Tag Archives: bipolar disorder

“How to Help Someone Who Is Experiencing Bipolar Psychosis” by Natasha Tracy

25 Feb
As Natasha Tracy writes, psychosis is most commonly associated with schizophrenia, but it can also manifest in people with bipolar disorder. People with bipolar I are at risk for psychosis during manic episodes; however, those of us with bipolar II aren’t off the hook. Tracy notes that while hypomania cannot cause psychosis (it can, however, result in delusional perceptions and thoughts),  severe depression puts us at risk as well. I can personally attest to this: during my worst moments, I’ve had visions of wraiths floating over my bed, seen my face turn into a skull in the mirror, and heard God’s voice telling me I was evil and should kill myself.
As there’s evidence that depressive episodes are more frequent and durative in bipolar II, those of us with that diagnosis shouldn’t make the mistake of thinking that we’re immune to psychosis. Considering the overlapping and symbiotic symptoms of bipolar disorder and PTSD, those of us with a comorbid diagnosis should be especially cognizant of the risks.
Reblogged from Answers.com

While psychosis is normally associated with schizophrenia, psychosis is also a dangerous mental state that can occur in people with bipolar disorder. A person experiencing psychosis may feel they are a deity and try to fly or they may feel like they can talk to animals. They may see, hear, taste, smell, and feel things that aren’t there. They may become highly agitated when these beliefs or experiences are questioned. Here’s how to help a person suffering from psychosis in bipolar disorder.

What is Psychosis?

Psychosis is a mental state personified by the presence of delusions and hallucinations. Delusions are false beliefs that may be held even in the face of direct evidence to the contrary. Delusions of grandeur are common wherein the person believes themselves to be extremely special in some way such as being a genius or a god.

While most people think of hallucinations as seeing things that aren’t there, that’s only part of it. Hallucinations can actually manifest through any sense although the most common is to see and hear things that aren’t real. Someone suffering from psychosis often hears people who don’t exist talking about him or her and this can be very distressing.

Other symptoms of psychosis include changed feelings, changed behaviors, and confused thinking. See: What is psychosis?

How Does Psychosis Manifest in Bipolar Disorder?

Typically, psychosis manifests as part of mania or a mixed episode. Bipolar mania is a highly elevated mood experienced by those with bipolar type I (or possibly Other Bipolar and Related Disorder). According to Medscape Reference’s information on bipolar disorder, it’s estimated that up to 75% of people who suffer from mania, also suffer from psychosis. By definition, psychosis does not occur in hypomania.

Psychosis can also occur during bipolar depressions. It’s less clear how many people experience psychosis in this mood state.

No matter how psychosis is experienced, however, it is typically considered a medical emergency and help should be sought immediately. See: Psychosis and bipolar disorder

How to Help Someone Experiencing Bipolar Psychosis

According to the British Columbia Schizophrenia Society, there are many ways to help someone experiencing psychosis. Helpful things to do include:

– Stay calm and protect the safety of all involved.
– Be aware that unusual behavior during this state is a symptom of an illness and is not about you.
– Avoid arguing with the person about their delusions. Delusions are extremely difficult change.
– Connect with the emotion behind the delusion. For example, it’s easy to understand that some psychosis symptoms would be very scary, so you could say, “It must be very frightening to believe that you are Jesus Christ.”
– Calm down the environment and remove stimulation such as people and noises
– Show compassion for how the person feels and give him (or her) the help he asks for. For example, if he thinks the television is trying to kill him, turn it off.
– Show him you are on his side with your body language. Sit next to him, rather than across from him.
– Speak slowly, clearly, and calmly and allow plenty of time for the other person to understand and respond.
– Give step-by-step instructions, if needed.
– Be aware that even if the person suffering from psychosis isn’t expressing much emotion, they still may be experiencing a lot of feelings.

And above all else, it’s critical to get professional help for anyone experiencing psychosis. If his doctor cannot be located in a timely fashion then an emergency healthcare team should be called or a visit to the Emergency Room should be arranged. See: What to do about psychosis symptoms

People with bipolar disorder can experience psychosis during the manic, mixed, and depressive phases of the illness. How psychosis is manifested varies but it can include hallucinations, delusions, confused thinking, and changed feelings and behaviors. Psychosis is typically considered a medical emergency so professional help should always be sought. Until the help arrives, however, it’s important to be calm, protect everyone’s safety, not argue, and remove excess stimuli from the environment.

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“Conspiracy of Silence: When the Psychiatrist Has BP” by Sara Solovitch

26 Aug
From bp Magazine (www.bphope.com):

One morning when she was 27, Suzanne Vogel-Scibilia, MD, went to work, a young, up-and-coming resident psychiatrist at a major Pittsburgh hospital and left, hours later, as a person with bipolar disorder.

The diagnosis—her own and later confirmed—took place as she was routinely questioning a distraught patient who, after spraying her neighbor with a hose, had been brought into the emergency room by police.

How much sleep had the woman been getting, Dr. Vogel-Scibilia asked. “Not much,” she answered. “Maybe a couple hours a night.”

And I’m thinking, me too.

How about food? Was she eating? “Oh, I had some dinner last night,” the woman responded. “I wasn’t very hungry.”

And I’m thinking, that’s interesting. Same as me.

Was she under stress? “Sure,” the woman said. “But you know what’s really annoying me? They’re talking about me on the PA system.”

And at that moment, I could hear the PA system and they’re not talking about her. They’re talking about me. And I’m not hearing a damn word this woman is saying. I’m just thinking, ‘What diagnosis does this woman have? Bipolar?’ Oh my god! Suzanne, you’ve got bipolar disorder!

Dr. Vogel-Scibilia was convinced that her diagnosis—which she now traces back to age 15, the first time she attempted suicide—would mark the end of her career.

The medical profession doesn’t look kindly on mental illness within its ranks. Michael Myers, MD, clinical professor of psychiatry at the University of British Columbia, Vancouver, British Columbia, and former president of the Canadian Psychiatric Association, argues that the stigma attached to mental illness is greater in medicine than anywhere else. Worst of all, he says, are psychiatrists who suffer from “internalized stigma.”

“Just because we’ve trained in psychiatry doesn’t mean we’ve purged ourselves of out-dated and discriminatory attitudes,” says Dr. Myers.

“I’ve looked after psychiatrists who feel dreadful—-some actually say they feel fraudulent—that they are taking care of depressed people when they themselves are on antidepressants. I say, ‘Hold on a minute, I’m sure there’s an endocrinologist out there who has diabetes.’”

Research shows that doctors in general are at greater risk of depression, mood disorders, and suicide than other professionals. “Psychiatrists commit suicide at rates about twice” the rate of other physicians, according to a 1980 study by the American Psychiatric Association, which found that “the occurrence of suicide by psychiatrists is quite constant year-to-year, indicating a relatively stable oversupply of depressed psychiatrists.”

“It’s an oversimplification to say it’s all due to the stress and strain of practicing medicine,” cautions Dr. Myers, a specialist in physician mental health. “It’s more to do with who we are: Many of us in medicine are wounded healers. We’re interested in practicing medicine precisely because we come from families with problems.”

Higher rates of family dysfunction, parental alcoholism, sexual and physical abuse, parental death, and psychiatric hospitalization were reported among female psychotherapists than in other women professionals in a 1993 study in the journal Professional Psychology, confirming the image of wounded healers.

Continues Dr. Myers: “Coupled with that, there are certain personality traits among people who become doctors. We’re perfectionistic; you have to be if you want to practice proper medicine. And people who are that way are hard on themselves.”

Yet the stigma of mental health continues to create what he and others have called “a conspiracy of silence” among doctors—psychiatrists in particular.

Disclosure

By her last year of college, Beth Baxter, MD, “knew” there was “something wrong” with her brain; during the previous four years, the top student and class president had routinely slept only four hours a night. She would enter the cafeteria only during off-hours, eating peanut butter sandwiches day after day, just to avoid running into her classmates. She fought suicidal urges and had already made several half-hearted attempts.

In her second year of medical school at Vanderbilt University, she became convinced that the songs being played on the radio were carrying messages to her. Her grades began to slip for the first time, so she took a break and visited her grandparents’ cattle ranch in Texas. While there, she went missing. She left on an imagined meeting with friends and followed some “messages” on the radio. Found wandering a day later, she was picked up by police on the side of a highway.

So began Dr. Baxter’s first hospitalization when she was diagnosed as having bipolar disorder. She managed to return and graduate from medical school, hiring a tutor to talk through all of her class notes.

She was accepted into an internship in internal medicine in Memphis, Tennessee. “They accepted me before they knew I had bipolar disorder,” she recalls. “The dean of students told them I’d had counseling, but it wasn’t fully explained, and they were kind of angry when they found out.” A year later when she transferred to Rochester, New York, she changed specialties. “Because,” she says, “I knew how much good a psychiatrist could do and I wanted to do that for somebody else.”

After her residency, her symptoms worsened: she became increasingly depressed and suicidal; she tried to slash her neck and had to return to her hometown of Nashville, Tennessee, where she was hospitalized for a year and the doctors told her parents that the most she could expect was to work on an assembly line. And the diagnosis had now changed to schizophrenic affective disorder.

“I was a pretty sorry sight,” she recalls. “I’d lost 70 pounds and I had a movement disorder—jerky hands and feet.”

By this time, however, her parents had become active in the local chapter of NAMI (National Alliance on Mental Illness). When the local NAMI officers learned that a doctor was hospitalized in Nashville, they approached her with a request: would she write an educational training program for people who have mental illnesses? Baxter completed the project while she was still on suicide watch.

Little by little she began to come back. “A psychiatrist there had a lot of hope in me,” she says, “and that hope was really important.”

Dr. Baxter is still on medication; the last time she was hospitalized was in 2000, when a prescription change failed to work. But today, she runs a large private practice in Nashville, where—just as in medical school, when she hired a tutor—she now retains an older and more experienced psychiatrist “to help me talk through my cases and review how they’re going.”

She talks about her experiences openly, addressing NAMI workshops around the country, speaking at physician conferences, and often sharing her story with patients—“to show that you can recover from serious problems in your life.”

She is famous around town for giving away little clay turtles from Guatemala: she sees turtles as a symbol of perseverance and determination, and has hundreds of clay, plastic, and ceramic turtles throughout her house.

Openness, for Dr. Baxter, was hardly a matter of choice: her medical history made disclosure an all too obvious decision. “But I still think it’s good when people know,” she says. “Then, when I got sick and bad things happened, they were more compassionate.”

Dealing with bp in practice

Mental Health Awareness Week in Canada features an annual campaign called the Four Faces of Mental Health. It’s a way of putting a human face on conditions, such as bipolar disorder, schizophrenia, and depression. For the first time last year, one of the four faces was a doctor.

“I had to convince myself to do it,” concedes Michael Paré, MD, a Toronto, Ontario, general practice psychotherapist. “I’m always telling my depressed patients that they don’t have to feel ashamed: They’re not bad; they’re not crazy; they’re not weak. But doctors—while we’re taught to say that—are not actually following through and admitting it. If it [mental illness] isn’t our fault, then why is it so bad to stand up and be counted?”

After a “very, very difficult childhood,” Dr. Paré sunk into a major depression in his mid 20s. “Literally, every day was like a terror, like being alive was the worst possible thing,” he says. “It’s impossible for me to remember the feeling, but I do remember my knowledge of it. Like when I opened my eyes in the morning, it was like, ‘Oh no, I’m still alive.’”

He swallowed a lot of pills one day and fell into a coma for a week, recovering only after undergoing a lumbar puncture, or spinal tap.

A few years ago, Dr. Paré was invited to address a large group of psychiatrists on the subject of depression. It was a professional talk, but at the end, he impulsively made mention of his own experience.

“I said, ‘Interestingly enough, I’ve suffered from major depression.’ And there was no reaction. No one came up to me after the talk. I thought I was dropping a bomb, but not one person acknowledged it. And these were psychiatrists who work with depression every day.”

Despite his own candor, Dr. Paré typically counsels young doctors against disclosing any history of mental illness at the beginning of their careers.

Most young doctors don’t need to be told. Consider the case of M., a 24-year-old California woman diagnosed as having bipolar disorder during her second year of medical school in Lebanon. She is so fearful of one day being denied a medical license that she refuses to see a psychiatrist now that she is back in the U.S.

Instead, she orders her medications online. They cost $400 a month and they’re generic, but they have one overriding advantage: they arrive unmarked from India and Australia.

“I’d go to any lengths to have my medication,” she says. “If I go to a psychiatrist here, my whole future is ruined—everything I worked for. There are always questions on the residency or licensing applications—do you have a medical condition? That’s why it’s so important to keep it to myself.”

That fear is widespread. A 2001 survey of Michigan psychiatrists found that half of them would rather self-treat than risk having a history of mental illness on their health insurance record.

And with good reason, according to psychiatrists who point to the widely publicized case of Steven Miles, MD, whose own bipolar disclosure turned into a cause célèbre.

In 1994, Dr. Miles, a well-respected gerontologist and professor of biomedical ethics at the University of Minnesota Medical School, had sought help for depression from a psychiatrist who diagnosed bipolar disorder II. After a few weeks on medication—and with no interruption in his teaching or clinical work—Miles began to recover.

But several months later, on filling out the annual renewal form for his state medical license, he answered the questionnaire affirmatively when asked if he had ever been diagnosed with or treated for manic depression, schizophrenia, compulsive gambling, or other psychiatric conditions.

Though he had never been the subject of a patient’s complaint, and though his name appeared regularly on lists of the state’s “Top 100 doctors,” the Minnesota Board of Medical Practice began an investigation, demanding a letter from his psychiatrist and full access to the records of his psychotherapy sessions.

Dr. Miles refused, and for the next four years he fought the board, arguing that its policy was overly invasive and served to deter physicians from seeking help for mental health disorders. After a protracted standoff and threats of legal action, the licensing board eventually changed its policy.

Today, many state licensing boards have adopted similar changes, but there is no consistent state-to-state policy. Nor is there any specific system for physician health care in the U.S.; the only health programs aimed at doctors are those restricted to drug and alcohol treatment.

In Canada, a physician wellness program has been set up in every province; its directors have joined to create a federal network, Canadian Physician Health Network, to share information and strategies. Under this system, a doctor who has bipolar disorder, for example, can be assisted and will be monitored at least three to five years, after which—if he or she is deemed stable—the monitoring is decreased or even removed.

Here’s how it works for one Toronto doctor, a 41-year-old resident psychiatrist who last year was diagnosed as having bipolar disorder. A., as he asked to be identified, was someone who didn’t “do” just residency. He simultaneously created a banking project for residents, invested $8,000 of his own money into a biotech company, organized a charitable organization for autism, conducted research into schizophrenia, and juggled a series of home renovation projects.

“I always have to self-monitor to slow down,” he explains ruefully, “because the rest of the world doesn’t operate as fast as my world does.”

Then last year, everything crashed. “A secretary made a note saying I was speaking too fast, had taken time off from work, and that I’d asked for a referral to a psychiatrist. And suddenly, there’s this note going around saying I have bipolar disorder—and no one had even diagnosed me at the time.”

After a letter was sent off to the Ontario College of Physicians and Surgeons, the self-regulating body for the province’s medical profession, A.’s first instinct was to fight.

“I don’t want to be labeled just because I’m outside the box,” he says. “No way in hell was I going to have a label like that. I didn’t want someone labeling my enthusiasm—even though I realized some of my experiences were perhaps bizarre.”

His psychiatrist reassured him, however, that he was not alone, that other physicians had similar problems, and that the system’s checks and balances would allow him to continue in his career.

“I thought that was a bunch of hogwash,” A. says. “All my faculties are based on my judgment and if that’s taken away from me how can I practice when people’s lives are dependent on my judgment?”

That insight doesn’t always mitigate the irritating presence of the system’s checks and balances. To A. they feel like an albatross, like he’s being “policed.”

“I have to inform my program director that I have an illness,” says A., checking off the list. And everything I say to my psychiatrist becomes open to the College of Physicians and Surgeons. They want me to see a mood disorder specialist. I have a case manager to keep an eye on me and make sure I’m functioning on all cylinders.

“I also have the people who ‘supervise’ me at work,” A. continues. “So all these eyes are on me. It feels like I’m being policed even though I’m not being policed.”

The choice is no longer his. His behavior had become so erratic that he could no longer deny his problems by working harder and plugging in the answers that he knew would get him off the hook with his fellow psychiatrists.

“With our specialized training we may be able to rationalize or deny our symptoms,” says Mamta Gautam, MD, an Ottawa, Ontario, psychiatrist who restricts her practice to physicians.

“And, a doctor’s ability to function at work is often the very last thing to go. In fact, you see that most people don’t have any idea that a colleague is struggling, because if anything they’re more productive than before. When, really, it’s just a mechanism—to keep working and stay with what’s known rather than stop and reflect.”

Coping and reaching out

Long before Dr. Vogel-Scibilia examined the patient who had bipolar and saw herself reflected back, she had figured out ways of adapting to her seasonal mood swings. Anticipating depression in winter, she scheduled her most challenging coursework for the fall.

“I’d do the research, pick the cards, and do the bibliography,” she says, “so if I had to write the paper I’d just have to write the text out. I would try to compensate for things, study stuff in advance.”

Now a practicing clinical psychiatrist in Beaver, Pennsylvania, she operates an independent mental health clinic and serves as clinical assistant professor at Western Psychiatric Institute, the same hospital where she did her residency and diagnosed herself.

Today, she is president of NAMI at the national level and a consultant for psychopharmacology projects at the National Institute of Mental Health and is a grant reviewer for the federal government.

But at least once a week, she gets a call from a young medical student or resident doctor—usually, she says, it’s a psychiatric resident secretly struggling with mental illness. Some of them offer to fly or drive long distances for a consultation.

“I have this theory,” she says. “If you were a patient before you were a doctor you don’t have so much trouble being in a patient role. But if you’ve been the doctor first and then you get sick, you have a hell of a hard time being a patient.

“You could do a study [about physicians having mental illnesses], but there’d be no sample, because nobody would agree to be interviewed. Actually I could just poll my friends. The trouble is it wouldn’t be a random sample. It would be the friends of Suzanne.”

http://www.bphope.com/Item.aspx/102/conspiracy-of-silence-when-the-psychiatrist-has-bp

Natasha Tracy’s Bipolar Burble: Fantastic Blog

15 Aug

Natasha Tracy is a tech geek turned award-winning mental health writer. Her blog covers a wide variety of issues relating to bipolar disorder including breakthroughs in medical research, navigating the relationship between bipolar disorder and self, and the perennially raging debate of how we define and label mental illness.

Tracy fully endorses the biomedical model: she argues against nonadherence to medication and reports on developments in neuroimaging and gene mapping. Even if you disagree with her on that, I urge you to check out her blog. Her research is thorough, her writing is fresh, and she’s compiled a wealth of online resources about bipolar disorder, including research developments and treatment options. The comment sections are also edifying, in part because she mediates them thoroughly (the tech geek thing probably helps). This is easily one of the best bipolar blogs the Web has to offer.

http://natashatracy.com/topic/bipolar-blog/

“Posttraumatic Stress Disorder in Patients with Bipolar Disorder: A Review of Prevalence, Correlates, and Treatment Strategies” by Michael W. Otto et al

9 Aug
From PubMed:

 

Abstract

OBJECTIVES:

In this article, we review the evidence for, and implications of, a high rate of comorbid posttraumatic stress disorder (PTSD) in individuals with bipolar disorder.

METHODS:

We reviewed studies providing comorbidity data on patients with bipolar disorder, and also examined the PTSD literature for risk factors and empirically supported treatment options for PTSD.

RESULTS:

Studies of bipolar patients have documented elevated rates of PTSD. Based on our review, representing 1214 bipolar patients, the mean prevalence of PTSD in bipolar patients is 16.0% (95% CI: 14-18%), a rate that is roughly double the lifetime prevalence for PTSD in the general population. Risk factors for PTSD that are also characteristic of bipolar samples include the presence of multiple axis I disorders, greater trauma exposure, elevated neuroticism and lower extraversion, and lower social support and socio-economic status.

CONCLUSIONS:

These findings are discussed in relation to the cost of PTSD symptoms to the course of bipolar disorder. Pharmacological and cognitive-behavioral treatment options are reviewed, with discussion of modifications to current cognitive-behavioral protocols for addressing PTSD in individuals at risk for mood episodes.

 

http://www.ncbi.nlm.nih.gov/pubmed/15541062

“Mind over Mood: Recovery Refresher” by Stephen Propst

26 Jul

From BP Magazine:

 

Over the past five years, “Mind over Mood” has provided practical, recovery-oriented approaches to managing bipolar and maintaining balanced living. We’ve examined everything from sleep and self-esteem to wellness workouts and mental makeovers. Now, it’s time for a refresher. Here, from previous columns, are 20 of the most recurring themes and best strategies for keeping on course, when it comes to helping yourself or someone you love who’s on the road to recovery.

SELF-INVENTORY: Every now and then, it’s a good idea to take inventory of your thoughts, emotions, beliefs and behaviors, and ask yourself where there’s room for improvement. Doing so may provide some insight, which is crucial to recovery and a better quality of life.

THINKING: What you think and believe impacts your self-esteem, your well-being and your recovery. In the midst of mania, thinking you are indestructible can have devastating consequences. In the depths of depression, believing that your situation will never improve can put you into a deeper slump. When you have a twisted thought or backward belief, stop and restate the remark more realistically. Change “I’ll never get better” to a resounding “I can recover!”

PERSPECTIVE: Are you guilty of looking at the glass half empty, rather than half full? Do you find yourself thinking that you’ll never get better or never achieve your dreams? When you actively adopt a more positive outlook, that step alone brings wellness into closer reach. A change in perspective begins by focusing more on possibilities and less on problems.

IDENTITY: Having a mental illness is not easy, and it doesn’t help matters to define yourself as the illness. Identifying with your symptoms while ignoring everything else that makes you unique makes no sense. Don’t let bipolar become the sole focus of your life, because there’s so much more that’s singularly sensational about you.

SENSITIVITY: As someone with bipolar, it’s easy to let even the smallest things get to you. And wearing your emotions on your sleeve can thwart recovery as well as hurt your relationships. If you develop a Teflon-like outer shell that allows some of the small stuff to slide, you’ll eliminate a lot of stress and have fewer messes to clean up.

LAUGHTER: Laughter is an excellent prescription for better health. It reduces stress, wards off illness, and helps us manage pain. It also provides a feel-good outlet for pent-up emotions. Make a commitment to laugh out loud each and every day. I can always tickle my funny bone by spending time with friends who make me chuckle.

ANGER: Allowing your anger to get the best of you can lead to hostile, aggressive behavior with regrettable consequences. If you are having trouble controlling your anger, seek out help from your therapist or a professional who specializes in anger management.

SELF-ESTEEM: When bipolar disorder coexists with low self-esteem, a vicious cycle can occur. Poor self-esteem creates anxiety and stress, which negatively affects your stability. High self esteem gives you a more solid foundation from which to manage bipolar, work on your recovery, and move on with your life. Therapy can be invaluable in helping you accept yourself for who you are.

CHANGE: Even if you recognize that you need to take steps to improve your situation, you may become paralyzed out of fear that you might go too far down the wrong path. Once you know that you want to make the changes necessary to reach your full potential, trust yourself to take a step in a new direction.

STRESS: Use stress to your advantage. Instead of letting it wear you down, turn it into a catalyst for building strength, stability, stamina, and self-esteem. When you learn to control your reaction to the source of stress, you turn stressful situations into opportunities for growth.

SLEEP: Getting plenty of sound, restful sleep positively impacts the brain’s capacity to control emotions, handle decision making processes and govern social interactions. The better you manage your sleep, the better you’ll manage your mood.

MEDICATION: The right medication is an essential ingredient in recovery, but it’s not the only one. Drugs are no panacea. A prescription is not going to teach you effective behaviors or generate positive reinforcers. If you must, seek professional help to change false assumptions and beliefs or negative thinking.

SUPPORT: Support groups can be a safe harbor in the midst of a storm. They offer the opportunity for people with a common burden to provide mutually beneficial encouragement for one another. Explore support groups in your community, for a safe environment for sharing thoughts, gaining new insights and renewing hope.

MINDFULNESS: A total wellness workout means minding both mood and muscle. It means tackling triggers as well as working out with weights. And it means sleeping well and eating right. Only when you pay attention to both mind and body can you look and feel your best.

FEAR: There are times when fear may keep us from participating fully in life. Once we realize that fear is a state of mind, we can choose to face our fears, change our minds, and create the life we want to live. Start by separating what you desire from what you fear. For example, don’t let the fear of trying a new medication keep you from finding one that might have fewer side effects. Sort out your thinking, and stay focused on your goal.

PATIENCE: We all want immediate results, but with bipolar disorder there simply are no quick fixes. Counting on a miracle cure will only cause frustration. The road to recovery is not a straight shot; it’s a winding path with delays and detours. Progress can be made, but it takes time. So let patience be your guide. And here, some tips for loved ones and others who make up the important support networks for those with bipolar.

UNDERSTANDING: Educate yourself about the illness and try to understand its implications on your loved one’s life. Armed with knowledge, you’ll be better equipped to offer the kind of encouragement, motivation, and support that can make a world of difference.

COMMUNICATION: Before you “fire away,” take a moment to consider how what you say may have an effect on someone with bipolar. Choosing your words carefully can strengthen relationships, fuel recovery, and make for a better quality of life for everyone.

NURTURING: If you care for someone with bipolar, don’t forget to take care of yourself, as well. You won’t be of any service to anyone, if you get exhausted or sick. So, take a deep breath, be easy on yourself and don’t believe it’s solely your responsibility to turn things around and make everything right.

HOPE: If there is one piece of advice for anyone who cares for or about someone with bipolar disorder, it is this: keep the faith and never give up. Many times in my life I had nothing to fall back on but hope (and the fact that I am still writing this column is living proof that it kept me going). So, let your hope for a loved one spread—it’s contagious!

Remember, you don’t have to squash your appetite for a rich, satisfying life. Using the right recovery tools can help you function productively, cultivate meaningful relationships and feel better through and through.

 

http://www.bphope.com/Item.aspx/637/mind-over-mood-recovery-refresher#.UfINf83iz7Q.twitter

 

“The Role of the Family in the Course and Treatment of Bipolar Disorder” by David J. Miklowitz

22 Jul

Curr Dir Psychol Sci. 2007 August; 16(4): 192–196

 

Abstract:

Bipolar disorder is a highly recurrent and debilitating illness. Research has implicated the role of psychosocial stressors, including high expressed-emotion (EE) attitudes among family members, in the relapse–remission course of the disorder. This article explores the developmental pathways by which EE attitudes originate and predict relapses of bipolar disorder. Levels of EE are correlated with the illness attributions of caregivers and bidirectional patterns of interaction between caregivers and patients during the postepisode period. Although the primary treatments for bipolar disorder are pharmacological, adjunctive psychosocial interventions have additive effects in relapse prevention. Randomized controlled trials demonstrate that the combination of family-focused therapy (FFT) and pharmacotherapy delays relapses and reduces symptom severity among patients followed over the course of 1 to 2 years. The effectiveness of FFT in delaying recurrences among adolescents with bipolar disorder and in delaying the initial onset of the illness among at-risk children is currently being investigated.

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2184903/?report=classic

 

 

“Delusional Bipolar Depression More Common Than We Think?” by Natasha Tracy

16 Jul

From the blog Breaking Bipolar:

Delusions are false beliefs that are held in spite of a lack of evidence or even evidence to the contrary. For example, a delusion might be believing that the FBI is surveilling you every day or that you can predict the future. Delusions are a part of psychosis which can be present in bipolar depression or bipolar mania.

Delusions are easiest to spot when they’re exaggerated, like in the above examples, but I would suggest that delusions are much more common when we give them credit for. I would suggest that delusions are present in most cases of severe bipolar depression.

I’m the Worst Person in the World

People with bipolar depression often believe things that are decidedly untrue. Examples of this are:

I’m the worst person in the world.
The world would be better off without me.
I’m the ugliest person on the planet.
Everyone hates me.

These things are clearly untrue but can be staunchly held beliefs anyway. I don’t think these statements would get you diagnosed with psychotic delusions, but I would argue they certainly are. Even when a person can state they know they aren’t true, they will frequently also admit to believing in them anyway. That’s a delusion plain and simple. It doesn’t involve the FBI, but it’s a false belief nonetheless.

Dealing with Psychotic Delusions

In bipolar disorder we fight our brains on what we know to be real in many ways. We fight the hypomania when we know it’s not a good idea to paint our living room purple at 2 o’clock in the morning and we fight the depression when we don’t kill ourselves. Fighting delusions is, in some respects, the same. We have to fight the poor signals coming from our brain with what we know is real. And once we can grasp that our beliefs truly are delusional, this can be easier to do.

Treating Bipolar Depression Delusions

As the name implies, antipsychotics were developed to treat psychosis, traditionally in schizophrenia, but many antipsychotics are now prescribed for bipolar disorder whether recognized psychosis exists or not and they work quite well. And maybe the reason they work in the cases of severe bipolar depression is because what we’re really experiencing is delusions, is psychosis, but is not recognized as such. Maybe the reason why they work is because that end of bipolar disorder is closer to schizophrenia than we think.

(And, by the way, research on the brain supports the link between bipolar disorder and schizophrenia. It’s pretty common to see similar brain deficits between the two disorders only, in the case of schizophrenia, it tends to be more pronounced.)

I could be wrong about this, but I don’t think I am. I think what we’ll find as brain research matures is that the underlying problems in severe depression where these kinds of false beliefs are held are similar to the problems in the brains of people with schizophrenia.

So maybe it’s time for some of us to recognize that what we’re experiencing is delusions and not just garden variety depression. It might help to put things in a new perspective and make those beliefs easier to handle.

http://www.healthyplace.com/blogs/breakingbipolar/2013/07/delusional-bipolar-depression-more-common/

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