App to Detect Onset of Mania In Development by Sane Australia

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Credit to flickr user Christian Hornick. Used with permission under a Creative Commons license.

Mania, which can include irritability, hyperactivity, over-spending, and promiscuity, is often devastating to people who suffer from bipolar disorder. Unless the bipolar sufferer knows themselves and their disease very well, oncoming manic episodes can’t be detected. And occasionally, patients even ignore or deny their symptoms. Sane Australia, a mental health organization, is testing an app that will detect the onset of manic episodes.

The app works by monitoring the bipolar person’s interactions with their digital devices. Over time, this data can be compared with touchstones of stability in the person’s life. If instable patterns–such as not sleeping for days on end–arise, then the bipolar sufferer and a trusted confidant or medical professional are notified by the app so they can take action to prevent the episode from getting worse. The data can also be shown to psychiatrists working with the bipolar person to demonstrate patterns of behavior and create treatment plans in response.

Sane Australia is hosting a three-month non-clinical trial in July with 400 people–200 with bipolar and 200 people close to them–to determine if the app actually works. Initially, the app, funded by Gandel Philanthropy, will only be available on Android smartphones, but the company plans to release it on tablets, laptops, and other devices.

Eventually, the company plans to address the onset of depression as well as the onset of manic episodes. They hope to analyze data gathered by a large user base, which will give them bellweathers of instability across a population of bipolar sufferers.

This app, if it works, is a promising addition to a bipolar patient’s arsenal to prevent their disorder from consuming their life. According to the app’s website, “Destructive mania is often detected too late to take preventative action.” If manic episodes can be found early, then medical professionals and careers can respond quickly, and head off the worst of the symptoms.

The app is scheduled for release in the Australian market sometime in 2018.

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What to do if You Run Out of Medication

Medications. Like it or not, sufferers of mental health problems usually need to take them to manage their conditions. Being compliant with your prescribed pills is the best path to stable moods. But what happens when you run out?  Here are a few tips to deal with just that.

1. Don’t Panic

If you have a mental health issue that’s triggered by stress, panicking is the worst thing you can do for yourself. Withdrawal symptoms can be harsh, but not as bad as triggering your illness. Breathe. Remind yourself that this is a temporary problem, which can be fixed. Which brings us to our next point…

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2. Call Your Doctor

Call your doctor immediately, and keep them apprised of the situation. If you can’t meet with them, find out if they will call in a prescription for you to a pharmacy. Any doctor at your regular office should have access to your files, and should be able to fill a prescription.

3. Use a Regular Pharmacy

If you can, visit the same pharmacy and get to know your pharmacist. Bring your empty prescription bottles with you to talk to the technicians, and they might be able to give you an emergency five- or seven-day supply, or direct you to an emergency clinic that can. You are unlikely to get one if you are sixteen or younger, as pharmacists are reluctant to give out medication to minors. Take an adult that you trust with you to help smooth things over.

4. What if I Can’t Afford Them?

If you can’t afford your medications, ask your doctor. He or she may have access to free samples of the pills you need, or be able to prescribe you a cheaper generic drug. If you’re an American citizen and you’re uninsured, find out if the pharmaceutical company that manufactures your drug has a patient-assistance program. You may qualify for these programs if your income is 100% of the poverty line, but it’s unlikely that you will if you receive Medicaid benefits. Ask your pharmacy if they have a discount program if you pay in cash. If you’re over fifty and have a membership with the AARP, you can receive discounts on pills.

There is no reason for you to go into medication withdrawal. Ideally, you’d be able to have your doctor prescribe some drugs months in advance, but if that’s not the case, contact your doctors and pharmacy to find out what they can do for you. They want to work with you.

Have you ever run out of meds?

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4 Ways to Educate Someone About Mental Illness

How often have you heard an insensitive–and inaccurate–remark about mental illness? How about something like, “the weather can’t decide whether to be hot or cold. It’s so bipolar!” or “these basketball players need to talk to each other. They’re so schizo!” These expressions are stigmatizing because they connect mental illnesses to undesirable behaviors.

It’s not your job–and it certainly isn’t fair–to have to educate others about mental illnesses. But, if you feel the need, how do you approach someone who uses terms of disorders in a healthy way? These four tips will hopefully help.

1. Is Engaging Worth It?

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First, figure out whether you want to engage the person. You’ll be opening yourself up to criticism, especially if you have a mental illness yourself. If you’re dealing with a stranger in a crowded place, it may not be worth it to correct them. However, if you’re dealing with a well-intentioned friend, feel free.

2. Watch Your Tone

As difficult as it is to not become defensive, try. Coming across as positive and kind will go a long way towards educating the ignorant, because they’ll be more likely to open a dialogue with you rather than getting defensive themselves. It’s not fair to have to police  yourself like this, especially when tempers are boiling hot, but if you want to correct someone, it’s better to not go on the offense.

3. Get Personal

Try to use “me” statements such as, “When you say things like that, it really hurts me.” If you’re comfortable talking about your mental illness, tell a bit of your story to demonstrate the effect of their words on you.

4. Offer Resources

Hopefully, the person you encounter will be open to discussion. If so, then you can offer them resources which they can use to educate themselves further. Websites like nami.org, for the National Alliance of Mental Health, are a good starting point. You want to make sure your resources are as comprehensive as possible.

Again, it’s not fair to have to educate anyone about your struggles with mental illness, and it’s certainly not pleasant to have to police yourself in order to engage with someone. But, the more you educate, hopefully the less you’ll have to deal with insensitive remarks in the future.

Have you ever educated anyone?

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The History of Bipolar Disorder

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Credit to Feedspot

A quick housekeeping note: I was recently awarded the nineteenth spot on Feedspot’s Top 100 Bipolar Disorder Blog list. The blogs were ranked by a editorial panel based on Google search rankings, popularity on social media websites, and quality and consistency of posts.

Thank you. We now return to your regularly scheduled post, The History of Bipolar Disorder.


 

The history of bipolar disorder is a fascinating study of a mental illness that goes back to the second century. The ancient Greeks and Romans found that lithium salts in baths eased the symptoms of what they termed “melancholia” and mania. Aretaeus of Cappadocia demonstrated a link between the two mood states, a finding that would go unrecognized for several hundred years. Many mentally ill people were executed at this time based on fears about demon possession.

Early Chinese authors recognized bipolar disorder as a mental illness. In his Eight Treatises on the Nurturing of Life, Gao Lian (c. 1583) outlines the disorder. Avicenna, a Persian physician, established the disease in 1025, separating it out from other forms of madness, like rabies.

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Credit to flickr.com user Jessi RM. Used with permission under a Creative Commons license.

In 1854, French psychiatrist Jules Baillarger coined the term “dual-form insanity,” describing the oscillating symptoms of depression and mania. Two weeks later, Jean-Pierre Falret called the same disorder “circular insanity” while detailing that the disease clustered in families, proving a genetic link.

Emil Kraepelin was the next psychiatrist to address the illness, in the early 1900s. He coined the term “manic-depressive psychosis” to differentiate it from schizophrenia and to describe the relatively symptom-free intervals in the course of the untreated disorder. Carl Jung made a distinction in 1903 between bipolar I and bipolar II, focusing on psychotic states vs. that of hypomania.

John Cade, an Australian psychiatrist, then discovered the calming effect of lithium on patients with manic-depressive illness in 1949. But it took until 1970 for the U.S. Food and Drug Administration to approve of lithium’s use.

In 1952, the idea that the disorder ran in families was revisited in an article published in the Journal of Nervous and Mental Disorder, termed “manic-depressive reaction.” Then, Karl Leonhard introduced the terms bipolar (with mania) and unipolar (with depressive episodes only) in 1957.

People with bipolar disorder at this time and throughout much of the 1960s were institutionalized due to manic-depression not being recognized as an illness. That changed in the early 1970s, and in 1979 the National Association of Mental Health (NAMI) was founded.

The term “bipolar disorder” didn’t appear in the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) until 1980, but it has quickly been accepted as less stigmatizing than “manic-depressive illness.” The history of the condition is a captivating look into the evolution of how we as a society treat mental illnesses.

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Mental Illness in the Media–An Incomplete Picture

The mass media has a horrible track record when it comes to factually portraying mental illnesses. Television, movies, and newspapers all characterize suffers of mental health issues as violent, slovenly, and unpredictable. Unfortunately, many misconceptions about mental conditions are born here, because this is where many people get their information about mental conditions.

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Up to 73% of sufferers of mental illnesses in television shows are portrayed as violent, compared to roughly 40% of “normal” characters. And, to make matters worse, only 24% of female characters without mental health issues are violent, which makes the 71% of violent female characters with disorders even more shocking.

Films are just as bad. The most typical example is Psycho, where mild-mannered Norman Bates is dominated by his “mother-half,” a homicidal split in his personality run by his deceased mother. Even if the director has the best intentions and portrays bipolar disorder accurately, like in Silver Linings Playbook, having the two main characters’ issues washed away because they end up together is highly inaccurate and almost insulting.

Print media gets it wrong as well. In 2011, 14% of articles referred to suffers of mental illness as a “danger to others.” Tabloid newspapers especially focus on violence, using graphic descriptions and terms like “crazed” in the headlines to attract attention. Most newspapers engage in armchair diagnoses, which means they speculate on the mental state of article subjects without evidence to back up their claims.

But the fact is, people with mental illnesses just aren’t more bloodthirsty than the general population. A new study published in the scientific journal JAMA found that only 8% of those with schizophrenia and no substance abuse were violent, compared to 5% of the general public, a statistically insignificant number. Research demonstrates time and time again that the media is dead wrong in its estimation of violence among the mentally ill.

So how can you sift through the information presented and gain a critical eye, and instill that in your children as well? First, you can ask why you’re being told something. What bias do reporters lean toward, and, if applicable, what are they trying to sell you?

Second, recognize that crimes are more reported on than everyday, slice-of-life stories. Violence sells, and mental illnesses, when involved, become the focus of the story. Very few stories about recovery are published on a daily basis, because therapy is boring to read about.

Third, seek other sources, especially first-hand accounts. There are several reputable websites available, like nami.org, the official site of the National Alliance on Mental Illness, and nimh.nih.gov, the site for the National Institute of Mental Health.

What about your kids? Train them by following the first three steps, with the addition of asking them why they think people with mental illnesses are portrayed the way they are.

With these steps, you can learn to filter the mass media you consume, and help combat the stigma that sufferers of mental illness face everyday.

What sorts of portrayals of mental illness have you seen in the media? 

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5 Ways to Cope with a Diagnosis of Mental Illness

Hearing a diagnosis of mental illness can be heartbreaking for many. Some people feel relief at finally having a name to put to their issues, where others may become angry or afraid because they have a disorder to cope with.

However, a diagnosis is important because it means that you can move on to treatment. Doctors can use their experience with similar diagnoses to construct a personalized plan to address disorders, and advise you about future health risks. Most importantly, insurance companies will have a reason to apply aid now that they have a name for the condition.

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But what do you do with a diagnosis once you have one?

1. Learn

First, learn about your diagnosis. Ask your doctor to recommend books or websites, like nami.org, the official site of the National Alliance on Mental Illness. Once you learn the basics, like what the symptoms of your illness are, you can transition to learning about treatments and what you can do to help your recovery.

2. Find Doctors

Next, create a treatment team. Ideally, you’d have a therapist and a psychiatrist–or nurse practitioner–who can prescribe medication for you. Presumably you already have one, if you have a diagnosis. But make sure your team is rounded out. There are low-cost options for mental health services out there. Try looking into support groups offered by local NAMI chapters or ant your local library. Ask your doctors if they offer sliding scale fees based on income. If you’re near a university, see if they have a graduate program for psychology, where a therapist-in-training can take you on as a client. Here’s a list of 406 free or low-cost clinics in Washington state, 138 of which offer mental health services.

3. Journal

Writing down your troubles is a proven way to start addressing them. If you have concerns about your diagnosis, write them down so you can bring them up with your doctors later. Scribble down what you plan to do as a result of this diagnosis, whether it be sharing your condition with loved ones or keeping it close to your chest. Figure out whether you need to adjust your treatment team, regarding whether or not you’re relating to the people responsible for your care.

4. Find a Team You

Team You, a term taken from the delightful blog Captain Awkward, is a term used to describe the supportive, unbiased people in your life like counselors, psychiatrists, parents, reliable sitters, religious figures, and friends who may or may not have kids of their own. This assistance is invaluable to a person dealing with a diagnosis of mental illness. Unfortunately, collecting a solid Team You takes time. If you’re a parent, then hopefully you have parent friends—ideally ones who you are comfortable explaining your struggle to. Attend groups from Meetup.com or local libraries. Try out classes, and take notes on your classmates as well as the subject material. Toddler groups are excellent places to search for potential allies, too.

5. Hold Yourself Accountable

Once you have a treatment team and a Team You in place, don’t flake out on them. Attend your doctor’s appointments and take your meds. Keep updating your journal regularly with shifts in your moods, so you can find out if the treatment plan you’ve been given is working. Keep up with your friends and allies.

A diagnosis of mental illness isn’t a life sentence. Many people can and do recover completely from their disorders, and more severe mental conditions can be managed. Help is out there. You are worth exploring every avenue of care.

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8 Myths About Mental Illness

Mental illness is widely misunderstood by the general public. People who suffer from mental disorders can find that many myths surround their condition. These misconceptions contribute to stigma, making it more difficult to seek treatment and manage disorders. We’d like to dispel some of these fictions.

1. People Can Use Willpower to Recover

While there is no definite cure-all for mental illness, it definitely can’t be treated by willpower alone. People can’t just “snap out of it.” If only managing a condition were that easy! Conversely, treatment such as medication, psychotherapy, and Electroconvulsive therapy (ECT) actually works. Scientists are frequently discovering new advances in treatment, and with them, sufferers of mental illness can manage their disorders and lead healthy, productive lives.

2. Mentally Ill People Can’t Work

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Nope, this is bogus as well. People with mental disorders can and do contribute to the workplace and home. Most of the time, the mentally ill are excellent at “covering” for their illnesses, which basically means that they can successfully pretend that all is well. They can be so good at covering, friends and family don’t even recognize that the disordered are mentally ill.

3. It’s Just Bad Parenting

No, no, no. The causes of mental illness are varied, including genetics, physiological changes, and environmental stressors. Neglect and unusual stress in the home tend to exacerbate underlying conditions which have biological causes. It’s not the parent’s fault that a child develops mental illnesses. Which leads us into our next point…

4. Children Can’t Be Mentally Ill

Children make up a great percentage of the mentally ill. More than half of all mental illnesses show up before a child turns fourteen, and three-quarters of them appear before the age of twenty-four. Even very young children can demonstrate symptoms of mental disorders.

5. Mentally Ill People Are Violent

Dead wrong. Suffers of mental illness make up a meager 3-5% of the incidences of violent acts in society. Hollywood has a terrible habit of stereotyping the mentally ill as violent, from Norman Bates in Psycho to Jim Carrey’s character in Me, Myself, and Irene. In fact, disordered people are ten times more likely to experience violence than the general population.

6. Mental Illnesses are Uncommon

This is absolutely not the case. One in five adult Americans endure mental illnesses each year. Roughly six percent of the population suffers from a debilitating disorder. You’re not alone if you have a mental health problem.

7. Most Mentally Ill People are White

Actually, most mentally ill people are minorities. African Americans are the most at-risk group, vulnerable to mental disorders such as depression due to increased stress from economic disadvantages.

8. People Can Recover With Drugs Alone

Medications and ECT are only part of the equation. The rest is talk therapy, which most people prefer to use rather than drugs, and peer support groups. These latter strategies try to lessen the effect of environmental stressors, which can trigger or exacerbate underlying conditions.

These myths are damaging to the mentally ill. By educating yourself about mental disorders, and spreading the truth about them, you can help combat dangerous misconceptions which stigmatize sufferers of mental health issues.

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Learned Behaviors: Passing on Coping Mechanisms

Learned behaviors are just as it says on the tin: behaviors that are learned rather than innate, such as a dog being taught to roll over. These behaviors are born from experience, coming from conditioning through rewards and punishments. Learned behaviors can also be f0und in the children of the mentally ill.

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Some learned behaviors of children of ill parents are over-responsibility, inability to cope with life unless it’s chaotic, or equating worth as a person solely with achievements. As they grow into adults, many kids will mirror symptoms of the disordered parent even if they themselves are not mentally ill.  For example, children of depressed parents can exhibit depressive symptoms when under stress even if the children themselves are not depressed.

Habits–good or bad–can be passed on. Most children learn coping mechanisms when dealing with their mentally ill parent–possibly negative ones such as temper tantrums, lying, and manipulation, if the parent is an unhealthy role model. When I’m too tired to cook, which happens depressingly often, I’ll pack the kids into the car and go through the drive thru at Taco Bell or some other fast food restaurant. I take a lot of pleasure in eating out. Now I worry that these bad eating habits will be instilled in my children. Nolan, my eight-year-old, already asks if we’re going out on a regular basis.

How the house is run can also be passed on. My own mother–who does not have bipolar disorder–learned her disorganized patterns from her mother–who demonstrated symptoms of the illness–and I’ve learned them from mine. From frequently being late to rarely making meals on time, we have three generations of chaos under our belts.

But there are also positive aspects of mental illnesses that can be learned by children. My own son has learned to be patient with me when I have down days or up. He is also compassionate, which I largely attribute to his having learned how to interact with me when I’m not at my best. And he’s sensitive as well.

This is not to say that I subscribe to the behaviorist theory of mental illnesses, which is to say that disorders are learned. Not in the slightest. The causes of bipolar disorder are genetic, physiological, and environmental stressors which trigger those who are already susceptible to the disease. Just that some coping strategies–healthy and otherwise–can be passed on to children of mentally ill parents.

What habits are you afraid to pass on to your children? Conversely, which habits do you want them to get from you?

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Nature vs. Nurture: The Causes of Bipolar Disorder

What causes bipolar disorder? Scientists aren’t actually sure, but are taking into consideration several risk factors, such as genes, brain structure, and environmental causes.

Genes

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Genetic studies of twins have shown promising results with regards to bipolar disorder. According to a a study by Berit Kerner, “The heritability of bipolar disorder based on concordance rates for bipolar disorder in twin studies has been estimated to be between 60% and 80%.” However, if one identical twin develops Bipolar I, the rate of the other twin developing it is roughly 40%, compared to fraternal twins at 5%. Parents have a 10 to 15% chance to pass bipolar disorder to their children if one parent has the disorder, compared to 30 to 40% if both do. This means genetics play a crucial role in the transmission of bipolar disorder.

Brain Structure

Recent evidence suggests that the structure of the brain may contribute to people developing bipolar disorder. MRI studies have found the over-activation of the amygdala, which processes memory, helps decision-making, and controls emotional reactions. People who are manic showed decreased activity in the interior frontal cortex, which assists problem solving, memory, language, judgment, and impulse control. Certain psychiatric medications work on neurotransmitters, suggesting that these messenger chemicals play a significant role in the function of bipolar disorder, but no one knows how exactly they’re responsible.

Environmental Factors

Stress is a significant predictor of bipolar disorder in people who are susceptible to the disease. Life events such as childbirth, trauma, job loss, or grief over a death in the family may trigger a mood episode. My mania and subsequent psychosis was set off by the birth of my first child, Nolan, but my second child’s birth did not trigger anything. However, substance abuse, hormonal issues, and altered health habits can also spark the illness.

Many factors set in motion the development of bipolar disorder. With more research, scientists will discover the roots of the disease, and possibly be able to prevent it in the future.

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What is Bipolar Disorder?

Bipolar disorder, also known as manic depression, is a chronic mental illness characterized by swings between depression and grandiose moods. Over five million people live with the illness. The disorder often runs in families, affects women and men equally, and appears around the average age of twenty-five.

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To fully explain bipolar disorder, we must first look at the two “poles” of the disease: mania and depression. Mania includes racing thoughts, elevated mood, over-excitement, a lack of a need to sleep, irritability, impulsive decisions, and sometimes delusions. Depression includes feeling sad or sluggish, overeating, insomnia or over-sleeping, severe lack of energy, trouble making decisions, and possibly thoughts of suicide. People with bipolar disorder can swing between these two states over periods of days, weeks, months, or even years. Rapid cycling occurs when four or more mood episodes happen over the course of a year, which is difficult to treat. Four episodes per day is called “Ultradian Cycling.”

Mixed episodes occur when symptoms of mania and symptoms of depression happen at the same time, increasing the risk of suicide. It is very difficult to treat a mixed episode, as most medications do not treat both sets of symptoms at the same time.

Children with bipolar disorder tend to have tantrums that last for hours, and possibly turn violent. Thirty percent of kids who have a major depressive diagnosis will eventually receive a diagnosis of bipolar disorder. During mania, kids tend to have trouble sleeping, be irritable, and speak quickly about a variety of topics. Depressive episodes see children complaining a lot about stomachaches or headaches, have no interest in fun, and possibly think about death or suicide.

There are three types of the disorder: bipolar I, bipolar II, and cyclothymia.

Bipolar I

Bipolar I is diagnosed when a person suffers from manic symptoms longer than seven days, or severe enough to require immediate hospitalization. Depressive episodes often last two weeks or more. Both states prevent normal function, and require treatment in order for the individual to fully live their life.

Bipolar II

Four times more common than Bipolar I, Bipolar II is characterized by both depression and hypomanic (“below mania”) episodes, but not full-blown mania.  Often productive, persons with Bipolar II are rarely hospitalized.

Cyclothymia

Cyclothmia is a tricky diagnosis with manic symptoms less severe than Bipolar I and depressive symptoms less severe than Bipolar II. Impact on productivity varies; some individuals may be hyper-productive with little impairment, whereas others are manic or severely depressed for most of their lives. Cyclothimics may have periods of stability, but those last less than eight weeks.

There are several risk factors under consideration. Genetics may play a part, though studies of identical twins have found that one twin may develop the disorder while the other twin does not. Brain scans show that the structure of the brains of sufferers of bipolar disorder have differently sized portions of the brain compared to healthy people. Family history seems to contribute as well, as those who have a family history of the disorder tend to develop it more often than those who do not.

Treatment for bipolar disorder requires a range of psychotherapy and mood stabilizing drugs like lithium and Depakote. Electroconvulsive therapy (ECT) is also used, with mixed results. Several illnesses are comorbid with bipolar disorder, such as Attention Deficit Hyperactivity Disorder (ADHD) or anxiety-related illnesses. These related conditions make it difficult to treat the underlying bipolar disorder, as stimulants used to treat ADHD can sometimes trigger a manic episode. 

With treatment, people with bipolar disorder can lead productive, healthy lives, managing their illness as it comes.

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