Growling & Bipolar Disorder:Bipolar & Schizoaffective Disorder
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Q:  Growling & Bipolar Disorder :  Bipolar & Schizoaffective Disorder


Dr. Phelps,
My 14 year old son, with history of viral encephalitis (1 month) partial complex seizures (8 years old), sensory issues has now been diagnosed bipolar.  Until puberty things were moving forward without major issues for a developmentally delayed child and then overnight literally a change occured.  He has been on tegretol for 6 years with only a few seizures which occured in the first two years after the initial one. We tried changing to depakote with horrible results, we have tried all the 2nd generation neuroleptics and abilify, all which made him worse. He just recently started lithium (3 weeks ago)150 bid and we just increased it to 225 bid last week.  He is  extremely med sensitive reacting to even the smallest doseage. He seems to cycle rapidly and has major bouts of psychosis. When he cycles down currently,  a growling voice is his predominate speech pattern with  swearing and deminished actual words. When we tried carbatrol he experienced non stop laughter even though   it is pratically the same as tegretol xr.  Can a person have a latent psychosis associated with tegretol after taking it for years and then when hitting puberty it appears?  Is growling something that is common in bipolar? What is the difference in  bipolar and schizoaffective disorder? Should we try and discontinue the tegretol or change to another MS?  All of our current  docs are puzzled. 

Thanks,
 

Dear Ms. W' --
This is obviously a very complicated and difficult situation. Here are some thoughts:

1. Psychosis could definitely show up for the first time around puberty -- with or without Tegretol in the picture. It's pretty common for a big symptom shift to show up then.

2. Growling is not common in my experience but I don't work with kids. Haven't heard of this from colleagues, though.

3. Schizoaffective differs from bipolar in that there are phases of psychosis with no "affective" (read that as "mood") symptoms. This is a very hard distinction to make in my experience. Instead, I think "schizoaffective" gets used when the doctor is struck by the psychosis and thinks it's in some way more fundamental to the illness than the mood symptoms, so wants to emphasize that in the diagnostic label (and in my view, it's easy to be wrong about that given the way psychosis can be so obvious and mood symptoms so subtle, at least by comparison). When you get right down to it, there's not too much difference in the way they're treated except that with psychosis/schizoaffective disorder, the emphasis ends up being on antipsychotics, and with bipolar disorder, on "mood stabilizers". Although there are some antipsychotics among the mood stabilizers, there is more of an emphasis on lithium, for example.

Dr. Phelps

 

Published August, 2004

 

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