Bi-Polar Disorder

LegacyUser

Hi.

A member of my family was diagnosed with bi-polar disorder about two years ago. At the moment this person is going through their third "episode" or whatever you want to call it - where they simply WILL NOT take their medication, are completely, frighteningly altered and keep disappearing for days on end, might be dead, calling the police in various cities to see if they have been pulled out of rivers etc. It is then almost more heartbreaking to deal with them when they do appear - moods vary from really really aggressive and/or paranoid, high as a kite,"I'm not mad you are the mad ones", hearing voices etc. etc....

I don't want to go into too much detail (!), suffice to say that the stress and worry this is causing immediate family members is verging on unbearable.

I know that is is a physical condition, and that without medication it cannot be regulated, so therefore it is inappropriate to blame the person themselves for anything that goes on once they have missed even one dose of medication.... and I am aware of all the ethical issues involved...

However this post is written specifically from my point of view and I have three questions - if there is anyone reading this who has experience of this condition, I wonder if they could give me some advice.

1. For anyone diagnosed with bi-polar disorder - I've heard that the medication situation, i.e.: the realisation that you will need to take mood altering drugs every day for the rest of your life is akin to an alcoholic only being able to deal with their condition when they themselves have finally realised there is a problem - in other words, no matter how many times someone tells you this, you have to cop onto it yourself before progressing. Is this true, and if so, what was it that finally caused you to come to that realisation and how long did it take for you to come to terms with your diagnosis?

2. For family and /or friends of people with this condition - I am of the opinion that some sort of policy is needed by the family as to how to deal with an "episode" as soon as it becomes apparant that the person in question has stopped taking their meds. This person was committed against their will once before, and it was so traumatic for family members that they seem to be avoiding the possibilty of doing it this time - however I strongly feel that what we are doing now, i.e. "playing it by ear" and seeing what happens from day to day is maybe gentler on the person themselves, but it is damaging to family members, in that the extreme stress is threatening our own mental health... and in the long run we are doing the person no favours because no matter which softly softly approach we take, this person is not getting better in our care and although we know the person well, we are not psychiatrists. So how do other families/friends deal with it?

3. For people with bi-polar disorder in their families - have you seen any hereditary patterns? Having seen the condition in action, this last point worries me a lot in relation to having kids etc.

So much for not going into detail.......

Any advice would be greatly appreciated.

nesf

It is not true that you might end up taking mood stabilisers for the rest of your life. Some don't need to, some do. Plus, even if you have to take them every day it's not really that bad. You get used to it after the first few years

http://www.rcpsych.ac.uk/info/help/manicdep/index.asp <-- The Royal College of Psychiatrists information for parents, family and friends of those who suffer from the illness.

As for your other 2 questions, yes bipolar can be hereditary and can run in families but it is not so strongly so that every child will carry it. If you know what I mean.

The other question is something that you should put to the psychiatrist of your relative. They will be the best source of information on this.

Galvia

sharpe wrote:

3. For people with bi-polar disorder in their families - have you seen any hereditary patterns? Having seen the condition in action, this last point worries me a lot in relation to having kids etc.

Any advice would be greatly appreciated.

Read a little about this condition once. Hereditary, yes. If one side of the family (mother's or father's) has been diagnosed with bi-polar (also known as mood disorder or manic-depressive or affective disorder), then there is about a 30% chance that one of the children will have it. If both sides of the family have had a bi-polar diagnosis, then the chance that a child will have it is very high, at around 70% incidence. Now, these are population averages, and this means that some families will not have any children with bi-polar, whereas, others may exceed the percentage of incidence.

There is also other related conditions; i.e. uni-polar, where the patient is either manic or depressive. Uni-polar and bi-polar can be combined with other conditions, and in some severe cases, lead to other types of dysfunctional conditions. The literature on young children is poor, but a lot is known about adults. Onset often occurs during puberty or a severe traumatic event (war, death of a loved one, rape, etc.).

Treatments vary. Often they use drugs. Sometimes they don't, but rather use behaviour modification or cognitive treatments. The new approaches seem to use a combination of two or three of these approaches. It would seem that the more enlightened therapy does not rely totally on drugs, because of a history of these "episodes" you mentioned. When drugs are combined with behavior modification and/or cognitive treatments, the likelihood of episodic reoccurrance is reduced.

There have been famous people with bi-polar. Russian composer Tchikovski clearly had the symptoms, and some historians have claimed that French Emperor Napoleon was bi-polar. There was a recent film about John Nash of Princeton University and a Nobel Prize winner who had it, in combination with other conditions (Film title: A BEAUTIFUL MIND). There were many others, but I cannot recall the names at the writing of this post. Nash was placed on drugs, and occasionally skipped medication and had the episodes. Later, he stumbled upon his own form of cognitive treatment (self-administered), and when combined with drugs, once again resumed his teaching and research post at Princeton. You should see this film. It was an Oscar winner and is quite well done.

Should you want to discuss this further, send me a PM. But please realise that I am not a therapist or medical doctor or in any position to offer an official opinion (just a student). I know that it sometimes helps to chat about it.

nesf

Um, Nash had schizophrenia...


Could you link to your references for the 30% figure. This interests me greatly

Galvia

nesf wrote:

Um, Nash had schizophrenia...

After the film, I read a bit about this Nash. Yes, a combo, as stated earlier in my first post. Affective/mood/bi-polar/uni-polar (whatever) can lead to paranoid and/or schizophrena (among other things). When bi-polar, he would evidence manic driven tendencies to solve math problems without solutions, or work day and night nonstop to find a pattern in magazine clippings, etc., of the conspiracy that his schizo mind was suggesting. Schizos are not necessarily driven, but schizo-manics are to extremes. He also experienced severe depressions, where he was completely dysfunctional, and would sit on a porch (in the movie) doing absolutely nothing. Yes, medication contributed to this, but back then, they often got the medication for him wrong, and a cycle into depression was part of the result.

Could you link to your references for the 30% figure. This interests me greatly

It's been awhile, and I was a lot younger. Maybe 4 years ago. I think that I ran across those 30% and 70% percentages from a closed circuit TV seminar that was given by the Hershey Medical School of the Pennsylvania State University, PA, USA. I'm a student and not a shrink, but tagged along with a faculty psychologist friend to the CCTV event. Cannot remember the MD/Psychiatrist who gave the talk, but he was on the faculty of the Medical School at the time. A search of the American Journal of Psychiatry against Penn State faculty between the years 2001-2004 might turn up the article he published (but then again, I am not sure of the journal, but I am certain of the percentages, because they shocked me at the time).

Tomohawk

Hi,
to answer your 1st question it took me about over 10 years to fully come to terms with my diagnosis. Labelled at 21, the internal stigma I felt started to vanish in my mid thirties. I would now comfortably tell prospective partners early on in a relationship and discuss it with close friends who might ask about my experiences.
Repeat a idea enough times and it becomes truth - the extremely close connection between skipping meds and experiencing illness (going high) was finally brought home to me in counselling the last time I was hospitalised a few years ago. Simple enough at last to grasp 'cos there was nothing else wrong with me, once the high had passed. I was in and out in 1 month, and even found this visit to psych hospital a positive experience. Still I was 11 years between pitstops!! When I was first diagnosed at 21, after a crucifying nervous breakdown I might add, in the early months I took the meds somewhat begrudingly just to keep the doctors and family happy, but over the years it has become a routine habit as easy as brushing ones teeth. And as taking the meds gives me back real stability and quality of life then it's not an issue anymore. Tell your loved one it gets easier with age, it really does...

2nd question - Go straight to the your GP/ or psychiatrist with your troubled family member. Don't waste time! Speed is of the escence - Trust me I have been saved from hospitalisation once or twice by swift action from a family member. Getting high can come on and keep getting worse in about 3 or 4 days. Once sleep deprevation and elation have kicked in for this lenght of time it can become impossible to abate the symptoms by self-help and nursing at home. Often the mania will have taken too strong a hold and even the strongest of people (myself included) cannot calm and control the mind anymore. If this hightened state is reached, then in my personal experience the sooner hospitalisation occours, the better!! as the sooner comedown is achieved and normal service is resumed, which means the sooner the individual can leave hospital and return to their real life. So don't mess about, do the sensible thing and go right straight to the Doc! (As a fellow bi-polar, it's what my rational mind would want to do in such a case, but would not be able to as I would be ahem, temporarily incapacitated) Less stress for the other in the family too this way. I have seen the negative effect my older brothers illness (bi-poloar too) had on our family the first time he became ill and we didnt know what to do, it was like the Amityvile Horror our house that summer! This was a year or 2 before I got sick for the first time too. Now you could say we're experts in bi-polarism as my dad who's retired has it too and had a bout of it in the late nineties, and I nursed him thruough his hospital stay a few years ago. He was last hospitalised in the 1950s before that I think, but he was clear all those years. Just got on with things I suppose and did the normal things in life, got married, had kids, held a job down, carved out his own happiness on the tree of life.

I suppose that last bit about my dad touches on your final question about hereditery issues. My advice - have kids if you want to, Bi-polarism ain't the worst thing in the world to have you know, having been in group therapy and been exposed to the other conditions that people live with in their daily lives trust me it ain't that bad. Also remember that medical science is making yearly advancements and our understanding of the condition is growing all the time. When it comes time to have your kids who knows what we will have achieved.

It is widely believed that enhanced creativity is one of the gifts of bi-polarism. (I also personally believe there are others) Throughout History many outstanding and highly;) creative individuals in the areas of film, music, science, even religion and politics are and have been manics-depressives...do a search on the old woo woo and you will be pleasantly surprised the fine company we keep...

Best of luck, and keep the faith
Tomohawk.

http://www.aware.ie/

nesf

Galvia wrote:

After the film, I read a bit about this Nash. Yes, a combo, as stated earlier in my first post. Affective/mood/bi-polar/uni-polar (whatever) can lead to paranoid and/or schizophrena (among other things). When bi-polar, he would evidence manic driven tendencies to solve math problems without solutions, or work day and night nonstop to find a pattern in magazine clippings, etc., of the conspiracy that his schizo mind was suggesting. Schizos are not necessarily driven, but schizo-manics are to extremes. He also experienced severe depressions, where he was completely dysfunctional, and would sit on a porch (in the movie) doing absolutely nothing. Yes, medication contributed to this, but back then, they often got the medication for him wrong, and a cycle into depression was part of the result.

I was going from what I've read of Nash. Everything I read, which really wasn't that much, said he suffered from scizophrenia (though I imagine that this would be a generic umbrella term for psychotic symptoms rather than a specific medical diagnosis).

Galvia wrote:

It's been awhile, and I was a lot younger. Maybe 4 years ago. I think that I ran across those 30% and 70% percentages from a closed circuit TV seminar that was given by the Hershey Medical School of the Pennsylvania State University, PA, USA. I'm a student and not a shrink, but tagged along with a faculty psychologist friend to the CCTV event. Cannot remember the MD/Psychiatrist who gave the talk, but he was on the faculty of the Medical School at the time. A search of the American Journal of Psychiatry against Penn State faculty between the years 2001-2004 might turn up the article he published (but then again, I am not sure of the journal, but I am certain of the percentages, because they shocked me at the time).

My leanings tend me to like to see the data, or at least the trials and methods used, before taking any medical data at face value. It's very easy with a small sample to produce very odd figures in medicine (or just to have an odd sample). Did the test account for enviromental factors correctly (ie seperated twins etc)? And so on...

Galvia

nesf wrote:

My leanings tend me to like to see the data, or at least the trials and methods used, before taking any medical data at face value. It's very easy with a small sample to produce very odd figures in medicine (or just to have an odd sample). Did the test account for enviromental factors correctly (ie seperated twins etc)? And so on...

I would tend to agree with you in terms of being skeptical of any research results reported, no matter the source. All research is flawed. Our job as consumers of research is to first identify these flaws before considering the results and conclusions.

Given that we have both superficially mentioned a little reading that we have done regarding this issue, you must admit that no one thus far has given extensive citations to support their positions taken.

Given that I was very young and inexperienced at the time, and just a tag along with this faculty friend, I cannot authoritatively recall or assess the methodological rigour of the study reported. I am under the assumption that it was a meta-analysis of research conducted by others, but I could not swear to it. Once again, the Hershey Medical School, Pennsylvania State University, would be a good place to start to obtain the details of the study or studies mentioned and reported by their school (if your interest persists).

Once again, I cannot assess the validity or reliability of the model used to establish these two percentages. A meta-analysis would obviously have a different design than a representative sample of the population at, per se, the 95 or 99 percent confidence level, with perhaps a 2 or 3 confidence interval. And if a sample, obviously there would be other sources of potential limitations associated with sampling frame, estimates of error, etc., etc. (these statements herein being hypothetical for discussion purposes).

Of course, this raises the issue of these boards in general, and the ability of posters (like ourselves) to say anything at all.

To be honest, I have yet to see a convincing scientific argument on these boards; e.g., with problem statement, theoretical orientation, assumptions, methodology, data analysis, results, limitations, conclusions, and citations (in perhaps APA style). And even with this increased rigour, the conclusions, be they percentages of bi-polar incidence, or whatever, can still be problematic.

Just for fun, we could both do independent literature reviews on bi-polar disorders. Then we could come to agree on a premise for argument sake, then proceed with a battery of theoretical and empirical citations like grape shot from a cannon in support of our positions, be they similar or different. It might be a worthy exercise for us, but I doubt seriously if others who witnessed it on these boards would really care.

At the same time, we could elect not to debate the issue, but rather defer to sites maintained by public and private organisations. For example, I cited the medical school, and the Royal College of Psychiatrists was cited earlier. In this case as posters, we really have no opinion at this point, with the OP directed to outside sources (which could also be problematic in their research designs and conclusions).

Once again, this raises the issue of our ability as posters to say anything about bi-polar disorder, or for that matter, anything at all addressed on these boards.

The OP asked for an opinion, and we gave them. Hopefully the OP derived some benefit and not added confusion about the serious matter of bi-polar disorder.

In concluding, it could be said: Let the consumer of board opinion beware!

LegacyUser

Thanks very very much for your replies everyone, especially Tomahawk.

I don't know if this article will help the developing discussion, it might be interesting to you - i haven't followed the links or anything but it seems like somewhere to start......

http://www.psycheducation.org/depression/risk.htm

LegacyUser

"At the same time, we could elect not to debate the issue, but rather defer to sites maintained by public and private organisations. For example, I cited the medical school, and the Royal College of Psychiatrists was cited earlier. In this case as posters, we really have no opinion at this point, with the OP directed to outside sources (which could also be problematic in their research designs and conclusions).

Once again, this raises the issue of our ability as posters to say anything about bi-polar disorder, or for that matter, anything at all addressed on these boards.

The OP asked for an opinion, and we gave them. Hopefully the OP derived some benefit and not added confusion about the serious matter of bi-polar disorder."

Just to say as well that I have already read an awful lot on the internet about this condition and I appeciate the difficulties involved in researching this area, in generally taking as gospel what you read anywhere never mind on the internet, and that "this is not a medical board" etc. etc. so don't look for definative medical info here.

All replies have been of benefit to me. What I want to do is connect, as a family member, with people who have experienced this condition firsthand, so that I can compare 1.) what I have read, 2.) how I personally feel about whats going on and 3.) what other people feel / have done in a similar situation - and thus try to determine the next steps and the way forward for my family in the future.

I work in the area of Autism, so its not been too difficult to get my head around the idea of this as a physical condition, it's nobodys fault when my relative terrorises us (purposefully chosen language there !), how the various health services work and how to get them to work for you, the medical facts and the research methodogies and findings - in other words, the theoretical and objective standpoint.

However, when it arrives on your doorstep its another situation entirely. A friend of mine who has done research regarding siblings of people with learning disabilities (Down's Syndrome and Autism) told me that it comes up over and over again in research that the siblings of people with a mental illness which has its onset late in life have a much much harder time coming to terms with things than the siblings of people with developmental disabilities - no matter how much you understand the theory, for all of their lives up until a point in time the bi-polar person has been "normal", so deep down inside the family members cannot help thinking "snap out of it".

Thats really where I'm at I suppose, and its why I'm reaching out. So please debate the issue, don't debate it and post links, give personal experiences - whatever you do its really helpful.

Silent Grape

nash did have schizophrenia, which is not an umbrella term or anything like it. schizophrenics have a hugely different set of symtoms to Bi Polars. vastly different. im not going to go into it, lacking time, but please dont say that schizophrenia is an umbrella term for many mental conditions! its a seperate illness!

Galvia

Galvia wrote:

In concluding, it could be said: Let the consumer of board opinion beware!

:rolleyes:

TheVan

Well I personally do not have too much knowledge on this topic but....

my granny is bi-polar and now 78. Just believe me that treatments have improved and unbelievable amount from when she was first diagnosed.

nesf

Silent Grape wrote:

, but please dont say that schizophrenia is an umbrella term for many mental conditions! its a seperate illness!

I wasn't say that. What I was saying is that sometimes when things are reported that labels are tagged onto people because they are quite broad, ie a misuse of them.

I did not mean to imply that schizophrenia was not an illness in it's own right. Apoloiges for that. But I would be slow drawing solid heavy lines between mental illnesses you are going to miss out on part of the picture.

nesf

Galvia wrote:

...
In concluding, it could be said: Let the consumer of board opinion beware!

I completely agree with what you said. The only reason I'm looking for references is that I've a strong interest in this topic and would interested in seeing the original data.