Hard to make treatment recommendations in this forum. But generally speaking, psychiatrists try to avoid the hospital if not entirely necessary (eg, suicidal intentions). Short of that, it seems reasonable to me to call your doctor to describe the problem and ask if any changes to current medicines might be advisable in advance of your upcoming meeting (at which time she can capitalize on the opportunity to assess the effects of a possible change made now).
Xanax and Klonopin dosing are about 1:1 equivalent, so if I follow correctly you've been (consistently?) taking 3 mg/day of Xanax and are now taking 4 mg/day of Klonopin...which, if that's the case, it would be quite unlikely that a higher dose of benzodiazepine-equivalent dose is causing withdrawal. It is alternatively possible that one medicine (eg, Xanax) could be better tolerated than another for a given individual. If a patient of mine called me to report a headache in this context I would be inclined to advise traditional over-the-counter headache/pain remedies (Tylenol, Advil) if there was no reason not to, and if the problem persisted then I would probably ask them to come in so I could assess in person. Certainly though yours is a reasonable question to ask your own doctor.
"The" gold standard therapy for phobias (including claustrophobia) is behavioral: exposure therapy with response prevention, which is basically a systematic desensitization. I've never heard of time line therapy and NLP is generally thought of as pseudoscience by the mainstream scientific community.
No on-line test can make any psychiatric diagnosis. A consultation with a licensed mental health professional (psychiatrist, psychologist, social worker) would be the appropriate way to obtain a comprehensive evaluation of the problems you are having to determine if bipolar disorder, or any other diagnosis, best accounts for the problems, and what the best course of treatment (medicines, psychotherapy, etc.) would be most appropriate, depending on the problem.
DSM-IV technically, and arbitrarily, defines a "mixed episode" as the occurrence of a full manic (not hypomanic) episode plus a full major depression in people with bipolar I (not II or NOS) disorder, lasting for at least a week. DSM-5 has eliminated this designation and instead created the "specifier" term "with mixed features" to be applied to a full manic or hypomanic or depressive episode with some elements of the opposite pole, but falling short of a full episode of the opposite pole. DSM-5 also will for the first time "allow" for the designation of "with mixed features" in people with unipolar depression who have never had a full manic or hypomanic episode -- furthering the perspective that the line between unipolar and bipolar disorders is often fuzzy.
Currently, frankly, most practitioners are quite unaware of these technical designations and tend to take a more, let's say, "impressionistic" approach to diagnosing mixed states -- I don't think very many are even aware of the DSM-IV criteria, for example. The value may be a greater recognition of the co-occurrence of manic/hypomanic and depressive symptoms arising simultaneously; the hazard will be sloppy, casual diagnoses based on recognizing only one or two symptoms without imposing at least some degree of rigor on identifying symptoms that are present versus absent.
The changes to DSM-5 in the mood disorders section are far less sweeping than many people had hoped for, and are more a reshuffling of the symptom deck (e.g., in diagnosing mania or hypomania, increased energy is being elevated to an "A" [necessary> criterion than a "B" criterion), rather than any keen new insights or great scientific advances. So, I would not expect DSM-5 to create any big changes in how patients with mood disorders are recognized or treated. IMHO.
If your doctor thinks that Lamictal has been helpful for you and is worth continuing, then the logistical question might be to find out from your pharmacist and/or insurance carrier what provisions can be made for a bulk supply to cover you while you are overseas. It may also be worth finding out if Lamictal is available in the country you'll be going to, and if it would be feasible to find a doctor in that country who could prescribe it for you (and monitor your condition). Your doctor would be the best person to offer you recommendations about whether other medicines or strategies are advisable if, for some reason, Lamictal could not be procured while you are overseas.
Lithium can cause slowing of reaction time, slowing of movements, or fluency of thinking, and possibly problems with short-term memory. That is the extent of its known (documented) adverse effects, which in themselves are often dose-related and typically go away if lithium is stopped.
I just posted a response to this but the WebMD site somehow erased what I wrote. Will try again.
It's hard to generalize about rigid behaviors and inability to change tasks. Some people are just more rigid while others are more flexible in their ability to shift sets. Sometimes, trouble shifting sets cold reflect executive function problems, such as those inherent to bipolar disorder (or other conditions).
There are no validated laboratory or neuroscience tests for bipolar disorder, or any other psychiatric disorder; they are more akin to disorders such as migraine, Parkinson's Disease, tinnitus, irritable bowel syndrome, and fibromyalgia in that none of these conditions have any laboratory tests to make a diagnosis -- so diagnosis relies (at least for now) on clinical signs and symptoms.
It's hard to make general statements; some people are just more prone to rigid thinking while others are more flexible.
There are no established neurobiological indicators of any psychiatric diagnosis. Psychiatric diagnoses are more on par with conditions such as migraine, Parkinson's Disease, irritable bowel syndrome, tinnitus, or fibromyalgia, inasmuch as diagnoses are based solely on clinical features rather than any laboratory test, since none exists.