It’s Sunday morning in San Diego. Yesterday afternoon I rolled into town to register for the American Psychiatric Association annual meeting, the mother of all mental health conferences, which attracts about 20,000 psychiatrists and related professionals.  As I mentioned in my previous blog, I plan on attending sessions on topics regarded as tangential to bipolar, and so far I am operating according to plan.

Last night I attended a three-hour dinner symposium on schizophrenia and today I was up bright and early for three hours of hard breakfast time on hypersomnia.

What’s the relation? What do these topics have to do with bipolar?

As we are discovering more and more, bipolar is not just a mood disorder. Cognition and sleep have a lot to do with it. In fact, psychiatrists are discovering what a lot of us have known for years, that even as the mood symptoms clear many of us still struck with thinking straight. Our pdocs may think they fixed us, but we are still impaired.

When it comes to cognition, the schizophrenia experts have been on the case for years. Significantly, if you think of bipolar and schizophrenia as occupying part of the same spectrum, there is some overlap. Psychosis, for one, is a feature in both bipolar and schizophrenia, not to mention some forms of depression. Similarly, although bipolar and schizophrenia are very different illnesses, certain cognitive impairments may bleed into both conditions.

In other words, both disorders may share some of the same underlying brain circuitry.

Speaking of cognition and brain circuitry, at this morning’s hypersomnia symposium, Stephen Stahl MD of the University of California, San Diego made a good case for thinking disorders actually being sleep disorders. Basically, if you have trouble becoming aroused and staying awake, you are going to have trouble thinking.

Significantly, Dr Stahl is more interested in the symptoms and underlying brain circuitry than the actual diagnosis, which he says he claims to forget about once he’s filled out the paperwork.

“Putting down the diagnosis is how I get paid,” he told the gathering. Getting the patient better involves other considerations.

Another interesting comment: “The FDA doesn’t regulation the practice of medicine. The FDA regulates the sale of medicine.”

In other words, don’t be fooled by whether a particular medication is indicated for a particular illness. If different mental conditions share the same circuit, he said, it is likely that a med that works on that particular circuit will help with all the conditions.

There will be much more on cognition and sleep in blogs to come. The point here is that to fully understand bipolar and to use our knowledge to get well and stay well, we have to think outside the bipolar box. Many of our best insights into our illness come from people outside the field.  

Now I’m off to a bipolar luncheon symposium. How did that happen?