Questions re: Bipolar Disorder
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Q:  Questions re: Bipolar Disorder

In 1978, my high school sweetheart lost his younger sister to a head on collision with a drunk driver.  Within 4 months he was experiencing depression followed by his first severe psychotic/delusional manic episode. He went to a local hangout and pretended to be a rock and roll star! The locals laughed at him and he took offense. He locked the door and held everyone hostage with a pool cue.  A deputy sheriff talked him out and he was put in a straight jacket and transported to the nearest psychiatric ward where he was eventually diagnosed with manic depression/bipolar disorder.  His diagnosis has never been disclosed to the hometown people.

     His life has been one of divorce, numerous broken relationships, relocations, and job layoffs.  He seems to have a 4 year pattern of psychotic/delusional manic episodes.  The last episode followed a work related trip to China.  He was balanced when he left but the day he returned he was experiencing the beginning of a manic episode.  One of the most peculiar changes that I observed was a complete change in the sound of his voice. It became very deep and totally unrecognizable to me. For the next two weeks, I observed him becoming more and more argumentative, aggressive, offensive, rude, crude, sexually aggressive, socially inappropriate, impulsive, etc.  He started frequenting the clubs,  womanizing with indiscretion, and playing his guitar as if he were a rock star.  He befriended complete strangers and avoided those he had known. 

He lost his job.  He eventually sought psychiatric treatment and was prescribed Zyprexa.

    My questions are as follows:

1) Is it common for Bipolars to experience voice change at the onset of a manic episode?   

2) Do most Bipolars have the same delusion (ex. Rock Star) with the onset of each of their manic episodes during their entire lifetime?

3) Does lengthy travel, especially to the East, cause a disruption of the circadian rhythm and this in turn causes the Bipolar to experience a manic episode?


Dear Concerned Friend --
I have a solid answer for #3; will take a stab at 1 and 2… 

1. I haven't heard of this.  But I have heard of people who do have some rather striking changes.  For example, here is a case of someone who cycled every 24 hours and had recognizable differences in handwriting in the two phases, manic and depressed.  

2. Frankly, I should know the answer to this one, but I have to say “I don’t know”.  We had one fellow who was often in our hospital who quite consistently would have delusions based on the StarTrek series. So there’s one for whom, yes, the delusions were very similar in theme, repeatedly. But how often does this happen? I don’t think it as frequent as “most”… I’d guess occasionally, not uncommonly.  

3. You’re right, this one I can confirm based on published research.  Here are two papers that describe mania after travel east: one from Hawaii, and one from London.  As noted in both papers, depression is more common in those hospitalized after traveling west.  

Thanks for your questions.  

Dr. Phelps

Published April, 2010


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