Bipolar disorder from the clinician’s perspective
I recently came across this great video by Dr. Jeffrey Applebaum, a Family Medicine physician at UC Davis in the USA. He provides a cool, calm look at Bipolar Disorder and seems to 'get it'. Well worth the watch.
I’m back
Apologies for being away for so long, but the bipolar took hold of me and threw me around a fair bit in the last nine months. Please expect more regular updates now.
Also, I want to let you know that I've just launched a sister site to this one, DefeatingBipolar.com, where you will find books and dvds hand-picked to help you care for yourself or for those you love who suffer from this evil disease. Please feel free to visit the site often, as I'll be updating the information on there regularly.
Thanks for still being around,
Lee
When to suspect bipolar disorder
The Journal of Family Practice has a useful practitioner’s guide to identifying when a patient may be presenting with bipolar disorder symptoms.
As the authors say, bipolar disease is often misdiagnosed, sometimes repeatedly.
The authors—Muruga Loganathan, MD, Kavita Lohano, MD, R. Jeanie Roberts, MD, Yonglin Gao, MD, and Rif S. El-Mallakh, MD—report that close to one-third of patients with bipolar disorder seek medical care within a year of the onset of symptoms, but nearly 70% do not receive an accurate diagnosis until they’ve seen four physicians.
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) defines 4 types of bipolar illness: bipolar I, bipolar II, cyclothymia (the most mild form), and not otherwise specified The key feature of all 4 types—and the distinguishing characteristic that diagnosis typically hinges on—is a manic or hypomanic episode.
Although a full-blown manic episode may not be hard to identify, hypomania is easily missed. By definition, hypomania—with its heightened sense of well-being and productivity—is not problematic and is rarely a patient’s primary complaint.
Mixed mania, a feature of bipolar I, is the worst of both worlds: It is a state in which a full manic episode is superimposed on a full depressive episode—a depression with all the energy and force of a mania. Patients who have experienced one episode of mixed mania have a 12-fold increase in mixed states, 6.5 times more depression, and 1.7 times more dysthymia than those who experience manic episodes without the overlay of depression.
I and countless others can attest as to how horrible it is.
The authors recommend using the Mood Disorder Questionnaire (MDQ) constructed by Hirschfeld et al. as a useful guide to bipolar disorder identification. There’s a copy of the MDQ in the JFP’s article, as well as the original source article.
If you or someone you know is wondering if they might have bipolar disorder (and one psychiatrist I know of is convinced that all ‘depressive’ patients have an element of mania within their history and should therefore be considered in a new, bipolar, light) then ask their GP to administer the MDQ, or refer them to someone who can.
It could be the help they need to get them on the path to managing their illness appropriately.
Sources:
Hirschfeld RM, Williams JB, Spitzer RL, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry.
2000;157:1873-1875.
Loganathan, Muruga; Lohano, Kavita; Roberts, R. Jeanie; Yonglin Gao; El-Mallakh, Rif S. When to suspect bipolar disorder. Journal of Family Practice, Dec2010, Vol. 59 Issue 12, p682-688, 7p
Please see our medical disclaimer.
Today is World Suicide Day
World Suicide Prevention Day is observed on September 10 each year to promote worldwide action to prevent suicides. Various events and activities are held during this occasion to raise awareness that suicide is a major preventable cause of premature death.
World Suicide Prevention Day promotes issues such as suicide prevention. This photo is used for illustrative purposes only. It does not imply the attitudes, behaviour or actions of the models used for this photo. ©iStockphoto.com/Valentin Casarsa
Nearly 3000 people on average commit suicide daily, according to the World Health Organization. For every person who completes a suicide, 20 or more may attempt to end their lives. About one million people die by suicide each year. Suicide is a major preventable cause of premature death which is influenced by psycho-social, cultural and environmental risk factors that can be prevented through worldwide responses that address these main risk factors. There is strong evidence indicating that adequate prevention can reduce suicide rates.
World Suicide Prevention Day, which first started in 2003, is annually held on September 10 each year as an IASP initiative. The World Health Organization co-sponsors this event. World Suicide Prevention Day aims to:
- Raise awareness that suicide is preventable.
- Improve education about suicide.
- Spread information about suicide awareness.
- Decrease stigmatization regarding suicide.
In Australia our annual toll of deaths by suicide is greater than the number of deaths on our roads, yet we only hear about the road toll. Mental health organisations are making slow but steady inroads into the macho culture of Australia and getting politicians and fund holders to realise that reducing the mental health burden of our country is good for our country’s health – fiscal, physical and mental.
There are plenty of places to go if you think you or someone you know might be in need of help to cope with anxiety, depression of suicidal thoughts. Try any of these:
- Lifeline Australia – tel 13 11 14
- Kids Helpline - 1800 55 1800
- Suicide Line (only in Victoria, Australia) – 1300 651 251
- SANE Australia – 1800 18 SANE (7263)
Psychoeducation intervention for bipolar sufferers
I recently completed a 10-session therapy course for bipolar suffers and can attest to the help that such courses can offer.
The course first looked at the causes of bipolar disorder, what medical treatments are available, then moved on to the individual experiences involved, including identifying triggers and relief behaviours.
Each of the sessions lasted for three hours, including a mid-session tea/coffee break, and comprised not only individual self-assessment exercises but also group discussions where we shared our experiences – the frustrations and the benefits – of our bipolar lives.
I’m sure you can understand that the ‘frustrations’ far outweighed the ‘benefits’.
But even after only 12 weeks after the end of the course I find it difficult to remember any of the material we explored, suggesting that repeat, follow-up sessions would be advantageous. Naturally, no such sessions exist because there’s no funding for them in the Australian mental health system.
Emily Griffiths and David Smith from the department of psychological medicine at the University Hospital of Wales have briefly outlined in Mental Health Practice some of the findings their own research has uncovered into psychoeducation.
Psychoeducation, they say:
involves providing clients and their families with accurate and reliable information about their diagnosis to empower them to better manage their illness.
In the course I attended there was no space for family members, nor do I think they would have been invited – self-disclosure amongst peers is fraught enough with risk; disclosing our experience of our illness to non-sufferers would have potentially generated emotional responses no one would have welcomed. As it was, of the two facilitators our group had only one was a psychologist; the mental health-trained nurse seemed less flexible and less able to comprehend – other than academically/intellectually – our psychic pain.
Griffith & Smith’s group sessions involve:
- Introduction
- Diagnosis of bipolar disorder
- Causes of bipolar disorder
- Rôle of medication
- Rôle of lifestyle changes
- Relapse prevention and early intervention
- Psychological approaches
- Women and bipolar disorder
- Advice for family and carers
- Conclusions
They go on to point out that the mood disorders research team at their department has developed an online interactive psychoeducational tool for bipolar disorder, currently undergoing clinical trial with a view to becoming a cost-effective way of delivering high quality education to large numbers of bipolar sufferers. You can find the tool at BeatingBipolar.org.
You can also find out more about the Hospital’s bipolar programme at bep-c.org.
Source: Griffiths, S. & Smith, D. 2010. Psychoeducation intervention for people with bipolar disorder. Mental Health Practice, 13, 9, pp. 22-23.
Social Media panel at VicServ 2010 conference
I was fortunate to be a panellist at the VicServ conference, “Unfinished Business”, discussing the use and potential of social media with relation to mental ill health services in Australia.
- Factoid from Professor Patrick McGorry (Australian of the Year) that seemed to generate a lot of discussion: Each year about 40 MCG Stadiums full of people require some sort of mental ill health service, yet only 13 MCGs will receive help of any kind.
On the panel with me were Michelle Blanchard of Inspire, Tim Reid, Joanne Spain and the panel organiser Janet Hopkins (no relation), the CEO of Lantern (formerly ‘ReachOut’).
Here’s the recording of our panel:
http://media.libsyn.com/media/leehopkins/vicserv2010-socmed_panel-30apr2010.mp3
And here’s some photos:
 The panel |
 Joanne Spain and Lee Hopkins |
 Janet Hopkins |
 Tim Reid |
 Joanne Spain |
 Tim Reid and Michelle Blanchard |
Psychological Effects of Dog Ownership
Do dogs help us cope with depression, or do they cause us additional stress?
Do they provide us with comfort support and unconditional love, or is their love and presence placing yet another burden on our already overwhelmed shoulders?
The answer, it seems, depends on your gender, age and marital status.
North America reportedly has 75 million dogs and 39% of North American homes have at least one dog, according to the American Pet Products Manufacturers Association.
Dr Krista Marie Clark Cline from the University of Missouri–Columbia saw that the existing literature on pet ownership and depression didn’t break down what type of pet caused what result. Keen to know if dog ownership was the ‘godsend’ some dog owners had reported, Krista created a telephone survey lasting some 45-60 minutes that aimed to delve deeper into the research question.
Two hundred and one responses later, she ran several regression analyses (‘stats’ is not my strong point; see the original source article for more detailed descriptions) and came to some interesting conclusions.
But before I get to them, let’s consider a couple of theories about dog ownership and how dogs might interact with depression.
One theory, Role Strain Theory, holds that the individual with multiple roles – marital partner, employee, parent, friend, sibling, etc., – will possibly find adding another role, that of dog owner, to be one burden too many, leading to feelings of lower self-efficacy due to not being able to meet adequately the self-set expectations of each role.
Role Enhancement Theory, conversely, holds that the individual with, for example, too few roles will find the addition of a dog-owner role to be an affirming one, providing them with greater opportunities for feelings of emotional support, exercise (we all know that exercise is good for our mental health) and increased social interaction. Similarly, those individuals with too many roles may find the addition of dog owner a useful emotional buffer and a friend where one can go to for unconditional love and affection (because we all treat our dogs like they’re human, don’t we?).
So, to recap: having a dog may help us if we are living alone and are older in our years (because we have less role demands, are more likely to be single than when we were younger, and have less opportunities for social interaction); equally, having a dog may be a hindrance because they add one more burden to our lives and yet another expectation that we must meet, which can be overwhelming when we already have the role expectations of marriage, parenting, friendship, employment and familial duties.
So what’s the result of the study?
Dr Clark Cline found sex and marital status differences in the relationship between dog ownership and well-being, with women and single adults more likely to benefit from dog ownership.
But, as she points out herself, there are some serious flaws with the study.
Although dog ownership leads to higher well-being for single individuals and women, the reverse may also hold. People with more depression may seek out dogs as sources of companionship. The direction of causality is a question that can only be answered by carrying out longitudinal studies.
Meaning that we might go out and buy that puppy in the window, the one with the waggily tail, precisely because we are feeling great, only to find that our mood slips; or that we buy the puppy because we were feeling sad, only to find that our mood increases.
Equally, there is no distinction in the study between dogs who are pets and dogs who have some utility: guard dogs, ‘seeing eye’ dogs, and such like. It would be useful for future studies to make some sort of comparison between the utility of the dog and its companionship, including if the guard dog during the day becomes the family pet at night when everyone comes home from work, for example, and what impact that might have on our scant knowledge of the benefits or otherwise of dog ownership when looking at depression.
Although pets have a positive influence on health and well-being (Garrity & Stallones, 1998), no consistent relationship between dog ownership and well-being has been documented
-----
Sources:
American Pet Products Manufacturers Association (APPMA) (2008). 2007-2008 National
Pet Owners Survey.
Clark Cline, K.M. (2010). Psychological Effects of Dog Ownership: Role Strain, Role Enhancement, and Depression. Journal of Social Psychology, Mar/Apr2010, Vol. 150 Issue 2, p117-131
Garrity, T. F. & Stallones, L. (1998). Effects of pet contact on human well-being: Review
of recent research. In C. Wilson and D. C. Turner (Eds.), Companion animals in human
health. Thousand Oaks, CA: Sage
Mutrie, N. (2002). Healthy body, healthy mind? Psychologist, 15, 412–413.
Please see our medical disclaimer.
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- I’m back
- When to suspect bipolar disorder
- Today is World Suicide Day
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- BeyondBlue Australian depression organisation with great resources
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- Inspire Foundation Set up in 1996 in response to escalating rates of youth suicide in Australia
- The Black Dog Institute Australia’s premiere online resource for bipolar sufferers and those who love them
- The Mental Health Service Australia-wide organisation whose annual conference is a must attend, bringing over 1,000 mental health specialists together
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