Health and Psychology

These disorders may be due to a wide variety of causes.  For a diagnostic evaluation I'd like to see some rating scales, a continuous performance test, and some other measure of executive function.  I'd like to see enough of a history to have ruled out head trauma, child abuse and anxiety and depressive disorders.  A single rating from a teacher or parent is NOT sufficient for a diagnosis.

These disorders are quite common and often have nothing to do with any form of mental illness.  The most common forms of hallucinations represent sleep disturbance, or side effects of medication or drug use.  A small percentage of hallucinations are due to depression, schizophrenia, or bipolar disorder. Hallucinations may often be some of the first symptoms of a medical condition.  A thorough neuropsychological evaluation with a history of hallucination type is needed to clarify the nature and type of hallucination and to differentiate those symptoms from illusions, medical conditions, side effects of medication, side effects of drug use, or other conditions.  Oliver Sacks has written a several hundred page book on Hallucinations, focusing on the medical and neurological presentation of various types of hallucinations.

I've been seeing a number of people misdiagnosed with Bipolar Disorder that actually have personality disorders.  Mood changes are common.  Manic episodes are required for a diagnosis of Bipolar Disorder. Manic episodes are marked by rapid and pressured speech, significant sleep disturbance, a flight of ideas and grandiosity or irritability.  Manic episodes are quite dangerous due to a loss of judgement.  There are dozens of medical conditions that may present with mania as a symptom.  Hypomanic episodes are required for a diagnosis of Bipolar II Disorder.

Personality disorders may rapidly cycle between mood states with elevations of mood, and drops in mood but do not have the characteristic mania of Bipolar Disorder.  Although there may be serious problems with judgement, the mood states tend to be triggered by specific events such as fear of real or imagined abandonment.  Behaviors associated with personality disorders tend to be associated with the individual looking for something short term that will change their mood.  This includes sex, gambling, shopping, cutting, eating, or other behaviors that will temporarily change how the individual feels.  After this behavior stops being effective in changing the mood state, the person will revert to feeling badly again, coupled with shame and guilt over the behavior they used to manage their feelings.

The diagnosis of Bipolar Disorder in children is controversial.  This diagnosis does not seem to correlate to Bipolar disorder in adults and children with the diagnosis do not respond to medication in the same way adults with the diagnosis do.  Many of the children seem to have difficulties with self soothing and self-regulation of behavior.  Previously these disorders were diagnosed as behavior disorders and were treated with behavior management plans.

Our office is able to assist you with getting an adequate diagnosis.  Contact us.