research into context

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What is bipolar disorder? Someone diagnosed with bipolar disorder experiences swings in mood – from periods of overactive, excited behaviour known as ‘mania’ to deep depression. However, between these two severe highs and lows, there can be stable times. Some people diagnosed with bipolar disorder may see or hear things that others around them don’t (known as having visual or auditory hallucinations) or have uncommon, unshared beliefs (known as delusions). Everybody experiences mood shifts in daily life, but with bipolar disorder, these changes are extreme.

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Page 1: Research into context

What is bipolar disorder?Someone diagnosed with bipolar disorder experiences swings in mood – from periods of overactive, excited behaviour known as ‘mania’ to deep depression. However, between these two severe highs and lows, there can be stable times. Some people diagnosed with bipolar disorder may see or hear things that others around them don’t (known as having visual or auditory hallucinations) or have uncommon, unshared beliefs (known as delusions).

Everybody experiences mood shifts in daily life, but with bipolar disorder, these changes are extreme.

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Manic episodesSymptoms may include:

• Feeling euphoric - excessively ‘high’• Restlessness• Extreme irritability • Talking very fast • Racing thoughts • Lack of concentration • Sleeping very little • Excessive and inappropriate spending • Increased sexual drive • Misusing drugs/alcohol • Aggressive behaviour

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A person may be quite unaware of these changes in their attitude or behaviour. After a manic phase is over, they may be quite shocked at what they’ve done and the effect that it has had.

Sometimes, people experience a milder form (less severe and for shorter periods) of mania known as hypomania. During these periods people can actually become very productive and creative so see these experiences as positive and valuable. However, hypomania, if left untreated, can become more severe, and may be followed by an episode of depression.

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Depressive episodesSymptoms may include:

• A sense of hopelessness • Feeling empty emotionally • Feeling guilty • Feeling worthless • Chronic fatigue • Difficulty sleeping or sleeping too much • Weight loss or gain/changes in appetite • Loss of interest in daily life • Lack of concentration • Being forgetful • Suicidal feelings

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Types of bipolar disorder

Some people have very few bipolar disorders , with years of stability in between them; others experience many more. Episodes can vary in both length and frequency from days to months, with varying lengths of time in between.

Although some people may cope in between episodes, many still experience low-level symptoms in these relatively ‘stable’ periods which still impact on their daily lives.

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The current diagnoses in the UK are likely to be:

Bipolar I – characterised by manic episodes - most people will experience depressive periods as well, but not all do

Bipolar II – characterised by severe depressive episodes alternating with episodes of hypomania

Cyclothymic disorder – short periods of mild depression and short periods of hypomania

Rapid cycling – four or more episodes a year. These can be manic, hypomanic, depressive or mixed episodes

Mixed states – periods of depression and elation at the same time

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What causes bipolar disorder?

About one to two per cent of the general population is diagnosed with bipolar disorder (a roughly equal number of men and women) in their lifetime, usually in their 20s or 30s, although some teenagers are affected.Very little is known about the causes of bipolar disorder, although it does run in families, suggesting a genetic link. Some people, however, have no family history of it. During pregnancy, the effects of the mother’s nutrition and mental and physical health on the developing foetus are also seen as important factors.

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The fact that symptoms can be controlled by medication, especially lithium and anticonvulsants, suggests that there may be problems with the function of the nerves in the brain, and this is supported by some research. Disturbances in the endocrine system (controlling hormones) may also be involved.

Most research suggests that a stressful environment, social factors, or physical illness may trigger the condition. Stress (in a variety of forms) seems to be the most significant trigger, and sleep disturbance is an important contributor.

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Stressful life eventsSome people can link the start of their bipolar disorder to a period of great stress, such as childbirth, a relationship breakdown, money problems or a career change.

Family backgroundSome believe bipolar disorder can result from severe emotional damage caused in early life, such as physical, sexual or emotional abuse. Grief, loss, trauma and neglect can all be contributing factors – they all shock the developing mind and produce unbearable stress.

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Medication

It's possible that bipolar disorder could be a reaction to overwhelming problems in everyday life. Mania could be a way of escaping unbearable depression: someone who appears to have a very over-inflated sense of their own importance and their place in society may be compensating for a severe lack of self-confidence and self-esteem.

Life problems

If you go to your GP and he or she thinks you may have bipolar disorder, you may then be referred to a psychiatrist, who will be able to make a proper diagnosis and discuss the various treatments available. If a treatment does not suit you, say so and ask for other options.

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Almost everyone who has a diagnosis of bipolar disorder will be offered medication. Although drugs cannot cure bipolar disorder, many people find that they help to manage the symptoms, but they should be seen as part of a much wider treatment that takes account of individual need. The drugs used include lithium, anticonvulsants and antipsychotics. It is very important to monitor your physical health when taking any of these drugs.

How to copeTry to make sure you have support in coping with your own feelings. Give yourself time away from the person you are caring for, and ask friends and relatives for help. You may find counselling is helpful. Learning as much as possible about bipolar disorder can help you to cope better with your caring role.

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Managing your own conditionSelf-management involves finding out about bipolar disorder and developing the skills to recognise and control mood swings early, before they become full blown.It can be very difficult at first to tell whether a 'high' is really the beginning of a manic episode or whether you are just feeling more confident, creative and socially at ease. It can be a strain watching out for symptoms all the time, particularly when you are first learning about the effect bipolar disorder might have on your life. There are various books on self-managing bipolar disorder. They may feature checklists and exercises to help you recognise and control mood swings, like mood diaries, tips on self-medication, and practical tips for dealing with depression and mania. Self-management is by no means instant, and can take some time to use effectively. However, you may find you need to rely less on professionals, and have more control over mood swings. This can lead to greater self-confidence and lessens relapse.

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Recovery

Bipolar disorder need not be chronic and it can be possible to recover. There is a growing recovery movement among survivors. Developing countries have a far higher non-relapse rate than industrialised countries. Great recovery tools are hope, love, support and work.