Mar. 15th, 2004

urocyon: Grey fox crossing a stream (Default)
From "Impaired Cognition in Bipolar Disorder: Something to Think About" by John J. Spollen III, MD. (Medscape does require registration.)

Topiramate, an anticonvulsant that has been used in bipolar disorder but lacks studies with appropriate methodology showing efficacy, is probably the anticonvulsant most associated with cognitive impairment. Topiramate has been associated with impaired attention, concentration, verbal memory, fluency, word defining difficulties, and reductions in verbal IQ.[12] While these are dose-dependent and will disappear after discontinuation, these problems are probably of clinical significance.

Why does this not surprise me? I am glad to see it, though; it's some indication that I may not have been imagining things. It is hard to tell if the main problems have been verbal, though, or if I've just particularly noticed those difficulties; it's always been one of my "good" areas, and I acutely notice any differences there.

Given my general tolerance of the current meds, I don't think I want to go messing with them in the near future, though. I may dislike this probable side effect, but the Topamax has been remarkably free of others--far better than I can say for practically anything else I've tried.

One important and unfortunate fact about bipolar disorder is that although more than 97% of patients appear to recover clinically within 2 years, only 37% recover functionally during the same time period.[1] While not yet proven, it is possible a significant contributor to the substantial difference is residual cognitive dysfunction. . .Although the findings do not suggest a global cognitive dysfunction like that seen with schizophrenia, there is a pattern of specific cognitive deficits that include problems with verbal memory, sustained attention, and, occasionally, executive functioning.

Erm, yes. This can be particularly fun when you're sitting right in the middle of it, and not really able to put a finger on why you're not functioning so well within the wider world. I am glad that Dr. Vieta is in the early stages, at least, of looking into these persistent memory and concentration problems. Just from my experience, I do suspect that he's on the right track with pre-existing tendencies greatly exascerbated by too many of the medications.

That reminds me--I had been putting off finding a new GP here (I was not going back to see Rich Williams, having avoided it since '96 or so), and am not particularly looking forward to doc-shopping over there. At least Dr. Dubner did recommend that my meds be managed by a GP for now, as well as things have been going, so I can avoid the apparent hoops there. Hmm...would I ever have thought that dealing with the Commonwealth of Virginia and Virginia Premier would sound good? :)

A new GP also means "training" a new GP--in this case, most likely one who's had little or no exposure to people with quite different Native liver chemistry like mine. People who set up practice here pretty quickly get accustomed to prescribing around it (or to spectacularly ill and jaundiced patients, I suppose). I reckon trotting out the old, simplistic (in this case, at least) Gilbert's Syndrome explanation might be handy. For that matter, I still don't understand why Gilbert's is considered a disorder of any sort. Just because your yellow eyeballs or seemingly strange lab results make a medical professional upset, it doesn't mean that you have a problem. (Well, besides the upset person ordering lots more blood drawn without bothering to talk to you first--that does qualify as a problem, from experience.) And, unless you're adopted and haven't seen it before, you're unlikely to get too upset about turning yellowish when you've had the flu or too much to drink; it's just something that happens, to no ill effect.*

Not that exposure is any sort of assurance against ignorance, mind. My mom went better than ten years having misdiagnosed/dismissed gallbladder attacks with classic symptoms, consulting several doctors during that time--apparently from misapplication of the "fair, fat, and forty" rule of thumb. (The "SPF-50 Factor" might serve me in something, it seems, and I'm already a bit older than she was when the gallstones started giving trouble.) Her GP was rather horrified and embarrassed when he figured out what the problem was, and admitted that he hadn't suspected it due to her not fitting those silly risk guidelines. He should have been. In fact, according to the NIH, people of Native American heritage "have a genetic predisposition to secrete high levels of cholesterol in bile. In fact, they have the highest rate of gallstones in the United States." At least he seemed to know that women have twice the rate.

Properly formatted (yes, triple-checked) lj-cut tags were not working, for some reason, so I removed the quiz results.

* Or, as with one family member, you might not even notice it. He's made it into his fifties still surprised that people can tell he's been smoking pot (if far less frequently these days). The bloodshot yellow eyes might be a giveaway there. *g*

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