Cognitive impairment

[starbunny]

Always had mood episodes since age 12 when I was hospitalised.

Realised in 2005 that I was experiencing cognitive impairment - extreme forgetfulness / impaired attention apan/ability to organise mind.

Subesquently Dx Bipolar / psychotic features & Temporal lobe epilepsy (although I'm not convinced about the latter)

Placed on Seroquel 600mg, Tegretol 1400mg, which was meant to help both the mood element and cognitive problems. Thought I was getting better although mood episodes only partially controlled. Started part time job, 2010 but after a few weeks was told that I am making regular serious errors with basic things and having severe memory difficulties to the point where I am told I am unemployable. I was not aware of any of the errors / forgetting etc until pointed out. Thought I was doing fine.

Any idea what is going on? or what I can do about this? as always pdoc out of reach takes months to get an appt. Diddn't think bipolar had this level of cognitive impairment - is this typical?

[Peter Forster]

This is indeed a pretty confusing area. Medications can make this worse, but in my practice, the issue is more likely to be that the medications are not adequately treating the condition (anxiety or mood disorder) and the cognitive impairment is due to the condition itself.

The key to figuring out which is which depends on defining the nature of the impairment [We use something call CNS Vital Signs as a test of cognitive function when we want to see more clearly what aspects of cognition are being affected]; and then looking at the time course of the symptoms very carefully [We ask people to track cognitive symptoms along with mood and anxiety and medication changes].

Not noticing mistakes is either a sign of very significant neurologic illness (not the case with you I am pretty sure) or a classic cognitive manifestation of bipolar. Some part of this seems to be inherent in the disorder - in other words bipolar who are in a "normal" mood compared with other people tend to miss mistakes more. But it is particularly problematic in folks who are even a little bit hypomanic or manic.

[Jaquta]

You could always try discussing this with your family doctor in the interim.

As a layperson I'm not sure what to think.  A medication issue?  Forgetfulness due to seizure activity?  Lack of concentration due to mood issues?  ADHD??

I would try your own doctor.  Wait for a response from this forum expert and maybe even try the undiagnosed symptoms community forum (people there offer lots of misc. advice re: symptoms).

Good luck!

[Jaquta]

Maybe even a slight tweaking of the meds you are on could be helpful.  
I often think that some symptoms are because people are being over-medicated but sometimes it is the opposite and the symptoms are there because people are under-medicated.  It is something an experienced doctor needs to sort out.

Meds can be paradoxical.  Is ironic that one can be given to treat anxiety or depression but that anxiety and depression can also be a side-effect of it.  Sounds messed up.  Is a wonder they even work at all.

It sounds like it could be from both.  Have you looked at other medical causes?  For example, when I've been iron deficient I've had trouble concentrating and my mood and energy levels have been a lot lower.  Just a thought.

Sorry I haven't been much help.  I hope you are able to see your doctor soon and hopefully prior to Christmas to get some answers.

[starbunny]

Thanks Jaquta, my GP told me that my medications are being partly used to treat symptoms such as inattention / memory problems but unfortunately also them listed as a side effect - how confusing! :S

On a personal note I feel the seroquel / carbemazepine combo has definately slowed me down in general  - don't walk the dog as often, house is untidy, low motivation but can't tell if it is responsible for the cognitive impairment.

If meds are responsible I would like to know if there are any others which would be suitable to replace them that don't have this as a side effect. If it is related to bipolar or mental health I would like to know if this is usual or treatable and what my future chances are on terms of being able to work. Thanks again.