Cycling vs Mixed States vs Protracted Hypomania

[Guest Guest_Brishen_*]

Just some questions that are open for discussion.  I read the stickies above, but I still have some confusion regarding what the difference is between rapid cycling (especially ultra-rapid and ultradian cycling), mixed states, and "protracted" hypomania.  This may be purely an academic point, but I still don't get it.

I'm pretty new to the bipolar diagnosis, as of yet, and after navigating the mental health system (poorly) for many months, have been doing a lot of research.  My new psychiatrist is pretty good so far - for the first time, I feel supported and understood - and he said I was "Bipolar 1, 1 1/2" at my last appointment.  I looked up Bipolar 1 1/2, which mentioned protracted hypomania.  So that's where my questions arose, I guess.

I guess my confusion stems from the fact that I feel I've experienced the full gamut of affective issues.  When I read the literature, I see myself there, unequivocally.  When I was younger, I definitely suffered from broad, far-reaching mood swings that spanned the spectrum: the soul-searing depression, blissful fall hypomanias, and full-blown psychotic manias.  But as I've gotten older, my moods have changed significantly, which was what led me to seek help.  My pdoc pointed out a lot of mixed states in my history as well as rapid cycling, based on what I described.  But then he threw in this term "protracted hypomania."

I found this on http://www.psycom.net/depression.central.lieber.html

Hypomania - hypomania is of two types, euphoric and dysphoric or irritable. It is also of two durations, episodic and protracted or characterologic. Bipolar spectrum patients usually show episodic dysphoric hypomania. Euphoric hypomania feels good and is sometimes productive, but dysphoric hypomania produces irritability, emotional discomfiture, impulsiveness, temper dyscontrol and impaired judgment. It tends to interfere with interpersonal relationships and to limit productivity at work. There is a sense of inner speeding combined with restless over activity and racing thoughts, which can lead to a state of desperation. The hypomania frequently alternates with episodes of depression, and mood instability is almost always present. Sometimes brief euphoric episodes are added to the mix. The triad of irritable episodes alternating with rage episodes and paranoid episodes is characteristic of dysphoric hypomania.

That fits me to a T as well.  The problem is that they all do!

It's not that I am bothered by it, this reflection of myself in mental illness literature.  It's just confusing both myself and my psychiatrist.  He laughed and said I was an interest intellectually and academically to him, but also noted that that wasn't going to help me get well!  I agreed, so he is sending me for a second opinion.  We are having a hard time deciding what medications to try based on my symptoms.  I am definitely Bipolar 1, but it is unclear how to treat the worsening course of my illness.

Can anyone else explain the difference between these mood-states?  I am getting so confused that I am just going to explain my symptoms at my upcoming diagnostic session in my own terms rather than in medical nomenclature.  I am going to say, "I feel agitated, restless, and angry" rather than, "I feel I am suffering from a protracted hypomania."  Ya know?  Do you think that is a good idea?  Am I more likely to describe my feelings better if I just use my own words?  I really want to get well, and I am so relieved to be heard, and I just don't want to waste this opportunity to see some of the best researchers in the field.

Any info would be greatly appreciated, as well as personal insight from those who have come before me.  Also, I need to add that it was very therapeutic to be able to just write all that out and speak a little bit to the confusion and worry that no one understands me. 

[Dire Curves]

I get ya.

here comes a rant

Any physiological and psychological disorder is on a constant infinitely sliding scale.  This primarily is because of the various differences in human keryotypes (your genetics) and the environment that person is exposed to.  The "doctors" like to classify things in a smaller, less assertive way than what is truly there, that way it is easier to "classify" and "diagnose" people with the limited resources they have available at this time.  Researchers are constantly finding that many of the chemicals that are created in plants (primarily) have specific receptors in our brains, and that our bodies create either more or less complex chemicals than what we can ingest (i'm not even sure I'm making sense anymore.) Anyway, these complex protiens, sugars, salts, and trace metals create a highly correlative soup that lets us be.

My words. not a scientific thing, yet.

Use as many words as possible that describe what, when, and how you feel, act, and relate to your environment and be truthfull (I don't always but that's just paranoia.)

And as for not knowing whether you are making sense is a common thing, it is somehow related to curiousity and anxiety, both are good things when used at the right times.  but for i they always happen at the rong tymes.

[synthetic]

Can anyone else explain the difference between these mood-states?  I am getting so confused that I am just going to explain my symptoms at my upcoming diagnostic session in my own terms rather than in medical nomenclature.  I am going to say, "I feel agitated, restless, and angry" rather than, "I feel I am suffering from a protracted hypomania."  Ya know?  Do you think that is a good idea?  Am I more likely to describe my feelings better if I just use my own words?  I really want to get well, and I am so relieved to be heard, and I just don't want to waste this opportunity to see some of the best researchers in the field.

<{POST_SNAPBACK}>

I am a firm believer in treating the symptoms instead of the dx.  I too have difficulty determining if I am experiencing ultra rapid cycling, dsyphoric hypomania, or a mixed state.  Whatever it is, it sucks ass.  They all are pretty close in their symptoms, so I would think that the treatment for one would probably work for the other.  As you say, describing your symptoms is probably going to get you better treatment than trying to fit yourself into a medical category.  It sounds like you have a good pdoc, let him earn his money and satisfy his intellectual interest by giving you a med combo that will work.

[ncc1701]

Heya Brishen,

I have a chapter quote from a new psych textbook I just bought that lays it out pretty well.

I'm too tired to look for it right now, but try me tomorrow or Monday, b/c I really liked it.

(My house is a sea of paper due to my very complicated taxes and other crap.  Which agitates me.  Which is why I'm on CB and watching TV in the sunshine instead of doing anything about it.  Which will make me more agitated.  But I digress.)

At any rate.

The prevailing idea is that dysphoric mania, agitated depression, and mixed are also on a spectrum of crappiness, like the other spectra of crappiness that confuse us all.

So no clear boxes there, but there aren't any clear boxes in DSM for most of BP anyway.

I wouldn't worry about it too much, but it *is* interesting, and I'll go look for that textbook.

--ncc--

[Dee]

There are too many damn "flavours".  It will be interesting to see what Dr. McKintyre and Sagar will determine mine is.  I'm sure it's a good weird one.