Promoting Social Inclusion, Connectedness

This article entitled "Promoting Social Inclusion and Connectedness in the Mentally Ill Patient" was recently published in Clinical Psychiatry News. Written by two residents affiliated with the Family Center for Bipolar, the article describes numerous types of community resources that can help patients broaden their social lives.

Mania/Hypomania and the Creative Process

Mania and hypomania are often referred to as the "up" side of bipolar disorder. Though either a manic or a hypomanic episode can be quite destructive, we as clinicians often hear concerns from patients about treating these kinds of mood episodes. The reality is that after a long struggle with depressive episodes, a manic or hypomanic episode can sometimes feel like a welcome break for our patients. It is during these episodes that patients oftentimes become non-compliant with their medicine and other on-going treatment modes (e.g. therapy) - perhaps because a part of them does not want to let go of the euphoria that mania and hypomania induce.

As clinicians it is our responsibility to negotiate this difficult and delicate dilemma in our patients' mood functioning. On one hand we want our patients to feel good, and on the other we know how precipitous the guise of euphoria can prove to be for the patient, his/her loved ones, and for the course of treatment.

In my own experience working with patients with bipolar illness I often hear people express fear that treating mood symptoms, especially hypomania, will negatively impact their creative process. On one hand I can easily empathize with their concerns, yet as a clinician I worry about the impact that these concerns will have on their treatment and progress. There are no easy answers to this dilemma.

In contemplating about all this I recently came across a very interesting article that poignantly discusses this very real and fairly common predicament.

You can read the article here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181877/pdf/DialoguesClinNeurosci-10-251.pdf

If you have any thoughts or input on this topic - whether from a clinician's or patient's point of view - kindly share it with us. We would love to hear your thoughts.

What To Do When You Don't Want To Do Anything?!

When we’re not feeling well we often don’t feel like doing anything. However, a simple fact is that getting out to actually do something often makes us feel a bit better. Sounds like a catch 22, right? 

How do we get out to do anything if we don’t have the motivation to do it? 

We often hold the common misconception that we need motivation in order to actually do something. The truth is, it is often the opposite. We have to actually do something in order to ignite the motivation. The first step is often the most difficult.

 

Are you at a loss for what to do? Here is a link to a list of 279 Pleasant Activities: 

Let's Get Moving!

Look over the list and pick something new that you feel you can actually do in this moment. Whatever time frame you think you can do it for, scale it back (if you think you can do something for 20 minutes, plan for 15). 

Know that taking that first step is the hardest, but once you start the activity, you may realize your motivation has increased, along with increased positive thoughts, emotions and physical sensations!

Family Involvement and Relapse Prevention in BD

A recent article published in BMC Psychiatry in November 2011 titled Involving relatives in relapse prevention for bipolar disorder: a multi-perspective qualitative study of value and barriers focused on both the benefit and barriers of involving family members in relapse prevention treatment. Some of the benefits include another “pair of eyes” to monitor the patient, relatives' increased understanding of the illness, increased support during a crisis, and earlier intervention during a relapse. The paper also notes that during relapse prevention training it is important that each member clearly understands their role in the therapeutic relationship and does not use their new role in a threatening way.  In addition, some obstacles such as confidentiality and family dynamics must also be addressed in order for the relapse prevention model to be effective.

The research strongly supports the involvement of relatives in relapse prevention, while recognizing barriers to effective treatment and tools to prevent and overcome these barriers.

Dr. Burns

Children's Books

Bipolar Disorder and mental illness affect the entire family. It is especially important to make sure that young children feel loved, validated and supported.  One way to engage and provide age-appropriate psychoeducation to children is to read them thoughtful stories about Bipolar Disorder.  Please visit the links below.

The Bipolar Bear Family: When a Parent Has Bipolar Disorder
Why is Mommy Sad? A Child's Guide to Parental Depression
My Mother's Bipolar, So What Am I?
Sometime My Mommy Gets Angry

Family Support Groups

The following websites might help patients cope with family members who have mental illness:

P The Crooked House

P National Family Caregivers Association

P American Foundation for Suicide Prevention

P Family Connections: Coordinated by the National Education Alliance for Borderline Personality Disorder

P Families for Depression Awareness

P Families Together

P Depression and Bipolar Support Alliance

P Mental Health America

P The Children’s Society’s Include Project

P The National Alliance on Mental Illness Family-to-Family Education Program

P Support and Education Program for Families

P Network of Care

P Children and Adults with Attention Deficit/Hyperactivity Disorder

P Active Minds

P Substance Abuse and Mental Health Services Administration Resources for Military Families

P Compeer

P National PLAN (Planned Lifetime Assistance Network) Alliance

For full article entitled Family Support Groups: An Integral Part of Patient Care, visit the Families in Psychiatry Section of Clinical Psychiatry News.

Medication Tips!

Having bipolar disorder means that you probably have to take medications every day, which can be hard to remember and stay on top of!

Those day-of-the-week medication boxes from the drugstore are really useful! If you take more than one medication per day, it's much easier to fill the box once a week than to open several bottles every day. And if you're prone to forgetting your medications, it's easy to look back later in the day to see if you missed a dose! Remember to discuss with your doctor how often you remember to take your medication, even if you tend to forget! It's important for your doctor to know.

If you take medications from doctors other than your psychiatrist, it's really important to let your psychiatrist know!  

Medications can interact with each other in your body and change how effective they are - you could take your medication as prescribed, and it could be less effective, or too much for you!

Avoid those situations by keeping a list with you, in your wallet or purse, with your medication names, doses and how often you take them, something like this:

Lisa Smith
Aspirin, 81mg, one tablet daily

Those medication names can be hard to remember off the top of your head, so avoid all of that by keeping a list!

Want to start feeling better? Start doing!

Ever feel down and depressed? Lack motivation? What about feeling so depressed that you just feel like you can't do anything? Rest and sleep are important, but not when it means doing nothing else during your day. If you want to start feeling better, I find that it helps to start doing things. You can start small with simple things like going for a walk or getting up at the same time each day.  
 
Did you know that research has shown that waking up each day at the same time and experiencing sunlight when you first wake up has been shown to help people feel better and sleep better?

You can also plan out a few set times during the day to do some healthy activities that you enjoy. Building structure to your day can help you stay organized and feel a sense of accomplishment when you get things done, which can help you to feel better!

Maybe going to the library, contact an old friend to meet for coffee, volunteer, or engage in a little exercise. It doesn't have to be complicated. You can ask your family or talk to your doctor as well to get other ideas.  

The important thing is to start doing so you can start feeling better!

Reality check, please!

When we get sick, sometimes it is difficult for us to make good decisions. As a result, it is important when you are feeling well to establish people that you can trust to help you when you may not be feeling well. Our brain is the center for determining our sense of reality. Because Bipolar Disorder impacts brain functioning, it can be particularly difficult for people with bipolar disorder to make good decisions when they are sick.  
 Take a moment to write down a list of people that you can trust to help you in case your sense of reality is distorted when you get sick.

You may also want to write down some "reality checks" to help you in the moment. You can carry these with you and can pull them out if you find yourself in situations that are confusing to you or are situations that you have identified as potential triggers of your bipolar disorder getting worse (such as if you are about to spend a lot of money or if you have gone several hours without sleeping).

These "reality check cards" may look something like this: "When I feel like my thoughts are racing or I feel on top of the world, I should not make major life decisions (such as spend over a certain amount of money or book travel) without taking time to discuss these things with others (people on your list) before going through with them."

You may feel pressure to decide things, but for important decisions there is always time for a "reality check!"