Understanding bipolar disorder
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
helping families & friends find better ways
Understanding
bipolar disorder
What is bipolar disorder? What causes bipolar Therapy
Bipolar disorder is a mental illness disorder? Verbal therapies are a very useful
that was previously referred to as The causes are not fully understood, but a adjunct to medication for the
manic depression. It affects the normal genetic predisposition to the development management of bipolar disorder.
functioning of the brain so that the of the illness has been clearly established. The therapy of choice for bipolar is
person experiences extreme moods – Cognitive Behavioural Therapy (CBT),
mania and depression. Treatment and recovery but family therapy and other therapies
People may also experience psychosis
from bipolar disorder can also be helpful. Improving coping
mechanisms and identifying triggers to
in the manic and/or depressed phase. While there is no cure for this illness
it is highly treatable and manageable episodes can be achieved in this context.
A variety of types of bipolar disorder
and 80–90 percent of people recover. The development of and adherence
exists. According to the Diagnostic
to a Wellness Recovery Action Plan can
and Statistical Manual of Mental
Acute episodes be a very useful strategy for prevention
Disorders (DSM IV), the following
of relapse for people experiencing
are the distinct types: Community management of acute
bipolar disorder.
episodes of mania or depression depends
• Bipolar 1 disorder – characterised
on the degree of risk associated with the
by one or more major manic or Social
behaviours and mood. People will be
mixed episodes, usually accompanied People with bipolar disorder have a
hospitalised if their mania causes them
by major depressive episodes great need to maintain a healthy and
to engage in life threatening, risk-taking
• Bipolar 2 disorder – characterised behaviours and if their depression causes balanced lifestyle to reduce stresses that
by one or more major depressive suicidal ideation or similar. may trigger episodes. Social support and
episodes accompanied by at least meaningful occupation all support the
A biopsychosocial approach that includes
one hypomanic episode recovery process from bipolar disorder.
attending to the biological need (chemical
• Cyclothymic disorder – characterised imbalance), as well as the psychological Helpful interventions
by at least two years of numerous and social aspects of life is the most
Recognising that someone is displaying
periods of hypomanic symptoms effective method in the treatment of,
symptoms of bipolar disorder is the first
(that do not meet criteria for a manic and recovery from, bipolar disorder.
step to offering helpful interventions.
episode) and numerous periods of
Medication Overleaf are behaviours common to
depressive symptoms (that do not meet
the experiences of depression and
criteria for a major depressive episode) Medication helps the brain to restore
mania, with suggestions for helpful
its usual chemical balance. Medications
• Bipolar disorder not otherwise specified interventions.
commonly used for bipolar include:
– where bipolar features exist but do
not meet any of the criteria for any • Antipsychotic medication, used
of the specific diagnoses above. DSM to control psychotic symptoms
(IV) further divides these distinct and severe agitation
types into many subcategories. • Mood stabilisers, which are the
mainstay of maintenance therapy
How common is bipolar and improve symptoms during
disorder? acute manic episodes
1.6 percent of the population will • Lithium is the most commonly
develop bipolar disorder at some time used mood stabiliser.
in their lives.Understanding bipolar disorder
continued...
Insight into the experience of depression
Symptom Associated behaviour Helpful interventions
Remember, these behaviours are out
of keeping with the person’s normal
value system
• Depressed mood, loss of interest • Characterised by expressions of • Be aware you cannot jolly
or pleasure in nearly all activities helplessness and hopelessness the person out of this state
• Depressed most of the day • Connect with the emotion of the
• Loss of interest or pleasure in activities, experience rather than try to change
the person may not move much or may someone’s mind eg. ‘It must be very
just stare into space hard to feel so low’
• Skin may become coarse and dry, and • Reinforce your love for the person
hair lank and greasy or sparse • Try to sit beside and be in the person’s
• Sometimes a person can articulate having space – often people who are depressed
no feelings, but a depressed mood do not like to make demands on others
can be inferred from the person’s facial but they appreciate company. Likewise,
expression or demeanour you will need to do the talking rather
than expecting the person to do so
• Sometimes, depressive mood can be
exhibited in irritability rather than • Keep up good levels of communication
sadness, including persistent anger, even when not reciprocated eg Let the
overreaction to events, angry outbursts person know where you are going even
and blaming others if there is no response
• Social withdrawal
• Sometimes a significant reduction
from previous levels of sexual
interest or desire
• Inability to concentrate • Poor concentration and poverty of thought, • Attend to safety issues that poor
where the person has difficulty putting concentration can cause eg if someone
sentences and thoughts together, may works with knives or drives a vehicle
give monosyllabic responses, and need • Set realistic tasks
prompting
• Have realistic expectations
• May appear easily distracted or complain
of memory difficulties
• A reduction in ability to achieve
intellectually demanding tasks
• Suicidal ideation • Recurrent thoughts of death • Always treat talk of suicide seriously
• May talk about death or suicide • Be aware of suicide risk. Ask the
• May attempt suicide appropriate questions and communicate
with treating team about this issue. This
issue may be a reason for hospitalisation
• If the person expresses unexpected
happiness and begins to give possessions
away, seek assistance immediately
2Symptom Associated behaviour Helpful interventions
Remember, these behaviours are out
of keeping with the person’s normal
value system
• Decreased energy, • A person may report sustained fatigue • Avoid placing unrealistic demands
tiredness and fatigue without physical exertion on the person
• Smallest tasks seem to require • Be patient
substantial effort • Affirm small achievements
• May take twice as long as usual to
do things eg washing and dressing
in the morning
• Sense of worthlessness or guilt • May translate into belief that the • Connect with the emotion of the
person has done something terrible experience rather than try to change
and needs to be punished for it someone’s mind eg ‘It must be very
• May include unrealistic negative hard to feel so low’
evaluation or self worth • Affirm small achievements
• Guilty about preoccupations over • Avoid too much attempt at
minor past failings problem-solving. The person
• Misinterprets neutral or trivial day-to-day probably will not be ready
events as evidence of personal defects • Avoid long self-effacing, self-defeating
• Exaggerated sense of responsibility for talk from the person
untoward events
• Changes in appetite • Most commonly, reduced appetite • Be aware of hydration and nutrition
• Sometimes an increase in appetite issues. Again, these issues may need
but usually cravings for particular to be attended to in hospital
foods, eg sweets or carbohydrates
• Significant loss or gain in weight
• Changes in sleep patterns • Most commonly insomnia • Try to do some exercise like walking
• Not sleeping at all or waking early in around the block
the morning, (usually between 2am and • Medications can certainly assist
4am) when normally the person does
not have trouble sleeping
• Less frequently, over-sleeping
3Insight into the experience of mania
Symptom Associated behaviour Helpful interventions
Remember, these behaviours are out of
keeping with the person’s normal value system
Elevation in affect • Increased confidence • Be calm
(mood) • Inflated self esteem • Do not participate in the escalation of excitement
• Distractibility • Use simple, clear communications, and make sure
• May be described as euphoric, unusually good, the message has been understood. You may need
cheerful or high to repeat, but do not push
• May also alternate between euphoria and irritability. • Make sure that you move away from potential
Note: It is important to remember that the person’s conflictual situations. Use their distractibility to
mood is very infectious. They can get everyone come back again
contributing. However, when others participate in • When the person is able to take feedback, provide
the fun it can escalate the situation. Others can be something like ‘You are a little high at the moment,
presumed to be able to control their excitement. The
what about listening to some music’,
person in this state cannot, and the situation can get
in a gentle way
out of hand, which may result in some combativeness
and conflict.
Thoughts racing • Flight of ideas shown by continuous flow of • Do not make too many demands
accelerated speech, with sudden changes from • Reduce stimulation and loud noises
one topic to another
• When this is severe, speech may become
disorganized and incoherent
Inflated self-esteem • Uncritical self-confidence or, sometimes, marked • Avoid conflict
grandiosity. These can be delusional • Keep the person’s real level of expertise in mind
• May give advice on matters about which they Do not allow yourself to be overly influenced by
have no special knowledge their persuasive presentation of advice
• Despite lack of any particular experience • Remember that this is the illness speaking
or talent, person may embark on writing
a novel or composing a symphony
Manic speech • Typically, manic speech is pressured, loud, • This is very tiring so make sure that you get some
rapid and difficult to interrupt space, which you will need to regulate for yourself –
• May talk non-stop sometimes for hours on end and the other person will not recognize your need
without regard for others’ wishes to communicate • When you want space, try to manage your
• Sometimes joking, punning and emotional state as the individual will pick up
amusing irrelevancies on your distress and you may have to defend
yourself, as the person will not see themselves as
• Person may become theatrical, with dramatic
unreasonable
mannerisms and singing
• Be genuine, try not to turn off. When something
• Sounds rather than meaningful sentences may
is funny enjoy it
govern word choice
4Understanding bipolar disorder
continued...
Symptom Associated behaviour Helpful interventions
Remember, these behaviours are out of
keeping with the person’s normal value system.
Increased physical • Restlessness • Be conscious of the safety factor. The danger of
mobility and • Can set out on tasks that take great physical physical complications may be one of the trigger
energy exertion eg walking a long way factors to indicate the need for hospitalisation
• Unaware of thirst, hunger, heat or cold • If you can, help the person to use some of their
energy on a walk or helping in the garden
• Increase in goal-directed activity, often excessive
planning, and participation in multiple activities • Remember it is very easy for this person to end up
with disturbed sleep patterns, sleep late and spend
• Increased sexual drive, fantasies and behaviour
half the evening ringing people. You may need to
• May simultaneously take on new business ventures seek advice about medication for sleep
without regard for risk or satisfactory outcomes
• In hot weather, fluid replacement is important,
• Increased sociability – renewing old particularly when the person is on lithium
acquaintances, ringing friends (or even People can become so dehydrated that the blood
strangers) any time of day or night with no concentration of lithium increases to such an extent
regard to the intrusive, domineering and that the person can go into a hepatic coma. Lithium
demanding character of the interactions also increases sensitivity to sun
• May write a torrent of letters/emails on many topics • Encourage the person to drink small amounts
to friends, public figures or media regularly. Consider what the person likes to drink
and make it easily available. Address nutrition
in the same way, thinking of high-energy food
Decreased need • Person can be most active at night when • Encourage the person to have a bath or a shower
for sleep every one else is sleeping • Some people suggest warm drinks, but not coffee
• Increasing stimulation – radio, television or tea. This helps the person feel looked after
• Person awakens earlier than usual,
feeling full of energy
• Person may go for days without sleep
and yet not feel tired
Expansiveness • Unceasing and indiscriminate enthusiasm for • Be assertive about your own boundaries
and recklessness interpersonal, sexual, or occupational interactions in a friendly manner
• May start extensive conversations with • Take action to protect assets where necessary
complete strangers • Reduce access to dangerous situations
• Intrusive behaviour eg overly enquiring eg put car keys in a safe spot
• Crosses personal boundaries • Try to support the person in managing their sexual
• Spending sprees urges. If a young girl (in particular), try to organise
a friend to accompany her on her outings
• Risk taking eg driving fast, walking
on roads, jumping distances • Remember, in partner relationships intimacy
demands may increase substantially. You will
• Increase in goal directed activity eg composing
need to work out your own limits
a musical, solving a technical problem
• Imprudent involvement in pleasurable activities
such as buying sprees, foolish business investments,
indiscriminate sexual encounters with strangers,
or sexual infidelity when this is not characteristic
Delusions and • Delusions of grandeur eg ‘I am Jesus Christ’ • Do not argue about the reality
hallucinations, • Hallucinations • Connect with the emotion of the delusion or
especially of a hallucination eg ‘It must be frightening to believe
grandiose nature that you are Jesus Christ’
Risk taking behaviour is often related to manic episodes and can alert families and individuals to the onset of such an episode.
Mania may begin as pleasurable so that people will be reluctant to give it up, and develop into a state that is out of control
and frightening.
5What can family and Useful references
friends do to help?
Ask an expert – receive answers to
In addition to the specific interventions questions about bipolar disorder from
previously mentioned, there are many consultants and professionals: SFNSW
things friends and family can do to help. www.sfnsw.org.au/questions/discussion.htm
• Always remember that bipolar disorder Mental Illness Fellowship Victoria
is a medical condition that requires www.mifellowship.org
medical treatment. Just as you cannot
stop a person’s leg bleeding by talking Mental Health Services Website (Vic)
to them, you cannot stop bipolar www.health.vic.gov.au/mentalhealth
disorder without medical intervention. National Alliance of the Mentally Ill
Treatment is effective. (NAMI) (USA)
www.nami.org
MIFV2013/01
• Find out as much about the illness as
you can. Knowledge is power and gives Mental Health Council of Australia
you a much better chance of developing www.mhca.com.au
good coping strategies.
SANE Australia
• Be patient. People experiencing bipolar www.sane.org
disorder need to come to some insight
Beyond Blue
regarding their illness. This is not always
www.beyondblue.org.au
easy and takes time.
• Know what to expect of the mental Mental Illness Fellowship
health system and be prepared to be Victoria fact sheets
assertive in seeking appropriate care.
Understanding psychosis
• Link in with community organisations
that offer supports and services that Family and carer supports and services
complement the mental health system. Psychiatric medications
They often provide educational
Suicide and mental illness
programs, counselling and local
support groups. What can family and friends do to help
a person experiencing mental illness?
• Remember to stay healthy yourself.
©Mental Illness Fellowship Victoria 2013(ACN 093357165)
Do not underestimate the impact Stress-vulnerability-coping model
of the illness on you. Acute episodes
Bipolar disorder and drugs and alcohol
of depression or mania often involve
trauma and grief and have an impact Collaborating with professionals
on whole families. Be prepared to
seek support to develop strategies
that keep you well.
PUBLISHED BY:
Mental Illness Fellowship Victoria for people with mental illness, their families and friends
276 Heidelberg Road Fairfield Victoria 3078 T: 03 8486 4200 F: 03 8486 4265 W: www.mifellowship.org ACN 093 357 165You can also read
