ࡱ> []Zq` _NbjbjqPqP .`::_Flllllll$,YjT(|||||<<x $h+!l||ll|| l|l|ll|H  )0Y!!!l$*hT Y$ dllllll Understanding Bipolar Disorder (manic depression) What is bipolar disorder (manic depression)? Someone diagnosed with bipolar disorder (formerly known as manic depression) may swing from moods of deep depression to periods of overactive, excited behaviour known as mania. Between these severe highs and lows can be stable times. Some people also see or hear things that others around them don't (known as having visual or auditory hallucinations or delusions). Everybody has their ups and downs in daily life, but with bipolar disorder these changes are extreme. During the manic phase, people may feel euphoric, full of a sense of their own importance and brimming with ambitious schemes and ideas. They may spend money extravagantly, and build up debts. They may eat and sleep very little, and talk so quickly that it's difficult to understand them. They may be easily irritable and angry. Their libido can go into overdrive. A person may be quite unaware of these changes in their attitude or behaviour. After a manic phase is over, they may be quite shocked at what they've done and the effect that it has had. People can be very creative during mania, and may feel that it's a very valuable experience. Mania may flare up periodically, but depression is the most consistent symptom. People may feel overwhelming despair, guilt and worthlessness. They may feel chronic fatigue and gain weight, or have difficulty sleeping. They lose interest in everything. Problems concentrating and remembering things can make life very difficult and undermine the simplest tasks. The experience of bipolar disorder may provoke suicidal feelings. The current diagnoses in the UK in 2006 are likely to be: Bipolar I or II, depending on the severity and the duration of the episodes of mania and/or depression. Cyclothymic disorder - with short periods of mild depression and short periods of hypomania. Rapid cycling - four or more episodes a year. Mixed states - periods of depression and elation at the same time. Some people have very few bipolar disorder episodes, with years of stability in between them. They may experience a couple of cycles (episodes) in their whole lifetime. Others have more frequent cycles. About one to two per cent of the general population is diagnosed with bipolar disorder (a roughly equal number of men and women) usually in their 20s or 30s, although some teenagers are affected. Note: Some conditions, such as an overactive thyroid gland, can mimic the symptoms of bipolar disorder, and it is important that these are excluded by appropriate tests when the diagnosis is made. What causes bipolar disorder? There is no known cause of bipolar disorder, or a predisposition, but it is likely that a complex set of physical, environmental and social factors are implicated. Stress is likely to play a large part, and the role of cortisol on the developing brain is being researched. Prenatal stresses on the developing foetus are seen as important, both environmentally and nutritionally, as well as the impact of the mothers mental and physical health on the foetus. Stressful life events Some people can link the start of their bipolar disorder to a period of great stress, such aschildbirth, a relationship breakdown, money problems or a career change. Family background Some believe bipolar disorder can result from severe emotional damage caused in early life, such as physical, sexual or emotional abuse. Grief, loss, trauma and neglect can all be contributing factors they all shock the developing mind and produce unbearable stress. Life problems It's possible that bipolar disorder could be a reaction to overwhelming problems in everyday life. Mania could be a way of escaping unbearable depression. Constantly blaming other people and being highly irritable puts barriers up and could be the means of avoiding emotional dependence on friends and relatives. Again, talking treatments are thought to be helpful once the condition has stabilised. Seasonal effects Some people believe that their mood swings are affected by the seasons What sort of treatment can I get? If you go to your GP, he or she may refer you to a psychiatrist, who will be able to discuss the various treatments available. If a treatment does not suit you, say so and ask for other options. Medication Although drugs may control bipolar disorder, they do not provide a cure, and should be seen as part of a much wider treatment that takes account of individual need. Lithium is often prescribed for bipolar disorder and comes in two forms: lithium carbonate (Camcolit, Liskonum, Priadel) and lithium citrate (Li-liquid, Priadel). If you are taking lithium, you will have to have regular blood tests to make sure that the level of lithium in your blood is safe and effective. It is also important to maintain steady salt and water levels as far as possible. Common side effects of lithium include weight gain, thirst, and tremor. Long-term use is potentially toxic to the thyroid gland and the kidneys, and their function should be checked regularly during treatment. Alternative drugs to lithium are some of the anticonvulsants. Anticonvulsants are found to be particularly effective in people who have rapid cycling between mania and depression, and who have no family history of bipolar disorder. In the UK, carbamazepine (Tegretol) and semisodium valproate (Depakote) are licensed for use with bipolar disorder. Lamotrigine is also increasingly used, although it is not yet licensed for manic depression in the UK. Lamotrigine has the advantage of having antidepressant effects as well as being effective as a mood stabiliser for some people. There are adverse effects associated with all of these drugs, which should be made clear before beginning treatment. The drugs above are mood stabilisers, and are usually taken long-term. Some antipsychotic drugs specifically olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal) are also licensed for the treatment of manic episodes and may be taken at the same time as mood stabilisers; usually for short periods. In addition, psychotic episodes may be treated with older antipsychotics, such as haloperidol or chlorpromazine (Largactil). All of these drugs are associated with potentially serious side effects and should be used at the lowest possible effective dose for the shortest possible time Talking treatments Hopefully the use of talking treatments will increase. They reduce the relapse rate considerably and do not turn the disorder into a chronic condition as drug treatments tend to. Counselling, psychotherapy or sessions with a psychologist can help people understand why they feel as they do, and change both the way they think and feel. It may help people to overcome relationship difficulties often associated with the condition. It offers an opportunity to talk about the very stressful experience of manic depression and so to cope better with it. Unfortunately, psychotherapy for people diagnosed with manic depression is rare under the NHS outside a hospital setting, but it may be possible to find an organisation offering a low-fee scheme. Cognitive behaviour therapy aims to help people to identify problems and overcome emotional difficulties. It's a practical talking treatment with the focus on changing the negative thought patterns that are often associated with depression. There are new initiatives (2006) to make CBT much more widely available in the community, including self-help computerised CBT programmes. Group therapy can help too - either in or out of hospital or provided by a voluntary organisation. Hospital admission If you are particularly distressed, you may benefit from an environment that is not too demanding. At the moment, hospital is often the only place that provides this. It will give staff the opportunity to assess your needs and try to find the best way to help you. And, for those close to you, it may provide some relief. You can be admitted to hospital voluntarily, in which case you are called an informal patient. Most admissions are informal but, if you are unwilling to go into hospital, you may be admitted compulsorily under the Mental Health Act 1983. Your Community Health Council, a law centre, a solicitor, or Mind's legal department can advise you. Unfortunately, being in a psychiatric hospital or unit is often a distressing experience. The hospital may be very drab and smoky, with little privacy. People miss their own possessions and surroundings, and it can be frightening to be with other people who are acting in a way that is difficult to understand and is sometimes threatening. Some wards are still mixed sex, although this should change. There may be little opportunity to talk to staff. People who stay in hospital for a long time may become so used to the institutional routine that they find it hard to readjust to the outside world again. Crisis services Crisis services have been developed in some areas as alternatives to hospital. Sometimes they can offer accommodation (crisis houses), but otherwise they can offer support 24 hours a day in your own home, with the idea of avoiding admission to hospital. Crisis services rely less on drug treatments and more on talking treatments and informal support. ECT Electroconvulsive therapy (ECT) is a highly controversial treatment, which involves passing an electric current through the brain of someone who is under anaesthetic. It's given for severe depression and was regularly used to treat mania before antipsychotic drugs became available. ECT can cause short or long-term memory loss. It's much less common nowadays, although it is said that it provides some people with relief they can't otherwise get. It is disproportionally used on older women. What other support can I get? Everyone referred to psychiatric services in England should have their needs assessed and care planned within the Care Programme Approach (CPA). This should provide you with a thorough assessment of your social and health care needs, a care plan, a care co-ordinator who is in charge of your care, and ongoing reviews. You are entitled to say what your needs are, and have the right to have an advocate present. (An advocate is someone that can speak for you, if necessary. The assessment might also include carers and relatives. The same system applies in Wales. As part of the CPA, or separately, you can request social services to make an assessment of your needs for community care services. This covers everything from day-care services to your housing needs, with the aim of providing services in your own home or appropriate accommodation. You might need care workers, and the cost may need to be included in the needs assessment. It's important to find out as much as you can about local services you can make use of, whether they are run by the NHS, social services departments or voluntary organisations. Try asking your GP, the social services department, community health council, Citizens Advice and voluntary organisations, such as local Mind, or look on the internet or at your local library. Community Mental Health Teams Often community care assessments are made by Community Mental Health Teams. Their aim is to enable you to live independently. They can help with practical issues, such as sorting out welfare benefits and housing, and services, such as day centres, back-to-work schemes or drop-in centres. They can also arrange for a community psychiatric nurse (CPN) to visit you at home. Accommodation There are hostels where people in need of support can live for a limited length of time and be helped by staff to gain the confidence to live independently again. Sheltered housing Schemes offer less intensive support to a group of residents who can live there as long as they want. Day centres Day centres, day hospitals and drop-in centres can vary widely. Services may include therapy groups, counselling, information or advice. Some offer a chance to learn new skills, such as music, cooking or crafts; some organise day trips, or simply provide the opportunity for a cup of tea, a good lunch and a chat. You may need to be referred by a social worker or psychiatrist. What can I do to help myself? Getting support and understanding During a manic phase you may be quite unaware that your actions are distressing or damaging to other people. Later, you may feel guilty and ashamed. It can be especially difficult if those around you seem afraid or hostile. It helps if you provide people with information about bipolar disorder. After going through a manic depressive episode you may find it difficult to trust others, and may want to cut yourself off. These feelings are to be expected after experiencing such difficulties, but it may be far more helpful to talk through your emotions and experiences with friends, family, carers or a counsellor. There are now many support groups, where people who have gone through similar problems can come together to support each other. Managing your own condition Self-management involves finding out about bipolar disorder and developing the skills to recognise and control mood swings early, before they become full blown. It can be very difficult at first to tell whether a 'high' is really the beginning of a manic episode or whether you are just feeling more confident, creative and socially at ease. It can be a strain watching out for symptoms all the time, particularly when you are first learning about the effect bipolar disorder might have on your life. There are various guides to self-managing bipolar disorder. They may feature checklists and exercises to help you recognise and control mood swings, like mood diaries, tips on self-medication, and practical tips for dealing with depression and mania. Self management is by no means instant, and can take some time to use effectively. However, you may find you need to rely less on professionals, and have more control over mood swings. This can lead to greater self-confidence and lessens relapse. Day-to-day life Routine is important, as well as good diet, enough sleep, exercise and enough vitamins, minerals and fatty acids. Gentle stress free activities also help, like yoga or swimming. You could also try complementary therapies, such as reflexology and massage. Working life It's important to take things slowly and avoid stressful situations. If you already have a job, you might want to find out if you can return on a part-time basis to start with. If you are a student, most colleges and universities will offer good support and advice. Recovery Bipolar disorder need not be chronic and it can be possible to recover. There is a growing recovery movement among survivors. Developing countries have a far higher non-relapse rate than industrialised countries. Great recovery tools are hope, love, support and work. What can friends and relatives do? Seeing someone you care for going through the symptoms of manic depression can be very distressing. It's painful enough to be with someone who is in a deep depression, but during a manic phase they may not accept that there is anything unusual about their behaviour, and they may become hostile towards you. This can leave you feeling frightened and helpless. However, you can be vital in providing support and helping them to get practical assistance. How to cope Try to make sure you have support in coping with your own feelings. Give yourself time away from the person you are caring for, and ask friends and relatives for help. You may find counselling is helpful. Learning as much as possible about bipolar disorder can help you to cope better with your caring role. It's also worth remembering that, under the Carers (Recognition and Services) Act 1995, you may be entitled to ask for an assessment of your own needs from your local social services. Sometimes, people with manic depression experience suicidal feelings. If the person you are caring for feels like this, you might find it useful to contact a support organisation. Addressing difficult behaviour If someone is hearing or seeing things that you don't, there's no point trying to argue them out of it. Nor is it helpful to pretend you see or hear them too. It's much better to say something like,'I accept that this is how you see things, but I don't share that way of looking at it.' Try to focus on how the person is feeling at the time, to empathise with their emotions and encourage them to talk about them. Giving practical support Being organised can be a problem for people with this diagnosis. They may need help with practical matters (like ensuring they get enough to eat and sleep) and with their finances, particularly if they have built up debts during a manic phase. Try to work together with your friend or relative, rather than taking over completely. Ask them what support they want and then help them establish what is available. Encourage them to manage their own condition safely. Respect their wishes regarding care as far as possible. If they are in agreement, you can go ahead and approach agencies for help. Help them try to combat the stigma they may face from work colleagues or friends. Compulsory hospital admission If all else fails, particularly if the person is a risk to themselves or to other people, it may be necessary to seek admission to hospital. The 'nearest relative', as defined under the Mental Health Act 1983, has the legal right to request a mental health assessment from an approved social worker (ASW) to look at possible options and to decide whether the person should be detained. Further Information MDF The Bipolar Organisation. Runs self-help groups and self management courses.  HYPERLINK "http://www.mdf.org.uk" www.mdf.org.uk Rethink (formally National Schizophrenic Fellowship) - Offers support, advice and information to people who are experiencing schizophrenia and other mental health related problems.  HYPERLINK "http://www.rethink.org/"www.rethink.org 2^kp0M/  !%%**G,K,:.W.u335555526>67777::>>?? AAB@BBBDDɸɧړړ&hGah5CJOJQJ\^JaJ hGah@SCJOJQJ^JaJ!hGahB*OJQJ^Jph hGahCJOJQJ^JaJ$hGah0JCJOJQJ^JaJ#h2|h>*CJ4OJQJ^JaJ4:2_  g0N/ & Fddd[$\$gdgd$a$gd2|_N !!#k%%%#'x(**G,K,:.X.2u3355526>6777 9_::gd::;>>?? 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