Today I’ll address some more of the questions you’ve emailed me. As a reminder, I can only answer general questions, so I need to paraphrase some of your questions.
A reader expressed concern about custody issues regarding a spouse that may be suffering from bipolar disorder. This reflects on previous discussions (see Children and Bipolar Disorder Part I and Part II) we’ve had in this column regarding the effects of bipolar illness on children. In general, people in most situations are free to choose whether or not to seek treatment for any condition, including mental illnesses. However, it is clear that a guardian with untreated bipolar disorder could negatively impact the growth, development, and overall health of a child. In these kinds of situations, the individual’s right to refuse treatment may create a situation in which a court determines that the individual is not fit to retain custody of a child. In the setting of a legal situation such as a divorce proceeding, it will be essential to address this issue with a lawyer.
Another reader asked about mixed manic states. Mixed mania is a particularly unpleasant variant of bipolar disorder wherein the sufferer simultaneously experiences symptoms of both mania and depression during the same period of time. This is frequently marked by agitation, insomnia, and psychosis. Mixed mania may be more common in younger males, but can occur in anyone at any stage in their illness. In general, any psychiatric symptom exacerbation should be reported to your psychiatrist. This will allow for further consideration of the course of your illness, potential reconsideration of your diagnosis, and reassessment of the appropriateness of your treatment regimen.
I get many requests for referrals that I cannot individually address. In general, there are two practical considerations: 1) who is available in your area, and 2) who will your insurance company reimburse. Medicaid and private insurer reimbursement rates for psychiatric care are decreasing, with private insurers regularly trying to reduce reimbursement rates as much as possible while retaining an adequate number of doctors participating in their panels. Unless you are willing and able to pay out of pocket, the first step is to contact your insurer to get names of psychiatrists in your area that are on their panel. Unfortunately, my experience is that patients are frequently given inaccurate, out of date information. At this point, you should see if someone you trust (such as one of your other physicians) recognize any of the psychiatrists on your panel as being either a good or bad choice for you. Many psychiatrists are not formally accepting new patients, but often will accept a new patient that is referred by one of their colleagues. Because of this, a referral from your internist or family physician can often be the most efficient way to get in to see a psychiatrist who is not officially accepting new patients. The same forces that are causing insurers to experiment with reducing psychiatric reimbursements are also causing psychiatrists to withdraw from panels. This can have a profound impact on the delivery of mental health care, as it is not uncommon to “lose” your psychiatrist if they stop participating in your health care plan.
Thanks for your questions, and keep them coming!
Published On: October 24, 2006
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