Q: Growling & Bipolar Disorder : Bipolar & Schizoaffective
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.
Dear Ms. W' --
This is obviously a very complicated and difficult situation. Here are some
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.
Published August, 2004