Bipolar Disorder: Treatment and Preventing Relapse | Dr Patrick McKeon

the purpose of this evening's talk is to try and give you an overview of bipolar disorder what it is and how you can get your head around it as a as a concept because for many people it is a little puzzling for many people who come to talk like this or watch it on YouTube I have got to make sure that I'm not too repetitive got to change a little bit of the day presentation and always at this talk we try and introduce some you not necessarily have basic concepts about bipolar disorder but an understanding of maybe what's happening in in recent research and I'm going to start with that in the beginning because I think that as the night goes on I'll forget about one of the interesting things about bipolar disorder is that something like 46 percent of people who have recurring depression at an early stage in life go on to develop bipolar disorder if observed over a 15-year period pretty short period of time quite a big conversion from recurring depression to bipolar disorder wouldn't it be useful if we could work out which people go that way and which don't because it would have a lot of predictive worth getting to understand that particular group and to study them so one particular interesting piece of information that's come from research recently it has been that those who have recurring depression and go on to develop bipolar disorder have at the time that they have just the recurring a high level of uric acid uric acid is the component that's implicated in causing gout the painful house big toe syndrome okay so something as simple as that seems to be a very good predictor based on the research to date of those who have recurrent depression and may develop cows later or develop bipolar disorder go to the mind in a way which is maybe an interesting concept and does you're a gas is really cause bipolar disorder anyway it opens up a lot of other possibilities and something that I'm sure that if it is validated by some other studies I mean we've known for quite a long period of time that they occurrence of gout in people with bipolar disorder is quite high and first all's well that's probably related to weight gain the effects of medication generally and so on and so forth but we're talking about people who are tracked way before the develop bipolar disorder next instinct piece is in connection with why it is that if we think bipolar disorder is a highly inherited condition why is it that it doesn't show through in certain families where you'd expect it to be where there is already in a previous generation maybe a higher occurrence of bipolar disorder or why is it that when you've got identical twins where one of them has bipolar disorder that at most in the fellow twin the occurrence of bipolar disorder is about 70% and why is it that is so complex trying to understand the genetics of bipolar disorder it's probably the most complex condition to understand that in one way there's evidence that bipolar disorder is largely determined by genes but when you actually get down to the minutiae of it there's almost as if it evaporates so one of the possible explanations for this is that gene activity and the things that control gene activity is looks to be more complex and it's complex in the sense that the structure of the DNA molecule can be interfered with by other genes number one other chemicals number two and stress in a person's environment so stress and the person's life experiences at an earlier age in life may also switch ON or switch off genes in a way that and thus determine whether a person who has technically should be developing bipolar disorder we say within an identical twin set up in other words if if bipolar disorder is very significantly genetically determined you would expect if one identical twin hazard there's a very very high chance of the fellow twin having that condition and this again opens up again another pathway to possible therapeutic interventions in the future that may that we may learn ways of switching off the genetic impact coming from the original gene that is causing bipolar disorder and the final piece that I want to introduce to you is this concept of how best to treat rapid cycling mood disorder many of you will know that treating rapid cycling mood disorder is quite problematic because if you read studies ology indicates that any one particular type of treatment only works for about 30% of people who were having many many cycles of mood of a bipolar nature in the course of a year one interesting study that was published in the past few months was on looking at the role of tyro hormones in stabilizing moods we've known for a long time or at least has been in the literature for a long time that particular hormone called t3 was effective in stabilizing bipolar disorder so the thinking here is this that if you look at people who have bipolar disorder and they have an equal amount of depression in relation and they're big highs and big lows but very substantial periods of normal mood when you look at their thyroid hormone it's quite normal it's bang in the middle if you look at people who have a lot of highs often their thyroid function is right up at the upper limit of normal and then people who have rapid cycling mood disorders tend to have hormone profiles that are at the lower end of the normal range or slightly below that again okay so why was that happening is that secondary to the mood itself in other words if a person is having a lot of depression does that in turn mean that their old high roid system and endocrine system is a bit dampened down well while we don't understand exactly what's happening there what is emerging is that thyroid hormone can be useful for us so this study looked at if you have people with rapid cycling mood disorder and divide them up into three groups one a group that are given they're not well they're all given their usual treatment and the add-on treatment for these three groups is t4 for one group t3 for the second group and the other a placebo and it shows that people who are given t4 which is the main thyroid hormone that the thyroid gland excretes they have fewer days in depression and fewer episodes of depression when went on t4 and that's over a relatively short period of time so again an interesting study and it's also interesting from the point of view that heretofore we taught that t3 was probably more effective but again as with all these researchers to come out they've got to be replicated a few times before you can actually fully endorse using something like that so again it's just to show you there's there's always some work going on and that has a therapeutic point of view and trying to establish better outcomes for people with these conditions so in terms of understanding bipolar disorder what is it it's an increased rate of thinking or activity within our mind and body we have a thinking wheel within our brain it goes at a certain rate when a person is depressed in the bipolar sense it's slowed down when a person is high it's speeded up now this is crucial to the understanding of bipolar disorder and to the end and the prevention of misunderstandings of what bipolar disorder is not you see what you will find is that we can't always rely on how a person is feeling to diagnose bipolar disorder or even that we say the depression of bipolar disorder you might think if somebody says well I'm depressed and there the history of bipolar disorder well that must mean they're currently depressed but it's not as simple as that as you see when we look at the first night so as I say it's an alteration in the rate of psychomotor activity that's the mental and physical activity in the brain is the best way of understanding bipolar that's the core and everything else then is sort of put on as extra layers on that the person's personality the stresses they're under and so forth so what happens in depression is that this thinking wheel is slowed down and a few things happen then from that one is the most important thing is the person has difficulty projecting things onto the visual display unit in their mind we all have a visual display unison or mind we take it for granted when you mention it to people and say what are you on about well what are you doing tomorrow what are you doing next weekend images when you ask that question show up in your mind and you talk to them of them that's what we that's how we have our mind focus but the point is that when this wheel is rotating very slowly it can't get the thought upon to this visual display unit now two things happen with that is one when you ask the person how is the future let's say there is no future or it's bleak or it's blank just the words they use and consequent to that is the person has diminished energy because energy is a figment of our imagination if we can get a picture up there that we want to chase we'll have energy if we don't have a picture there we don't have energy the next thing that happens is that with this law inking we the person's thinking is very much focused on the past and on the negative aspects of the past the pains the upsets of early life misty's that the person may think they've engaged in but very often quite trivial ones but in the depressed state the person thinks of them in a very negative way and the next point is that with this load thinking wheel the person is difficulty concentrating because to absorb information our brain has to be going to a certain rage if it's slowed down we just can't suck up that information whether it's a string of phone numbers were given or a person's address or anything we read and the other point then is that the person's mental and physical awareness is shrunk its introspective so the person becomes more self-conscious and as as as sort of a social level where they make filled conspicuous awkward uncomfortable in social situations but also in that introverted state they're very aware of their body see normally we are outside we're thinking ahead all the time we're thinking up here but our thinking goes this way and introspective during a depressed state the opposite happens then during elation with this thinking will now been speeded up the person's thinking is into the future and there are plenty of things on the visual display unit the person's mind hopping from one to the other and it's much less about the past and initially the person with this speeded up wheel they can concentrate much better and as the wheel gets faster and faster their concentration then becomes impaired because their mind is going so quickly that as you're even talking to the person you can see their eyes flicking back and forth which is a reflection of the amount of thinking whereas when somebody is depressed they're vacant they're staring into space and you feel almost disconnected from them in that step in that state the other point then just to show the symmetry of this is that the thinking is extrovert rather than being introvert the person now is much less self-conscious in fact one of the things a person will say when they're mildly later I wish I was always as comforted as this in other words things just bounce off them and often then at a physical level the person is unaware of aches and pains if they have maybe asthma or a cardiac condition or something like that they will often go through the brain the pain barrier and not be affected by these things and often then cause damage to their physical being so again these are just the main symptoms which are not going to labor on but being down low depressed and remember that often the first symptom of at a feeling level in depression is anxiousness stroke panic because often in the lowest grades of depression its anxiousness is more to the fore the most common symptoms though in bipolar depression is tiredness feeling drained flattened leaden the person sleep is over sleeping or napping and are napping by day and early morning waking typically people with depression of bipolar disorder they don't have trouble getting to sleep the person's thinking is slowed down poor concentration and the thoughts are negative so the person has reduced interest in food works xtv their usual pursuits and then a lack of interest in themselves as well which we look on as self-esteem issues self-worth and so much so that the person may feel worthless or at the very far extreme feeling evil or wicked or damned always with depression there's an element of tightness in the body and those muscle that muscle tightness can cause almost any symptom you want from headache chest pains back pains bow lake pains in the years because every part of the body actually has I'm also stitched in there someplace even within we say the bile duct or ducts from the pancreas planned or whatever and so sometimes you find people when depressed have the weirdest physical but they can use that as a spotting technique because almost every time they get depressed it'll be the same pain that will come to give them an early warning symptom of where they're stuck at and finally then not wanting to live where the person sees the future as bleak blank and they have suicidal thoughts then inhalation never felt better great totally free of anxiety their energy is boundless despite maybe less sleep they typically have trouble getting to sleep or wakening within 2 or 3 hours of getting to sleep and at the same time not feeling tired the next day a reduced need for sleep the person is aware maybe of having rapid thoughts over talkativeness and a restless mind and in terms of interests everything excites the person everything listens be it sex religion politics or whatever your addiction is the value of the person puts on themselves is they're often very highly confident at one level right up to the far extreme of feeling having grandiose thoughts about their abilities and as I said very often in terms of aches and pains the person is relatively unaware of these things so that they break through stiffness and breathlessness but often damages their bodies indirectly in that way and typically the person has a feeling in ordinary elation that they're going to live forever now in terms of the types of depression or bipolar disorder bipolar one is where the high side the manic side is much it's quite extreme and as frequently in DES camp I would be defined as bad enough to land the person in hospital and it's typically followed by a depression and the person can be well for a months two years later probably the rate keeps varying but something like anything from 70 to 90% of people who have a one-off episode like this will have a recurrence next then is bipolar two are sure to say sorry unipolar mania now many people don't really recognize this as a phenomenon in its own right but frequently people who have the onset of bipolar disorder at an early age in life they will have just manic episodes only they may have a little dip in mood like this that they'll describe as tartness but it's not sufficient to be called depression and shouldn't be treated as depression because that it's self-righting of its own accord as you'll see in a moment there's a particular reason why we need to recognize unipolar mania and then we have bipolar - and here and bipolar - the highs are less severe in fact you may not the doctor may not be aware of it nor the patient and sometimes the families aren't even aware of it until you ask ask them to tabulate the person's mood over a few weeks or a few months so the person may come in with the history of recurring depressions no I never get high but until you actually describe the more subtle aspects of hi and they begin to documented it's only then that they realize yes that's been happening and again to distinguish it from rapid cycling the person is often well four months in between times then bipolar three is basically I'm going to abbreviate it like this it's bipolar 2 I generally mild eyes but it's triggered by substances including antidepressants steroids alcohol substances of one sort or another in other words if the person didn't wasn't on those substances are wasn't triggered by those they wouldn't get the bipolar episode at that point in time we've we we don't know for example suppose and they got by that point in time will they bipolar disorder at a later stage just come out of its own accord the answer is probably yes but we can't really prove that now rapid cycling bipolar disorder is where a person has four or more highs and lows in the course figure it's an arbitrary thing because you have to have to be diagnosed as depression using research tools you have to have the depression for two weeks as a minimum and the high must be either four days for hypomania or a full week for mania so when you divide that into 56 you begin to work out that you there's a limit to the number of rapid cycling in the year according to the formal way of looking at these things but in fact there are people whose mood will vary every few hours on and on and on there will be other people who are high for maybe a week down for a week and back into the high again and articles so it merges with what we call continuous cycling where there's no let-up in between the final piece is with mixed mood state and this is where the person has what we call a dysphoric high it's several names on this thing as where the person has what we call a non Pleasant high or dysphoric hypomania or that's formally called in the literature and mixed mood station okay so I'm giving it a fuzzy edge just to distinguish it so the point about this is that where is in the in the formal literature that you how's it mixed mood stage is only in relationship to depression and elation but in fact you meet people who have mania that is mimicked by depression anxiety agitation or paranoid states okay so what you've got to come back to then is what is the core of bipolar disorder the core of bipolar disorder is alternating episodes of overactivity of the brain and under activity of the brain relative to what's the normal rate of activity for that person okay so whether they tell you that they're experiencing depression anxiety agitation or paranoid state it's kind of almost irrelevant to the diagnosis but so the core aspect of the condition is what what one has got to focus on so in other words just because you've concluded that the person has we say an anxiety stage the next question is within that anxiety cluster of symptoms is there a driven s about the person is the person very over talkative have they're very marked trouble getting to sleep at night do they jump from one topic of conversation to another have their tremendous energy despite all their complaints of anxiety how much work are they getting through are they getting into conflict with people is there an element of anger there is there so within within an anxiety you've got to see is there within that a driven as' that is more in keeping with a bipolar phenomenon than anything else does that make sense and it's the same then with depression agitation in paranoid states so what this circle or two circles here is to represent the similarity and symptoms between the dysphoric hypomania and depression they overlap with one another almost 100% sometime that's it so it's generally very difficult for people who are even in experienced sufferers if I put it that way of bipolar disorder to distinguish dysphoria or an unpleasant high from depression but the characteristics that are worth looking at is one if the person is complaining of depression question do they have trouble getting to sleep at night do they feel worse in the evenings because depression typically feels worse in the mornings is there anger or irritability as part of their condition anger or irritability is not part of depression in an ordinary sense now yes there are plenty of people who are angry and depressed at the same time but one has got to work out and quit which is the driver here and we penis not going to make too much of we penis but it's just to remind you it is not a key thing but within the context of depression most people who are actually significantly depressed with the bipolar in this actually can't cry the might of the depression is very mild so the biggest part the biggest of who could see in diagnosing bipolar disorder it's it's it's it's very straightforward in many respects when you look at the typical symptoms but a myriad of different conditions many many conditions can have a bipolar component and the reason why it's so important to identify that take for example if somebody complains of depression and you accept it at face value there is depression but in fact it's an unpleasant hi and you treat that with an antidepressant you're going to worsen the condition likewise with anxiety if you start treating somebody with anxiety with CBT and their eye at the same time it's not going to cut it in the eyes even a minor tranquilizer if you give it to somebody who has ordinary anxious anxiousness is general anxiety it would be helped in the short term with a minor tranquilizer but on the other hand with more sip if there's an underlying bipolar component causing that symptom of anxiousness and a minor tranquilizer just won't work so I'm not going to labor on the genes and environment other than just to point out briefly there's for bipolar disorder it's known that something like 70% of the contribution to bipolar disorder is genetics and the other 30% is environment now by environment we mean things like substances alcohol bangs on the head brain tumors MS sex hormones big hormonal changes in a person's life but it's not straightforward in the sense that that's the average 70/30 but for some people it might be 10% genetic in 90% environment or 30% genetic and 70 and so on but the point is when you talk them all up that's what the average is and then the problem comes well where is the genome why can't we find it we don't have the answer to that but it doesn't mean that it hasn't and genetic effect what's becoming evident is that it's multiple genes each having a small effect is the problem now you've got that in diabetes as well but it's been possible to unpick those genes and work out exactly what's going on but now for bipolar disorder so just to remind you again of some of the environmental factors it's generally stress as stimulants in other words when we're confronted by a situation or something goes wrong in life we get into a wound up stage as a way of dealing with it and it's that of phenomenon then landing on somebody's head who is prone to been able to go up into seven to the rate or 10th or 12th gear wears other people cutoff it with a fifth gear they can't go beyond that there's a lot the sort of a block by within their system that stops them going up and up and up in terms of mental activity but it's at that point so for example a bereavement may do because the person might get wound up and I adjutant angry that's what's happened and so on and for some people that that were triggers so that's where how stress seems to be an issue there and then the substances are steroids and hormones because most we say sex hormones have a steroidal like effect antidepressants adrenaline and certain parkinsonian drugs alcohol and street drugs initially yes anxiety reducing but for many people they will elevate mood so what happens is these substances all of them give you an upswing in mood and then a downswing but very often the upswing has missed nobody observes it and the person is just complaining of being depressed it's not not picked up and then the environmental factors that are just worth looking at moving toward through time zones and changes of seasons infections and immune activation including a fever so you will see some people who every time they go high it's associated with an infection maybe some known people who have had recurring you need tract urinary tract infections and that for some people just simply being put on a preventative antibiotic stops the the rapid cycling for that person now they're I won't say they're absolutely typical but if you if you look at simple things like when a person gets a virus frequently that causes mental agitation and then when the mental agitation is over the person is lethargic and tired and we say in something like viral hepatitis or infectious mononucleosis many viral things it's very recognized that there is this biphasic aspect so there's something within the viral phenomenon or the body's immune system reacting to it that seems to trigger so this may be frequently when we relax go on holidays our immune system sits on the floor and when we're active and engaged and really going full-throttle were less prone to infections and there's some link between that and bipolar disorder you will often see people for example who might be very unwell mentally hospitalized to get an infection and their mental state improves like that overnight when the infection is sorter to go back into that state again so there is a very close relationship some people wouldn't maintained don't know there's enough proof of a jet that the pollen count at certain times the year is the reason why the seasonal variation of mood in other words they don't really accept that it's related to the amount of daylight and so on but that it may be associated with exposure to pollen in the air then things like pain sunburn and so on they work by disrupting a person's sleep if somebody has a history of bipolar disorder and they want to get a mood disturbance also got to do is not go to sleep for a night or two and they're off so in other words that sort of sleep disturbance nice work shifts travelled through time zones they all work on that principle of disrupting the sleep so when people go abroad to the zone on holidays you have a lot of factors coming into play both in terms of going going through time zones sunburn pain alcohol and you won't mention it now and then the physical and brain tumors multiple sclerosis concussion can lead to mood disturbance now just again to remind you how bipolar one disorder is and we just now want to look at the treatment of these different conditions so for people where it's mild sometimes lithium can be a useful tool but more often wasps will tend to be used if it's a mild episode is that one of these compounds the antimanic agents because they can be used in a low dose while one is waiting and seeing is this a more severe episode of elation or mania if it does become more severe and very often lithium is the best treatment because it's more predictable in ending the episode of mania within a defined period of time whereas frequently one gets the impression that some other compounds such as the what we'll call the antipsychotic agents they often take the the top of the aeration but frequently underneath it a lot of the behavioral disturbances sociated with the elation maybe something like overspending still continuous despite the apparent improvement in the person's mood state and then for more severe episodes frequently the antimanic are also what are called antipsychotic agents such as Allen's being to type in a missile pride and so on they need to be used before commencing the lithium just to try and settle the person down a little bit the management of the depression of bipolar one disorder the important thing is just to treat the depression as gently as you can because what you're trying to do is get the person out of the depression without kick-starting a high on the other hand you can't ignore the depression and wait for for them to recover so something like lamotrigine is gentle and quite an effective antidepressant the other ones that are useful are carbamazepine and ox karbas in there both tegretol and trial aptril which you may know them as and they do have in low doses a good antidepressant effect and then if you have to go the next step to a low dose of a standard antidepressant now so medication in terms of preventing the bipolar circuit didn't the nature of bipolar disorder is that it is a recurring condition there may be certain circumstances where it's going to be there as a one-off episode but that would be may be related to very often an environmental factor that is not the person isn't going to be exposed to again maybe the street drugs or a very excessive intake of alcohol or a head injury or something that one can't really say with certainty that there's going to be a recurrence so this is why preventative approaches are necessary and lithium is generally seen as the best preventative agent in terms of having lesser side effects than many other medications but it does need to be monitored carefully it's not without its problems but for most people if precautions are taken and the team and related blood tests are carried out it's a very effective treatment again in terms of preventing relapse things like carbamazepine rocks compazine or lamotrigine in low doses can be helpful so what you may find is for example somebody was on lithium that they're no longer getting the manic episodes but they're still getting depressions but the depressions are milder and less prolonged and very often some one of these other compounds can be useful so again it's just to make the point that carbamazepine and Knox compazine whereas their good mood stabilizing agents in lordose they do have an antidepressant effect and then other mood stabilizing agents are sodium valproate appealing to Perimeter or chocolate topamax and then the antipsychotic agents so unipolar mania the reason why I think it deserves a space on its own is for this reason that lithium only prevents recurrences in about 40% of instances if you add carbamazepine or compazine or any of the other agents to it it will bring that up to maybe 60% but you're still 40% shorter and for prevention for a lot of people and in those instances it's often necessary to use one of the antipsychotic agents with it now in terms of unipolar mania what often happens is that at a later stage in that person's life their high mood occurring on its own changes to highs and lows okay so again it shows you that how the brain responds to chemistry chemical changes within it both in terms of responding to different medications changes over the decades for bipolar 2 how do you prevent that in other words this is where you've got a high a mild high and a low with periods of wellness of months in between and the aim again is basically write throughout all of this is to deal with the elation first you have to get on top of that don't get up on top of that you're you're not going to get anywhere and in these instances what's been found is the things that work best are the anticonvulsant mood stabilizers so initially what you got to do is if the person is having frequent relapses is to reduce or discontinue the entity presence because they can be driving the elation and then the second point is using the anti epileptic mood stabilizers they are Carver's Enochs Carver's in sodium valproate and then the third line would be using one of the antipsychotic agents and it's often it's going through definite trials of that because we have no way of predicting who's going to respond to our and I'm putting them in the order of the ones that are sort of these side effects less interventionist and so in other words you'd have less side effects with just simply reducing the antidepressants and then the anticonvulsant mood stabilizers will be less problematic than using things like olanzapine and so forth and bipolar three again just reminding you bipolar three is basically bipolar two that's been triggered by substances so the first thing is to slow pace out the antidepressant slowly or whatever agent is triggering the thing and to use the mood stabilizers as we did with bipolar 2 and then for rapid cycling problems you've often got to look at why they happen and you can divide them into two categories I think one is where they right from the onset they are rapid cycling they want and then there are other people where the rapid cycling is an extension of bipolar - in other words but as the years go by the interval between the cycles the episodes is getting shorter and shorter and shorter so somebody might have started with unipolar depression just having high lows and then after a number of years they might move to bipolar - and then into the middle years it's often rapid cycling now why that happens it's not too clear there are case reports of people who've never had any mood stabilizer or antidepressant occasion you meet a patient who might present for the first time in their 60s for example with a rapid cycling pattern and they will describe having episodes of depression and then maybe small highs and then rapid cycling evolving in that way but coming on in the middle years and that's probably related to the way the brain responds differently to the hormonal changes that happen what do I mean by hormonal changes how the whole dopamine and noradrenalin and serotonin systems go in the brain and how they are affected by changes in sex hormones is often quite dramatic so you will often find for example if you use antidepressants in teenagers it often has a very agitating effect on them and they're generally and no no if at all possible in people in their teens because they can make them extremely agitated likewise in later you might have somebody who's going through their life and they're fine on a certain dose of an antidepressant no problems year in year out and then they come to the middle years and they get agitated on that same dose of antidepressant so it has to be reduced so it's a reflection of how the brain is able to cope with their antidepressant at that point in time and it's the same with any any substance sex hormones steroids alcohol and so forth a person's brain tolerance for these substances will vary with the years so so as I said there the second group of people are people who develop it from the certain jewels in hormones at certain phases post nationally midlife hormonal changes for both men and women remover removal of ovaries steroids or thyroid deficiencies and as I said after years of wellness on antidepressants the person can begin cycling so in terms of prevention of relapse in rapid cycling it's again phase out the antidepressants use the anticonvulsant mood stabilizers whereas lithium doesn't isn't highly effective here it still will work perfectly well for about 30% of people but that's the same type of response rate that you get from any one of the treatments in rapid cycling mood disorder but it's not that it's not the same 30 present but generally in most instances with rapid cycling mood disorder you will get a solution but it can often take quite a while because you got to put the person through a trial of each one for a period of time not days or weeks generally months before you can determine whether it's working because rapid cycling is a bouncing ball phenomenon and it takes a while to say oh it's beginning to Peter option it's not something that you're necessarily going to see happening overnight so what can you do in terms of preventing relapse one of the thing that's looked on these days is trying to help people to have a sort of a sense of mindfulness using exercise using yoga anything that has a calming effect because there's no doubt about it that anxiety or anything that is a threat to a person will activate the brain and for most of us when were activated in that way it's generally a productive thing but for somebody who was kinda inclined as I said to go into very high gears in response to that and Kickstarter high that's a problem so these are just some of the techniques that are used from things such as I'm not going to go through these in detail but mindfulness learning to tolerate to stress been aware of thoughts and emotions validating your emotions in other words when you feel anxious or you have a certain view on something how true is that if it's upsetting you what is that about is there evidence for it or not resisting our urge to fuel our just that fuel relation for example watching certain things that are going to have an emotional upset on you using things like alcohol and so forth and using sort of a wise mind approach where we take into account our thoughts and feelings about things in in a balanced way and then learning to what they call radical acceptance but that's really knowing when to let go of something and not keep wrestling with it so dealing with addictive behaviors alcohol drugs gambling sex food because again there is a connection between the genetics of bipolar disorder and some of the addictions that happen and they do overlap and all of those substances are mood altering dealing with anxiety social anxiety and panic we know that something like 50% of people have comorbid anxiety problems general anxiety OCD panic disorder social anxiety and they need to be treated once the the bigger picture of the bipolar illness has been contained and sorting out relationships that have been affected by the illness is important in terms of preventing relapses so what can you do now well first thing is to acknowledge the illness don't reject it it's a it's a real phenomenon I notice a tendency to change the name of the condition give you finish tech names to it and so forth and that that's okay one understands why that's a problem for people but we need to be careful that we don't disown it totally because if you don't face a condition like this and get to understand it and understand it the mechanisms behind it and how they relate to you it's it's hard to do you know there so getting to know it and how to overcome it and despite what we know about CBT and psychotherapies and different types of interventions mindfulness all of those may be helpful in preventing episodes but when it comes to treatment there's no evidence that any of them are work if the person's mood is significantly disturbed either in a depressed way or a manic way there is no literature that will give the support to that type of you not knocking those interventions they are important and if they do help keep keep of calm and keep them in a relatively anxious free stage the chances of relapse is significant lessened significantly lessened acknowledge the effect of the illness on relationships and other words encourage your family to get support to attend things like aware support groups and for you to do likewise the key thing in terms of managing relapse is being able to spot the relapse if you can spot an emerging elation and nip it in the bud it's not a problem patients should be encouraged to do that and there are three ways you can do it if the ordinary signs and symptoms and they're quite good for spotting depressions spotting many of the symptoms of elation but not necessary by any means all of them when you go if you're attending a doctor with bipolar disorder and you report between your visits how your mood has been in terms of depression and elation and what's what research is showing is that about 26% of the days that a person has being depressed are reported to the doctor at the visit the rest isn't and only about 17% of the high days are sponsorship so that how what a person reports at the session is determined by their mood on that day or two or three days beforehand not for the previous week not for the previous month after at the previous six months so in terms of the clinician getting a good handle on what the pattern of the mood is and how much intervention is needed and that will become I think a key aspect of preventing relapse is using some sort of daily monitoring then when people get high or low they often do things that are characteristic and this becomes important when somebody is high some people for example will dress in a particular way or take an interest in certain films or music or whatever where certain pull over that there wouldn't be seen dead in at any other time and the family spot that and it's it's useful or sometimes that particular patient spots or - and they no longer wear pullovers but the point is it is useful it is useful indicator but the ultimate way is appointing a spotter and this is a term derived by aware support support group members and it's to indicate the necessity to engage a family member because family members can spot an elation at mile they can spot it by the way a person holds the red the tone of their voice what they're talking about whereas the clinician won't spotted that quickly unless they know the person extremely well but they still won't spotted that quickly because of the formality of a clinical session okay sometimes you'd see people who come along here for admission in the admission office you sort of wonder well why would they revert into hospital there's nothing much wrong with them and ten minutes later you could see them on the ward and you see they're really quite a later so what we advise is that the person who is unwell once their mood settles that they pick a family member or somebody whose judgement they trusted to tell them at a time they think they're high that the mood has shifted that they need to get help but it also extends to you've got to take the car keys away from me take away my credit cards whatever you think is necessary even if that means bringing me to hospital and making sure that I get in there and get treatment that's an improve an invasion of somebody's privacy and their independence and so on yeah well that's the choice either let bipolar rule your life or somebody you trust so and it's it works extremely well because it's very clear that the amount of time people spend on well in hospital out of work out of their families and so on is dramatically reduced by using that process and this is this goes hand in hand with ice and pour this water is arranging an emergency supply of medication with your doctor that will enable you to adjust your medication to sort of get on top of the thing immediately rather than even even waiting a day or to know the triggers alcohol coffee lifestyle issues be aware of the daily lifestyle list in other words having a structure today and a structure as structured existence and finally to talk over the hurts that you've gone through in life so in in summary yes you can overcome bipolar disorder but you've got to know a lot of it makes sense a lot of it is sensible lot of unknowns that's for sure still waiting for the really big breakthroughs in treatment treatment is not by and large the big issue the big issue is the interval between the onset of the condition it been diagnosed correctly and the law the length of time it takes then to finally get the things stabilized so during that time in a person's life a lot of things can go wrong relationships end work goes astray people fall out of education get get into difficulty with the law and that's a lot of pain and suffering for the person and their families and that's where a lot that they are focuses on these days in terms of how can we help people are supposed to help themselves because in many ways the amount of detailed monitoring of mood when people are on well needs to be at the level that is readily available for people with diabetes the similarities are very much significant we still don we still haven't found the glucose in the system for as it were bipolar disorder and I wouldn't be is brush to suggest that it's uric acid but who knows thank you you

Channel: Aware

Views: 60,687

Keywords: bipolar disorder, mental health, depression, mania, treatment, preventing relapse, aware

Id: LCeLKT2SFQo

Length: 60min 51sec (3651 seconds)

Published: Wed Feb 06 2019