HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

How To Rule Out Bipolar Disorder?

Posted on Thu, 21 Jan 2016

Question: I know of a person that was admitted to the ER with a 4.0 XXXXXXX but she has bipolar disorder, and at the she was getting her medications adjusted. But the main thing is that her son was dying from a brain tumor at the same time. The attending ER Dr threw her into alcohol treatment, but what she needed was inpatient behavioral health for a suicide attempt. Now she is labeled for like with alcohol abuse. Why don't Drs treat alcohol OD's the same as prescription OD's?
I meant labeled for life with the alcohol abuse diagnosis, and i also meant prescription medication overdoses because they automatically refer them to an inpatient psychiatric YYYY@YYYY

Answered by Dr. Alexander H. Sheppe (15 minutes later)

Brief Answer:
Consultation

Detailed Answer:
Hello, and thanks for your question.

Your question is why someone with bipolar disorder who presented to an ER intoxicated was sent to detox/rehab instead of an inpatient psychiatric unit.

It is not possible to treat a mood disorder such as bipolar disorder when someone is actively abusing alcohol, which this patient was. The drug/alcohol problem must be treated first. Why is this? Because drugs and alcohol affect mood in a variety of ways, and only when they are totally removed can we begin to diagnose and treat underlying mood issues accurately. The ER physician here made the right choice -- alcohol intoxication and abuse must first be treated before bipolar disorder and suicidality can be treated.

Furthermore, alcoholism can result in withdrawal, which can be deadly, and inpatient psychiatric units are not equipped to handle the medical complications of withdrawal, so detox is an appropriate disposition for this consideration.

Once you are satisfied, kindly remember to rate and close this question thread.

I encourage you to contact me at my private link below, because we receive nearly double the payment from this website for direct questions, and after asking a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, or individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Alexander H. Sheppe (38 minutes later)

I DO NOT agree with you. This person was not abusing alcohol. She drank a lot of alcohol one night, otherwise just occasional social drinking. But that night from the stress of caring for, and watching her son die she was so depressed that she did not care if she lived that night, no alcohol withdrawals, so no detox needed, so inappropriate referral, she should have gone to an in patient psychiatric hospital. Now, she is "labeled for life" with the wrong diagnosis, and as you and I well know-you can't erase those PERMANENT LABELS, and so I gather from your answer that if someone is going to attempt, it is a much wiser to go the pill route, yet people have done the alcohol plus pill route and still get sent to a psychiatric hospital. How do you explain that decision?

Answered by Dr. Alexander H. Sheppe (1 minute later)

Brief Answer:
Followup

Detailed Answer:
Anyone who uses alcohol unhealthily, including using alcohol as a suicide attempt (without use of another agent such as pills to induce death), by definition has an alcohol use disorder. Addressing the person's relationship to alcohol and ensuring abstinence during treatment for a mood disorder is the first priority. A referral for alcohol use disorder treatment is an appropriate first step to ensure the best possible outcome for mood disorder treatment in the future. People may disagree and have different approaches, but I agree with this doctor's decision.

I encourage you to contact me at my private link below after asking a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, or individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Sonia Raina