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TRANSCRIPT
BIPOLAR EDUCATIONPROGRAMME CYMRU
NCMHNational Centre for Mental Health
Participant Handbook
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Contents
Welcome
One of the most effective ways to deal with any illness, physical or mental, is to understand it. Bipolar disorder is no exception.
“Psychoeducation” is an approach that helps people to understand their illness, learn to recognise early warning signs of highs and lows, and develop the skills needed to stay as well as possible.
There is evidence that psychoeducation works and we believe it should be more widely available.
That’s why Cardiff University Mood Disorders research group, the National Centre for Mental Health and the Big Lottery Fund have come together to create Bipolar Education Programme Cymru (BEPC).
We have designed this free course with input from people with lived experience of bipolar disorder. It aims to help people better understand the condition, with the intention of improving their quality of life.
Thousands of people have already benefitted from this award winning psychoeducation course for people with bipolar disorder, and we hope that you do too.
We have produced this handbook to accompany the Bipolar Education Programme Cymru group sessions. We hope you find it useful as you learn more about bipolar disorder, and how to manage your condition.
Thank you for being a part of BEPC.
Professor Ian Jones
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Part 1: What is bipolar disorder?
n Bipolar disorder is a complex brain disorder in which people experience episodes of low and high mood.
n Bipolar disorder is NOT a character flaw, a personality defect or your own fault.
n Psychotic symptoms can occur in severe depression and mania.
People with bipolar disorder have episodes of low mood (depression) and episodes of high mood (mania or hypomania).
Hypomania is a less severe form of mania. Everyone with bipolar disorder is different. Some people have lots of episodes (sometimes called rapid-cycling) whereas other people with bipolar disorder can be well for long periods of time.
Key messages
Did you know...n Psychotic symptoms can occur in severe depression and mania.
n It’s not unusual to get manic-type symptoms during depressive episodes and depressive symptoms during manic episodes. These are called ‘mixed episodes’.
n Anxiety symptoms are extremely common in bipolar disorder.
Symptoms of Depression
Symptoms of Mania
n Sadn Lown Emptyn Hopelessn Irritablen Guilty
Feelings
Feelings
Thoughts
Thoughts
Behaviours
Behaviours
n Dulled thinkingn Poor concentrationn Poor memoryn Poor attentionn Worried about minor issuesn Pessimisticn Indifferentn thinking about death and dyingn Suicidaln Psychotic symptoms
n Sleep less/moren Eat less/moren Less activen Easily tiredn Restlessn Apatheticn Less interest in sex
n Highn Happyn Elatedn Euphoricn Excitedn Irritablen Impatientn ‘Over-reactive’ to minor events
n Racing Thoughtsn Grandiose Ideas and Plansn More creativen Optimisticn Easily Distracted
n Over-reactiven More talkativen More socially activen Socially disinhibitedn Risky behaviours n Spending too much moneyn Sexually promiscuousn More productiven Annoying to othersn Argumentative
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Drawing a lifechart can be useful to see if there are any associations or triggers to your mood episodes.
Look at the example lifechart below, then try drawing your own on a seperate piece of paper.
Drawing a lifechart
Age
Depression
ManiaAdmitted to hospital
Prescribed antidepressants by my GP
Stopped taking lithium suddenly
20 30 40
!
!
!
Genetic Vulnerability
Part 2: What causes Bipolar Disorder?
n Lots of factors play a role in causing bipolar disorder. There is a strong biological basis but its onset often coincides with a stressful life event
n Bipolar disorder can be thought of as a malfunctioning “mood-thermostat” in the brain.
n Some people are more vulnerable to bipolar disorder and need less to trigger an episode of illness.
Bipolar disorder is due to a combination of biological, psychological and social factors. Although it has a clear underlying genetic basis it is not caused just by your genes or indeed just by your upbringing or life experiences (see the diagram below).
More research is needed to help us understand the causes of bipolar disorder and how to help people better who experience this condition.
Key messages
Diet
Irregular Routines
Exercise
Alcohol
Drugs
Lack of Sleep
Stress
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Did you know...n Identical twins have exactly the same genetic make-up, and studies show if one twin develops the disorder the other twin has a 60% chance of developing it at some point in their lifetime. The fact that this is not 100% confirms that bipolar disorder is not completely genetic.
n Long periods of stability can be achieved if the person can learn to manage stresses linked to previous episodes.
n For some people with bipolar disorder episodes can occur ‘out of the blue’ whereas for others a clear stress or precipitant is needed.
Stressful events can play a part in “triggering” episodes of bipolar disorder but we all differ in how much stress we can take before becoming unwell. We can think of it as a stress bucket, if the bucket fills with too much stress, it can overflow in a bipolar episode.
People have different size buckets at different times of their lives. When the bucket is small it fills up quickly and an individual is vulnerable to becoming unwell.
External factors such as support from friends and family can make a bucket bigger.
The “Stress Vulnerability” Bucket
Drinking too muchLack of sleep
Relationship problemsWork stress
Debts building up
Part 3: Medication
n Most people with bipolar disorder in addition to making lifestyle changes also need to take medication.
n The ideal medication for bipolar disorder would treat episodes of both high and low mood, help keep people well and have minimal side effects.
n There are pros and cons when taking all medications – it might be worth putting up with some side-effects if the medication helps you stay well.
Key messages
Did you know...n Studies have shown that between 25%-65% of people with bipolar disorder do not take their medication as prescribed.
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Cons of taking medication
“I think that being on medication can be stigmatising”
“I don’t like the regular blood tests”
“I feel too sedated on some of medication I’ve taken” “I miss my creativity” “I miss the high periods” “I don’t like the side effects (weight gain)”
Types of medication used in bipolar disorder
Mood stabilisers are the key to maintaining stability of moodAntidepressants are used to treat bipolar depression but:
n MAY not work very well for bipolar depression. n MAY trigger mania in some people with bipolar disorder. n MAY increase mood cycling in some people.
Antipsychotic medications are useful in managing psychotic experiences and in treatment of mania (it does not always mean that you have psychosis).
Pros of taking medication “I’m getting depressed less often on my medication” “Allows me to socialise” “I get less anxious” “I’ve got more money because I spend less” “My relationships are better” “It keeps me out of hospital” “My sleep and concentration are better”
Part 4: Psychological Approaches
n Educating people with bipolar disorder about the condition (psychoeducation) has been shown to be one of the most helpful psychological approaches.
n Many psychological approaches may be helpful, but in all the relationship with the therapist is extremely important.
n Psychological approaches work best when used alongside other treatments such as medication and lifestyle changes
The following approaches can be helpful for people with bipolar disorder:
n Education about the condition (psychoeducation) including self-management approachesn Cognitive-behavioural therapyn Interpersonal therapyn Person centred therapyn Mindfulness based cognitive therapyn Family therapy
It is often difficult to get access to psychological therapies. Psychological techniques can be undertaken with a therapist but some may be accessed via books or the internet.
Did you know...
A good relationship between the therapist and the person receiving the therapy has been found to be as important as the form of therapy itself.
Key messages
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Part 5: Lifestyle Approaches
n Changes in lifestyle can give people with bipolar disorder more control over their symptoms.
n It is very important to make sure that you get enough sleep, because lack of sleep is a strong trigger for relapse of a mood episode. n A regular pattern of sleeping, eating, working, socialising and exercising can help stabilise mood and prevent relapse.
Healthy Diet A balanced diet is important to stay healthy and improve general well-being.
n Eat healthy and regular mealsn Drink plenty of watern Reduce your caffeine intake – it can affect sleep and increase anxiety. beneficial effect on mood stability.
Key messages
Drugs and alcohol
Drugs and alcohol can be a real problem for people with bipolar disorder:
n They can lead to more severe and more frequent depressive and manic episodes.
n They can upset sleep patterns.
n They can cause problems with some medications.
n They are also a big factor in self-harm and suicide.
Daily Routine
Achieving a regular routine, getting enough sleep, taking regular exercise, not drinking excessively and avoiding recreational drugs can have a real beneficial effect on mood stability.
Did you know...
The endorphins which are released when we exercise are naturally occurring antidepressants and pain-killers.
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Part 6: Identifying Triggers
n Some triggers are important for everyone, such as too little sleep or too much alcohol whilst other triggers will be individual to you.
n Avoiding these triggers, once identified, is an effective way of reducing the likelihood that you will relapse in the future.
n Childbirth can be a time of high risk for women with bipolar disorder.
Filling in your triggers chart:
1. Start by ticking any of these triggers that you think are a factor in causing your own relapses. There is an ‘other’ section for you to include your own triggers.
2. First think about your most recent episode of depression, then of mania or hypomania, then go on to tick the triggers that affect you for depression, then mania, in general.
3. Once you have a list try and prioritise by selecting your ‘top 3’ triggers for both mania and depression. Use these to fill in the spaces at the bottom of the sheet.
Key messages
Top 3 Mania Triggers
1. 1.
2. 2.
3. 3.
Top 3 Depression Triggers
Triggers Most recent depression
Most recent mania or hypomania
Depression generally
Mania or hypomania generally
Work
Relationship
Family
Travel
Social
No obvious trigger
Drinking
Medication
Sleep
Too much activity
Pleasurable/positive events
Financial
Other
Triggers Chart
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Part 7: Monitoring Your Mood and Early Warning Signs
n Monitoring your mood is useful for recognising early when you are becoming unwell.
n Identifying your Early Warning Signature will help you to take some simple steps to stop depressive or manic symptoms from progressing.
n An up to date “Contact Sheet” of those professional involved in your care is an excellent way to ensure that you and yourfamily/carers can access help quickly.
You can fill in your Early Warning Signature by following these steps:
1. Start by writing down all of those things that you experience - thoughts, feelings and behaviours – when you are becoming depressed and when you are becoming manic. Be specific to yourself.
2. Next pick your ‘top three’ symptoms overall for a depressive episode; the most important three from your list. Do the same for manic episodes. Finally add anything else that changes when you feel yourself becoming depressed or manic.
3. Decide on some simple actions you can take to minimise the harmful consequences. These can be simple things such as telling someone how you’re feeling, or more definite steps such as adjusting your medication as previously agreed with your doctor.
Key messages
Early Warning Signatures
My warning signs for Depression are:
My warning signs for Mania are:
1.
1.
2.
2.
3.
3.
I should take these steps:
I should take these steps:
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Part 8: Family and friends
n Although people can cause problems they can also be a positive influence on your bipolar disorder
n Discuss with those close to you how they can best help you stay as well as possible and help themselves to understand your illness better
n A trusting and supportive relationship with family members or friends can be extremely beneficial
When you are well, have a full and frank discussion about what you would like your family and friends to do should you become unwell: n Agree on a plan of action for when you are experiencing early signs of becoming unwell.
n Make sure they are aware that regular routines are critical, particularly with regard to sleeping, eating and exercising.
n Make sure they have the correct numbers for your doctor, psychiatric nurse and psychiatrist, including the numbers to phone ‘out-of-hours’
n Many families often try to look after a friend or loved one who is becoming unwell for too long. Remember that many episodes can be ‘nipped in the bud’ with fast and effective treatment.
Key messages
Top tips for friends and families:
n Make sure you are well informed about bipolar disorder.
n Have a positive and long-term outlook.
n Be realistic: it is important to accept that even with medication and lifestyle changes there are likely to be episodes of depression and mania.
n Separate the illness from the person – difficult behaviour may sometimes be a result of the bipolar disorder and not the person themselves.
n Try not to take things personally: sometimes people with bipolar disorder can be difficult to be around and they might say or do things that make you feel rejected or offended.
n Talk openly about the positives and the negatives but focus on the good aspects of the relationship. Talk about how bipolar affects you – discuss what could be useful to help out when you are struggling with your mood.
n Don’t forget to look after yourself too!
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Contacts Sheet
Friends/Family
Primary Care
Secondary Care
Name:
Tel:
Name:
Tel:
Friends or Family I can contact:
My GP is Dr:
My Community Mental Health Team(CMHT) is:
My Care co-ordinator is:
My CPN is:
Tel:
Tel:
Tel:
Voluntary agencies /support services
Out of hours contacts
Name of agency/support service:
GP Out of Hours:
Nearest Casualty Department:
Support Worker:
Mental Health Service (Community Psychiatric Nursing or Crisis Resolution and Home treatment Team):
Tel:
Tel:
Other Mental Health professionals I can contact
Name: Tel:
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STABILITY Card
NCMHNational Centre for Mental Health
B i p o l a r D i s o rd e r
STABILITYSTABILITY
leep...
reatment...
void... recreational drugs, and overdoing it with alcohol
e positive... there is lots you can do to keep well
ntervention... get help sooner rather than later
ifestyle... follow a regular routine
nform... yourself and your family about bipolar disorder
riggers... learn what makes you more likely to relapse
ou... can take control of your illness
make sure you get enough
don’t miss taking your medication
BIPOLAR EDUCATIONPROGRAMME CYMRU
www.ncmh.info/bepcymru
Many people find the acronym STABILITY is helpful in coping with bipolar disorder and its symptoms:
Beating BipolarOur internet based interactive bipolar disorder psychoeducation programme is available free to all - just register at thewww.beatingbipolar.org
BEPCLearn more about Bipolar Education Programme Cymru at our websitewww.ncmh.info/bepcymru
National Centre for Mental Health (NCMH)Visit the NCMH website for information on a wide range of mental health conditions including bipolar disorder, a blog and real people’s stories.www.ncmh.info
Bipolar UKFor more information about bipolar disorder and the support available from Bipolar UK visit:www.bipolaruk.org.uk
Useful websites
Produced by the National Centre for Mental Health. The information in this leaflet is correct at the time of printing. Printed February 2015.
www.ncmh.info/walesmentalhealth
@ncmh_wales
NCMH is part of the research infrastructure for Wales funded by NISCHR, Welsh Government www.wales.gov.uk/nischr
Contact us
If you have any questions about BEPCymru, contact Project Coordinator Martina Svobodova:
You can also visit our website for more details:
FREEPOST RTEX-XTEL-AYUYBipolar Education Programme Cymru
Hadyn Ellis BuildingMaindy Road
CARDIFFCF24 4HQ
[email protected]* ( 029 2068 8399
www.ncmh.info/bepcymru