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Bipolar lidelse hos voksne, engelsk

Information about IN ADULTS The disorder, its treatment and prevention

Psykiatri og Social psykinfomidt.dk Contents

03 What is bipolar disorder?

04 What causes bipolar disorder?

06 What are the symptoms of bipolar disorder?

09 How is bipolar disorder diagnosed?

10 Different progressions and modes of expression

11 How can bipolar disorder be treated and prevented?

14 What can you do to help yourself if you have bipolar disorder?

16 What can your loved ones do?

Bipolar affective disorder (the term we will use in this publication is “bipolar disorder”) is a serious . When a person has bipolar disorder, knowledge of the illness is important. The more you know, the better you can handle and prevent the illness and its consequences.

This brochure describes the illness as well as options for its treatment and prevention. It is mainly intended for people being treated for bipolar disorder by the psychiatric service in Region Midtjylland.

We hope this brochure will help you and your loved ones to learn more about the diagnosis of bipolar disorder.

Kind regards The psychiatric service in Region Midtjylland Tingvej 15, 8800 Viborg Tel.: 7841 0000 Bipolar disorder in adults 3

Christian, 30 When I am manic, I’m completely different from how I am normally. I don’t need any at all. I don’t need any sleep I see everything own from my perspective. I feel I am the most important person in the world, and all my ideas are brilliant. I think so quickly that I can’t manage to say everything I’m thinking. I don’t have the patience to listen to other people and can only remain in one place for a short time. I pace the house restlessly. I drive much too fast in traffic, walk around the town and make contact with strangers and flirt with all the women I meet. I become veryirritated if anyone tries to put the brakes on me. I get ideas about starting several companies at the same time and I think nothing can stop me. lot in terms of reducing the progressionlot in terms theof symptoms and decreasing costs to thepsychological and social individual and the family. is bipolar disorder? t is bipolar There is a high risk of , but treatment and prevention can help a Other mental disorders are often seen alongside bipolar disorder – especially substance and various types Although the of disorder. symptoms and degree of severity vary, the illness is often associated with serous social, financial and personal consequences, and especially an increased risk of . This will usually be because doctors do not recognise the bouts of because as part of bipolar disorder, and mixed state are overlooked. This illness used to be called manicThis illness used to be approximatelydepression and affects of .1–2% of the population with equalBipolar disorder occurs men andfrequency in women and usually begins in adolescence or early adulthood. On average, it takes 8–9 years from the appearance of initial symptoms or episodes of illness until the illness is recognised and diagnosed. Bipolar disorder is a mental illnessBipolar disorder of ,characterised by episodes of mania),hypomania (a mild form state (a statedepression and/or mixed symptomswhere manic and depressive succession). coexist or occur in rapid Wha What causes bipolar disorder?

Research has shown that heredity is of the ’s neurotransmitters, i.e. very significant in bipolar disorder. the molecules the nerve cells use to Susceptibility, and not the illness itself, communicate. The effect of these is hereditary. External environmental neurotransmitters, e.g. dopamine and factors such as various types of serotonin, is what is affected by medical also have an impact on the development treatment of bipolar disorder. and progression of the illness. The more susceptible you are, the less strain it Trigger factors takes to trigger an episode of the illness. While an episode of illness sometimes Social and environmental factors can develops without any external influence, protect against or aggravate genetic in other cases it is possible to pinpoint susceptibility. one or more factors that have contrib- uted to triggering the episode. Research Genetic factors has shown that a number of biological, If your parents or siblings have bipolar psychological and social factors may play disorder, the risk of developing the a role in the development of both manic illness yourself increases by 10%. If an and depressive symptoms. identical twin has the illness, the risk that the other twin will become ill in- Among biological factors, the effect of creases further, up to 70–80%. However, light sometimes influences the course research indicates that several hundred of the illness. The occurrence of manic different genes are involved in devel- episodes is greatest in the spring and oping bipolar disorder, but each gene autumn months, and some types of contributes only a comparably slight depression occur notably in the darker increase in the risk of the illness. months.

With mania and depression, changes In women, hormonal changes may con- can also be demonstrated in some tribute to provoking mania, depression

4 or mixed state, e.g. in connection with pregnancy and giving birth.

Disruption of the circadian rhythm plays a major part in the development of an episode of illness. Mania may occur, for example, if a person does not sleep, or in connection with jet lag when travelling across time zones.

Cannabis, alcohol, speed and may contribute to provoking mania, mixed state and depression. Many people feel that , for example, has a calming effect on them, but in fact it increases the risk of episodes of the illness. That is why it is very Loss, violation, lack of important to resist taking cannabis or and family conflicts are some of the other substances. Anti-depressants may factors that can typically contribute sometimes provoke manic symptoms in to triggering depressive symptoms, people with bipolar disorder. while increased focused behaviour and increased commitment, e.g. in connec- Both positive and negative events, tion with an exam, overtime or falling in situations and changes may result in love, can contribute to developing manic mental stress and contribute to acti- symptoms. Factors such as personal vating manic or depressive symptoms. perception and handling of the situation Susceptibility to stress increases with determine whether a specific event or the number of episodes of the illness. certain factors give rise to stress.

5 What are the symptoms of bipolar disorder?

Bipolar disorder is characterised by tions (unshakeable convictions that run periods of unnatural changes in mood contrary to common sense) or halluci- and energy levels. During mania or hy- nations (sensory perceptions without pomania, the person’s mood is elevated any external influence). or irritable, and during depression, it is Hypomania is a mild form of mania, low. Changes in mood are accompanied characterised by mild optimism or by a number of changes in thinking, increased irritability, an energy boost, and behaviour. Below is a increased self confidence and a greater description of the symptoms of the var- sense of wellbeing. Often, increased ious types of the illness found in bipolar productivity is noted, and the need for disorder: sleep seems to be reduced by two to three hours compared to normal re- Mania is defined as the presence of quirements. In order to be able to make characteristic manic symptoms for at the diagnosis of hypomania, these mild least a week, or where hospitalisation is manic symptoms must have persisted required. The core symptoms of mania for at least four days. This state does are unnatural optimism and possibly not always affect a person’s level of violent anger and irritability. In addition, functioning, but will often be noticeable there is a significantly reduced need to those around the person. In some for sleep, an unnatural energy boost, people, hypomania may be a prelude to increased activity involving plans and mania, while others may suddenly slip ideas, strikingly fast, leaping thought into a depressive state. processes and a strong urge to talk, with frequent changes of subject. Final- Depression, as part of bipolar disor- ly, mania is associated with over-confi- der (also known as bipolar depression) dence in oneself, impaired judgement is characterised by the same symp- and loss of self control that may be ex- toms as unipolar depression (bouts pressed by haphazard and uninhibited of depression that have never been behaviour, such as unrealistic, excessive accompanied by mania or hypoma- spending, or increased nia). Depression is categorised by its libido and sexual activity. In severe degree of severity as mild, moderate manic states, psychotic symptoms may or severe, as well as severe depression occur in the form of either misconcep- with psychotic symptoms (you can read

6 Bipolar disorder in adults 7 ormally, I’m a quiet, reserved I’m girl. Normally, everythingWhen I’m hypomanic, wake upuddenly I’ll changes. S earlier than normal.two hours I have lotsMy thoughts are racing; ofof ideas and I have a feeling and able tobeing on top of things manage everything. I suddenly feel slow andthat other people are onboring. I talk to strangers I meet stop. That’sthe train or at the bus I’m usually not me at all, normally. but suddenly I’ll go quite thrifty, shopping a lot and buy all sorts of things I don’t really need. After two weeks of hypomania, I change states, usually from one day to the next, and I’ll wake up depressed one morning. Camilla, 18 where mixed states are accompanied where mixed states are accompanied by thoughts of suicide and at the same time increased energy/decisiveness, this state can be associated with a high risk of suicide. Mixed states are some of the most unpleasant states a person can experience – especially if manic and depressive symptoms occur simulta- of suicide is greater The risk neously. in a mixed state because, at the same time as being depressed, the person is also imbued with a violent, destructive energy. are characterised by the Mixed states are characterised by the simultaneous occurrence of manic and depressive symptoms, or by rapid switching between depressive and manic symptoms. Mixed states may appear as independent episodes of the illness or during a transition from mania to depression or vice versa. In oth- er cases, the manic and depressive symptoms are present in equal measure, while in still other cases, mixed states can be predominantly either manic or depressive. In cases In bipolar depression, so-called atypical so-called atypical In bipolar depression, are sometimes symptoms of depression need for sleep seen, such as increased Reduced and increased appetite. unreasonable self-confidence and self-reproach are common symptoms, and in moderate and severe depression, the person sometimes has thoughts of in the worst cases, actually suicide or, plans to commit suicide. In severe depression, psychotic symptoms are sometimes observed in the form of de- example, lusions or . For the patient may hear voices urging him or her to commit suicide. more about this in the brochure about about this in the brochure more about be able in adults). In order to depression de- diagnosis of depression, to make the persisted must have pressive symptoms 14 days. The core symptoms for at least of energy and are feeling down, a lack lack of aspiration. Sleep and appetite and the person are usually disrupted, with concentration often has difficulties and memory. When I am in severe depression, I wake up much too early with a feeling of anxiety and turmoil. I hate the dawn chorus. My body feels as heavy as lead, and I have difficulty even going out to the toiletand having my daily shower. I have no appetite and the pleasure and joy of everything has gone. I reproach myself for being this way and I don’t want to live. I think that everything is hopeless, and that I’ll never get well.

Woman with bipolar depression

8 Bipolar disorder in adults 9 to When I went for diagnosis bipolar find out whether I had it was important for my disorder, mum to be there with me. I was in mild depression at the time and was able to remember and clearly describe the depressive phases, but the highs were more difficult; in fact, I had regarded them as a welcome break from my depression. My mum was able to help describe how different I was during the highs, how I talked a lot more, had wild ideas and phoned early in the morning. I had difficulty remembering that but when she described it, myself, I was able to recall it. Nikolaj, 23 persistent fluctuations (over at least two persistent fluctuations and depressive years) between manic criteria of mania tendencies where the met at any time. or depression are not A milder variant of bipolar disorder is known as , characterised by The person is also examined for physical illnesses and the presence of other mental disorders, e.g. substance abuse, or , attention deficit. Bipolar disorder may be diagnosed if a person has had at least two episodes of the illness, one of which is manic, hypomanic or a mixed state. If it is a matter of mania, hypomania or a mixed state occurring just once, this is termed a single episode. d? diagnose on one or The diagnosis is based and special more in-depth discussions psychiatric interviews the person with possibly, in question. Current and, mood earlier episodes of unnatural and the swings, changes in thinking and activity person’s levels of energy the are charted. Emphasis is placed on presence, duration and severity of the individual symptoms in relation to the person’s normal level of functioning. The assessment also takes account of what appears reasonable and appropriate in a given situation. Information from relatives is often an important contribution to assessing the condition. er lar disord bipo is How Different progressions and modes of expression

The progression of bipolar disorder Between episodes of the illness, there varies a great deal from one person to are often stable periods of varying another, e.g. with regard to the number, duration, i.e. weeks, years or decades. severity, duration and nature of the ep- However, some people with bipolar isodes. Some have the classic type with disorder experience mild depressive or bouts of mania and depression, while manic symptoms outside the serious others experience only hypomania and episodes. For several weeks or months depression. In others, the progression after an episode of the illness, there can of the illness is characterised by mixed often be residual symptoms in the form states and bouts of depression. Studies of tiredness, lack of energy or cognitive indicate that bouts of depression occur impairment. In other words, problems three times more frequently than bouts with attention, memory, planning and of mania in people with bipolar disorder. overview. Some people with bipolar disorder may have ongoing cognitive When I am in a mixed state, I tend to impairment outside episodes of the wake up at 5 am and I’m full of beans. illness. In some cases, ongoing problems I have lots of rapid thoughts and ideas with attention, memory, planning and for new projects. I get up and start overview can result in reduced ability to cleaning the whole house even if it function in terms of work or education, doesn’t need it. I turn my up loud even though the person’s mood is stable. and forget all about the neighbours being asleep. I usually phone lots of my While the prognosis for individual epi- female friends to arrange to meet up sodes of the illness is relatively good, the over the next few days and I tell them longer-term prognosis is extremely var- everything’s fantastic and I’m feeling iable. In addition to relevant treatment, very happy. Around midday, everything good personal resources, a stable way suddenly changes. I become sad; my of life and social support have a positive thoughts suddenly slow down; I’ve lost impact, while the incidence of substance confidence in myselfand all my energy abuse or anxiety disorders will tend to has gone. I can’t cope with anything worsen the prognosis. else and I have the urge to run away from everything. I can’t contemplate the arrangements I’ve made, and I have to ring up and cancel everything.

Woman in mixed state 10 Bipolar disorder in adults 11 plays a vital part in both the Medicine plays a vital treatment. phase and preventive – or electric ECT (electro-stimulation occasionally usedshock – treatment) is – especially in emergency treatment or in severe bouts of depression people withsevere mixed states. When a fairly stable bipolar disorder are in to combine phase, it is often useful medical treatment with various types of counselling and . Psychoeducation is a type of dialogue- based teaching about the and its treatment. Medical treatment types of medicine are used Various in the treatment of mania, including as well as other types of anti- epileptic (anticonvulsants) and anti-psychotic . It is often necessary to supplement the treatment with calming medicines and sleeping of depression as part pills. Treatment of bipolar disorder differs from the treatment of ordinary depression – notably due to the risk of triggering manic symptoms by the use of anti- depressants. Anti-depressants are occasionally used, but must always be combined with a to protect against mania, e.g. lithium or a newer anti- psychotic drug. . Preventive efforts symptoms and curtail an individual episode of the illness – as well as to stop depression turning into mania or vice versa illness and social costs of the disorder The purpose of treatment is: subdue depressive or manic 1) To prevent new episodes of the 2) To prevent suicide 3) To minimise the psychological 4) To Treatment of bipolar disorder can Treatment treatment of be subdivided into the the illness and individual episodes of episodes. the prevention of further for each The treatment is adjusted disorder and the individual with bipolar progression of the various phases of the is another key illness. Involving relatives element of treatment. Hospitalisation is often required in con- nection with mania, severe depression and severe mixed states; in some cases, enforced hospitalisation is necessary. Milder episodes of the illness are treated in outpatient by practising psychi- atrists, in outpatient clinics or by the person’s GP mainly take the form of outpatient care. ted? preven ed and treat e er b lar disord bipo can How In most cases, long-term preventive For a while, most people with bipolar dis- medical treatment is recommended order find it difficult to accept the need for bipolar disorder. In some cases, to take medicine. Compliance problems preventive treatment is proposed after as regards taking recommended medi- even the first episode of the illness. The cines may, for example, be linked to the choice of treatment depends on factors person’s perception of his or her illness, such as information about early effects undesirable side-effects or a longing and side-effects of medicines, and on for hypomanic periods. In most cases, information about the previous progres- a dialogue is required to shed light on sion of the illness. The person’s wishes the advantages and disadvantages of for a particular treatment or a wish medical treatment. to avoid a specific side-effect are also important in the choice of treatment. If a woman with bipolar disorder is Consideration is also given to the pregnant or planning a pregnancy, she person’s age and any physical ailments. should be referred to hospital psychiatric services because of the increased risk It is important to know that it can of relapsing. At the same time, there is take up to six months or a whole year a need for advice regarding the proper for preventive treatment to work to preventive medicine during pregnancy. best advantage. If, despite preventive treatment, the person with bipolar Psychoeducation disorder develops significant symptoms Psychoeducation may be given as part of depression and/or mania, the of a person’s individual treatment or in a will usually be adjusted. structured group process, and includes, for example, information about the diagnosis, future prospects, causal rela- tionships and options for treatment and Anti-epileptics: A drug originally prevention. The spotlight is particularly developed for the treatment of on conditions or skills that are significant epilepsy, but also found to be in handling the illness and preventing effective for bipolar disorder. .

Antipsychotics: A drug with When the person with bipolar disorder effect that is in a fairly stable phase, it is useful to particularly affects symptoms prepare a personal prevention plan, e.g. such as , hallucinations in conjunction with relatives. The preven- and manic optimism. tion plan covers the person’s individual early warning signs of hypomania/mania, : A drug with an mixed state and depression and any trigger antidepressive and anti-anxiety factors, as well as a plan of what is to effect. happen if there are signs that an episode of the illness is developing.

12 Bipolar disorder in adults 13 take extra medicine, An important goal of preventive treat- goal of preventive An important or learn to handle stress, ment is to For in an appropriate way. to avoid it, could be about handling example, this leisure or stress at work, in education, as well close interpersonal relationships, routines, social as about stabilising daily patterns. activities and sleeping there is often a On an emotional level, the loss, offences need to work through follow in the and defeats that typically could be wake of the illness. This relationships or over the loss of close off studies or leave over having to break employment. Another subject is the guilt and shame linked to actions carried out during manic or depressive periods. Some people need help to deal with a perception of stigmatisation, i.e. a sense of being different and being singled out because of the illness. Others may need to work on personality difficulties that may be a consequence of the illness itself and/or may relate to temperament, upbringing and early life history. , the person needs a prevention plan so I know how toIn talking with my nurse, we have worked out react if a manic episode is flaring up. This is very to me, because above important all, I don’t want to become manic again. I have become aware that lack of sleep, trigger manic symptoms. My earliestexam stress and excessive alcohol intake can I talk more and much sign of mania is waking up two hours earlier than usual. even and I get lots of ideas about borrowing money to start a business, faster, plan is to though that is completely unrealistic. My action contact my therapist and avoid alcohol. My girlfriend also has to contact my therapist if she notices signs of mania. Young man with bipolar disorder In the depressive phase upportive counselling counselling Supportive and medical be a need to combine There may with provision of supportive treatment Coun- or psychotherapy. counselling group. be individual or in a selling may process The content of the individual needs and is depends on the person’s for the individual continuously adjusted of the illness. phases of the progression If the person develops mild manic symp- restrictingby help can therapist the toms, stimuli and the level of activity on the one by considering the hand and, on the other, advantages and disadvantages of acting on impulses and “good ideas”. help to break the depressive patternshelp to break the depressive isolation such as inactivity, of behaviour, appear that and passiveness. Tasks broken down intoinsurmountable can be easier-to-deal-with jobs. When smaller, the worst depressive symptoms have re- ceded, depressive thoughts can be worked on with a view to finding alternative and more balanced ways of thinking. What can you do to help yourself if you have bipolar disorder?

There are a number of things you can For most people with bipolar disorder, it try to do yourself to cope with the illness usually takes a while to strike a balance and help prevent new episodes. Whether between denial and over-identification you will be able to use some of the tools with the illness. An important goal in its depends on factors such as your current own right could be learning to define state, and whether you have access to yourself in ways other than merely the necessary support from the people through the illness. It is important to around you. focus on the resources and abilities you can use to make your life meaningful and Learn to recognise your illness give it substance. Here, developing any It is a good idea to learn about bipolar creative talents such as drawing, paint- disorder, its various symptoms and phas- ing or music could be of immense . es. Often, it takes time to recognise and accept the illness. If you had the illness Get to grips with your for a long time before it was diagnosed, depressive symptoms looking back and trying to make sense of If you are depressed, it might help to the periods when you have been most ill undertake simple, manageable activities can in itself be a major challenge. that could help improve your mood. You should take account of your current It takes time to learn to distinguish energy level and your ability to concen- between normal emotional fluctuations trate. If you are severely depressed, you and symptoms of mania/hypomania will often need the people around you or depression. It may be challenging to to help you to produce a daily plan and learn to strike a balance between being to go through with activities. Exercise aware of any of or other forms of movement can help to the disease, and not letting of new lessen depressive symptoms. episodes of the illness consume all your time. When you are in a stable phase, Consider advantages and as already mentioned, you can prepare disadvantages when you get new ideas a personal prevention plan jointly with Hypomania is often perceived as a your therapist and the people closest positive state that the person feels a to you. strong urge to act on. The person often has lots of ideas, and there is not much of a gap between thoughts and actions. Bipolar disorder in adults 15 ing problems to do with overviewing problems and you write your appointments planning. If it will be your calendar, and tasks on to in what needs easier to keep much the week, and how happen during in a day or a you can realistically manage specific systems week. Regular routines, can help you to or using the calendar appointments. remember things and treatment Comply with medical therapist in dialogue with your to find it difficult It is common for people medicine at to accept having to take to discuss doubts times. It is important medicines with and deliberations about you can your therapist so that, together, identify the medicine that gives you the best help with the fewest side-effects. People are different, but you need to have an open dialogue with your thera- pist about your medication. Establish a stable circadian rhythm, eat healthily and get some exercise As disruption of the circadian rhythm is particularly significant in bipolar a key aim can be to establish disorder, daily routines, fixed social activities and a stable sleeping pattern. It is generally advisable to have a set circadian rhythm, getting up and going to bed at roughly reg- A healthy, the same times each day. ular diet as well as regular exercise are important too. Be cautious with Some people with bipolar disorder in- crease their consumption of stimulants during some periods. Sometimes people drink more or start smoking cannabis in As previously mentioned, you may experience problems with attention, memory and initiative after overview, an episode of the illness. It is important to take account of these difficulties and not to take on too much. If you feel able, there are a number of things you can do to assuage any cognitive challenges. A calendar can be useful in overcom- Know your limits and demand less of yourself the person After an episode of illness, Perhaps you is usually more vulnerable. and tasks too will launch into activities overlooking the fact that you do quickly, not have as much oomph and energy as usual. There may be some days when your mood is suddenly low or elevated. When in some states, you will need to pay particular attention to ensure that that state does not suddenly switch to the opposite pole. An important objec- tive could be to adjust any unrealistically high expectations of yourself and to learn to say no in various contexts. Ad- justing your expectations and accepting that you can no longer manage to do as much or undertake as much responsibil- ity as perhaps you used to can often be a long and challenging process. It may help to consider the advantages to consider the advantages It may help and to of new ideas and disadvantages you with one or two people discuss them practise postponing can also . You The e.g. for three days. risky decisions, hypomania can energy associated with and any plans be used constructively, be tested on less for major projects can risky projects. comprehensive, less connection with episodes of the illness. about your illness is a recurring theme As previously mentioned, stimulants for most people with bipolar disorder. can trigger, aggravate and maintain When should you tell other people that manic and depressive symptoms, and you have bipolar disorder, and when long-term substance abuse can have an should you not? There is no straight­ adverse impact on memory and learning. forward answer to that question, but If you have difficulties controlling your as a rule, it is a good idea to weigh up intake, it is important to seek help. the advantages and disadvantages in the short and longer term in relation to Be open about your illness, being open about your illness in different when appropriate situations and contexts. Talk to your The question of how open you should be therapist about it.

What can your loved ones do?

It is often a challenge being close to common reactions among loved ones. someone who suffers from bipolar One woman describes her reaction to disorder. Sadness, uncertainty, anxiety, her husband’s mania as follows: irritation and helplessness are very

When my husband became manic for the first time, everything got very stressful for our whole family. It developed into a real . Several weeks went by before I realised that he was ill. To begin with, he described an incredible feeling of happiness and wanted to give us all presents. He got up very early in the morning and was on the go with all sorts of projects from morning till evening. I thought it seemed a bit strange, but I didn’t want to be a wet blanket. After a few weeks, he became increasingly angry, talked incessantly about his projects and couldn’t listen to me and the children at all. He hardly slept at all, he was horribly irritable and the children started to be afraid of him. He became more and more wound up and threatening, especially if I suggested he should get help. He was completely unrecognisable. My darling husband had been transformed totally. It was ghastly. In the end, I had to call the doctor and the police to have him hospitalised.

MIA, 39

16 Bipolar disorder in adults 17 , an emergency doctor or a psychiatric upport during depression Support during suicide is being contemplated and when to sup- doubt as to how best If you are in it is a in a depressive phase, port a person can offer ask the person. You good idea to great deal of varia- contact, but there is a person needs ortion in what a depressed some people inis able to cope with. While about how theydepression want to talk be distracted, e.g. byfeel, others prefer to unrelated things. talking about entirely the depressed person in can support You maintaining hope of recovery and offer person to keepencouragement for the pace. Recognitiongoing at his or her own of their efforts is absolutely crucial. ordinaryVery tasks, e.g. having a bath or getting up, require a great deal of effort on the part of someone with severe depression. While in some cases it may be necessary for relatives to relieve the person affected entirely of tasks, in other cases it is better to do things together rather than have you, the relative, taking over all tasks and functions. Thoughts of suicide are often part of depression or a mixed state. If you are worried that your loved one is contemplating suicide, you must try to talk to the person about it. Perhaps you can help him or her to recognise other solutions, but above all, it is important not to be condemnatory towards the person. If the urge to commit suicide is strong, the depressed person should not be left alone, and it is important to get in touch with the treatment centre, the person’s GP emergency ward. If the person affected is already undergo- ing treatment and agrees to it, the treat- ment centre can be your first port of call situations, e.g. In certain in an emergency. in the case of serious threats or violence, you may need to contact the police. Emergencies With depression, mania and the mixed state, it is important to recognise the first signs of fluctuations and to help the person affected to get treatment. In of mania, e.g. in the case an emergency, severe depression or mixed states, where the person experiences the urge to commit suicide, you can help them by making contact with their own doctor, an emergency doctor or a psychiatric emergency ward. What can you, as a relative, What can you, the person affected? do to help of someone with bipolarAs a relative about the you need knowledge disorder, and the the key symptoms illness, about progression of thevarious phases of the help you to under- illness. Knowledge can reacts as he or shestand why the person dealing with it, anddoes, the best way of to trywhat you might have to accept for support the persona while. If you want to out what he or sheaffected, you can find of the pro- needs in the various phases a counsellor counselling with cess. Family in this regard.might often prove helpful during treatmentThe support of relatives is important both in the acute phase and in the preventive phase. Support during hypomania and mania What can you, as a relative, During mania, many different difficulties do for yourself? can arise between the sick person and If you are to be able to provide long-term those around him or her. The failure to support and help, you will also need to recognise illness that often accompanies take care of your own needs and try to a manic state is a major challenge to the lead as normal a life as possible. You must relatives. It is often pointless arguing too try to accept that you will not always have much with a manic person, and in the the energy or be in a condition to provide worst case it can exacerbate the condition help. You may need to take a short or still further. During stable phases, it can longer break at times. This is why it helps if be important to discuss how relatives can you can share the responsibility with other best offer support if there are signs of relatives so that you do not have to bear hypomania or mania. In a hypomanic state, the brunt of the responsibility yourself. you could perhaps help the person to get a good night’s sleep and to restrict appoint- As well as making contact with therapists, ments and activities that could worsen you might benefit from contact with other the condition. However, you must take carers and patient-and-carer associations, account of the possibility of the person re- such as SIND’s Pårørenderådgivning (ad- garding the hypomanic phase as a positive vice for relatives), Bedre Psykiatri (“better part of his or her normal behaviour. psychiatry”) or Depressionsforeningen (association for depression), all of which Adjusting expectations provide advice over the telephone. If you As previously mentioned, after an episode personally feel you are becoming - of the illness, the person is typically more ally overburdened as time goes on and/ tired and vulnerable. The ability to be or you are developing distinct symptoms attentive, to remember things and to keep of anxiety or depression yourself, you track of things is often impaired. There can consult your own doctor to get help are various ways you can help the person. and support. In some cases, a referral to You can help by organising the person’s a practising will be possible everyday routine and maintaining a with a subsidy from health insurance. stable rhythm. You can pay attention to how you yourself give instructions and Remember children and siblings agree things. You might need to repeat When a person with bipolar disorder has important information and messages, or children or siblings, special attention write things down. Perhaps you can help should be paid to their needs and reactions. with planning, initiating and completing It is important to talk to the child about the specific tasks, e.g. housework, shopping, parent or sibling’s illness. In some parts gardening and leisure activities. If it is not of Denmark, there is provision for family possible for the person to return to his or counselling with the therapist and/or the her former level of functioning at first, you opportunity for the child to participate in must try to adjust your expectations, even a children’s or siblings’ group with other though this may be a bit frustrating. children of parents with a mental illness.

18 Bipolar disorder in adults

tion Sundhed.dk

Psykinfomidt.dk and bipolar disorder Depressionsforeningen.dk MD Poul Videbech, AUH Risskov. diagnoses in different languages Search illnesses – mental – mania Scan the QR code to access further Where can you find information about bipolar disorder in adults, useful links, videos, books, etc. more informa Here you will also be able to find articles on psychiatric Here you will also be able to find articles Larsen, AUH Risskov. Ph.D. Erik Roj in psychiatry, doctor specialising hysician, clinical associate professor, associate professor, Physician, clinical and Senior Hospital AUH Risskov, enior Hospital Senior HospitalPhysician, rofessor, the technical editor P Our thanks to traarup, psychologist specialising in psychiatry, psychiatry, specialising in Straarup, psychologist the writers Krista Nielsen Our thanks to Psykiatri ogS ocial psykinfomidt.dk

1st edition 2014