Bipolar Disorder as a Medical Illness
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Q:  Bipolar Disorder as a Medical Illness

My son and I have Bipolar.  I have applied for TEFRA, medicaid waiver, for my son, so that I can get more treatment for him because our private insurance is inadequate for mental health.  Unfortunately, SC aschews mental health and pretty much only gives waivers for medical illnesses.  My question is if Bipolar is best characterized as a Neuropsychological disorde, can it not then be characterized as a medical illness.  I am trying to find sources which will support this claim.


Dear Ms. M' -- 
This is so frustrating.  This distinction between "mental" disorders and "physical" conditions is so artificial.  Don't we all think that mental health symptoms come from someplace above the shoulders?  Don't we think the problem is in the brain somewhere?  I mean it's not likely that mania comes from your feet, is it?  And if that's so, then what's different about a condition that comes from the brain, as opposed to the heart or the kidneys? 

But, my ranting won't help you now will it.  So, how about racking up something firmer in the way of evidence.  This is a worthy project and more than I can tackle properly, but here are a few select references you could cite in your efforts.  

1.  Here's the most recent article I can find showing brain changes associated with bipolar disorder, just like you'd show a MRI study to document a stroke or a tumor up there: 

Regional prefrontal gray and white matter abnormalities in bipolar disorder.
Lopez-Larson MP, DelBello MP, Zimmerman ME, Schwiers ML, Strakowski SM.
Biol Psychiatry 2002 Jul 15;52(2):93-100

BACKGROUND: Previous magnetic resonance imaging (MRI) studies indicate that compared with healthy volunteers, patients with bipolar disorder have structural and functional abnormalities in the prefrontal cortex. The aim of this study was to investigate differences in prefrontal subregions between bipolar patients and healthy subjects.METHODS: Bipolar patients hospitalized for a manic episode (n = 17), and demographically matched healthy volunteers (n = 12) were recruited. Contiguous 1-mm coronal T1-weighted MRI slices were obtained using a Picker 1.5 Tesla scanner. The gray and white matter volumes of five prefrontal subregions of interest were measured: superior, middle, inferior, cingulate, and orbital.RESULTS: Bipolar patients had smaller left prefrontal gray matter volumes, specifically in the middle and superior subregions and smaller right prefrontal gray matter volumes, specifically in the inferior and middle subregions. White matter differences were not observed in any of the prefrontal subregions.CONCLUSIONS: The results suggest that bipolar patients have subregion-specific gray matter volume reductions in the prefrontal cortex as compared to healthy subjects. Further investigations into the role of specific prefrontal subregions in bipolar disorder are warranted.

2.  Here's an article that appeared in Time magazine recently.  It basically tells the whole story of bipolar disorder, in plain English.  Maybe this would be useful as you try to educate people about what you're facing.  Time article

Good luck to you.

Dr. Phelps

Published November, 2002


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