Fetal Alcohol Effects
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Fetal Alcohol Effects, or Bipolar?

Q: Dr. Phelps, First off, thank you for your time. My brother-in-law, 36 years old, has serious problems which myself and the family thinks might stem from being a victim of FAS/FAE, Fetal Alcohol Syndrome/Effects. It is a known fact that his mother drank heavily during her pregnancy. I recently spoke with my GP and he mentioned bipolar and manic depression. I have done quite a bit of research on FAS/FAE and his behavior as an adult is right in line with what the research shows. He has extreme ups and downs, cocaine/alcohol problems, CANNOT handle money, social interaction behavior of a someone that is 13 or 14 yrs old, and peer group that is nothing but trouble, but seems to be validating for him. I could go on and on, but wanted to know what your take was on the differences between an adult with FAS/FAE or an adult that has been diagnosed as bipolar? The symptoms seem to be closely in line with one another. FAS/FAE seems to be a "sleeper" in our society and the secondary disabilities that come along with it! I should mention, he has not been diagnosed with anything, we are trying to come up with a plan to get him in to see a doctor in a non-threatening way. Thanks for your time!

Dear Ms. G.  --
FAS is not very well understood, at least in the psychiatric circles in which I travel.  I could be missing something and your letter will alert me to keep my eyes out for opportunities to learn more.  In the meantime, here's the likely approach you'll run into by folks like me:

We don't know if someone with the behaviors you describe might have FAS, or bipolar, or both.  We're stuck making diagnoses on the basis of symptoms, and several conditions might cause similar symptoms.  However, we've learned quite a bit about treating the symptoms of bipolar disorder.  So we'd know how to start with this young man, using that diagnosis.

By comparison, to my knowledge we know little or nothing about how to treat FAS, or even if that is possible.  You may well know more than I about that by now.  Just use some caution and investigate the credentials and $-connections of anyone who says they do know how (like do they stand to make any money off this diagnosis?).

So, you can see where this leads.  If I'm right about us knowing little about treating FAS, and I know I'm right about knowing a lot about treating bipolar disorder, and if we have difficulty distinguishing the two, how about if we start by treating what we do know how to treat and see how that goes?  Both diagnoses are made by looking at current behavior, and knowing the genetic background.  Does/did his mother have symptoms that might be interpreted as "bipolar"?

Some day we'll have a decent "lab test" for these kinds of questions.  Until then, I fear you'll find people treating "empirically", as we say euphemistically -- meaning, "we can't be very sure about diagnosis here so let's take our best educated guess and treat accordingly".

Dr. Phelps

Published November, 2000

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