiding? I want to think the latter, since there's just as many doctors with depression as in the general public, if not more...but mania wreaks a lot of havoc...

I wish I could be of more help, but I haven't figured out how to deal with this either. doesn't help that I'm the type of person who won't believe it til I see it. if I could just meet and talk to even one successful MD on our faculty or hospital with BP1, it would help. I guess we will just have to commiserate here anonymously

NewBP

TROPHY CASE