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Q: With bipolar/mood swings, is the person aware of the mood swings
coming on before they happen?
Dear John --
Interesting question. Since there are so many different variations on
"swings", I suspect no single answer applies. Perhaps we could
phrase it: "is it possible for some people to see some of their
swings coming?" That answer is clearly yes. With practice
most patients can learn to see signs of trouble, especially things like
decreased sleep. One of my patients can tell if he's just got a little too
much to say in an email reply, or too many really great ideas on what the
company should be doing. At that point he's learned to turn up his
Depakote 125mg, just a little teeny bump up. He calls it "having his
ear to the rail". He's had psychotic periods and gotten himself in
big trouble during those episodes -- so he has a very great incentive to watch
closely for changes that look to be heading in that direction (and in between
episodes, he's just a smart guy with no symptoms, which makes it easier).
At the other end of the spectrum, there are folks who
are not aware of their mood swings even while they're in them, so obviously
there's no chance for prior awareness there. Which end of the spectrum is
most common? I see lots of both ends, but in my position there's a
tendency toward over-representation of the no-insight end of things, especially
for inpatient psychiatric unit work. I suspect there's a very broad
spectrum of "insight", and that the degree of insight can vary quite a
bit even within the same person.
Complicated, isn't it? Sorry I can't give you a
more direct answer.
Dr. Phelps
Published April, 2003
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