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.

Writing to Discipline My Thoughts

Disciplining My Thoughts By Writing

This morning I attended an OC Writers’ write-in. I haven’t attended a writers’ group in a long time. Been isolating myself and focusing on my son rather than my writing, rather than myself. Today, I left him home in bed, then left the meeting early to get him to class on time. When I got back home, he was dry-heaving in bed. Crap.

Hate spending my mornings trying to wake him up to do his homework and go to school. He will be seventeen next month. Time to wake up and do homework on his own. Unfortunately, his private school is not within walking distance, nor would it be a safe bike ride, and my kid has no interest in getting his drivers’ license yet. So, I’m still driving him to and from school.

The first week of June, during my son’s summer break when I didn’t have to act as alarm clock and chauffeur, I started cleaning my house with help of my next-door neighbor. She did most of the cleaning and organizing. I chatted and did a wee bit of organizing. We tackled the kitchen, spending two hours on Monday and two hours on Friday.

The second week of June was my son’s first week of summer school, so I took the week off cleaning and organizing. He has a full schedule this summer. He attended most of his classes last week, perhaps because I offered him $10/class/day. He’s motivated by money. It costs more to reschedule his classes than it does to pay him to attend.

Hypomania Raises Its Head (Again)

Last Tuesday in therapy, I said I no longer felt hypomanic. At the time, I seemed relaxed, at ease. By Wednesday my mind was racing. At night, when it was time to fall asleep, to slow down my mind – instead of thinking in my usual monologue, as an orator narrating my life – I heard a cacophony of voices.

I wondered if, when those voices crowded my mind, I should have written them down to see if I was thinking in dialogue. Were the voices characters wanting to be heard, auditory hallucinations, or thoughts racing so fast, I could not make heads or tails of them? Most likely speeding thoughts.

When I couldn’t fall asleep, instead of writing, I medicated myself to sleep. I force sleep when it won’t come on its own.

As I wrote last week during the day, while my son attended school, I could not hear the noise. Instead, I focused on my voice and that’s what I thought. Writing disciplined my thoughts.

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.

Diagnosing Bipolar II #DavidLeite #NotesOnABanana

Creator of the James Beard Award-Winning Website "Leite's Culinaria," David Leite, "Notes on a Banana: A Memoir of Food, Love, and Manic Depression"

“Diagnosis: Mental Lite!” — Chapter 33 of David Leite’s self-deprecating Notes on a Banana: A Memoir of Food, Love, and Manic Depression — reminded me of the two decades it took before I was diagnosed bipolar type 2.

For twenty-five years Leite was treated (unsuccessfully) for depression and anxiety. Like Leite, I was an overachiever who cyclically crashed. From eighteen to thirty-nine, I was diagnosed dysthymic (chronically depressed).  Finally as a mother of a toddler, I recognized my euphoric callings from God as symptoms of hypomania and called for help.

After seeing numerous psychiatrists since he was fourteen, Leite sought and got an accurate diagnosis of bipolar II from Neil De Senna, who at the time was a Columbia University Medical Center professor of psychiatry.

Here I excerpt as bullet points the questions Dr. De Senna asked that led to Leite’s diagnosis. Buy the book to read his life story and answers to these questions — you won’t regret it.

  • Did I ever have rapid, repetitive thinking?
  • Did I ever talk fast, sometimes so fast people couldn’t understand me?
  • Had I ever been so irritable, I shouted at people or started fights or became violent?
  • Had I ever had a decreased need for sleep? If I slept just a few hours, did I feel great?
  • Did I ever engage in risky behavior that endangered my life?
  • Had I felt unusually self-confident in myself and my abilities? Did I ever experience grandiosity?
  • Had I ever had morose, violent thoughts?
  • Had I ever contemplated suicide? Had I ever attempted it?
  • Had I ever lost interest in things because nothing gave me pleasure?
  • Were there times when I was very interested in being with people, and other times when I wanted to be alone?
  • Did I have crying jags, anxiety and panic, trouble falling asleep or staying asleep, bad feelings about myself?

Now I quote without editing, De Senna’s description of bipolar I and bipolar II:

He explained that there are two types of bipolar disorder. Bipolar I is the more severe form, what Kay Redfield Jamison, the author of An Unquiet Mind, has. In it, the manias are screechingly amped up and oftentimes dangerous. They’re emblazoned with inflated self-esteem and billowing grandiosity, a marked decrease in sleep, a pressing need to talk, sometimes with odd features such as “clanging,” where speech loses meaning and follows a pattern of rhymes or sounds. Someone suffering from full-blown mania can be grossly distracted; battle racing, looping thoughts; and engage in potentially dangerous and deadly activities, such as unchecked buying sprees, risky or anonymous sex, foolish business dealings, and reckless driving. All the while, psychosis—a disconnection from reality—can be skulking in the background, just waiting for a pause, an opening. These manias can disrupt a person’s life to such a degree that jobs are lost, relationships implode, families disintegrate. Hospitalizations usually follow.

“What you have, bipolar II,” he continued, “is a milder form of the illness.” While the depressions can be just as deep and disabling, disabling, he said, what makes the difference is the quality, degree, and length of the high times. With bipolar II, a person suffers from hypomania. Elevated, expansive moods that are seductively attractive to the sufferer and the people around him, hypomanias are a watercolor version of bright-neon manias. Through it all, life isn’t disrupted to the same degree, and there’s never a psychotic break. Hospitalizations aren’t common.

“It can be very, very difficult to diagnosis hypomania,” Neil said. “Especially in type-A people who are normally goal-oriented, high energy, and creative. Their personalities can mask the illness at times.”

By quoting from David Leite’s memoir, published by HarperCollins, I do not intend to avoid copyright law. My hope is to educate, and as an added bonus to Leite and HarperCollins, to promote a great memoir of a creative soul living with manic depression.