Sorry for not responding quicker, the object is not to control mood swings to the extent of flatening affect on an on going basis [indeed flattening of affect is a symptom of Schizophrenia - it is sometimes a consequence initially but it is not an objective] the objective is to bring the mood variations withing a range that can be controlled by the individual. Some unfortunate individuals may not be able to achieve this objective but it should be the objective. One perspective on this was given in Goodwin & Jamison's book on Manic depressive illness published by Oxford Press. They describe how the problem has been viewed, from one perspective, as an issue of excessively thight natural controls which are easily broken by relatively normal mood swings but once the moods exit the region of control they become out of control pathological swings. The objective is therefore to allow swings but widen the range overwhich natural control can be exerted. Hence, the moods don't become pathological. If one takes this perspective the object is not to flatten affect but to broaden the control boundaries. In practice this means using medications such as lithium in a more dynamic way, varying does with different phases carefully so as to avoid excessive "flatening" or loss of control. Overtime, as the excessive perturbances in mood are deminish a more static matainence dose can be used, only to be altered for more significant stresses or when physiological changes require changes. This perspective relates also to one theory which proposes that BP illness is subject to sensitization and kindling, as are the epilepsies. That is to say that the problem initially requires a large stressor to cause an initial swing, and overtime the stressor required becomes less and less until the swings become essentially "endogenous". The object could then be restated as trying to increase the robustness of the natural controls so that every increasing stressors are once again required.
In practice this means one should always bring Flattening of Affect, apathy, or excessive swings to the attention of a medic and dosages/meds should be varied to achieve an optimal out come. The price degree of optimality is very individual so some people may have a flatter affect than others while retaining control of swings.
Post Edited (SMSIRL) : 3/29/2006 4:20:43 PM (GMT-7)