ALPIM Anxiety-Laxity-Pain-Immune-Mood

Many of us living with mental illness have other chronic illnesses. Often we are not treated for our “physical” illnesses, as many doctors dismiss them as psychosomatic. “Mental” illnesses ARE “physical” illnesses, and “physical” illnesses affect our “mental” illnesses. We are not just our brains, just our bodies, just our minds, just our feelings, or just our souls. The more we learn, the more we understand interconnectedness and comorbidities.

The ALPIM Spectrum

In the Spring 2015 issue of the Journal of Neuropsychiatry and Clinical Neurosciences, researchers proposed The ALPIM Spectrum:

  • A = Anxiety disorder (mostly panic disorder);
  • L = Ligamentous laxity (joint hypermobility syndrome, scoliosis, double-jointedness, mitral valve prolapse, easy bruising);
  • P = Pain (fibromyalgia, migraine and chronic daily headache, irritable bowel syndrome, prostatitis/cystitis);
  • I = Immune disorders (hypothyroidism, asthma, nasal allergies, chronic fatigue syndrome); and
  • M = Mood disorders (major depression, Bipolar II and Bipolar III disorder, tachyphylaxis. Two thirds of patients in the study with mood disorder had diagnosable bipolar disorder and most of those patients had lost response to antidepressants).

Study Conclusion

We conclude that patients with ALPIM syndrome possess a probable genetic propensity that underlies a biological diathesis for the development of the spectrum of disorders. Viewing patients as sharing a psychological propensity toward somatizing behavior essentially denies patients access to care for the diagnosable medical conditions with which they present.

– J Neuropsychiatry Clin Neurosci. 2015 Spring;27(2):93-103. doi: 10.1176/appi.neuropsych.14060132

Download the Study

Should you want to read the journal article, I purchased the pdf version: A Novel Anxiety and Affective Spectrum Disorder of Mind and Body—The ALPIM (Anxiety-Laxity-Pain-Immune-Mood) Syndrome: A Preliminary Report (J Neuropsychiatry Clin Neurosci. 2015 Spring;27(2):93-103. doi: 10.1176/appi.neuropsych.14060132). No copyright infringement intended.

Associations in ALPIM Domains

ALPIM SYNDROME FIGURE 5. A Schema Demonstrating Significant Associations Within and Between ALPIM Domains. Anxiety - Pain Attacks (included in Phenotype). Laxity - Joint Laxity Syndrome (Beighton), Mitral Valve Prolapse. Hernias. Scoliosis. Double-Jointedness. Easy Bruising. Pain - Fibromyalgia (included in Phenotype), Headache, Prostatitis and Cystitis. Immune - Asthma, Rhinitis, Irritable Bowel Syndrome, Chronic Fatigue Syndrome, Hypothyroidism. Mood - Major Depressive Episode (included in Phenotype), Bipolar II Disorder, Bipolar III Disorder, Tachyphylaxis. This schematic diagram depicts, via line connections, significant associations within and between the ALPIM domains (see the Results for a description). Table 2 repors corresponding significant probability levels, odds ratios, confidence intervals, and Wald statistics. ALPIM, anxiety, laxity, pain, immune, mood.
J Neuropsychiatry Clin Neurosci. 2015 Spring;27(2):93-103. doi: 10.1176/appi.neuropsych.14060132

Diagram of Comorbidities

FIGURE 7. The ALPIM Syndrome: A Neuropsychosomatic Spectrum Disorder. Schematic Venn diagram showing the hypothesized spectrum of comorbidity in patients having a core anxiety disorder with laxity, pain, immune, and mood disorders. The overlapping circles demonstrate that comorbidities exist along a spectrum, in which a patient might have anywhere from just one disorder under one domain to multiple disorders under multiple overlapping domains. ALPIM, anxiety, laxity, pain, immune, mood.
J Neuropsychiatry Clin Neurosci. 2015 Spring;27(2):93-103. doi: 10.1176/appi.neuropsych.14060132
Bipolar III is cyclothymia, a “milder” form of bipolar than bipolar II.

Sick with Dread

Dread background image of red alarm clock

Frustrating to parent an adolescent who feels sick chronically. Difficult to know if he feels sick because he is sick with a contagious disease, or if he has a migraine, or if he is anxious. Honestly, right now, I’m feeling sick to my stomach. Sick with dread. Dreading a summer trying to get my kid out of his bed, out of his bedroom, out of the house, and to summer school.

Silent Lately

Silence - background of clouds over Saddleback mountain range formation and trees in foreground

I haven’t written in a while, nor have I read or commented on others’ posts. I used to write brief reviews after reading a book. Recently, I’ve simply left stars on Amazon and Good Reads.

Why? Because I simply needed to recover. Recovering not from an episode of bipolar disorder – though I do live with that illness and must take care of myself – but from exhaustion, physical illness, and the demands of life.

Sometimes I need silence. Sometimes I must do less. I must NOT do.

Since my mother had her stroke November 2015, I’ve had added responsibilities overseeing my parents’ finances and care. My sister helps me make decisions and offers emotional support, but she lives in another state and has her own life to live.

I parent a high-needs adolescent who gets sick A LOT and has struggled throughout his life with migraines, ADHD, depression, and anxiety.

My husband, son, and I have all been sick.

All this weighs on me.

So, I’ve pulled back.

I’ve been silent.

I’ve binge-watched TV.

I’ve done lots of jigsaw puzzles on my iPad.

Hope - yellow hibiscus background

Starting Monday, I’m hiring my neighbor, who has been a caregiver to seniors, to help me with my chaotic physical environment. Together, we will organize and clean my house. It’s cluttered and dusty. The floors and refrigerator need cleaning. Hopefully, that will improve both our physical and emotional health.

Time to Write Again?

taking-it-easy_5

Pre-Christmas Travel Writing

I jump from one app to another. Jigsaw puzzle to reading to writing. Back and forth, writing and jigsaw. Uneasy. Jittery.

Uneasy. Not at ease. Tense. Guilty. Dramatic, yes, but so fucking what. That’s who I am. I have no desire to change that about myself. Besides, honestly, I keep most of my drama inside.


Back Home Organizing My Thoughts

Haven’t been writing much over this past holiday season. Left my time and energy for family and myself. Since my post-Thanksgiving chest cold, I’ve been doing jigsaw puzzles and not engaging in as many verbal activities.

Kind of like my mother. She nods yes, shakes her head no, or stares blankly not seeming to understand. She no longer reads the newspaper. Just turns the pages, pulls out the ads, and organizes the paper by section. Reassuring daily routine, even if she can no longer read.

Although I visited both my parents before both Thanksgiving and Christmas, I felt guilty leaving them behind when I visited my sister and in-laws. Broke my heart. So much guilt, even though I know after trial and error that we are giving our parents the best of care. Just can’t be in two places at once.

Last year around Christmas time, my Mom was psychiatrically hospitalized. More to the point, I had her psychiatrically hospitalized. Heart breaking decision, but I tried to do the right thing every step of the way.

We had hoped to have them living together back then. Our mother went from stroke rehab to the psychiatric hospital, then to another stroke rehab before moving into a board and care with my father. They did not do well in the board and care, so we ended up moving them into a high-quality memory care community.

Since that time, we’ve found that they do better apart in separate communities. I feel terrible that I’ve had her in so many places, but she’s stable now and my father’s health has improved. They both seem to be happy, even though they miss each other. Their memory communities arrange a weekly Skype session so they can “see” each other.


Visited My Parents This Week

The new year begins. I visited my parents before and after the holidays. When visiting my mother on Sunday, I took her out shopping. We terrorized fellow shoppers as we tried to navigate using an automated cart.

Once I got back home I debated whether I could bring her home to live with me. Our house, though, is not well suited for a stroke survivor. Bedrooms are upstairs. Our flooring is tile and hardwood. Our stairs steep and without a landing.

Just thinking about moving my mother in, I started to ramp up, to get mildly hypomanic. I found myself unable to sleep. Instead of sleeping, I researched stair treads, hand rails, stair elevators, and purchasing a single-level home.

The fact remains that my own mental health is stable because I avoid stressors that trigger symptoms and cycling. I give myself time to recover. If I was a full-time caregiver of my mother, I would not be well.

Yesterday I visited my father and brought my teen son along. My son continues to miss far too much school due to illness and migraines, which frustrates me. I try. I really do. But, I can’t carry a sixteen-year-old adolescent to school when he has a fever, is vomiting, or is coughing. I’m at my wit’s end.

My sister and I decided to give our parents’ living situation a year. They are both doing well. The quality care they receive is why.

Caregiving Can Wear You Down #RealTalkAboutCare

My mother, father, & I in watercolor filter

Since Thanksgiving weekend, I’ve been sick with an upper respiratory infection (URI). As an asthmatic, URI’s tend to go to my lungs. My son, too, is sick and in bed (no way for a teenager to spend the weekend). URI’s are highly contagious. We tend to share far too many illnesses in my family. Even our labradoodle Thumper is taking antibiotics for a cough.

Until my mother had a stroke November 2015, she was my father’s caregiver. Since then, caregiving has become my responsibility, as now both my parents have dementia. My father has alcohol-related dementia (alcohol is a neurotoxin). My mother now has vascular dementia with behaviorial complications (brain damage can do that) and she cannot speak.

As I live with bipolar disorder while parenting an adolescent migraineur, I couldn’t care for two aging parents with dementia without help, for doing so would likely put me in a psychiatric hospital. Finding long-term care that could address their needs proved challenging. For now, we’ve had to separate them – heartbreaking, but necessary for their health. To pay for their care, we had to sell their beloved beach house, for memory care is extremely expensive.

If my mother had more caregiving support before her stroke, perhaps she may not have had a stroke, perhaps she would have received more timely medical care. My mother was exhausted, stressed, and taking antidepressants (caregivers are at risk of depression). My father just thought that my mother was napping. His dementia interfered with his ability to respond to her stroke appropriately.

My mother, a caregiver, needed help, needed respite, needed care herself. My sister and I had been talking to our mother about downsizing and moving closer to my sister. But, my father fought the idea of moving out of their beach house, leaving our mother essentially trapped.

Thankfully they are doing well now, given their current life circumstances. Take care of yourself. Take care of your brain. Take care of your heart. Good health is a blessing.

Caregiving Resources: AARP Caregiver Resource Center