Bipolar Moods: Treatment and Preventing Relapse | Dr Patrick McKeon

thank you for the invitation to speak at the aware lecture for November tells my pleasure to address this meeting anything I know about bipolar disorder I've learned from people with the condition and their families some hard learn lessons but there you go to say they're the best lessons of all the lecture is very much going to funk focus on what I believe are the core aspects of bipolar disorder and its management because it's very easy to get lost in the sea of information about depression and bipolar my main focus is really on trying to give a core understanding of the key features that make up this condition unconscious is the fact that many people here this evening will be coming to a lecture like this for the first time so one of the aspects of trying to understand the prevention and treatment of bipolar disorder will be understanding the condition itself what it is what the signs and symptoms are and what we focus on now on this slide is the core aspect of heart bipolar disorder is about it's a disturbance of the rate of activity of our thinking and our motor function in the head going too fast or too slow or the body going too fast or too slow it's incidental that the person might feel depressed or agitators or distressed or anxious you've got to keep your eye on the ball and the ball in this instance is is the process speeded up or is it slowed down because that's really the key thing a lot of other symptoms get spun off from this hyperactive or overactive mind or slowdown mind and they're important but the point is you can be quite distracted by anxiety that's driven by an underlying manic episode or hypomanic episode manic the word itself means speeded up depression actually means slowed down it's not it's it exists as a phenomenon of activity actually not a mood state in the way we understand it today in other words I'm feeling depressed the use of the word depression in that sense is a relatively new thing in the history of mankind you go back to the original Greek description of the word depression it means slow down and mania means speeded up so there you go it's in the words if we only understood them so it's it's it's been able to see that as the key thing and that all the other symptoms emerge from that so here we have a thinking wheel in somebody who is depressed so it's slow down and that's the key thing now what happens with that slow down thinking is the person is less to say there's less thoughts on their mind they have less thoughts that they can project onto the visual display unit in their mind such that there's nothing there there is no future it's empty it's bleak it's blank and because there's nothing on that visual display unit there's nothing to pursue in life and that's where the lack of energy comes from so energy in that sense is a figment of our imagination the thinking is also into the past and a dominates the past see normally when were well we look in the past in the good old days now and every for every era it's different the good old days people look back at less traffic on the road people more polite people satisfied with less in life and so on but there are thousand one awful other things like TB being rampant unemployment being out early to control immigration being a major major problem worse than we've seen in in our lifetimes when people get depressed the focus on the past is on the negative side of things and people will often say well look the reason I'm depressed is because of this thing in my childhood but frequently when that person comes out of depression it's all gone they forget about that particular aspect of their past and it's not just that they're repressing it is just not there as a phenomenon annoying the person and upsetting them so when a person's psychomotor activity is speeded up the thinking now is thrown into the future there are a thousand and one things up on the visual display unit of a positive nature in the person's mind and they hop from one grandiose thought to another often not realizing that that's basically what's happening initially that improves the person's concentration but as the whizzing in the brain gets worse and worse the person loses their concentration and has difficulty functioning there a great sense of the future of great energy reduced need for sleep and so on so if we just look at these things in a more ordered way you will see there's a whole platter of symptoms of depression but they all come back to the core thing of how quickly or how slowly the person's rate of thinking is because the key that the earliest symptom to occur in depression is generally reduced energy anxiousness loss of confidence and eventually maybe feeling low or down then tiredness flattened leaden over sleeping reduced the sleep at night and sleeping very often by day the thinking is slow down with the result that the person has as I said reduced concentration and thinking a loss of interest in everything in every phase of the person's life the person has no value upon themselves starting with low self-esteem which gets worse and worse I may end up in the far end of the extreme where the person feels hopeless useless worthless evil the person when depressed generally would have a tautness or a tightness in their muscles because of the tension in their body and this causes headache chest ache back pain even bowel disturbance and so forth because there almost isn't one part of the body that doesn't have a muscle attached to it from the heart to the bile duct to the bile pancreatic glands to the middle ear you name it and it will often produce a wide array of symptoms that can seem bizarre I've known plenty people who for the first symptom they always got was a headache for other people a backache and so forth and they got to know that in the context of their depression but could you diagnose depression just on that no you've got to go back again to the slowing down of the rate of mental and physical activity the direct opposite then happens during inhalation the person's mind is speeded up they feel great typical statement I've never felt better free of anxiety boundless energy reduced need for sleep trouble getting to sleep and this is an important one frequently people overlook this key symptom of a mood disturbance trouble getting to sleep at night if somebody is depressed and they've trouble getting to sleep at night the most important thing to look out there is the trouble getting to sleep it because that's directly related generally to the mind being too active now I'm not saying people wouldn't have trouble getting to sleep if they're anxious but you'd have to work out what it is the ranch is about were they always anxious over the years when there were anxious did they typically have trouble getting to sleep so you've got to sort of factor that in but for most people who are depressed and have trouble getting to sleep at night their psychomotor phenomenon is overactive therefore you've got to question what's the primary thing there is a depression or is it that the mind is too active and that's the core issue so the thinking is rapid the person's over talkative their mind is restless and the final clutter of ones are everything excites the person everything glistens Markel's the person is highly confident right up to having grandiose delusions another key phenomenon is the person is relatively unaware of pain or any physical distress so somebody with bronchitis or asthma will often behave as if they weren't distressed in that way and injured themselves as a result in other words to make their respiratory function and suffer even more so and finally often the person in these states has a sense that they're going to live forever so let's now move on and look at some of the subtypes because these subtypes these are terms you're going to run across no matter what you read in this area and it's just to give you a brief understanding of it so what we're looking at is these subtypes are determined by how frequently and how big the elations are are the hyperactivity of the mind bipolar one bipolar 2 bipolar 3 and a brief mention of bipolar for bipolar 1 is where a person has a big high that lasts months and in days gone by it would be defined as bad enough to warrant hospitalization so it's a big high it's not somebody who's slightly over talkative and so on it's it's it's it's quite a significant thing now for many people that is followed after a period of time of days weeks or months by hello that and they maybe then well for weeks to months to years afterwards as you know one of the big emphasises on treating bipolar disorder is because it's a recurring condition prevention becomes a big thing so if you have a one-off episode of a high how likely are you together again if it was only a one-off episode we wouldn't be talking about prevention the reality of it is that the vast majority of people who have worn high how further ones when I started off in psychiatry it used to be said it was 50/50 then it was 60 percent 70 80 now it's in the 90s when people do surveys of people who have a one-off high and follow them up over a period of time the vast majority have recurrences and that's why the emphasis of the management of bipolar disorder has to be on prevention another one is what's called unipolar mania unipolar because it's really only got one pole it has a slight little bit of a dip here and the person will tell you they feel tired it doesn't really go on to a full-blown depression but it's quite mild frequently people who get that they gather there's a younger age in light and if the thing is left untreated and they have recurrences later in life they have the high but the bigger laws then begin to become more evident but it's very important obviously that that little bit isn't treated with for example antidepressants it's to try and deal with the big high again next is bipolar - what's the difference between the two bipolar 1 and bipolar 2 in bipolar 2 the person has very mild highs something that lasts maybe slightly more than four days but it's also accompanied by our alternates with periods of depression that by definition have to last two weeks a person's family may very be very aware of that but maybe people at work might say oh he's in great form today so it depends on how well the person is known to you whether you're going to spot that or not now bipolar three is where the person has a either bipolar one phenomenon or a bipolar two phenomenon more typically where they're triggered by antidepressant steroids ECT alcohol so anything that in that way stimulates the the high bipolar four is where a person has a recurring depressive illness very discrete very definite depressions often weeks months or sometimes years in between the depressions but they have a family history of bipolar disorder why do we put it into the bipolar category I think it makes sense because frequently the person does have little highs but they're so slight they get overlooked but when you get to know the person over a number of years you can begin to see it when the family looked more carefully at errs they begin to see it not in to write home but those highs but the point is what they are indicating is that you need to treat it in the same way with mood-stabilizing medication if you just give antidepressants for that you'll actually worsen the cyclical phenomenon now next is rapid cycling bipolar to mood disorder this is where a person has four or more cycles of mood in here and a cycle is a high and a low or a high only why this emerged as a sort of a subtype is simply this when researchers in the late 1960s and 1970s began to look at people who didn't respond to lithium in the great way that everyone else did who had bipolar responded to lithium they found that it was frequently people who had rapid cycling mood disorder that just didn't get stabilized with lithium now it doesn't mean that lit him doesn't work in those instances but it works much less frequently than it does for people with a recurring bipolar one disorder so it's a period of high then followed by a low a high followed by a low and very often the intervening well periods here's one over here are quite short but there are all sorts of mixtures of it and there are many different definitions about it but it's just has to be recognized as a phenomenon that is notoriously more difficult to treat not impossible but more difficult because you see what what you'll often find happens initially with people who come along with this problem they would come typically with a depression to put on an antidepressant and they seem to get well with the antidepressant initially ie took on a bit high but nobody still recognizes that as such and then they flop and then people say what happened what happened at home what happened is worth in other words it's only when the mood recurring pattern that the high followed by the law is followed over weeks to months that it becomes evident that this is a cycle that's determined by internal factors not external factors and finally we come to mix smooth States mixed in the sense that is a mixture of depression and elation or hypomania within them it's also known as unpleasant highs or dysphoric meaning just dysphoric means just an unpleasant mood vorak is mood this is this is not this hypomania okay now let's look at this a little bit because at dysphoric hypomania mimics depression anxiety agitation or paranoid ideation whatever you want okay can mimic anything but if you keep your eye on the ball and say is the person's mental state rate of thinking more active than is the normal for them not higher than average but what is normal for them so you've got to find out from the family what is the normal rate of this person's expressiveness their daring or harm avoidance or cautiousness and in that way you get a feel of what's going on so you look for the key things that indicate this now the problem is that here you've got shared symptoms while we say depression and the unpleasant hi the overlap literally 90% the symptoms that distinguish the dysphoric hypomania from depression are trouble getting sleep at night feeling worse in the evening time agitation or anger and surprisingly we penis because people typically when people have a depression of of bipolar disorders and sort of a it's a shutdown stage and people actually often can't cry and it's often only as they come up out of the depression they go through a phase of maybe anxiousness and then you might see a little bit of the the wee penis coming through but do remember when you go back and look at the original descriptions in the lacy 1890s we say to 1920 what you will find is that the users talk about depressive mania anxious mania paranoid mania in other words they recognize those as part of that frequently people come along with anxiety where they're very agitated and there's a big chunk of anger and irritability and they've trouble getting to sleep at night frequently that is a non pleasant high masquerading as anxiety now what causes a bipolar disorder well what research basically shows is that the key factor is genetic but on an average basis so if you take a large group of people thousands of people who have bipolar disorder and you work out how much of that has a genetic basis what you will find is that on average 70% of it runs in families through many generations and for the other 30% therefore it's got to be environmental but that average can be made of 10% genetic and a whopping 90% environmental or 30 percent genetic 70 percent environmental and so on okay so that for any one individual what you will find is that if they have multiple people in previous generations who have had recurring depressions or bipolar disorder it will often take little or no environmental upset or distress in their lives to tip them into overt highs and lows okay as a trigger but then you have other people who have little or no family history of bipolar moods and it takes enormous catastrophic events in their life maybe to trigger their mood upset so let's look at some of the environmental factors well the first one now is stress what stress does is when any of us are put under pressure is we try harder that's the first thing we do when we try harder if we've no block that stops us only trying so hard the mood goes high that's basically where the stress happens very often people who come and complain of being depressed you say well why what's happening in your life why did you get depressed no nothing everything is going well nice relaxed life just this came out on me out of the blue and I was surprised that it happened because 18 months ago I went through an awful time what were you doing I was doing this that and the other I was up all night I was doing okay yes they were doing that who to deal with a catastrophic situation in their family life or in their business life or both and that had them in overdrive and it's followed by the other side of the coin okay so that many depressions that appear to be triggered by events are in fact the consequences of the mind being overactive for a period of time because of pressure steroids antidepressants hormones adrenaline the dentist might put in a local anesthetic parkinsonian drugs they can all induce highs that a certain you get adrenaline like drugs in we say sign ik tablets that are used for sinuses for ear infections and block to nose and things like that alcohol and street drugs generally reduce anxiety and elevate mood and for people then who are prone to go high those substances can really inflame the thing most people might be a little bit buzzed up over with any of these substances but the point is if that person has a tendency to go high those substances then really put the mind on fire in a sense so other environmental factors that we need to be careful of is jet travel through time zones and changes of seasons many people would think that's not terribly relevant but again it's relevant to the person whose brain has a tendency towards mood problems there's no question about that often you will find if you look at admissions to hospital like this that the peak months of admissions happen to be from late October into early November and again you find the same thing in in springtime anything that disturbs sleep pain sunburn to take whatever it may be is a surefire trigger for putting a person high if you want if anyone wants to get high just don't get to sleep for a good while okay most people eventually switch off and fall asleep but somebody who is prone to by porridges or it will triggers concussion multiple sclerosis brain tumors that affect certain areas of the brain again can trigger high so that for example if somebody develops bipolar disorder and there's absolutely utterly no family history of it that's one of the things you will think about those environmental factors say you know wonder about street drugs have that has the person had a bang on the head getting an MRI scan all of these things become important in in those sort of situations so let's look at the treatment now and I'm going to focus initially on the medication end of it but that's no by no means and the whole story in terms of bipolar one disorder if it's mild very often lithium can be a very useful agent if it is recurring one of the things about using something like lithium at an early stage in somebody who has by who's had a high particularly is if they've had a couple of them is to give it at that point because what you will find is over a period of two to three weeks the person's mood will come down out of that high and then you realize that the person has had a good response to it that's the first thing but that also means generally that that person will do very well on that compound as a preventative agent as the years go by one of the things about lithium is that once it works it doesn't done work for a first episode where it's relative mild again something like sodium valproate or epilim or lands have been quit even for quicker antimanic effect where it's again used in very minut doses can quell the problem for modders episodes often lithium with an antipsychotic agent now often what an antipsychotic agents are which we preferably called an anti manic agent and these are things such as a lens being quetiapine risperidone and so forth a missile pride and soul pride what they do is they they'll often take the top off the high but they're still of grumbling sort of sort of manic type thinking they're happening beneath the medication whereas lithium and sort of quenches it in a much more definite way and often in a very black-and-white way within two weeks generally of the person been on an adequate antimanic dose of of lithium now when it's a severe mood disorder you've got to focus on the mood sleep and activity needing to be contained by an anti manic or anti psychotic agent before commencing little because the person may not be eating they may be totally chaotic not getting enough fluid and so forth so it's it's not safe using the team at that point but generally after a very short period of time the person's more overt manic behavior can be helped by an anti manic agent and then the lithium can be continued now in treating the depressive side the trick is to are the intention is to lift the mood without triggering another relation so therefore you've got to be very gentle with the antidepressants you use lamotrigine is very effective but an extremely gentle antidepressant there's very few side effects carbamazepine also known as tegretol or ox carb is een known as trilateral low doses can have an antidepressant effect and when using antidepressants generally in treating somebody in the depressed phase of bipolar one low doses of antidepressants are best now preventing lap relapses is where again most of the focus from for people who have that recurring tendency again lithium is still the treatment of first choice it works if if somebody has a a bipolar one pattern of illness where it's a high followed by a low and then a period of normal mood for months in between times lithium I believe works in about 90% of instances if you're not using lithium as a preventative agents the other ones you would look at would be the epilim tour pyramids or topamax or one of again called the antipsychotic agents olanzapine quit I've insult pride and a missile pride these compounds again what they're basically doing is focusing on quelling the high side because that's where that's where the emphasis has got to be if you want to stop a person having the depressions of bipolar disorder you can't do that until you prevent the recurrence of the highs now let's look at the treatment of unipolar mania are the prevention of it in unipolar mania lithium only works in a it's a particular study we did here in st. Patrick's a number of years ago we found that lithium only works in about forty percent of people with this pattern carbamazepine tegretol sodium valproate when added to the lithium rescues another 20% and ultimately the things that work best in this instance are the basic antimanic agents such as olanzapine quetiapine or haloperidol prevention in bipolar 2 again the emphasis has got to be on trying to prevent the person is down you they've come out of it with the help of an antidepressant and you're trying to prevent this high happening so that this law doesn't follow so the aim is to stop at the recurring elation and the depression tends to lessen of its own accord but frequently an entity present or some type of agent is needed so the first thing if somebody has a bite too poor or too problem is to endeavor to phase out the antidepressant if he can and that's particularly the case if the elation keeps occurring so you gradually then move in a mood stabilizers such as carbamazepine ox carpeting sodium valproate so you're trying to sort of have a balance between the amount of up word direction of mood from the antidepressant and trying to cap it then with the stabilizer there's a lot of tailoring then in the dosages that are required in those instances because great variation between from one person to another now bipolar 3 as I said these are triggered by antidepressant steroids ECT and alcohol again is to try and get the person to see that that's the pattern in other words that those agents need to be removed to try and deal with it so you phase out the edge depressant slowly or whatever agent is triggering the high the mood stabilizer are similar to those used in by four or two now as you can see in bipolar 2 very often the emphasis is on using epilim tegretol trilateral things like that as stabilizers you know there's the anticonvulsant stabilizers lithium would be less successful in those instances but not something that one wouldn't try if the other didn't work so what do we do then in people who have rapid cycling mood disorder well the first thing is to remember that rapid cycling mood disorder there are many different types of it but one big group is where it's seems to be have its onset first of all rapid cycling mood disorder seems to be more common in women secondly it's often found post nationally midlife hormonal changes dramatically then if a woman has her ovaries removed or if the person is put on stage and sometimes then another pattern is where a person gets it as they get into their middle years so in other words a person may have a recurring depression with lengthy periods of wellness between the depressions sometimes may be ten years in the beginning the twenties the thirties might drop down to five then two and then it starts cycling in the middle years middle years I suppose being nineteen fifty and seventy that means you live 240 no so to sum it's probably shift either in the hormones probably the most likely explanation but it's also possible that there's a change in brain chemistry over the years because we do know that as people get on in years that the amount of antidepressant they need as an antidepressant agent is actually much less than they would have needed at an earlier stage in their life so in terms of the rapid cycling mood disorder I'd say first is to try and phase out the antidepressant use anticonvulsant mood stabilizers and they work in about 50% of instances after the antidepressants are phased out what you will find is with the rapid cycling mood disorder is that it's more difficult to treat takes a very determined approach to it it's very important that the person is documenting their mood on a graph in some way on a daily basis [Music] and whereas lithium doesn't sort of work as well as the mood stabilizers more recent data is showing well it's actually just as good so everyone deserves a chance if you find that for example the person with the rapid cycling mood disorder comes from a history of may be recurring depressions in earlier life and then bit by bit the interval between them gutter less and less often I think lithium is is more effective in those instances but again the focus on the rapid cycling mood disorder is you got to get the highs under control if you don't do that you won't get anywhere the person themselves so will only be interested getting rid of the depressions and that can be a tough sort of situation where the person is browned off very important depressions and a lot of the research is now showing that maybe for every two or three days of a high the person might have another 30 days of a low but the secret of getting rid of the low is to stop the high now preventing relapse the focus has got to be on medication sure but the importance of mood monitoring is absolutely vital we torsionally underestimate the the need for this imagine you had got type 1 diabetes and your endocrinologist or general practitioner relied on your blood sugar of the day you came to the clinic they're very hard to control well mood disorders are not dissimilar it's been shown from research that when somebody comes along for an outpatient follow-up how they report their mood has been in the three months or six months or one month since the last visit is largely determined by how they're feeling on the day of the visit and for the two days before that so that's how inaccurate is okay it's pretty meaningless and people you know they're not going to recall the highs absolutely not sure is great next 10 is so getting that right because it's really all about good information and that's why again it's vital to have families involved in giving that feedback not any state secrets they're going to be telling us but just really given information that can spot what's happening with the mood lifestyle changes getting to bed at a fixed time getting rid of the laptop computers whatever TV having quite time before you go to bed having a fixed writing time fix mealtimes because all of those cool down the circadian rhythms project what jet travel does is it resorts that what night duty does it disrupts that was [Music] anything the poses you up too much coffee steroids or whatever you're into that's again what it does regular exercise has a calming effect on the brain no no it's very important that it's not frenetic exercise because again too much exercise compulsive people exercise is an antidepressant it can make people high if the person is difficult to you rising in the morning use the trick of foot on floor try not to think soon as you your brain wakes up shift move because once you create momentum and the body keeps gets going the brain gets going and it doesn't get stuck in the sort of anxious and [Music] complaining thoughts that the brain has or all the rubbish it's thrown at your first thing in the morning so that's probably one of the most important things people can do in preventing relapses and taking small steps and I don't mean small steps to the toilet I mean just basically small steps doing things just do the next right thing to get momentum in other words I'm doing the next right thing might be just tying your shoelaces fix the corner of the room whatever it may be because everything like that creates momentum and to get the brain going when a person is depressed it's just about getting momentum just go back to the core thing it's a slowing of the psychomotor phenomenon if you get that going here you're on your way now another key thing about preventing relapse is quite nning the mind this is all about quieting the mind because medication does it that's fine but the point is what you're trying to do is keep keep the mind cool so that it isn't on fire with things that go on in life there are things about understanding you are not your illness using mindfulness how to tolerate distress being aware of your thoughts and your emotions in other words when there there are some flames then what is it who is it Mart phone call what letter what drink whatever it is just begin to become aware of those things validation your emotions in other words don't suppress them because very often people cope by not looking at what they're feeling resisting the urges urges that fuel emotion in other words if talking about politics are watching and on it's gone now Vincent Brown whatever his or coach what inflames you get away from us wise mind in other words using a mixture of your emotional brain and your intellectual brain if you're too emotional do nothing give yourself time to cool down and then hopefully you'll have a more balanced approach to it they're useful little tricks here and there that help people a lot if you're doing something always one way and it's not working for you think about doing the opposite can't be much worse and then radical acceptance of illnesses that does mean giving in to it just means not fighting with it it's just really accepting that is there and how how can you chip away at that phenomenon in your life and get feel well again so in terms of preventing relapses the next thing we look at are dealing with the consequences of the mood problem in other words a person who because of their mood problem or independently ever have an addictive behavior without called street drugs gambling or sex because again they all are involved with the dopamine system which drive this psychomotor phenomenon okay because gambling sex any addiction is driven by the dopamine system anxiety is a very common core occurrence or what's called a comorbid condition alongside bipolar disorder even when it's settled so a person may not have had much anxiety and they may have been quite calm people before they ever got bipolar disorder but when the bipolar sort of inflames the brain frequently even though the person's mood is stabilized they can be left with a lot of anxiety afterwards and they need to address that so things like panic attack social anxiety can be helped by CBT had other interventions and then finally not finally but sorting out relationships so to come to the final piece of evening what is it you can do right now well the first thing is to acknowledge the illness and that's that's a tough thing because particularly acknowledging it and its implications is very very tough but again that's something that's got to be phased get to know it know why it's there how you can modify it what works for you what makes things worse what you got to stay away from what you got to embrace medication is a central part of the treatment for most people with bipolar disorder many different psycho therapies including CBT have been recommended as core treatments their secondary treatments there's no evidence whatsoever that the workers a primary treatment there's been a lot of research done in this area over the years and unfortunately the medication is is is still the key factor the next thing is to acknowledge the effect it has on you as a person but also on relationships and I think there's there are many things you can learn about how to handle those relationships in the context of pipe waters or where both you and the family member concerned or work colleagues or whatever it may be I can't get their heads around the aware support groups are absolutely fantastic in terms of helping people cope with everyday life very often the people who have attended it over the years are absolutely full of information full of wisdom that they are only too happy to impart and to learn from you because you know time and time again service that have been done in aware 3t key things come out of it why do people call me why do they keep coming one they need to be with others who have the same condition - they get help from others three they get great benefit from helping others and that sort of fellow ship aspect of it is invaluable now in terms of prevention the more the key thing as I say is monitoring mood and a key aspect of that is how to sponsor elapsed you can't always rely on signs and symptoms sometimes people have a personal sign that indicates that they're going high as a nonsmoker going back to the cigarettes the family will often know that that's an indication the person is going high the person who has no great taste for tato and suddenly liver tastes rotate or change in internal salt metabolism is often a sign that the person's mood is shifting all the times it can be an item of clothing a person wears when they're beginning to go high and wouldn't be seen dead in there any other time but all of those things are sort of not turbed you reliable because they're a bit after they the fact the key thing in terms of spotting or relapse is generally almost always the person if they get into pressed will be the person who spots themselves then obviously generally spotted weight before their family not always but generally when it's a high the family will always spot it first if somebody tells me they can spot the right before their family I'm not sure no matter how education the person is how much professional qualifications they have in managing these things if the mood has gone high a family member would tend to special first if somebody comes in to me and I think they're not high and the family member says they're I I do i I always take their word for I think once in 40 years I was I was wrong in that sense of relying on what a relative said but the point is relatives do sponsors much more readily because then all the person they know them intimately even the way the whole the read the words issues what they think about you know just we all have our own little pattern and when we deviate outside that it's a family member was spotted in my love why did you say that no it's just to take that on board so what what is essential is that you as we're members came up with this term appoint a spotter it's not pointing your spotter as you would as a gun dog but it's asking a family member whose judgment you trust who you see regularly to be allowed to say to you I think your mood might have gone up a little bit the need to put it gently but there needs to be encouraged to do it it's important that you invite the person to do that at a time when your mood is stable not when you're high not when you're low but when your mood is sort of in the normal range you must give them full permission to take away the car keys call the doctor get me into a hospital do whatever you think no you might say well am I crazy to do that well you either trust them or trust the illness you know that's really what it comes down to because people get into all sorts of difficulties if they don't address that issue the final point I'm just going to make is about family members inevitably when somebody is to press or more particularly when they're high they'll do or say things that upset people around them relatives being supportive and caring are sympathetic understanding and forgiving they say ah don't worry about it so the problem gets swept aside that's okay for a one-off episode but if that happens time and time again it's like sweeping dirt under the carpet everyone looking on in the family doctor concerned counselor whoever is involved with the person from it from a therapeutic point of view can see what's happening here and then suddenly one day the relationship is over and the person with the illness couldn't see you coming everyone else could so it's important when things settle down in the mood that the person is encouraged to go and talk to that member that they probably know that obsession and talk frankly and say look those things I said to you last week when I was in hospital can we talk about our not forget about I don't know it's over and done with you must encourage them to talk about it to get out there hurt to express their upset because in that way they will learn to let it go if they keep it to themselves it just Fester's inside and then just erupts one day in a breakdown of a relationship that's very hard to put together at that point next couple of things are arranging an emergency plan with your treating doctor in terms of what to do should it be depression should it be elation sometimes people who are very knowledgeable about their episodes of highs can be given medication that will keep them going for a few days and bring things under control as long as they're in regular contact know the triggers and the alcohol coffee tea lifestyle changes so for example if somebody finds after X out of coffee it's hard to get to sleep at night that person is inviting disaster they've got to reduce their intake but how they do that is determined by what they can take in coffee in any day that is not going to cause difficulties watch the lifestyle changes because again often people who have mood problems it can be hard to manage sleep and getting that sorted out rising at a fixed time means at a fixed time all of that are very very helpful bipolar disorder is something to put your arms around embrace and managers it is something that is treatable if a person avoids it they won't get too far generally it's something one has got to face and accept that it's there but with help and assistance and being open people can be helped one of the things that people can do also in terms of getting the monkey off their back is learning to talk to others about it we did some research here years ago where we compared the outcome for people who had bipolar disorder if they went to a support group went to an educational program like this that was run over a four-week period in different combinations all went to none so in other words those that didn't go to quite a thing went to the support group went to the lectures or a combination of both the people who did best were those who went to a support group they had fewer elapses they were more confident in themselves they had less restrictions in their life they weren't hiding away from people and that seems to be the key factor of hiding away avoidance because when a person goes and puts it out there to others they're also seeing at themselves if we keep things from others we also actually keep them from ourselves we can't actually see them so that's why it's so important to share with others because it's free and it works thank you you

Channel: Aware

Views: 101,437

Keywords: bipolar disorder, treatment, relapse, symptoms

Id: FLGTxug41Uo

Length: 58min 12sec (3492 seconds)

Published: Mon Jan 15 2018