Dr Patrick McKeon - Bipolar Disorder: what it is & what to do (July 2015)

Well, then they'll talk about

bipolar

disorder

. Many of you are familiar with the condition, but it is necessary to start from the very basics because there are many people here who are attending a conference like this for the first time. The purpose behind this talk. is to give you a practical understanding of

what

the condition is, how it can be recognized, how you can become familiar with the signs and symptoms, know how often and why the diagnosis is missed, how it can be best treated,

what

kinds of things should make people. in relation to lifestyle management on a practical everyday level and what are the final comments on staying well, so the first thing we start with is what is

bipolar

disorder

, it was previously known as manic depressive illness, bipolar in its way it captures a certain essence of but in another way so did the word manic depressive illness because what manic really means is to accelerate the word depression derived from the Greek means to decelerate so in essence that is the core of what bipolar is, in other words that if you imagine that for a moment where we all operate in terms of mood between these two lines, we can be excited about something and maybe other times depressed about something, but it is only when you get to this level that you experience depression .

In other words, a clinical nature is about the severity of the symptoms and up here, a person would be in a manic state or later, so we have a certain degree of variation and it is only when a person's mood drops here for extended periods. Being here for prolonged periods of time, you meet the criteria for bipolar disorder, so in essence it is a mood swing problem of some severity and, in essence, the severity of it is relatively disabling, maybe not for the person themselves at that moment. over time, but maybe for the people around them, in other words, it's not just about the impact it has on people, so, for example, depression should be present for about two weeks and be there practically all the time, euphoria or mania must be present. for four days for what is called hypomania, in other words, small mania and for a full-blown manic episode, it must be present for at least a week, in a moment we return to the signs and symptoms how often the disorder occurs Bipolar depends on the way it is defined and certainly over the years what has tended to happen is that our understanding of how frequently lesser degrees of bipolar disorder are present in society has expanded enormously and This is important because, as we will see shortly, if a person is going through periods of mild ups and downs but their complaint is depression;

In other words, as far as the person is concerned, he suffers from a depressive condition, if he doesn't catch those little ups and downs, he can't actually turn off the depressions because they are linked together, in other words, for certain types of bipolar, the forms more severe, what is called bipolar, which I will define in a moment, it has been said over the years that about one percent of the population in their lifetime will experience this, but the point is that the degrees minors of bipolar disorder are extremely common and due to overload they are overlooked because the person who is a little high does not approach a doctor to tell him that he is in In other words, if for the person it is a painless experience, perhaps only when If the person becomes very agitated or has problems at home, at work, or with the law because of their mood disturbance, they may realize that something is serious. bad from a mood standpoint and then properly diagnosed, so let's look at some of the symptoms and signs of bipolar disorder.

Many of you are familiar with the standard symptoms of depression, where there is an alteration of feelings and the person feels depressed. or the person's energy is reduced when the person has difficulty sleeping and where the person's thinking slows down, in other words, what we call the festival symptoms, thank you, then the mood, in other words, feeling low e is for energy s is for sleep and T is for thinking, so these are the core symptoms that you will experience in depression and euphoria, which consume energy, sleep intermittently or sleep too much and think quite slowly due to having concentration problems. .

Now, when you inhale, you get the opposite: the person feels euphoric, he couldn't feel. any best tremendous tremendous energy the person has great trouble sleeping at night to go to sleep and the person has racing thoughts jumping from one topic of conversation to another and therefore is impulsive and very scattered, so what should we do now? is to look at some of the core aspects of a model that would help you manage bipolar disorder and a useful model is this: If you imagine that inside our head we have a thinking wheel, we don't imagine that we have We think at a certain pace and accept that rhythm of thought, but one of the first things that happens when a person becomes depressed is that this wheel of thought slows down.

The words don't come to mind. The person has fewer thoughts. He says less in conversation. and they have difficulty projecting their thoughts into the future, what do I mean by into the future? If I ask you what you're going to do on a break over the summer, what you're going to do next weekend, assuming you're not too depressed, something will. it appears on the display unit in your mind that that same process is weakened or absent during depression, then the person looks at the screen and you ask him what is there, is it gloomy, is it blank or is there nothing there, are all three absolute terms that are that.

People often describe it now because there is nothing on the screen, the person has very little energy because energy is a product of our imagination, we see something out there and we look for it, obviously it is in our mind, in other words, I have to do this. I have to do that I have to do that other I have to pack the briefcase I have to do this and we chase it so that when a person doesn't have something there or we see a mountain in front of us on the display unit it has a fatiguing effect, so here you have a person who thinks slowly and has difficulty assimilating information from the world around them;

In other words, he can't; His thought process moves so slowly that he can occupy the individual pieces of information in the world and put one there, the next, and so on, he cannot put things together, so the person cannot really concentrate on what is happening. that he is reading. The next point about depression is that when people are depressed they tend to No, when they are not able to project themselves into the future in that way, they tend to become introspective and the two aspects of that being introspective: a person can be introspective psychologically, where there is a growing awareness of everything you do, perhaps you feel alone as yourself. - aware of your thoughts is aware of yourself in the presence of others for other people is an awareness of yourself and your body in other words your skin the color of your eyes the size of your ears and a headache that then such Maybe it hits from time to time and now a tumor grows in the person's Mind's Eye, in other words, something very serious, so, in other words, what happens is that with this introspection you have this hypersensitivity to things. , the next thing is that the person tends to retreat. and think about the past because they don't really go to the future and people go back to the past and they will resurrect negative things from their past now, normally when we look at the past quite curiously, if we are in good shape, it actually talks about the old days, how things were better, how people were more polite, how there were fewer cars on the road, etc., etc., but you know there were no good ones or bad ones.

Shakespeare says, but thought does so in a sense when a person returns. and sees things in a negative way, what will tend to happen is that with that negativity the person will often attribute the state of mind they are in to their memory of the past, in other words, saying I am depressed because of something I did in my past. and that's where the feelings of giving come from, but as soon as that depression goes away, lo and behold, that goes away and you say to the person, well, you were saying that you got involved in something in the past when you were depressed and now that you're out of it.

Depression, can we talk about that? What are you talking about? You know it has come so far for the person and it has little meaning for them now. The point is that when you move to Elation you get the complete opposite. What happens now is that the wheel of thought goes very fast and because it goes fast, the person will often have a feeling of pressure in their head, as if their head is about to explode, they will have a thousand thoughts against one and no he only has one display unit in which there are interesting things, the person will have many display units and as he looks at the person he looks at this one and then his mind jumps to this one and then to this one, in contrast to the person who is depressed when they look at the display unit they look vacantly into the future and it is as if the world is empty for them, while this person in the elevated state sees one thing, then another, then another and you see their eyes sparkle and dance, literally moving back and forth even as you speak to them and therefore it is difficult for the person to assimilate what you are saying because their mind is going so fast that they simply cannot absorb any more information that they have. tremendous energy because there are things here that they want to chase, they will cut and change in the conversation they will be impatient impulsive often so they can only see things that are positive here we have in the depressed state pressing maybe they can only see the negative, so the thought of the person is much more in the future and it is about positive things and this is what leads to poor judgment because in a sense, when we come to a decision point with our thinking, we have the option to choose between this, generally , a positive or negative movement. state of mind and what happens then is that if the person only sees one positive thing, they see another thing again and it is just positive, so, for example, a person could say I think I'll go on vacation, I would really like a vacation , the negative.

The next positive thing is that I really like this booklet. I think I'll bring my family. Next up, I think I'll bring the whole family. John in the future has not had a vacation. For a long time and we continue to do so, it is that kind of anatomy of judgment that escapes when a person's state of mind is disturbed. Now the opposite is true, when someone is depressed they cannot go beyond the first, so, in other words, less money may be needed. spent on food maybe yeast is rejected maybe stock isn't ordered for the store animals are sold to farmers and stored etc so you can see how these contrasting images suddenly start to make sense and they probably all can be traced to a Central The phenomenon is fine, in other words, the treatments used often focus on trying to speed up the wheel or slow it down depending on the state in which the person is.

Having looked at it from that perspective, we have to go and look at the symptoms. then on another level and what is necessary here is to first look at the different degrees of depression and euphoria, so we simply call it severity, starting with depression, the first thing is that when a person is mildly depressed they feel tired and have difficulties concentrating. They are often anxious and are often a symptom of anxiety as one feeling precedes any feeling of depression for many people and they may even have a panic attack even before feeling depressed and the other then feels self-conscious when a person is that is mild, moderate and severe, so in a mother's depression, a person has all the symptoms that are described, a withdrawn state, is calm, little to say, difficulty concentrating and finding everything a little effort, everything is uphill, everything is a problem, maybe lack of food.

Generally, a person feels worse in the morning than later in the day. Usually, the person's sleep will be that he wakes up repeatedly during the night or sleeps too much and sleeps during the day, when a person reaches severe depression. We often have very negative thoughts where the negative thoughts take control and produce what we call delusions and our hallucinations. Now it is important to remember that in a depressive state those fixed false ideas, which are delusions, are fixed false ideas that have nothing better in reality. They are nothing more than the negative thinking that is an integral part of mild depression, in mild depression a person may feel that they are not a very valuable person, they are not a very good mother or father, or perhaps they would be better off if they left the company for which they work but do nothing about it moderate depression is more intense the person may begin to make comments to other people about thesethoughts but here when it becomes more severe the person is actually firmly convinced of it will feel their Useless and useless people will feel that the world will be better off without them or they may actively ask the people around them if they would help them get out of this life .

On the other hand, the person may feel that they have some terminal illness and simply see that. As a release, very often now hallucinatory experiences where a person has voices or visions can, in extreme cases, be part and parcel of that image, but it is very important that people who have these experiences are open about it because they are something . that is very treatable and again is nothing more than an extension of What is in the mild and moderate form? So when we look at the relationship again, it's the same phenomenon. Now you will know that when I mentioned mild depression I did not see that the person felt depressed because that is the curious thing about depression, seeing what depression is.

It's actually not a great word to describe depression and it has different meanings to different people. Often, from an emotional point of view, a person feels more anxious than depressed, so when a person goes into depression, what usually happens is they are very anxious at this point and then they are anxious when they come out again, but Down here it's almost as if the anxiety goes away; In other words, it's the brain's way of turning off the awfulness of depression. Now, interestingly, it's actually here. at these points the person is most distressed and it is often at these points, the entry and exit point of depression, the people who are most at risk of harming themselves, so when we look again at the different degrees of severity with Elation, it's more or less the same, for a mild euphoria, the person might feel great, never felt better, confident in the strange energy now, generally in this phase, no one will know that there is something that a miss with the person Apart from your immediate family, usually your work colleagues, extended family will not detect.

It is only the people who live with the person who can see the contrast between the person they knew and what is there now moderate illness the person is hyperactive too talkative says things out of order to people quite uninhibited in what they say what they do maybe the clothes they wear, the sexual activity, the amount of alcohol, the illicit drugs they may use, they often get very little sleep and the lack of sleep fuels the problem because one of the things you will find about bipolar disorder if you want to start an episode manic just let the person sleep because two or three nights without enough sleep are usually enough to trigger it, so in the severe phase of the illness what happens is that the person returns to having these delusions and hallucinations or hallucinations, in In other words, the person may see themselves as all-powerful or feel that they will live forever or that they can cure anyone or come up with great inventions or solve the world's political problems and be quite convinced of this now again, it is important to remember that Those characteristics are just as treatable as these, in fact, in many ways, more treatable because what tends to happen is that when a person is that seriously ill, it will be obvious to everyone and they are more likely to get help fairly quickly, often people with mild illnesses.

The ways this accumulates huge debts will often have given away a lot of their possessions and maybe the possessions of others um and that causes a lot of pain. The next thing I want to address is where there is a diagnostic difficulty and this is what they are with. called, you will often hear the term mixed moods when a person is going through a state of euphoria like this foreigner, if not, everyone in a state of euphoria has periods of time where they are a little teary, a little agitated, distressed, feeling hopeless and, if you ask Them, at that moment, how do you feel?

They'll use the term I'm depressed to describe it, but any casual observer looking, well, you know, 10 minutes ago I was talking non-stop, everything seemed fine, delighted with the world and the vast majority. time in this that is the symptom or the way the person is so the question is how do you distinguish these types of conditions because what tends to happen is that if that person is really convinced that they are depressed and they go to their doctor and He tells him I'm depressed, how can the doctor distinguish that from actual depression? And this is one of the big problems in the treatment or recognition of bipolar disorder because what usually happens is that for a certain percentage of people, in fact, it says that up to 30 percent of people who are in a high mood are in these mixed moods, in other words, the person categorically says that they are depressed, what is the difference between this depression and that depression and the reason why it becomes important is that they said that something like 30 percent Of the people who have recurrent depression actually have undiagnosed bipolar disorder simply because they are very depressed and very often it is difficult for doctors who do not have experience in this area to recognize it as such now, this has huge consequences because if you treat this with antidepressants, that's what you get, in other words you make the situation very significantly worse, so let's look at the way we separate these things now, this is also known as dysphoric, which means unpleasant feeling.

Mania, they said, speed it up or foreign hypomania. So, in other words, what's going on? Here's this, if you remember that the core aspect of depression is that it is a slower physical and thinking state, it is like a dead battery syndrome in an unpleasant high state or a mixed mood. or a dysphoric state, these are all interchangeable terms. The key is that the person's mind is still hyperactive, in other words, even if the person says they are depressed when you look at them very often, you can't understand a word in Israel. It may be a state of anger, it may be a hostile state, it may be a state of great fear, but still you cannot utter a word.

In Edgewoods, the person typically has trouble falling asleep at night, while someone with depression typically has no trouble falling asleep. sleeping at night, in other words, if someone with depression has trouble falling asleep at night, the first thing to think about is what a depression is, the second thing is that the person's eyes are animated, while the person in a depressed state you are empty and staring into space, so from a symptoms point of view, from your own point of view, how would you distinguish the two because they are very, very important, so it is relatively easy in some senses?

What's going on? Here's this if you just draw it this way that if it's all the symptoms of depression and all the symptoms of unpleasant mood almost overlap each other completely, so I'm just going to tell you what the distinguishing symptoms are between the two. The first is difficulty falling asleep, anger and, if you don't like that word, irritability, number three is worse at night, depression tends to be worse in the mornings, in other words, this is the unpleasant high state of What are we talking about. at night, I have trouble falling asleep, I have anger or irritability, I tend to feel worse at night and cry, now this one is not very reliable, the little crying, the reason I put it is just to emphasize the point that often when people are clinically depressed with bipolar depression during the depressed mood the person, um, is usually not cheerful, uh, you see in this unpleasant elevated state, it's a distressed state, it's a torturous state, it's a very, very unpleasant state, the risk of someone harming themselves. state is actually much greater than in the business state and, in fact, probably many of the suicide attempts associated with bipolar disorder occur in these states, erroneously called depressive states, states of depression for years and years.

What is surprising about this is that this condition as such was recognized in 1910, at the beginning of the 20th century and towards the end of the 19th century and, surprisingly, it was overlooked in clinical practice and is only now being recognized for what it is and the reason why. the one that is important is this. that often with people with recurrent depression what you will find is that when they describe it they will say: I get depressed for X period of time and then I am fine for a few days, weeks or months and the same thing happens and again when Ask the person: Have you ever do you recover too much?

Do you ever go through periods of time where you seem to need little sleep? Do you ever go through periods of time where you are hyperactive and talkative? No, sometimes, when you bring the family and interview them. They would say, well, generally speaking, no, you can't, you can't blame the person who is in particularly good shape in the commercial for the depression, they deserve a period of well-being, but when you get the person to start documenting it, what you find it's actually it's substantial enough that every time the depression ends there's this high level now it's this high level that seems to contribute to this next in other words, that increase in mood seems to be associated with this, so if you didn't see those increases and you just treated it like a depression, you would be totally missing the point because what you would do is this, you would actually be exaggerating the whole phenomenon.

What happens is if you put a mood stabilizer in here and stop the antidepressants from overacting right now. Finally what happens is the mood pattern is like this over a period of time, the exaggeration once the euphoria stops happening, what you will find is that the depressions start to appear, they just fade away over time, that can take months, even up to a couple of years, but all of this is trying to find this particular phenomenon as part of what is called bipolar II mood disorder, in other words, it is really a bipolar diagnostic problem and here is where the person has a large high frequently followed by a Now, by definition, is a large burden that is bad enough to put the person in the hospital.

It's just a rough definition, but it's when the person has symptoms of an extreme degree for at least a week, but that's just from one point of definition. Very often these phenomena last weeks and months. Untreated bipolar II disorder is where the person has a lower degree of high and then lower, in other words, that's what we call hypomania, in other words, it's something that is much shorter and much less disturbing and maybe is overlooked and all we hear is the depressive aspect because the person is relatively unaware of the high, now bipolar 3 refers to a pattern similar to this, perhaps where the person rises after the low, but It happens because the person is taking an antidepressant.

In other words, they were depressed, they started taking an antidepressant, and their mood improved and got over the line, so you could say we're going to stay away from antidepressants, yes, relatively speaking, but the point is that if we do, does, the person stays there, so the problem here is that we need to keep this within the Spectrum. We now talk about the Bipolar Spectrum to recognize the fact that there are different degrees of this condition. Somewhere, the high is very mild but at the same time of great clinical importance because if it is ignored, the point is that the person's mood remains in free fall.

Yes, we tend to use as few antidepressants as possible when treating bipolar depression because it increases the chances of the person's mood going up and down, but what we have to do is first. The most important thing is to deal with this, try to prevent the recurrence of the mood, the recurrence of euphoria and gradually fade away. If you stop the antidepressant, the person just goes down and stays off, so it's often a matter of trying to balance two powers equally. one is the antidepressant that helps the person get up and then something here that blocks their progress Beyond a certain point now the other point is that there is a subgroup of people within the bipolar group that only have high levels but by definition they still It is called bipolar disorder even though there are At this stage, there are no two poles to the condition, very often this is a condition, or what we call Recurrent Uniportal Mania, is where the person often has a very serious illness that it incapacitates another manic nature that will be quite disturbing in the person's life, but when they come down from the high level, they fall slightly below the line and the only thing they can complain about is tiredness, but you will often notice that the word depression It is never spoken by the person as far as they are concerned, it is just a high level.

Now, the reason why this condition is so difficult to manage is that because the person does not feel much pain due to this phenomenon, the difficulty he has is to warm up to the treatment recommendations, follow the advice, takemedications, whatever it is, someone has had a bad hit. Depression behaves differently because they have a vested interest in doing everything they can to stay well now. As a result, for people with this it can have a quite disabling effect. People often lose their jobs, their marital home and their finances, so let's look at the treatment. for a time when a person is going through a big peak and coming out of this side and there are a variety of different medications that are used to try to help contain this and they are often included under the umbrella term of antimanic medications, but often on the market as antipsychotic medications, basically their goal is to try to slow down the person's pace of thinking so that they can contain themselves and their increased energy and dynamic nature that is starting to cause them problems now very often.

What the compounds do is remove the top part of the condition and very often there is some sort of appearance still under there. The other class of tablets are medications that are used and are called anticonvulsants, so among these antimonial things would be things like Zyprexa Circle. I'm using brand names here because you may or may not know the other serene Risperdal names, so the second group are anticonvulsants. Now what anticonvulsants do and things like epilimp, Tegretol and Trileptal seem to have a calming effect. about this and probably epilim is probably the most effective for severe relationships, the ultimate mood stabilizer for this.

The condition is lithium and it is by far the most effective treatment because it has lost its reputation as a compound over a period of years simply because it was not marketed and it is very cheap, costing a few cents instead of hundreds of euros. Well, no one was promoting it or researching it, but research over the past five years has shown that it is actually not only superior to these, but also has fewer side effects. Many of these compounds, although effective, cause a lot of weight gain, increase people's cholesterol and cholesterol. blood glucose, while lithium has its own problems, perhaps related to kidney function, but generally if managed carefully over the years and people do very well and have a longer lifespan, better quality of life and a much more stable mood than lithium.

What it tends to do if you look at it closely is that when the person starts taking it for almost a two-week period, if they take enough lithium, their mood goes down that way. You could almost set your clock now, it doesn't work. for everyone, but it works for the vast majority of people with severe, direct euphoria and very often what happens is that the person is prescribed some of these antimony medications while waiting for the lithium to take effect because it is very difficult for people who are on drugs. have patience and take medication and maybe stay in the hospital at the same time because their mind is going so fast that it is difficult for them to cope.

The problem with episodes of euphoria is that they are almost always followed by episodes of depression, even in people with Uniport Romania, which we will refer to later, if you follow people like this throughout their life, who may be in their teens, between their 20s and 30s, they are mainly tall, but as they reach middle age, surprisingly there are more depressions than they begin to have. emerge, so that when the depression ends and is treated, the person can be well for X period of time. In the past it used to be said that the chances of a person having a second episode were about 50, now we know that it is actually much higher than that and probably 70 80 even 90 percent in some studies, so a new approach is needed. preventative for upcoming episodes and the options generally fall between those three categories: antipsychotic agents, anticonvulsant agents, and lithium, generally the treatment of choice in this case.

In the event that you have a high level followed by a low level, the treatment of choice is lithium now for people who have what we call the bipolar 2 pattern, while a very low level and a certain amount of high level, The treatment of choice here is to first try and lift the person out of depression with an antidepressant and if the effect is significant, use an antidepressant plus a stabilizer. Now, in this case, anti-seizure stabilizers seem to be more effective; In other words, things like Tegretol Trileptal epilium are particularly good. To solve this now means first reducing antidepressant number two putting on a mood stabilizer and trying to find a balance between those two forces until the person is taking a low enough dose of antidepressant or no antidepressant plus a stabilizer in other words Yes One person was taking a stabilizer alone, that person may be depressed, or another person may not be, so vary the doses of the stabilizer and antidepressant until the rocking pattern begins to stabilize.

There is another pattern called rapid cycling and this is where a person has four or more of these episodes over the course of 12 months for some people, although now it is even faster than ultra-rapid cycling, you will often see this pattern postnatally or if someone is on an antidepressant and are very sensitive to the antidepressant, the person's mood can change a lot if a person takes certain medications like steroids or if a person has had their ovaries removed, so it seems to be a hormonal phenomenon that leads to greater mood instability, that person may have had a relatively simple mood pattern that was relatively treatable, but hormonal changes seem to have an impact on it, and again, they are more often the mood stabilizers. anticonvulsant mood which are useful. here lithium will work for some people, maybe 30 of the people with this, so there is often a lot of work over a period of time trying to figure out what is the best compound for these main causative factors of bipolar disorder to be genetic , so we know that on average, if you need if this bar represents 100 percent, on average 70 percent of the contribution is genetic and the other 30 is environmental, we know this from twin studies, adoption studies, Rare twins together, twins raised apart, this statistic seems to be true. throughout research done over a hundred year period actually, but that average is made up of all kinds of different figures.

It could be the other way around for some people where it's 70 environmental and 30 genetic and here it could be that a person has a vague hint of bipolar disorder deep down, maybe someone from previous generations who suffered a lot of depression, we don't even know if they were on drugs or they may have been a compulsive drinker, but in that person's environment there has been a lot of trauma in their past and probably more in their present life. For another person, it might be 90 genetic and 10 environmental. In other words, in this case the person got sick when little or nothing had gone wrong in their life, but it was a very, very, very strong family. history of bipolar disorder, so you get all these variations when we look at your genetics, we don't have a clear understanding of what genes were involved, what we have discovered is that it is tremendously complex, it is more complex than diabetes blood. blood pressure heart disease any other phenomenon and it seems that there are a lot of mechanisms from a genetic point of view in the mind that are important in this case and we don't really understand how they start to play a role in what Do we know the environmental factors well ?

Environmental factors are the usual stressors and stimulants, and stimulants are large amounts of coffee, energy drinks, illegal drugs, amphetamines, cocaine, steroids, certain medications, some homeopathic remedies, um, different, anything that is a stimulating, can do. In other words, what might be as mild a stimulant for the average person as it would be for another person with vulnerability or a family history of bipolar disorder, may be what sets the illness in motion and then the other big headline, the three s are social rhythms if we, if a person prone to bipolar disorder has not been able to fall asleep for some reason or another, they could be in prolonged pain, they could be sunburned, it could be too light outside, whatever. .

It may be that working alternating shifts at work disrupts the biorhythms, the circadian rhythm in the brain, which in turn creates almost a jet-like phenomenon within a person and can totally destabilize a person's mood, so that these factors are actually quite susceptible to intervention. So, for example, stay away from coffee and other stimulants, avoid steroids unless you need them for something life-threatening, go to bed at a fixed time, get up at a fixed time, be careful to observe what effect it has shift work on your mood and if it has any effect, get the attention of your employees and employers, so fix the time to go to bed, fix the time to get up, fixed meal times are extremely important, we should do it too .

I'm afraid putting smoking among the stimulants has shown that certain aspects of smoking have an effect. A measure quite similar to antidepressants who did not know that the first thing is to recognize may seem elementary, but for many people they do not leave the starting point because they cannot recognize what is happening even though they can intellectually know it in a moment. certain level, but on another level, no one cares this is my illness, stay out of my space, etc., etc., but a lot of that is the phenomenon of the illness itself, so it can be difficult for people when maybe they are a little high accept what this disease is doing to their lives, so being able to recognize it means being able to tell family what is happening, maybe some close friends, not everyone on the street please , but just keep it in a small circle and because again, when a person does that in a public space and I mean public within the family and they are actually starting to take responsibility for what is happening.

He is prepared to share what is going on and take suggestions from others and help you learn the facts. about the illness often because, you know, I was diagnosed with bipolar disorder. It's scary for people who don't want to hear the word. You know, the biggest threat to anyone with depression. Did you say I was bipolar? In other words, it's not me, please no. Don't tell me that, um, but the point is that often a person with depression has to take that into account, it may just be that size, but we have to put some kind of label on ourselves in a way that helps the person get over it. . an idea of ​​what the treatment is about, otherwise they are actually quite lost about it, so learning about disease number three is getting emotional support, talking to other people who have the condition and who have been through it way before you through support.

Conscious support groups are a great way to meet people who know what they're about. You might think they can see around corners. Seeing many people, for example, coming to where the support groups will find out in the course of the group's holdings. They come in with depression and realize that yes, they actually have symptoms of being high from time to time and then once they can take that information to their doctor or therapist, you can put it into your treatment plan and it makes a big difference. . how they are handled now, once the person is willing to do something about it, this is the key to detecting a relapse if a person is on drugs and you can sponsor them quickly, I mean, within a few hours of what is happening, Doesn't it mean it doesn't interfere with your family life or your work?

It doesn't mean that there are less altercations at home around this or time off from work or loss of study time, etc., so how to spot it well? The common signs and symptoms I have given you are fine for depression, but they are actually quite useless for euphoria because euphoria is a relatively pleasant phenomenon for the person in question. The second way to relapse into Sparta within you is to know what your personal sign is. I mean your personal sign, when someone is high, everyone does something that is characteristic of them and that you wouldn't see them doing.

Dying doing the opposite, wearing a certain sweater, or buying certain items, wanting to go out the back and see an acre of potatoes, never think about that. Apart from one eye, he suddenly smokes, a non-smoker suddenly takes a cigarette. Now the point here is that the family knows, from the person's previous behaviors during highs, that this is what Tom or Mary do when their mood changes, in other words, this all comes from the first sign and is personal. in the sense that one day it is not there,next day there are problems with many things like sleep disturbances, etc., it is when you have problems falling asleep for half an hour or in hours or two hours, you call it sleep disturbance, in other words, the person will say: "well, I was just a little excited that night or I had too much coffee or something, ultimately though not both of those things are inferior to the next and that's choosing someone." whose judgment you trust, preferably someone you are living with, and asking them to tell you if they think your mood has improved simultaneously, you have to give them permission to act on your behalf, that could be if you see me in that state again please take my car keys take me to the doctor even if you have to take me to the hospital I give you permission to do it okay that is not abused I can assure you I have never seen abuse what tends to What happens is that When a person has a safety net like that, what happens is they don't end up in the hospital because it's caught early, it's treated early, and it's managed very effectively.

The three S's are better to set the time. I will set a regular fixed time. like monks, stimulants, coffee, anything you find that gives you a high, most people know when they've had something or yes, I need to be careful with that, it's often better to stay below that level, where You find out that it's affecting you and um. obviously trying to limit the stress in your life as best you can, it's probably true to say that mindfulness to reduce stress in a person's life will be shown to have a great effect on reducing the rate of relapse when the Stress is a factor in a person's bipolar illness.

The last issue is talking about your past when people are depressed, but more particularly when they are on drugs, they do things that upset others and very often that is left out when the person is getting along and then the person themselves doesn't want to. particularly. bring up a thorny topic when they are recovering and the family doesn't want to do it either in case it bothers the person and they end up lying on the carpet but if that happens a few times someone starts tripping on that carpet and Suddenly, relationships end with the end of the marriage, whereas if you can encourage the person to bring up their wounds and talk openly about them, you prevent that from happening, so what we advise people is when the person's state of mind has stabilized, not while he is still high. when they are still depressed when the mood is stable talk to the person they think they have offended and say look when I was high the last time I called you X Y and Z or did such and such or spent all this money or whatever that I need to apologize for this.

First I take full responsibility. Okay, yes, it may be an illness-based behavior, but if the person will benefit from being honest about it and taking ownership of it, they will be less likely to do it again. facing the pain, the concerned family member or friend might say oh no, forget it, no, the person that friend needs to let the person say what they have to say if they keep quiet and don't express themselves, that family friend will. hold a resentment that will eventually cause problems thank you for your attention