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NEWS & RESOURCES
THE IMPORTANCE OF KEEPING YOUR BODY MOVING THROUGH EXERCISE.
WHAT’S TRENDING? SEE WHAT IS TRENDING IN THE LATEST RESEARCH FOR LUPUS.
RESOURCES THAT ARE AVAILABLE TO YOU.
In March 2015, the American Academy of Family Physicians released a report that indicated the United States would experience a shortage of between 46,000 and 90,000 physicians by 2025. The American College of Rheumatology defines a rheumatologist as "an internist or pediatrician who received further training in the diagnosis (detection) and treatment of musculoskeletal disease and systemic autoimmune conditions commonly referred to as rheumatic disease. These diseases can affect the joints, muscles and bones causing pain, swelling, stiffness and deformity."
The Journal of Arthritis & Rheumatology, examined the educational system and how its current arrangement wont be able to graduate enough new rheumatologists to keep up with demand for this type of care.
Couple that rising demand with the fact that many doctors currently practicing in the field of rheumatology are nearing retirement age themselves, and you start to see the scope of the predicament.
U.S. News & World Report (2018),
OBESITY, DISEASE ACTIVITY PARADOX FOUND IN SLE
Meeting showed an inverse correlation between body mass index (BMI) and disease activity in systemic lupus erythematosus (SLE) after adjusting for use of prednisone. "This is the first evidence to our knowledge of an obesity paradox in systemic lupus," the researchers wrote.
To study how BMI changes would affect disease activity, reseachers examined 2406 patients in a prospective SLE cohort, assessing their weight at each visit. Patients were categorized into 5 groups according to weight: low (BMI ,20kg/m2), normal weight (reference; BMI 20-24.9 kg/m2),overweight (BMI 25-29.9 kg/m2), obese (BMI 30-34.9 kg/m2).
Stojan G, Fu W, Petri M. Body mass index and disease activity in systemic lupus erythematosus-a paradoxical relationship? Presented at ACR/ARHP 2017 Annual Meeting; November 3-8, 2017; San Diego, CA. Abstract 1634.
CHARACTERISTICS OF EARLY-ONSET SLE DISTINGUISHED FROM MIMICKING CONDITIONS
Patients with early SLE had higher rates of unexplained fever than those with SLE-mimicking conditions. Clinical manifestations differentiating early-onset systemic lupus erythematosus (SLE) from SLE-mimicking conditions have been identified, according to a study recently published in Arthritis & Rheumatology.
This study included 389 individuals with SLE and 227 with conditions that mimicked SLE. Baseline data were collected using Academic Lupus Centers located in 4 continents and included individuals who had been referred for potential SLE within the past 3 years with less than 1 year of symptoms.
Mosca M, Costenbader KH, Johnson SR, et al. How do patients with newly diagnosed systemic lupus erythematosus present? A multicenter cohort of early systemic lupus erythematosus to inform the development of new classification criteria [published online July 23, 2018]. Arthritis Rheumatol. doi: 10. 1002/art.40674
DEPRESSION TIED TO DOUBLE THE RISK FOR LUPUS IN WOMEN
A history of depression is associated with more than double the risk of developing systemic lupus erythematosus (SLE) among women, new research suggests.
The study, which included data from almost 200,000 participants in the Nurses' Health Study ll (NHS ll), supports the hypothesis that depression is a causal risk factor for developing SLE, note the investigators.
JAMA Psychiatry. Published online September 12, 2018. Abstract
Retreived from: (October 01, 2018)
ARTICLE HEADLINEHEALTH PROPOSALS IN PRESIDENT’S BUDGET WOULD REDUCE HEALTH INSURANCE COVERAGE AND ACCESS TO CARE
The health policies in the President's fiscal year 2019 budget are a continuation of the Administration's health care agenda of the past year. Throughout 2017, the President pressed Congress to enact legislation repealing the Affordable Care Act (ACA) and making deep cuts to Medicaid. Meanwhile, the Administration is using waivers and regulatory changes to implement (and allow states to implement) policies that make it harder for eligible people to get health coverage and care. The budget doubles down in both of these areas. It embraces the ACA repeal-and-replace bill sponsored by Senators Bill Cassidy, Lindsey Graham, Dean Heller, and Ron Johnson (the "Cassidy-Graham" proposal), then proposes to cut funding for coverage programs deeply below the levels in that bill. It also includes additional proposals designed to make it harder for low- and moderate-income people to enroll in Medicaid coverage and marketplace subsidies, even while these programs remain available in their current form. In total, the budget cuts Medicaid and ACA marketplace subsidies by $763 billion over ten years, with the cuts growing steeply over time.
Outside of these areas, some of the health proposals in the budget have merit and deserve further consideration — for example, a number of its Medicare payment reforms. But even in the areas where the budget puts forward a more positive agenda, such as behavioral health and prescription drugs policy, aspects of its proposals raise concerns.
Affordable Care Act Repeal and Medicaid Overhaul
The budget embraces the Cassidy-Graham ACA repeal-and-replace bill, then proposes to cut coverage funding deeply below the levels in the bill. Specifically:
The budget would completely eliminate the ACA's Medicaid expansion, which has extended coverage to 12 million low-income adults, as well as its marketplace subsidies, which help more than 8 million people afford coverage. The budget wipes out these programs and demands that states come up with alternatives in less than two years. The result, according to the Congressional Budget Office (CBO), state insurance commissioners, and state Medicaid directors, would be massive disruption, given the scope of work, unrealistic timeline, and insufficient resources.
The budget would replace the ACA's major coverage expansions with a vastly inadequate block grant. After an initial increase, block grant funding levels would ultimately fall far below current-law funding for coverage programs, since the block grant would grow only with general inflation, with no adjustment for population growth or health care costs. (These cuts would come on top of the large reductions in federal funding for coverage resulting from the December tax bill's repeal of the ACA's individual mandate, the requirement that most people have health insurance or pay a penalty.) Block grant funding also would not adjust from year to year for unexpected costs, leaving states entirely on the hook for any and all such costs from recessions, natural disasters, public health emergencies, or prescription drug price spikes, making it even harder for states to use these funds to even partially replace ACA coverage programs. In analyzing the Cassidy-Graham legislation, CBO concluded that its block grant would not enable states to establish coverage programs comparable to those in place under current law. Instead, states that did not expand Medicaid would use block grant funds in part to supplant state funding for existing programs, while Medicaid expansion states would struggle to maintain coverage for low-income adults and would generally not be able to replace the ACA subsidies that make marketplace coverage affordable for moderate-income
The Cassidy-Graham bill the budget endorses also gives states broad authority to eliminate or weaken many of the ACA's protections for people with pre-existing conditions. Depending on how they used block grant dollars, states could permit insurers to charge higher premiums for people with pre-existing conditions or exclude key benefits from coverage for all individual market plans. As the CBO wrote in its preliminary analysis of the Cassidy-Graham plan, because the proposal would create such extreme disruption in insurance markets, states would face intense pressure to try to stabilize their markets by weakening these protections.
These proposals — in combination with other proposals in the budget (some discussed below) — would cut federal funding by a total of $763 billion over the ten-year period ending in 2028 (see Figure 1), compared to current-law funding for Medicaid expansion and subsidies, and by about $1.1 trillion relative to the baseline before the tax bill repealed the individual mandate. The result would be millions losing coverage and worse or less affordable coverage for millions more. Experts concluded that the Cassidy-Graham proposal for Medicaid and the ACA used as the framework for the budget would — in combination with repeal of the individual mandate — likely lead to a total coverage loss of more than 20 million people, and the budget's proposed cuts to coverage are much deeper
Center on Budget and Policy Priorities
February 16, 2018
Peggy Bailey, Matt Broaddus, Shelby Gonzales, Hannah Katch, and Paul Van de Water
Alternative Pain Management For Lupus
The majority of lupus patients are prescribed pain medication for lupus. But have you thought of alternatives that are less harmful to your body? Well I have, you see I have been in constant pain for the pass 3 months, no I didn't take any prescribed medications for my pain, but came so close to going to the ER. I knew that there had to be an alternative to manage my pain, after researching the topic of acupuncture came to the conclusion this was the right choice for me.
Acupuncture The Technique
The Chinese technique of acupuncture is one of the oldest most commonly used integrative procedures in the world. Acupuncture is characterized by the placement of extremely thin needles into the body and reacts with the brain to release chemicals that reduce pain, regulate hormones, and influence many of the bodies systems. A great deal of research has since and continues to be done on acupuncture. Current research in western medicine shows that acupuncture has an impact on many of the bodies functions, receptors, and systems. Its demonstrated that it can be effective for a number of conditions. Back and joint pain, circulation, digestive system regulation, depression, stress, and anxiety, hormone outputs, immune system balance, muscle tone, nervous system regulation.
But what does research state about this treatment for Lupus Pain?
The National Institute of Health ran a study on the use of acupuncture treatment in lupus patients; they found that 10 sessions of acupuncture was safe and very effective for patients with Systemic Lupus. Acupuncture decreased pain and reduced fatigue in the subjects. The objective of this study was to determine the feasibility of studying acupuncture in patients with systemic lupus erythematosus (SLE), and to pilot test the safety and explore benefits of a standardized acupuncture protocol designed to reduce pain and fatigue. Twenty-four patients with SLE were randomly assigned to receive 10 sessions of either acupuncture, minimal needling or usual care. Pain, fatigue and SLE disease activity were assessed at baseline and following the last sessions. Safety was assessed at each session,. Fifty-two patients were screened to enroll 24 eligible and interested persons. Although transient side effects, such as brief needling pain and lightheadedness, were reported, no serious adverse events were associated with either the acupuncture or minimal needling procedures. Twenty-two participants completed the study, and the majority (85%) of acupuncture and minimal needling participants were able to complete their sessions within the specified time period of 5-6 weeks. 40% of patients who received acupuncture or minimal needling had >30% improvement on standard measures of pain, but no usual care patients showed improvement in pain. A ten -session course of acupuncture appears feasible and safe for patients with SLE. Benefits were similar for
acupuncture and minimal needling.
Greco DM, Kao AH, Maksimowicz-McKinnon K, et al. Acupuncture for systemic lupus erythematosus: a pilot RCT feasibility and safety study. Lupus> 2008;17(12):1108-16.
The American Opioid Epidemic
by Taylor Walker
This study examines the medical, legal, and socioeconomic problems underlying the ongoing opioid epidemic in America with emphasis on finding effective policy solutions. In the medical system, a lack of oversight of pharmaceutical companies, deceptive marketing practices used by pharmaceutical companies targeting doctors, a massive increase in opioid production and sales, and the industrialization and automation of the medical profession are all major factors that contribute to the epidemic.
The legal system contributes to the epidemic through its punitive stance towards drug use/abuse that has persisted since the 1970s which caused a massive increase in the incarcerated population and corrections spending.
Additionally, the little training police officers receive concerning substance abuse, and the lack of access to rehabilitation and treatment programs in prisons also contribute to this epidemic. Socioeconomic problems relate to the lack of community-based programs for those at highest risk of addiction, and those programs have been underfunded and understaffed for decades. This paper concludes with several policy reform suggestions for our medical and legal systems.
Overall, this study suggests that adopting a less punitive stance towards the epidemic, and, instead, addressing it as a public health problem would help curtail the ever-increasing death toll and bring an end to the epidemic
America is currently facing an unprecedented epidemic of opioid abuse. This epidemic is mainly due to the fact that for the past few decades opioids have flooded onto America’s streets. However, many of these drugs have not come from the shady hands of drug dealers but rather from the trusted hands of medical professionals.
Additionally, the sheer number of opioids involved in this epidemic is astounding with most of the them having come from the labs of pharmaceutical companies rather than the labs of drug traffickers (Lembke, 2016). These drugs are on America’s streets mainly due to the efforts of pharmaceutical companies promoting the liberal use of prescription opioids. These efforts have resulted in a massive increase of prescription opioid addictions in America
The Current Epidemic
The current epidemic is quite different than those that have occurred in the past. Generally, past epidemics have been shorter, and did not involve that many Americans. For example, in the early 1900s, America faced a heroin epidemic that was similar to our current epidemic.
However, it was quickly suppressed by the Narcotics Tax Act of 1914 which banned physicians from prescribing opioids (Alam and Jurrlink, 2016). While this law took care of the supply of opioids, economic reforms in the 1920s and 1930s helped decrease demand of opioids, and prevented a rebound in opiate use (Jones, 1995).
Currently, there are 2.4 million Americans suffering from severe opioid use disorder (Vashishtha, Mittal, and Werb, 2017). Additionally, opioid overdoses have substantially increased over the past decade. For example, Figure 1 shows that in 2002 opioids caused around 12,000 overdose deaths, but in 2015 opioids caused almost 35,000 overdose deaths. This means that opioid overdose deaths have almost tripled within the past few years.
Further compounding this epidemic is the fact that physicians are prescribing more opioids for chronic pain, resulting in prescription opioid sales quadrupling since 1999 (Reinl, 2017). Lastly, this epidemic costs the US almost $128.2 billion dollars per year, and has affected every demographic in the US regardless of wealth, race, or location (Clarke, Skoufalos, and Scranton, 2016). Simply put, most of these statistics are due to the shortcomings and policies of America’s medical, legal, and socioeconomic systems which will be addressed in the following sections
Systemic Problems Underlying the Opioid Epidemic
The largest contributor to this epidemic are the systemic problems in the medical field. These problems have mainly come about due to the high number of prescription opiates handed out each year. Two hundred and seven million opioid prescriptions were handed out in 2013, while only 76 million were written in 1991 (Kanouse and Compton, 2015).
This shows that prescriptions for opioids have doubled within the past two decades. Additionally, opioid sales have also increased. Between 1999 and 2010, prescription opioid sales and prescription opioid usage quadrupled (Manchikanti et al., 2012).
Americans consume about 80% of the world’s prescription opioids, and, in 2007, prescription opioids were the second most abused drug in America (Manchikanti et al., 2012). Along with the increase in opioid usage, the number of emergency room visits and overdose deaths also increased.
From 2004 to 2008, emergency room visits related to prescription opioid abuse rose by 105% (Kanouse and Compton, 2015). Additionally, almost 50% of all drug-related emergency room visits are due to drug abuse, and opioids are the second most commonly abused drug involved in those visits (Kanouse and Compton, 2015).
Finally, these increases in usage have culminated in the significant rise of opioid overdoses. Currently, prescription opioids cause about 1 death every 36 minutes in America (Manchikanti et al., 2012). Additionally, in 2010, 57.7% of the 38,329 overdose deaths involved opiates (Kanouse and Compton, 2015). Today’s doctors not only have to contend with fighting opiate addiction but also preventing opiate overdoses.
The explosive growth of opioid sales is mainly due to the influence of pharmaceutical companies. The best example of the massive amount of influence pharmaceutical companies have in the medical community is the production and marketing of Oxycontin.
In the early 2000s, there were allegations within the medical community that companies falsely marketed commonly prescribed opioids, such as Oxycontin, as having a reduced risk of addiction (Kanouse and Compton, 2015).
These companies also marketed their product to physicians by distributing coupons and releasing promotional videos which falsely claimed an addiction rate of less than 1% (Kanouse and Compton, 2015). By directly advertising to physicians, these companies were able to dramatically increase their sales even though they knew some of the information they distributed was false.
These companies eventually admitted to the false marketing allegations. Purdue Pharmaceuticals had to pay a fine of $634 million dollars for misbranding Oxycontin (Lembke, 2016). These companies responded to the allegations by coming up with derivatives of Oxycontin which were specifically designed to prevent abuse (Kanouse and Compton, 2015).
However, these derivatives have also contributed to the opioid epidemic in the same way Oxycontin did (Kanouse and Compton, 2015). Sadly, instead of taking the initiative to try and curb the opioid epidemic, it seems that pharmaceutical companies have tried to capitalize off of it.
Further perpetuating this epidemic is the changing nature of practicing medicine in the US. Over the past few years, the medical field has become industrialized and automated which has resulted in doctors being left with very little agency (Lembke, 2016). The medical expertise of doctors has been usurped by the financial motives of hospital administrators and insurance agents, and this has been very detrimental to the health of patients (Lembke, 2016).
Due to these changes, doctors are concerned about whether they are meeting the billing quotas set by their employer (Lembke, 2016). As a result, doctors have little time to determine if a patient is abusing opioids and have even less time to assist patients who are abusing opioids (Lembke, 2016). Doctors have become increasingly overburdened in the past few years, and these regulations and quotas have only made matters worse. Unless the medical field changes, doctors will not be able to properly combat this epidemic.
There are multiple factors that determine the levels of substance abuse within a society. Most of these factors relate to the political economy of local areas, particularly the levels of poverty, job opportunities, and income inequality (Gorelick, 1992).
However, there are also other factors which can promote substance abuse. Factors such as a high crime rate, the presence of drug dealers, and the availability of drugs in general can also contribute to the amount of substance abuse within an area (Fishbein and Pérez, 2000). Educational attainment is also strongly related to substance abuse, and individuals that are most susceptible to substance abuse are those who have dropped out or disengaged from school (Gorelick, 1992).
For example, the prevalence of substance abuse among high-school dropouts is 9.3 percent, and college dropouts have a prevalence rate of 11.2 percent (Gorelick, 1992). This is significantly higher than high-school and college graduates who have a substance abuse rate of 7.5 percent and 6.8 percent respectively (Gorelick, 1992).
Substance abuse is also prevalent among racial minorities, the homeless, and those living in rural areas (Gorelick, 1992). Substance abuse is especially problematic for the homeless. One study found that the homeless population has a lifetime prevalence rate of substance abuse of 30.8 percent (Gorelick, 1992).
It is important to note that none of these factors by themselves would necessarily be responsible for substance abuse but rather the interaction and combination of these factors may eventually result in substance abuse (Fishbein and Pérez, 2000). Generally, these studies show that those marginalized by society would benefit the most from drug treatment programs due to socioeconomic factors exacerbating substance abuse problems among these populations.
Sociodemographic factors can also affect the type of treatment given to patients. Researchers have found that physicians may rely on stereotypes when diagnosing patients with substance use disorder. These studies have found that doctors are more likely to diagnose patients with substance use disorder if they are non-white, have little to no education, and are of low socioeconomic status (SES) (Gorelick, 1992).
These stereotypes can also apply to referrals, and are more likely to be made for patients who are African American or for those who are of low SES (Gorelick, 1992). Furthermore, these stereotypes also extend to the type of treatment programs patients are referred to. Generally, physicians are more likely to refer poor patients to government funded treatment programs, while wealthier patients are referred to privately funded treatment programs (Gorelick, 1992).
Some studies have found that whites are more likely to be referred to self-help groups, and blacks are more likely to be referred to inpatient care (Gorelick, 1992). These studies show clear discrepancies in diagnosis, referral, and quality of care given to different sociodemographic groups with the most marginalized groups generally being given the worst treatment.
Sadly, most of the treatment programs that serve marginalized populations are understaffed and underfunded. This is mainly due to treatment programs competing for funding with other agencies that combat drug abuse, such as law enforcement (French, 1995). Thankfully, as Figure 4 shows, the federal government has increased spending for treatment programs over the past few years. In 2007, only $8 billion was spent on treatment while in 2016 $15 billion was spent on treatment (Figure 4). America currently spends around $30 billion dollars to combat drug abuse, and 48% is spent on treatment programs (Figure 4).
However, more funding still goes toward the enforcement of drug policies rather than the treatment of drug abusers (Figure 4). As one study showed, this may be due to the lack of clear monetary benefit of treating drug offenders (French, 1995). Simply put, it is hard to see how much money these programs save. Overall, there are multiple factors, both individual and social, that determine who becomes a drug abuser and the level of care available to abusers.
Alam, A., & Juurlink, D. N. (2016). “The Prescription Opioid Epidemic: An Overview for Anesthesiologists.” Canadian Journal of Anesthesia, 63(1):61-68.
Clarke, J. L., Skoufalos, A., and Scranton, R. (2016). “The American Opioid Epidemic: Population Health Implications and Potential Solutions. Report from the National Stakeholder Panel.” Population Health Management, 19:1-7.
Clear, T. R., and Frost, N. (2014). The Punishment Imperative: The Rise and Failure of Mass Incarceration in America. New York: New York University Press.
Abstract Number: 1182
Opiod Use and Death in Chronic Pain Patients with Systemic Lupus Erythematosis
Romy Cabacungan1, Clifford Qualls2, Wilmer Sibbitt Jr.1, Timothy Moore1, Luis Salayandia1, Roderick Fields3, Suzanne Emil1, Monthida Fangtham1, Konstantin Konstantinov4, Tej Bhavsar1 and Arthur Bankhurst5, 1Rheumatology, University of New Mexico, Albuquerque, NM, 2Biostatistics, UNM, Albuquerque, NM, 3Internal Medicine/ Rheumatology, University of New Mexico School of Medicine, Albuquerque, NM, 41 University Of New Mexico, University of New Mexico, Albuquerque, NM, 5Rheumatology, University of NM Medical Center, Albuquerque, NM
Meeting: 2016 ACR/ARHP Annual Meeting
Date of first publication: September 28, 2016
How Lupus Can Cause Bipolar - Like Mood Symptoms
DEPRESSION TIED TO DOUBLE THE RISK FOR LUPUS IN WOMEN
OAK PARK DOCTOR AND SON ACCUSED OF RUNNING ILLEGAL PAIN CLINIC
NOW THERE EXISTS SEVERAL LAYERS TO THIS STORY, NOW THE RAID WENT DOWN TUESDAY. IN, OAK PARK MICHIGAN, THAT’S ABOUT FIVE MILES FROM WHERE I LIVE. NOW THERE ARE THOSE OF US WHO PUT ARE TRUST IN DOCTORS. BUT HAVE YOU EVER WONDERED IF THE INDIVIDUAL IN THE DOCTORS OFFICE IS TRULY LICENSED AND HAVE THE MEDICAL TRAINING TO ADMINISTER INJECTION?
JUST THINK ABOUT THAT, AFTER HEARING THIS STORY HOPEFULLY IT WILL GET YOU TO THINK AND BECOME PROACTIVE WITH YOUR HEALTH CARE BY ASKING QUESTIONS TO THOSE WHO ARE RENDERING YOUR HEALTH CARE AND ALSO RESEARCHING TO SEE IF THEY (HEALTHCARE PROVIDER) HAS ANY VIOLATIONS, OR LAWSUITS AGAINST HIM/HER.
FIRST THERE EXISTS AN ALLEGATION OF HEALTHCARE FRAUD, DOING SOMETHING AND CHARGING FOR SOMETHING MOORE, ALLEGATIONS OF NOT BEING LICENSED, AND DOING SOME PROCEDURES THAT WERE NOT STERILE.
TUESDAY FEDERAL AGENTS RAIDED PAIN STOP MD A CLINIC LOCATED ON GREENFIELD IN OAK PARK, MICHIGAN, AND WHILE THEY WERE DOING THAT THE TWO MEN RUNNING THIS CLINIC WERE IN FEDERAL COURT BEING CHARGED WITH HEALTHCARE FRAUD. DR. GANDAM JAYAKAR, MD, WHO OWNS THIS CLINIC AND HIS SON SANJI JAYAKAR WORKS THERE AS WELL.
THE FEDS, ARE CHARGING BOTH WITH HEALTHCARE FRAUD, STATING THAT THEY WERE GIVING PATIENT ELECTROACUPUNCTURE DEVICES THAT ARE NOT COVERED BY MEDICARE BUT BILLING AS THESE DEVICES WERE IMPLANTABLE DEVICES, WHICH ARE COVERED BY MEDICARE. IN ALL THESE TWO INDIVIUALS BILLED MEDICARE $2,7 MILLION DOLLARS.
THE SECOND HALF OF THE STORY IS THAT THE SON SANJI THE SON OF GANDAM JAYAKAR IS NOT LICENSED. A NURSE WHO WORKED THE THIS CLINIC INFORMED INVESTOGATORS THAT SHE WATCHED THE SON PERFORM CERTAIN PROCEDURES THAT WERE NOT STERILE.
“THE NURSE STATED THAT SANJIT WORE NON-STERILE MEDICAL GLOVES THAT HAD A TEAR ON THE HAND. (HE) WIPPED HIS NOSE, THEN WITH THE SAME HAND PROCEEDED TO PICK UP THE NEEDLE AND INSERT IT INTO THE PATIENT. NOW THE SON ALLEDGELY ADMITTED TO AN EMPLOYEE THAT HE WAS NOT MEDICALEY TRAINED AND WAS NOT A DOCTOR. THE RESON WHY HE WAS DOING IT, IS BECAUSE HIS FATHER HANDS WERE TO SHAKY”.
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood,
energy, activity levels, and the ability to carry out day-to-day tasks.
There are four basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity
These moods range from periods of extremely “up,” elated, and energized behavior (known as manic episodes)
to very sad, “down,” or hopeless periods (known as depressive episodes). Less severe manic periods are known
as hypomanic episodes.
Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are
so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically
lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic
symptoms at the same time) are also possible.
Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the
full-blown manic episodes described above.
Cyclothymic Disorder (also called cyclothymia)— defined by numerous periods of hypomanic symptoms
as well numerous periods of depressive symptoms lasting for at least 2 years
(1 year in children and adolescents). However, the symptoms do not meet the
diagnostic requirements for a hypomanic episode and a depressive episode.
Other Specified and Unspecified Bipolar and Related Disorders— defined by bipolar disorder symptoms
that do not match the three categories listed above.
Signs and Symptoms
People with bipolar disorder experience periods of unusually intense emotion,
changes in sleep patterns and activity levels, and unusual behaviors. These distinct periods are called
Mood episodes are drastically different from the moods and behaviors that are typical for the person.
Extreme changes in energy, activity, and sleep go along with mood episodes.
People having a manic episode may:
People having a depressive episode may:
Feel very “up,” “high,” or elated
Have a lot of energy
Have increased activity levels
Feel “jumpy” or “wired”
Have trouble sleeping
Become more active than usual
Talk really fast about a lot of different things
Be agitated, irritable, or “touchy”
Feel like their thoughts are going very fast
Think they can do a lot of things at once
Do risky things, like spend a lot of money or have reckless sex
Feel very sad, down, empty, or hopeless
Have very little energy
Have decreased activity levels
Have trouble sleeping, they may sleep too little or too much
Feel like they can’t enjoy anything
Feel worried and empty
Have trouble concentrating
Forget things a lot
Eat too much or too little
Feel tired or “slowed down”
Think about death or suicide
Bipolar Disorder and Other Illnesses
Some bipolar disorder symptoms are similar to other illnesses, which can make it hard for a doctor to make a
diagnosis. In addition, many people have bipolar disorder along with another illness such as anxiety disorder,
substance abuse, or an eating disorder. People with bipolar disorder are also at higher risk for thyroid disease,
migraine headaches, heart disease, diabetes, obesity, and other physical illnesses.
Psychosis: Sometimes, a person with severe episodes of mania or depression also has psychotic symptoms,
such as hallucinations or delusions. The psychotic symptoms tend to match the person’s extreme mood.
Someone having psychotic symptoms during a manic episode may believe she is famous,
has a lot of money, or has special powers.
Someone having psychotic symptoms during a depressive episode may believe he is ruined and penniless,
or that he has committed a crime
As a result, people with bipolar disorder who also have psychotic symptoms are sometimes misdiagnosed with
Anxiety and ADHD: Anxiety disorders and attention-deficit hyperactivity disorder (ADHD) are often diagnosed
among people with bipolar disorder.
Substance Abuse: People with bipolar disorder may also misuse alcohol or drugs, have relationship problems,
or perform poorly in school or at work. Family, friends and people experiencing symptoms may not recognize
these problems as signs of a major mental illness such as bipolar disorder.
Scientists are studying the possible causes of bipolar disorder. Most agree that there is no single cause.
Instead, it is likely that many factors contribute to the illness or increase risk.
Brain Structure and Functioning: Some studies show how the brains of people with bipolar disorder may
differ from the brains of healthy people or people with other mental disorders. Learning more about these
differences, along with new information from genetic studies, helps scientists better understand bipolar disorder
and predict which types of treatment will work most effectively.
Genetics: Some research suggests that people with certain genes are more likely to develop bipolar disorder
than others. But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that
even if one twin develops bipolar disorder, the other twin does not always develop the disorder, despite the fact
that identical twins share all of the same genes.
Family History: Bipolar disorder tends to run in families. Children with a parent or sibling who has bipolar
disorder are much more likely to develop the illness, compared with children who do not have a family history of
the disorder. However, it is important to note that most people with a family history of bipolar disorder will not
develop the illness.
Treatments and Therapies
Treatment helps many people—even those with the most severe forms of bipolar disorder—gain better control of
their mood swings and other bipolar symptoms. An effective treatment plan usually includes a combination of
medication and psychotherapy (also called “talk therapy”). Bipolar disorder is a lifelong illness. Episodes of
mania and depression typically come back over time. Between episodes, many people with bipolar disorder are
free of mood changes, but some people may have lingering symptoms. Long-term, continuous treatment helps to
control these symptoms.
Different types of medications can help control symptoms of bipolar disorder. An individual may need to try
several different medications before finding ones that work best.
Medications generally used to treat bipolar disorder include:
Anyone taking a medication should:
Talk with a doctor or a pharmacist to understand the risks and benefits of the medication
Report any concerns about side effects to a doctor right away. The doctor may need to change the dose or
try a different medication.
Avoid stopping a medication without talking to a doctor first. Suddenly stopping a medication may lead to
“rebound” or worsening of bipolar disorder symptoms. Other uncomfortable or potentially dangerous
withdrawal effects are also possible.
Report serious side effects to the U.S. Food and Drug Administration (FDA) MedWatch Adverse Event
Reporting program online at http://www.fda.gov/Safety/MedWatch or by phone at 1-800-332-1088.
Clients and doctors may send reports.
For basic information about medications, visit the NIMH Mental Health Medications webpage.
For the most up-to-date information on medications, side effects, and warnings, visit the FDA website.
When done in combination with medication, psychotherapy (also called “talk therapy”) can be an effective
treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar
disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:
Cognitive behavioral therapy (CBT)
Interpersonal and social rhythm therapy
Visit the NIMH Psychotherapies webpage to learn about the various types of psychotherapies.
Other Treatment Options
Electroconvulsive Therapy (ECT): ECT can provide relief for people with severe bipolar disorder who have not
been able to recover with other treatments. Sometimes ECT is used for bipolar symptoms when other medical
conditions, including pregnancy, make taking medications too risky. ECT may cause some short-term side
effects, including confusion, disorientation, and memory loss. People with bipolar disorder should discuss
possible benefits and risks of ECT with a qualified health professional.
Sleep Medications: People with bipolar disorder who have trouble sleeping usually find that treatment is
However, if sleeplessness does not improve, a doctor may suggest a change in medications. If the problem
continues, the doctor may prescribe sedatives or other sleep medications.
Supplements: Not much research has been conducted on herbal or natural supplements and how they may
affect bipolar disorder.
It is important for a doctor to know about all prescription drugs, over-the-counter medications, and
a client is taking. Certain medications and supplements taken together may cause unwanted or dangerous
Keeping a Life Chart: Even with proper treatment, mood changes can occur. Treatment is more effective
client and doctor work closely together and talk openly about concerns and choices. Keeping a life chart that
records daily mood symptoms, treatments, sleep patterns, and life events can help clients and doctors track
treat bipolar disorder most effectively.
A family doctor is a good resource and can be the first stop in searching for help.
For general information on mental health and to find local treatment services, call the Substance Abuse and
Mental Health Services Administration (SAMHSA) Treatment Referral Helpline at 1-800-662-HELP (4357).
The SAMHSA website has a Behavioral Health Treatment Services Locator that can search for treatment
information by address, city, or ZIP code.
Visit the NIMH’s Help for Mental Illnesses webpage for more information and resources.
For Immediate Help
If You Are in Crisis: Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255),
available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential.
If you are thinking about harming yourself or thinking about suicide:
Tell someone who can help right away
Call your licensed mental health professional if you are already working with one
Call your doctor
Go to the nearest hospital emergency department
If a loved one is considering suicide:
Do not leave him or her alone
Try to get your loved one to seek immediate help from a doctor or the nearest hospital emergency room, or
Remove access to firearms or other potential tools for suicide, including medications
Ebola Funds Won't Help Congo Until the Disease Spreads
This month, Ebola moved from the Democratic Republic of Congo, where it re-emerged in August 2018, into neighboring Uganda. The World Health Organization confirmed that a 5-year-old boy was the first fatality from the virus in Uganda. Reuters reported on Thursday that the boy’s grandmother had also died, citing a health ministry official, and fanning fears that the spread of the virus has begun.
Since 2017, the World Bank has been issuing “pandemic bonds,” which use private investment to help developing nations tackle outbreaks of infectious diseases. The particular bond that covers Ebola, among other diseases, pays investors a coupon of 11.1 percent over Libor, funded by donor nations Japan and Germany. Since the first case of Ebola in August last year, almost 1,400 people out of 2,000 infected have died in eastern Congo, a region with rich mineral deposits but one of the poorest countries in the world, according to the UN. But that doesn’t mean they get the aid money. In fact …
The World Bank's pandemic bonds will not only benefit affected nations once they jump international borders and a positive ate of growth of the outbreak is confirmed, according to a person familiar with bonds. Then and only then would the Washington- headquartered World Bank pay $90 million to help both governments and international aid responders tackle the crisis. Additionally, since their introduction, pandemic bonds have yet to pay out to affected nations.
For further updates to this Crisis follow:
Dead Kids, Hospital's Secret Tapes; Hush-Hush Alzheimer Tx? Trina CEO Going to Jail
This past week in healthcare investigations
Dead Kids, But Business as Usual
The New York Times provides an in-depth look at high death rates and behind-the-scenes operations at North Carolina Children's Hospital, part of the University of North Carolina medical center in Chapel Hill. Cardiologists wrestled with whether to send children there for heart surgery after seeing unexpected poor outcomes including deaths --yet the hospital continued doing the procedures. Tapes of meetings that took place from 2016 to 2017 obtained by the Times, involving cardiologists at UNC, reveal concern and alarm over elevated death rates among surgical patients, even for relatively low-risk procedures. The recordings included one cardiologist saying, "I mean, our house is in total disarray. This is crazy what we're doing. I should be as pissed as anybody, and in fact
more. I've never seen anything like it, quite frankly. And we're going backwards, not forward."
The cardiologists weren't sure why the surgical results were so poor, but limited resources and a chief pediatric cardiac surgeon whom many didn't trust were reasons why several doctors referred more children to other hospitals. Meanwhile, administrators at the Children's Hospital did everything they could to hide the problem.
maybe. After the Times report appeared, North Carolina's health and human services secretary announced the state would conduct a "thorough investigation" alongside federal authorities, according to North Carolina Health News. UNC Health Care's CEO (and dean of UNC's med school) told staff that the Times' criticism was "overstated." To follow this story go: