Experts: Travel, Sleep Disruptions Can Aggravate Bipolar Disorder

A press release from the Miami Dade Police Department confirms that Rigoberto Alpizar, the man who was shot and killed by federal air marshals at Miami International Airport on Wednesday, was likely suffering from an episode of manic depression when he said he had a bomb.

The release validates various witness reports that Alpizar's wife, Anne, frantically tried to tell people that her husband was ill and off his medication. Alpizar was shot after he "left his seat and exited the aircraft with a backpack strapped to his chest, yelling that he had a bomb," according to the release.

Health experts agreed that Alpizar's behavior was consistent with that of someone in the throes of bipolar disorder, and that his death was an example of the difficult decisions law enforcement professionals face when dealing with a person's deranged and threatening behavior.

Bipolar disorder is a mental illness that can cause extreme "manic" highs paired with depressive lows. Sufferers are five to 10 times more likely to die from suicide than the general public.

Abuptly stopping medication can cause a dangerous change in mood for people with bipolar disorder, Dr. S. Nassir Ghaemi, director of the Bipolar Disorder Research Program at Emory University in Atlanta, said via e-mail.

Bipolar sufferers also tend to be heavily affected by changes in sleeping patterns and time zones. In fact, there have been notable situations where ambulances met airplanes on the tarmac to assist a person who was in a manic state, Ghaemi said.

"If both risk factors occurred -- he [Alpizar] had not taken his medications on his trip to Ecuador and he was sleep-deprived due to a long international flight -- it would not be uncommon for a manic episode to be triggered," Ghaemi said.

Although Alpizar's wife was aware of her husband's illness, she would have had little ability to predict his behavior and should not be blamed for the incident, said Linda Rosenberg, president and chief executive office of the National Council for Community Behavioral Healthcare.

"It's not [an] uncommon reaction when someone has a family member with a serious mental illness, there is often guilt. They wonder: 'What could I have done differently?' " Rosenberg said. "He probably was not aware of or able to communicate [his state of mind]."

Most law enforcement personnel are given training on dealing with mentally ill people, but that's not always enough to prevent cases like Alpizar's, said Seattle psychiatrist Gregory Simon of the Group Health Cooperative.

"Unfortunately, in these times, anyone who acts out in a way that is perceived as threatening -- that's going to draw a lot more attention than it did five years ago."

Rosenberg agreed, and said she hoped that some good could come from the situation.

"One of the things you can always do is say: 'What can we learn from this?'"

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