Bipolar Disorder - Lecture 2014 - Dr. Patrick McKeon

this talk an annual talk uh for quite a number of years um I try and focus on a mixture of the commonly needed information that people encountering bipolar disorder and their families experience maybe in uh at the outset of an illness and in the early stages of its management um some of it will seem repetitious for people who are uh highly experienced in in these areas uh but also to talk about um the skills needed for staying well so it's really about trying to give you an understanding of the illness its basis its signs and symptoms what causes it what impact it has on people's lives and what people can do to to stay well uh I will also deal very briefly with uh as usual one uh interesting uh topic that's emerged from the research literature over the past year or so and it's in connection with sleep apnea and its relationship to bipolar disorder the term bipolar disorder obviously implies that there are two poles to the condition a high and a low it replaces the term manic depressive illness um hopefully it has lost none of its meaning in in that sense but in a curious way the term manic depressive illness had a lot of meaning hidden behind those two words even though we maybe um didn't quite understand them uh manic actually means speed it up and people often mix the word up with Maniac uh depressed depressed or depressive means slowed up and in essence that's basically what bipolar disorder is about it's essentially a condition of alternating over activity and underactivity within a variety of different systems within the body but largely overactivity of emotion and thinking and it's spelling that out and seeing how those interrelate uh to form the classical symptoms of the condition whereas it is called bipolar disorder for some people though uh they will mainly have one pole of it so there are two poles as I said the high and the low the high side or the manic side and the depressed side uh can be represented in this way but for many people the lows are the main aspect and the high they may get might be very slight indeed for other people then it's where the highs are the predominant feature and the lows are fairly slight for some people just to cause it cause it little bit of confusion for some people is that the highs for quite a number of years of the condition sorry that should go there so in other words the person may just have highs and no lows so why then still call it bipolar disorder well it is just called that and we just have to to accept that anomaly in other words there are some people who will have highs only uh certainly for a number of years of the condition that is when it is untreated so more recently another term that has emerged uh from research is what's called bipolar spectrum and it comes back to this very uh important point that even small amounts of elation in themselves are extremely important to recognize and to have effectively treated now a person might say it's only a small amount of a high I I my sleep was only upset for a night or two okay I was over talkative and I uh said things I shouldn't have said during those two or three days but the point is that if that high is left unchecked and untreated what it means is that ultimately the depression that happens in subsequently um will continue to occur and occur and occur occur uh if the person is having these small highs that go unchecked so uh whereas the individual person if they had a small depression like that they would be quite well aware of it they' be able to remember tell you exactly when it started when it ended but people by it the very nature of the condition are relatively unaware of highs it's from the person around the individual that they that can spot it so what I want to do now is just to having explained a little bit about the concept of bipolarity where it emerges out of uh manic depressive illness and the concept then of bipolar Spectrum in other words you have different spectrums the more severe unipolar Mania recurring depression slight highs waves up and down um you've a whole Spectrum of uh minor degrees of bipolarity that can maybe almost appear as if it's affecting a person's personality and it gets diagnosed mistakenly as a personality disorder whereas in fact behind that uh there's a very definite mood disorder so let's go and look at the signs and symptoms and again I'm just dealing with this for people people who are coming to it aresh so within depression it's useful to look at it from this point of view that within depression if you imagine that within your mind you have a thinking wheel that rotates at a certain rate we're quite used to that rate our rate of speech our rate of thought our rate of facial expression whatever it may be when a person gets depressed that slows down and because it slows down you can begin to see that the whole person's appearance changes they become less expressive their eyes are more vacant the person is inclined to stare into space the person is to say they find it hard to string sentences together words just don't seem to come uh quips seem impossible um and bit by bit the person's whole demeanor changes in the sense of the length of the strides they take they're uh just bodily gestures until eventually the person is seen as somebody who is in a depressed state even from a distance but if you take it the that this is related to The Driven machine of thinking up here that's going at a certain rate so you can conveniently look at bipolar disorder as a disorder of emotion or of energy or of thinking I think it's convenient to look at it as a disorder of rate of thinking in other words that's that core to it because when it comes to sort of teasing apart different diagnosis within the is uh one has to have some sort of framework on which to to look at it so basically what happens in depression is that the thinking wheel slows down because of that the person has less to say they're less expressive now the next thing that happens from that is that the person has difficulty spread um putting their thoughts out into space of their mind in other words when you ask somebody how it is they see uh the future what's ahead for them most people if they're not depressed will look to the left or right and within an instant that say well I'm looking forward to that game tonight if only you'd get on with this lecture okay or somebody might say um I'm thinking of a holiday at the at the beginning of August I really I'm looking forward to heading down the country and having a nice relaxed time so in other words we have that capacity to put a picture upon the visual display unit in our mind but that almost seems to need a certain momentum from this wheel where we can spin thoughts off and that thus also creates our sense of future so when people are very depressed they just simply can't do that and what happens is that if you ask them how do you see the future what they will say it's Bleak it's blank or there's nothing there so it's amazing how often uh people actually use those words not realizing the significance of what they're saying but if I note uh as I do when people are uh describing their sense of the future um this these three terms keep cropping up and what it says is the nothingness of the future so a person can feel disconnected and it's very frightening for people in that state because we take that sense of the future so much for granted now the next thing is that because there's uh nothing there on this slate or on this visual display unit uh a person doesn't have the energy to pursue the future we think energy is something that um comes from glucose and other things that we take yeah sure it's important and having blood pressure and having a reasonable hemoglobin they're all important but in terms of the energy that we take for granted in everyday life it's really a figment of our imagination we throw something up here on the visual display unit and we chase after it that's what our energy is when there's nothing on the visual display unit everything seems difficult empty it's very hard for a person to have any initiative or any um drive or or motivation when we're burdened by major problems in our life there's the mountain there ahead of us and that is depressing it it it impedes us taking action so in a sense um we create our own energy uh if we have the mood to do it so again you can see how all of these things are connected with the rate of thinking I hope some of this is beginning to make some sense for you the next thing is that we have trouble when depressed taking information in because information comes in like this like a string of dots and they have to fit on to it's as if one bit goes there the next bit should go there uh the next bit over here and so on and we string that information together and it's as if then that eventually goes into a thinking wheel on which all that information is kept now what happens when a person is depressed because the the wheel is rotating so slowly the information is coming in and it just all gets lodged in the first slot and the Brain just can't cope with it and process the information likewise because the memory wheel is slowed down during depression a person has difficulty accessing information so at this point here the person's ability to absorb information I.E to concentrate and take information in is impaired and when a person is uh depressed the thinking wheel is slowed up it's not that the person has lost their memories they just can't readily access them but it's really when people say their memory is affected during depression it's actually more their concentration in other words that if you slow the thing down and give them the same information and really get their attention they can take the stuff in but many people of an older age group as they begin to get get depressed they will point to their memory and maybe incorrectly believe that it's the onset of Alzheimer's so they're the key symptoms of depression as slowing down of the whole process now in Elation you've got the complete opposite we use the word Elation uh Mania which is really speeded up State and the other uh term would be hypom Mania as a lesser degree of mania so with the thinking wheel now what's happening is that it's going much quicker than normal and that's great fun initially uh the person has a lot of things to say a lot of ideas everything seems to be uh attracting the person's attention so in other words all this information the person can really absorb uh lots of phone numbers lots of names and seems to have it all in that sense but as the thinking wheel goes more quickly it's just absolutely taking up nothing it's going so fast absorbing nothing so you can see people who will go through uh for example maybe a prolonged hospitalization during a manic episode and their recollection of the length of time they were in hospital or the treatments they've had or who visited them um almost nothing registers a person might believe for example and I exaggerate not they may say I was in hospital for 3 days it could have been 3 months um and it's not that they were so medicated that they were unable to recall it it's just simply that they uh ability to absorb information from their environment is limited because the person is so into their own thoughts they've got so many of them in other words they dominate the person's thinking so that when you're looking at a person who is depressed they're vacant their eyes are vacant they're staring into space whereas when a person is high or a later they're thinking so quickly their eyes are darting from one picture to another and what the pictures are are that the person is throwing thoughts up here here and here and so on and they're jumping from one picture to another in their mind so you can see that aliveness or the person's eyes dancing during a high State again because there's so many things up here on these pictures the person has tremendous energy they can manage then to keep uh pursuing things incessantly but frequently they will jump from one thing to another and maybe not finish one task before they move on to another one the result of all of this is that the person is over talkative Restless impa patient energetic enthusiastic able to concentrate on an enormous number of things but frequently their judgment is impaired and let's look at just the anatomy of judgment in that sense for a moment so when we have a decision to make what happens is we jump up um from this point to this point the thought might be um I want to uh go go on a particular holiday so we'd look at the positive side of that yes it would be a very enjoyable thing to do I found memories of been there before um the rest of the family would enjoy it and so forth the negative side would be um I can't afford it uh some of the uh aspects of the holidays of that holiday weren't all that Pleasant for everybody and we weigh things up carefully in that way when people are depressed they will only tend to see the negative side uh I can't afford it it's too far to drive uh the temperature is too hot it probably will be raining uh whatever H in other words sorry I've seem to touched somebody's card there um so in that way um we we arrive at decisions when somebody's high they can only see the positive side um everyone will enjoy it I'm going to bring everybody the family the extended family and John and Tommy on either side of it can come too in other words the person ignores the cost whether it's uh something that the neighbors and the extended family really want H whether they can take off time work etc that the person will jump from one decision to another in a high State and only see the positive side and that's where the damage is done in other words that the balance between constantly weighing up car carefully which we do in an instant when our mood is okay we can arrive at a balanced decision that's right for us but when a person is high or low there are difficulties with the decision-making process but in a low State uh because of the inability to enact the negative decision the person doesn't have the the energy or the drive to do something about it generally it doesn't cause as much trouble but for example if you're a shopkeeper and decide I can't afford to buy stock when you can for to buy stock well that's obviously going to fairly profoundly affect your business um but it's it's more people who are in the high state that are more likely to get into major difficulties with poor decisions uh during that time so we can trace the elements of bipolar disorder back to an underactivity or an overactivity of the thinking process and it's often called psycho motor slowing in other words the Mind slowing and the body slowing as part of depression and PSY psycho motor hyperactivity has been the opposite and there're just terms to describe what because that's what one would look for in terms of trying to make the diagnosis of this condition okay so let's now look at the individual signs and symptoms within this and we use the pneumonic Festival to try and help us remember what this is so during depression a person will feel low sad depressed sometimes mainly anxious remember that people who are anxious by Nature when they get depressed they simply get more anxious now behind that symptom of anxiety there are the typical features of depression in terms of maybe Disturbed appetite Disturbed sleep uh poor energy poor concentration but the person does not like being told your diagnosis is that you're currently depressed when actually all their feeling is anxiousness but bit by bit the person will begin to realize that so in other words uh we need to bear in mind the importance of anxiousness in that sense e is energy the most common symptom from what I can see of people with depression and bipolar disorder is uh uh a disturbance of energy people feel tired and that tiredness is not relieved by a good night's sleep sometimes people will describe it as a mental tiredness other people will describe it in a very physical way in sleep disturbance as part of depression the person will have broken sleep generally from 3 p.m. or 3:00 a.m. onwards broken sleep um early morning wakening and maybe oversleeping during the day te is for thinking in depression as we said the thinking is slowed down with the result that the person um has difficulty concentrating they may feel wooden headed um and can't uh Focus mentally would be another way of putting it I is for interest the the interest a person has in in the world around them we when we have the emotion we can express it and uh interact with the world around us colors people's faces what people say things that attract us um what happens in depression is that they all shrink and they will often be most noticed by a person uh to affect the thing that they consider particularly important to them it may be food it may be the Daily Newspaper it may be soaps it may be uh interest or affection for their family any of those things uh may be affected even football guys do come in and say I know I'm depressed and stop following the local team hard for women to believe but uh does happen uh so it's food sex religion whatever it is that's particularly important to a person value V for Value the value a person puts on themselves May range from I'm not a very good person right over to useless and the far extreme would be damned or Wicked next A is for eggs as part of depression there's frequently a tightness in the muscles a tension in the body and for many people that's felt as a headache back ache uh chest pain um or if the person had an old injury from work or from uh sport or something like that that injury uh for example within a muscle as those muscles become tight around the injury that uh original pain will be reactivated like a pain in the leg or whatever so there are many people for whom when they're first getting depressed again that is the first symptom that they are aware of and um L is for live basically not wanting to live and feeling suicidal and very often uh the suicidal feeling is related to the sense that there's nothing there in the world that the person is disconnected from the world so even if you cannot um identify all of the symptoms the point is that it's a disturbance of feeling energy sleep and thinking and really if um for example if somebody says they're very depressed uh but their energy is okay well it's probably not depression uh they may be distressed by what's happening in the world around them but if they have those core symptoms of depression uh it's unlikely to be depressed that the the person is depressed on the other hand if four or five of those Main sympt are present uh and they've been present for we say two-ish weeks or thereabouts the chances of it being depression uh is very high indeed uh now it can be other things such as anemia an underactive thyroid and so forth but uh the frequency with which uh depression would explain that level of tiredness fatigue and sleep disturbance uh would would be much higher now inhalation you get the complete opposite rather than feeling sad depressed and anxious the person feels extremely energetic and enthusiastic so ales optimistic never felt better they would be typical statements a person would make and they might say uh I don't know why I'm here talking to you uh I have never felt better I can't understand why my family insists that I see somebody energy super and need little sleep in other words the person might find that they can't switch off and go to sleep the person may complain of their thinking it may be very um energetic thinking as it were very Lively thinking on the other hand the person may feel that their mind won't switch off now with the result that actually it forms the basis for the person's trouble getting to sleep at night in other words because the person can't switch off their mind they're not able to go into sleep at night and thus uh that's a very typical manifestation of elation often people think that when people are depressed that they have trouble getting to sleep at night to my mind that's unusual if a person has marked trouble getting to sleep at night it more than likely is a reflection that the person's mind is overactive now you can see maybe all the time I'm coming back to the same concept that if there if the person is if it is bipolar the person's thinking is going to be slowed down and one should be able to see that in the process of talking to the person watching their expressions if somebody is their mind is overactive you would see it in things like their eye movements their gestures their interruptive in conversation the tendency to dominate the exchanges and so forth interest um will be for a thousand one things in other words the person will jump from one interest to another um or as somebody says everything that littered seems like gold to the IND idual they're just attracted to absolutely everything the value they put on themselves is that they're great are the greatest are greater than the great okay EG and pains H curiously EGS and pains disappear almost when people go high L is for live uh when a person is high um as far as they're concerned they're going to live forever now I'm talking I've been talking about Elation in this sense but there is another aspect to this that we need to look at and it's an important aspect and because not all highs or manic phases are Pleasant elation by any means so let's just look at when a person is going into depression to start with when people go into depression frequently at this phase and at this phase as they come out of it they will often experience anxiety and it's only when they go down further into depression that the brain begins to slow down and switch off now curiously that phase and that phase are from a feeling point of view more hard hard harder for the individual person in the depressed state to cope with because it's almost as if the brain slightly switches off at this point that clear enough inhalation what happens is that are in a high State always during a high there will be little times where the person gets sort of a little bit agitated even though it's a pleasant high and during that phase the person might if if you stop them and ask them how are they they will say they feel depressed and they might be weepy and maybe frustrated now in that in that particular State what's happening is that you realize that it's not a depressed state as such they're just momentary disturbances of feeling because you saw them a few minutes beforehand and they were talkative joyous elated in great form full of thoughts and plans and you could meet them again 10 minutes after this episode and their their mood would have shifted again so that variation in mood uh is is quite normal during inhalation but it's easy enough for families and others to see that the person is still pleasantly high but there are some people who right throughout the relation have this depressed weepy frustrated State and if you ask them how they feel they're convinced they're depressed they will convince their family they're depressed they will convince their doctor they are depressed and for all intents and purposes yes they are depressed but there's one important difference and the important difference is in this state of depression a true depression the person's thinking brain and motor function in their body is slowed down this person even though they're saying they're depressed they feel depressed but if you stop and look at them they're still quite talkative their eyes are still dancing they're agitators they're uh still highly expressive they will talk about the intense awfulness of their feeling they're in extreme distress but the volume of their vo is up they're still talking rapidly they will tell you theyve trouble getting sleep at night they will tell you that they can't switch off their mind at night so it is quite different in the sense so it is not depression in the true sense it's what we called are called an unpleasant High also known as dysphoric meaning an unpleasant um mood a dysphoric hypomania and you will also hear it referred to as mix moods in other words people emphasize in that way the mixture of depression and Elation in other words yes the sort of overactivity of the mind is there the racing thoughts the energy the um sleep disturbance of a high but mixed in with that is is depression um I tend to favor either this term or this term for a very good reason uh one is that yes from a purely symptom point of view it is mixed moods that are present that's for sure but the reality of it is when you come to treat it you have to treat it as if it were inhalation because uh if you treat that with anti-depressants you tend to make it worse whereas something that's used to treat relations such as orpine or haloperidol serenes uh risedal things like that it they immediately have a camming effect within hours of this condition secondly in this unpleasant mixed mood State uh it's not unusual for people to go untreated for a long time or mistakenly treated as having depression uh but it carries quite a high suicide rate with it because um the person still has the energy now and the frustration and the awfulness of their feelings uh churning around in their head and um often the person will be maybe very angry with people around them get into fights um but also can turn on themselves and want to end their lives uh fairly quickly so these unpleasant High states are actually quite hard to spot um but is very very important in the management of bipolar disorder that they're dealt with uh fairly quickly moving on now to talk about some of the complications that occur you get disruption in relationships secondly people uh um use alcohol street drugs as a way of quelling the unet minds that they're experiencing um and there's no doubt that as many as 50% of people with certain types of uh mood disorders uh do end up becoming dependent on alcohol and that has to be treated in its own right as a separate problem simply treating the person's unstable mood is not going to get rid of The Addictive process that has has started and um nor is simply staying off drink but sort out the moods so both of them have become problems in their own right and need individual management people accumulate major debts um people with highs and lows are by bipolar disorder often have tremendous energy tremendous ideas are very creative very energetic um are maybe very good at the work very determined very driven and they build up a lot of resources in their lives in many ways but then when the lows happen or the highs get out of hand all of those things are lost so it's it's very seesaw or in a sense has become part of the common language uh a person ends up leading a bipolar existence now the mortality with untreated bipolar disorder is something like 15% it's extremely high and um the occurrence of bipolar disorder in the general population uh for what we call bipolar one which is a big high followed by a low um the lifetime occurrence of that is about 1% so the 1% of the general population in the course of the lifetime will have that type of pattern but then when you look at bipolar Spectrum in other words lesser degrees of highs and lows what you'll find is that the figure goes up to uh maybe up as far as 5 to 6% now some researchers would say it's much higher than that and that uh some people people would maintain that any very severe depression if you look at it carefully enough that the per that person has had little bits of highs that have gone unnoticed and there's a fair bit of evidence to support that for example we know that in the course of say if you take a group of people who develop recurring depression in their teens or early 20s and follow them into adulthood you will find that uh at least one3 go on to develop bipolar disorder um secondly if you take people attending the average Clinic where everyone in the clinic is supposed to have depression uh you will find that probably a third of those are at that clinic believing they've got depression but they don't now the way we uh discovered this is that within aware when people came along to support groups um believing they were depressed It's Not Unusual for people to go away even after the first meeting and realize no I get highs and lows or I get unpleasant eyes but they didn't actually recognize it as such and the reason it's it's hard for doctors uh particularly um doctors that mightn't know the patient that well to spot the high is that people don't come in and say I'm high I'm in great form I'm here for treatment um because it's not painful enough painful for those living at home and dealing with and supporting the individual but but not uh always for the individual themselves what causes bipolar disorder well what um just giving you a very brief overview of it what do we know from studies uh that have been conducted both at an sort of within families between families within Twins and between uh identical and non-identical Twins and twins that are uh at Birth maybe separated in the course of wars or other things and brought up in different environments and one twin goes on to develop bipolar disorder and the other doesn't what we have come to understand is that from these family studies uh so in in other words within um any family if one person has bipolar disorder uh we say bipolar one disorder there's about um a 15% chance that one of The Offspring will have depression or uh bipolar disorder uh within twins that are identical twins what you will find is that if one has bipolar disorder that as many as 70% of the fellow twins will have the same condition now you might say well you know they're brought up together they look alike talk alike go to the same school wear the same clothes why wouldn't they have the same illness well if you take twins that are separated at Birth identical twins what you will find is pretty much the same sort of figure emerges um and even in those instances for that we say the other 30% people would say well what about the other 30% that didn't develop the condition what you will find is The Offspring of those who didn't develop the condition their offspring developed bipolar disorder at the rate you would have expected uh within a family setting so no matter what way research has looked at this this is what keeps emerging from it however we do not know what genes are involved there's some thoughts about different genes but it's turned out to be extremely complex the whole genetic aspect of this so what we need to try and understand is that for a person to go and develop bipolar disorder what tends to happen is that they might have on average a contribution something like 70% genetic and 30% is related to their environment their childhood experiences and that determines the 100% figure and thus bipolar emerges but that is an average figure and it's not very you know it's important not to get too haunt in on that because there will be some people for whom the figure is the other way around 30% genetic and 70% environmental in other words where the person went through a very traumatic and upsetting experience in their childhood and there's little or no history of bipolar or mood disorder in their family but maybe a number of uncles who uh Drank In bouts um uh in a way uh that um some people would feel is almost a form of polar drinking there' be other people where it's 90% genetic and 10% environmental and in that instance what's basically happening is that the person might have one or two or three um siblings and our parents who have uh the same illness and in that instance it takes little or no environmental uh effect it could be just simply the change of seasons is is enough to trigger the onset of that person's first depression or Elation or their first trip abroad or uh it it can be something really quite simple so what we know is that from an environmental point of view there are certain things that can trigger it and but it tends to be in instances where there's already a a genetic predisposition uh our ability to tease out the genes um is uh uh is is now halted at a point because our understanding of genetics not just genetics of the Mind actually doesn't extend beyond that and it's only this has emerged from the study of genetic uh conditions of mental health over the past 10 to 20 years in other words it's reached its scientific limitation at the moment because of the complex structure and interaction of genes it's not just simply about bipolar disorder but what do we we know about the environmental things well a lot of people point to Early Childhood experiences as been determines of um developing a bipolar disorder that's actually quite a complex one and not one that's easily uh dealt with uh because what you will find is that you could have maybe three uh two brothers and a sister in the same environment they experience exactly the same exposure uh within the the family uh been born almost within a year of one another maybe in the middle of a larger family and uh lo and behold maybe just one person develops the condition um so it's not that uh simple what we do know is probably is that people who have a tendency to bipolar disorder or depression probably more of the life events and upsetting factors in their lives are inclined to stick to them in other words some people just even as children have inability to shrug things off oh well you know he was losing the head for a while for a few days The Old Man and that was the way it was for somebody else that just sticks to them and it just lodges in them and they don't seem to be a to process it so the actual processing of events may have been affected in a quiet way by the illness at at an early stage certainly from an observational point of view I would get the impression that that's what happens um what's important is anything that disrupts sleep uh once a person gets into their teens is important so whether it's heading off to the sun getting a bad dose of sunburn or drinking too much with your leaving C bodies uh can be uh the reason why a person will have their first episode of high so disrupting sleep if you take somebody who has a tendency or a history of bipolar disorder and want to make them high just stop them sleeping for a night or two and off they go so it's in one way as simple as that um so things like tea coffee stimulants of any sort are highly dangerous street drugs alcohol have a much more profoundly disturbing effect on people's uh Minds where there is a history or a tendency within that family to bipolar disorder so it's very important that uh parents are careful in that sense around children and the children are aware of that sort of risk um so it's almost as if uh the person who has a tendency latent or expressed of bipolar uh condition um that alcohol caffeine steroids other things like that have a much more powerful punching effect on on their mood than on uh for the average person and as I said the same goes for street drugs now let's deal with very briefly uh the next uh three topics I want to deal with one is uh the management of bipolar disorder the second is dealing with uh sleep apnea and the third is a list of the dos and don'ts um that people should be aware of so from a treatment point of view the main treatment uh for bipolar disorder are mood stabilizing agents and the reason we talk about mood stabilizing agents is that bipolar disorder by its very nature nature tends to be a recurring condition but the the whole emphasis really has to be on preventing the next episode so if we look at what's called bipolar one disorder this is bipolar one in other words a big high and a big low and bit by a big High I mean a high that's bad enough to land a person in hospital now for a condition such as that uh lithium is still reckoned to be the treatment of First Choice so what it's basically doing is trying to prevent the next upswing because if you can prevent the next upswing the downswing uh isn't as bad or isn't as intense now frequently then the person will need maybe some other uh compound to lift them out of and keep them out of the depression and that may be uh substance called lamal which is an anti-convulsant uh compound with very gentle anti-depressant effect for other people you will find that carbamezapine epilim is often then used as an alternative to lithium for people who can't go on lithium in these instances and can be effective however research over the past four to five years has clearly shown in these instances that lithium is superior to epilim and sometimes the adding of lithium and epilim together doesn't really convey any greater benefit than uh lithium on its own bipolar 2 is maybe where a person has had recurring depression sometimes for a certain phase in their life and then as they come out of the depression they begin to have highs and then as time goes on the highs get a bit bigger and the interval between the depressions can get shorter so what's used in those instances as the primary treatment would be something like epilim or Tegretol but there's awful a lot of individual tailoring because it varies an awful lot from person to person now the next pattern that you'll hear about is what's called Rapid Cycling mood disorder and that's where a person has four or more mood swings in the year now in those instances your total emphasis has to be initially on trying to get a mood stabilizer that uh will deal with the highs you would tend to start with something like epilim lesso tegral and another class of drug would be what are called uh anti psychotic stabilizers and there are things like um Zyprexa uh CCU uh respidon so the whole trick is trying to deal with the highs now next thing just briefly and this is very brief is about sleep apnea sleep apnea is a condition where people go through a prolonged pause during their sleep in other words you're looking at the person asleep and there's no breath being taken for quite a lengthy period of time and then their whole body shudders and they seem to inhale the whole room in other words and then there's a snore now what happens is in those States is that there's something either at a central level in the person's respiratory system in the brain that drives breathing or the person's physical build or their weight is causing what's called an obstructive apnea in other words that when a person lies down and they're sort of tucked in like that at night all of the tissues around here um and the soft pallet at the back of the mouth and the tongue going backwards into the mouth all of those things uh obstruct uh the breathing process there's some implication that it's associated with bipolar disorder uh there's a recent study and until it's replicated I wouldn't go so far as to say it that as many as 50% of people allegedly have this tendency now the dos and don'ts number one know your illness it is yours acknowledge it understandably people go to all sorts of lengths to deny it to themselves uh denying well it won't be that bad if I don't take lithium therefore my illness isn't that bad uh uh people will use all sorts of other words to describe uh or terms to describe their symptoms and their condition and won't necessarily be bipolar disorder again it's understandable but there's a sort of a lack of uh Truth uh in that see it's not so much necessarily how the person dialogues with the world around them about it but it also means that they're actually hiding the the facts from themselves um illness is a hard thing to cope with managing it is a hard thing to cope with with the but the biggest thing uh for many many people with bipolar disorder is recognizing it and accepting it from what it is so that you can give it a decent battle and and overcome it so um so acknowledging it just means talking to people letting people know about it in the family bringing the family on board so that they have an understanding of what it is because they can help and be supportive to say it's nothing to do with them as none of their business is not really um going to be terribly helpful because you are tied to them whether you like it or not by your emotions and when emotions get Disturbed it's bound to affect the relationships in the family um so know the signs and symptoms get emotional support from family people you're close to confide in somebody um and if you have the courage to do it uh go to a support group because they're fantastic at helping people uh realize that they're not alone that it is something that can be treated and that they can also help others so in other words no matter how bad you are there's somebody always worth and um that helps all around but time and time again in the aware support groups no matter where they're held no matter what age of people go to it you find it's the same thing people go because they realize when they do they're not alone to they see others with the same condition three other people can help them four they can help others and every survey a where is done that's always the stuff that comes up very simple very straightforward but extremely extremely effective now the next thing is spotting the illness there are three ways you can spot the illness or the highs in particular because see most people recognize depression although some don't particularly men they'll uh say it's the flu or whatever the virus or um so the ordinary signs and symptoms that we've mentioned in other words sleep disturbance energy disturbance the festival symptoms that I've listed the second one is um what one would call personal Signs Now what a personal sign is this that when a person is high or low they will do things that's characteristic of them at that time that they don't actually uh spot themselves and it's very important that uh and the family will frequently know what that sign or symptom is so I gave you one earlier on John who never smokes only smokes when he's going high somebody else will wear an an item of clothing somebody else will want to uh um so an acre of potatoes um somebody else will want to travel to China nothing wrong with any of those things in their own right that's not the point the point is the person isn't thinking about that H every day of their lives it's just when their mood is up okay and the family begin to recognize that and they can use that information to try and help the person um spot the high relatives can see High is um just by the way a person holds their head the loudness of their voice their tone on the phone whatever it may be the person who's depressed will generally spot their depression first so what you need eventually is to appoint a spotter and what a spotter is um a support group members came up with this term um is somebody who you trust to help you identify when your mood changes in other words if somebody's going a bit high that they have somebody there who will gently tap them on the shoulder and say um maybe your mood is up a bit do you think we might need to go and see the doctor the purpose behind that is that if you can spot a high quickly it can be dealt with uh within a matter of hours if it's let run and the person is at Full Tilt by the time they go and get help for it where they're not getting any sleep at night they've been off work they've been disruptive um in what they're doing um the result is that uh major damage is done so the purpose behind all of this process is really the dos and don'ts is about good management and preventing complications see bipolar disorder eventually settles down but there mightn't be much left in life in relationships and incomes and so on by the time it's settled number six is tablets know them and that means the names side effects dosages so on tablet box get a tablet box it's impossible to remember whether you've taken a tablet that day uh number seven alcohol know your limits uh if you can't keep to your limits I.E uh a Max of two drinks at any one time maybe it's best to be thinking to be without it uh to watch out for things like coffee and so forth in other words if a person finds when they take coffee uh Beyond a certain amount it has uh quite um a buzz effect for them or it's keeping them awake at night well then they're on too much in other words keep cutting it down until that's no longer happening um and the final thing I'm going to mention is deal with hurt in the course of a depression or Elation particularly an Elation people will do or say things that are extremely upsetting to others particularly close family members uh when the person goes to hospital or whatever and the whole thing settles down uh the person who's unwell is embarrassed about it and wants doesn't want to hear about it the next of K says oh well he was unwell or she was Ill or whatever it may be and they don't want to bring it up but what happens then is all that hurt gets swept under the carpet and when it does that's okay maybe once off but that pattern of behavior will be repeated each time the person relapses and uh eventually suddenly that relationship ends the important thing is that a person stops and deals with the hurts they've called caused others it may mean it means going to the individual concerned and say look I called you uh during that uh I I did such and such in the house I did such and such in terms of um money that was squandered and so on and it's to acknowledge that now the point of acknowledging it is twofold one is a person is less likely to repeat that pattern of behavior in the future but secondly the family member is hopefully going to express some of their annoyance at that time they may say oh no you run well don't bother forget about all that no you must allow them Express their annoyance and anger they're bound to be annoyed and they're just really um suppressing it so having that out in the open in an understanding way is important but again it must only be done when the person's mood has stabilized sometimes people want to go and do it when they're high to conclude bipolar disorder is an understandable condition um it has its dos and don'ts it has its Corners it edges um it can be a very destructive condition um but the sooner people who experience mood swings like that take uh heed of the condition and address it uh promptly and apply knowledge to it and not run from it uh the sooner their mood will be stabilized the vast majority of people who attend to the condition do get it stabilized for some for some aspects of it it settles within a matter of months for other people with Rapid Cycling mood disorder you could be waiting a couple of years between uh one thing and another getting it absolutely stabilized um many many people that I know with bipolar disorder over the past 40 years are maybe seen twice a year for for uh mood reviews uh medication reviews and so on and they get on with their lives in terms of being within their families working and being active members of society thank you

Channel: Aware

Views: 218,256

Keywords: Bipolar, Depression, Elation, Treatment, Dr. Patrick McKeon, Aware, Support

Id: HByl6pCGEps

Length: 64min 13sec (3853 seconds)

Published: Thu Jul 24 2014