By Mitzi Waltz O'Reilly & Associates, 2000 Review by Christopher A. Lamps, M.D. on Jan 3rd 2001
One of the cornerstones of effective pediatric psychiatric treatment
is education. In practice, education is sometimes a casualty of
the time limits facing mental health practitioners. Patients and
their families may struggle to find accurate and helpful information
on mental illness and its treatment. In the case of childhood
bipolar disorders, this is particularly true since patients may
have a broad range of impairments in addition to sometimes facing
isolation and stigmatization in their communities. This book is
a leap forward in enabling the families of children with bipolar
disorder to educate themselves. In her preface, Mitzi Waltz states
her goal: "This book is intended to bring together all the
basic information needed by parents of a child or teenager diagnosed
with a bipolar disorder. Professionals who work with bipolar disorder
should also find it useful." This is a Herculean task, but
Waltz accomplishes it. Interestingly, she is not a psychiatrist,
a psychologist, a social worker, or any other professional mental
health provider. She instead is a journalist as well as the mother
of a child with a bipolar disorder. She shares the story of her
daughter's (and her own) struggles as part of the preface.
The style and structure of Bipolar Disorders make its 442
pages easy to read and reference. The spacing and font size minimize
eye fatigue. Frequent brief clinical vignettes based on the author's
communications with others illustrate and highlight key points.
After the preface, the book has nine chapters. The first chapter,
"What are Bipolar Disorders?", describes the diagnostic
criteria for bipolar disorders and discusses their causes, comorbid
illnesses, and potential negative effects of these disorders.
The second chapter, "Getting a Diagnosis", provides
information on getting and understanding a diagnostic evaluation.
Though in general these chapters provide fundamental and useful
information, some of their content is questionable. For example,
in discussing psychotic symptoms in bipolar disorders, Waltz writes:
"When a person has psychotic symptoms, some kind of chemical
or electrical process in the brain has gone terribly wrong. This
cannot be fixed by psychotherapy, although therapy may be a useful
part of a total treatment plan There are many medications
available that can alleviate psychotic symptoms". It is true
that psychotic symptoms associated with mood or psychotic disorders
require medication treatment. However, hallucinations sometimes
occur in the context of a broad range of conditions including
substance abuse, seizures, migraines, grief and stress reactions.
In some of these cases psychotherapy may be an effective treatment.
Despite this and a few other questionable conclusions, these two
chapters provide a good introduction to bipolar disorders.
Chapter 3 provides great insights into how to live with a child
with bipolar disorder. Its recommendations range from improving
the structure of the home, to handling substance abuse, to the
utility of support groups. Chapter 4 reviews medications used
for bipolar disorders, including medications not currently available
in the United States. Chapter 5 discusses therapeutic interventions
for bipolar disorders. This chapter provides a very good summary
of the types of therapy available as well as the various qualifications
of potential therapists. Chapter 6 introduces some alternative
treatments ranging from acupuncture to dietary changes to herbal
supplements. Though there is little scientific evidence to support
many of these treatments, this chapter provides a balanced discussion
of these treatment options.
The final three chapters focus on handling insurance, schools,
and the transition of bipolar patients into adulthood. Each of
these provides valuable and practical information for parents.
I found the chapter on schools particularly valuable. The laws
covering special education are complicated even for those used
to working with the system, but can be a daunting maze for the
uninitiated. She includes sections on the systems of other English
speaking countries (United Kingdom, Ireland, Australia, New Zealand),
broadening the utility of this book. Waltz does a good job of
providing both an overview of special education and a guide to
advocating for those in need of it. Finally, the book has an appendix
listing a broad range of resources for parents or patients seeking
more detailed information.
Mitzi Waltz has written a practical and extremely valuable resource
for parents of children with bipolar disorder. Besides recommending
this book as essential reading to the families of my bipolar patients,
I will also recommend this text to professionals, including psychiatry
residents, seeking to broaden their understanding of the range
of treatments and interventions for bipolar disorders.
Dr. Lamps is
the Medical Director of the outpatient pediatric psychiatry clinic
at Arkansas Children's Hospital in Little Rock. The clinic is
also part of the University of Arkansas for Medical Sciences (UAMS),
where he holds his faculty appointment. He attended medical school
and trained in adult psychiatry at Vanderbilt University, and
completed child psychiatry training at UAMS in June of 2000. His
primary clinical activities include patient care and supervising
psychiatry residents; his primary clinical interests are in treating