BIPOLAR EDUCATION PROGRAMME CYMRU Participant Handbook NCMH National Centre for Mental Health
Contents 2 www.ncmh.info
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 info@ncmh.info 3
Part 1: What is bipolar disorder? Key messages Bipolar disorder is a complex brain disorder in which people experience episodes of low and high mood. Bipolar disorder is NOT a character flaw, a personality defect or your own fault. 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. Did you know... Psychotic symptoms can occur in severe depression and mania. It s not unusual to get manic-type symptoms during depressive episodes and depressive symptoms during manic episodes. These are called mixed episodes. Anxiety symptoms are extremely common in bipolar disorder. 4 www.ncmh.info
Symptoms of Depression Feelings Sad Low Empty Hopeless Irritable Guilty Thoughts Dulled thinking Poor concentration Poor memory Poor attention Worried about minor issues Pessimistic Indifferent thinking about death and dying Suicidal Psychotic symptoms Behaviours Sleep less/more Eat less/more Less active Easily tired Restless Apathetic Less interest in sex Symptoms of Mania Feelings High Happy Elated Euphoric Excited Irritable Impatient Over-reactive to minor events Thoughts Racing Thoughts Grandiose Ideas and Plans More creative Optimistic Easily Distracted Behaviours Over-reactive More talkative More socially active Socially disinhibited Risky behaviours Spending too much money Sexually promiscuous More productive Annoying to others Argumentative info@ncmh.info 5
Drawing a lifechart 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. Mania! Admitted to hospital Stopped taking lithium suddenly! 20 30 40 Age Depression! Prescribed antidepressants by my GP 6 www.ncmh.info
Part 2: What causes Bipolar Disorder? Key messages 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 Bipolar disorder can be thought of as a malfunctioning mood-thermostat in the brain. 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. Alcohol Exercise Drugs Diet Genetic Vulnerability Stress Irregular Routines Lack of Sleep info@ncmh.info 7
The Stress Vulnerability Bucket 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. Drinking too much Lack of sleep Relationship problems Work stress Debts building up External factors such as support from friends and family can make a bucket bigger. Did you know... 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. Long periods of stability can be achieved if the person can learn to manage stresses linked to previous episodes. For some people with bipolar disorder episodes can occur out of the blue whereas for others a clear stress or precipitant is needed. 8 www.ncmh.info
Part 3: Medication Key messages Most people with bipolar disorder in addition to making lifestyle changes also need to take medication. The ideal medication for bipolar disorder would treat episodes of both high and low mood, help keep people well and have minimal side effects. 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. Did you know... Studies have shown that between 25%-65% of people with bipolar disorder do not take their medication as prescribed. info@ncmh.info 9
Pros of taking medication I m getting depressed less often on my medication Allows me to socialise I get less anxious Cons of taking medication I think that being on medication can be stigmatising I don t like the regular blood tests I ve got more money because I spend less I feel too sedated on some of medication I ve taken My relationships are better I miss my creativity It keeps me out of hospital I miss the high periods My sleep and concentration are better 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 mood Antidepressants are used to treat bipolar depression but: MAY not work very well for bipolar depression. MAY trigger mania in some people with bipolar disorder. 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). 10 www.ncmh.info
Part 4: Psychological Approaches Key messages Educating people with bipolar disorder about the condition (psychoeducation) has been shown to be one of the most helpful psychological approaches. Many psychological approaches may be helpful, but in all the relationship with the therapist is extremely important. 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: Education about the condition (psychoeducation) including self-management approaches Cognitive-behavioural therapy Interpersonal therapy Person centred therapy Mindfulness based cognitive therapy Family therapy 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. 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. info@ncmh.info 11
Part 5: Lifestyle Approaches Key messages Changes in lifestyle can give people with bipolar disorder more control over their symptoms. 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. 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 wellbeing. Eat healthy and regular meals Drink plenty of water Reduce your caffeine intake it can affect sleep and increase anxiety. beneficial effect on mood stability. 12 www.ncmh.info
Drugs and alcohol Drugs and alcohol can be a real problem for people with bipolar disorder: They can lead to more severe and more frequent depressive and manic episodes. They can upset sleep patterns. They can cause problems with some medications. 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. info@ncmh.info 13
Part 6: Identifying Triggers Key messages Some triggers are important for everyone, such as too little sleep or too much alcohol whilst other triggers will be individual to you. Avoiding these triggers, once identified, is an effective way of reducing the likelihood that you will relapse in the future. 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. Top 3 Mania Triggers Top 3 Depression Triggers 1. 1. 2. 2. 3. 3. 14 www.ncmh.info
Triggers Chart 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 info@ncmh.info 15
Part 7: Monitoring Your Mood and Early Warning Signs Key messages Monitoring your mood is useful for recognising early when you are becoming unwell. Identifying your Early Warning Signature will help you to take some simple steps to stop depressive or manic symptoms from progressing. 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. 16 www.ncmh.info
Early Warning Signatures My warning signs for Depression are: 1. 2. 3. I should take these steps: My warning signs for Mania are: 1. 2. 3. I should take these steps: info@ncmh.info 17
Part 8: Family and friends Key messages Although people can cause problems they can also be a positive influence on your bipolar disorder 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 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: Agree on a plan of action for when you are experiencing early signs of becoming unwell. Make sure they are aware that regular routines are critical, particularly with regard to sleeping, eating and exercising. Make sure they have the correct numbers for your doctor, psychiatric nurse and psychiatrist, including the numbers to phone out-of-hours 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. 18 www.ncmh.info
Top tips for friends and families: Make sure you are well informed about bipolar disorder. Have a positive and long-term outlook. Be realistic: it is important to accept that even with medication and lifestyle changes there are likely to be episodes of depression and mania. Separate the illness from the person difficult behaviour may sometimes be a result of the bipolar disorder and not the person themselves. 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. 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. Don t forget to look after yourself too! info@ncmh.info 19
Contacts Sheet Friends/Family Friends or Family I can contact: Name: Tel: Name: Tel: Primary Care My GP is Dr: Tel: Secondary Care My Community Mental Health Team(CMHT) is: My Care co-ordinator is: Tel: My CPN is: Tel: 20 www.ncmh.info
Other Mental Health professionals I can contact Name: Tel: Voluntary agencies /support services Name of agency/support service: Tel: Support Worker: Tel: Out of hours contacts GP Out of Hours: Mental Health Service (Community Psychiatric Nursing or Crisis Resolution and Home treatment Team): Nearest Casualty Department: info@ncmh.info 21
STABILITY Card Many people find the acronym STABILITY is helpful in coping with bipolar disorder and its symptoms: Bipolar Disorder STABILITY S T A B I L I T Y leep... reatment... make sure you get enough 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 www.ncmh.info/bepcymru don t miss taking your medication BIPOLAR EDUCATION PROGRAMME CYMRU NCMH National Centre for Mental Health 22 www.ncmh.info
Useful websites Beating Bipolar Our internet based interactive bipolar disorder psychoeducation programme is available free to all - just register at the www.beatingbipolar.org BEPC Learn more about Bipolar Education Programme Cymru at our website www.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 UK For more information about bipolar disorder and the support available from Bipolar UK visit: www.bipolaruk.org.uk info@ncmh.info 23
Contact us If you have any questions about BEPCymru, contact Project Coordinator Martina Svobodova: * bepc@cardiff.ac.uk ( 029 2068 8399 FREEPOST RTEX-XTEL-AYUY Bipolar Education Programme Cymru Hadyn Ellis Building Maindy Road CARDIFF CF24 4HQ You can also visit our website for more details: www.ncmh.info/bepcymru NCMH is part of the research infrastructure for Wales funded by NISCHR, Welsh Government www.wales.gov.uk/nischr /walesmentalhealth @ncmh_wales 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