Thursday, October 20, 2005

Care for those with bipolar disorder: guide for caregivers

What caregivers need to know about symptoms of manic and care for those who are depressive or bipolar mood disorder, and the medications that are used to treat this condition?

What was once called manic, or manic-depressive behavior is now called Bipolar I and Bipolar II disorder, based on the presenting symptoms. The focus here will be on manic, or Bipolar I illness.

There are three levels of mania, beginning with cyclothymic disorder. This is not considered a major mental illness, and there are plenty of people with this condition, who we all think of as very moody, with strong ups and downs. No medication is needed and the individual is able to function in all areas.

The second level of mania is hypomania, which means below mania, and it is more intense, and can be seen by spending sprees, food binging and minor disruption of daily living. There may be some absentism from work or school, and the tendency to engage in questionable and impulsive behavior exists. However, it is the degree of disruption of daily life and ability to function that determines the degree of mania.

Full blown mania is a frightening thing to see.

While the patient feels confident, attractive and able to perform above and beyond his normal abilities, this false eupohoria is the beginning stage of true Bipolar Disorder. Loved ones and family members often mistake this phase for drug use, and manics will describe this as a cocaine-like high.

Typical symptoms include rapid and sometimes violent mood swings, with laughter, crying and even rage. Insomnia is common, and often there is a decline in personal attention to grooming and hygiene, eating and concern for one's physical needs.

A manic may run outside in shirt sleeves or nightgown in a downpour, or may dress in a provocative and exposing way. They may refuse meals stating they will eat later or there is no time to eat, and you may have trouble even expressing your concerns before the patient's attention is directed elsewhere.

As the attention span decreases, the mind continues to race, and the manic likes to think of himself as the most clever and humorous individuals. Frequent jokes with an emphasis on punning and rhyming are classic presentation.

Also typical is a train of thought termed tangential.

In tangential thinking the individual in an acute manic phase will "go off on tangents." If you say "it is raining cats and dogs, you better put on a jacket", the patient will say "dog my cats!" or make reference to the movie "Full Metal Jacket and The Dog Days Of War." While initially entertaining, this rapidly becomes both tiring and exasperating for those attempting to co-exist with the manic patient.

Mania is caused by a biochemical imbalance in the brain, and there are a variety of medications used in its treatment. The classic medication is lithium carbonate, a naturally occuring salt, which has a narrow range of effectiveness, and can be toxic at high dosages.

Another medication, used for both mania and seizure control is carbamazepine, (Tegretol). It is the drug of second choice, but may be used if there are health problems such as heart or thyroid conditions that may preclude the use of lithium.

Bipolar patients have difficulty seeing that their behavior is out of line or that they can endanger themselves in an acute manic episode. The massive high, which seems abnormal to us seems normal to them, and there is an unfortunate tendency to self medicate or avoid medication whatsoever.

A manic who has been up for days without sleep or proper nutrition is at risk for developing manic related psychosis. Symptoms may include increased vigilance, paranoia, hallucinations such as believing others are whispering about them or are devils. In this phase acute, and frequently locked psychiatric observation and treatment is required.

At this extreme level of mania, it is common to find no therapeutic level of Lithium or Tegretol in the bloodstream. Strong medications called anti-psychotics or psychotrophics often are given such as Haldol and Thorazine. The goal is to rapidly reduce the mania, using the above medications, anti-manic medications and sometimes tranquilizers in combination with close observation.

At this level patients cannot safely be managed in the home environment, and may suddenly turn on loved ones or friends. Some hostage situations and murder-suicides have been linked to this extreme and disorienting level of manic behavior.

In the home setting, once regulated on a maintenance dose of medication, it is important to follow the Doctor's stated regime exactly.

Medication side effects such as weight gain and edema can be expected but more severe adverse effects such as tremors, lethargy and metallic taste in the mouth and vomiting should be reported immediately.

Be alert for increasing euphoria or high energy levels as the patient commonly decreases the amount of medication they are taking or flushes it from the body with abnormal amounts of fluid intake. A loved one who tells you everything is fine and brushes off your concerns is liable to be heading for another full blown episode.

One way to avoid this is to be vigilant for sudden mood swings, noncompliance with regular lab tests and Doctor's visits, (these help to regulate the safe dose of medication in the blood stream and will pinpoint non medication compliance), and return of previously risky patterns.

It is said the patients with a Bipolar I diagnosis are often intelligent but not wise. It is then up to the caregivers to educate themselves, attend available support groups and be alert to help loved ones, and themselves, maintain the highest quality of life.

10 comments:

Anonymous said...

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2. Avoid the tempting lure of caffeine or sugar-laden foods such as coffee, tea or chocolate. Caffeine may perk up your energy levels temporarily, but it also has a bad habit of leaving you sluggish after the effect has worn off. Instead, choose whole grain foods, fruits and vegetables to give your body the fuel it really wants! Eating healthier will boost your mood, elevate your alertness, change depression anxiety medication and make you feel better all day long.

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4. Sometimes, afternoon slumps can be your body’s way of telling you that it needs something. You may be feeling tired if your blood sugar is low (which happens especially after the effect of those caffeine and high sugar foods has worn off!). Packing a low calorie snack like graham crackers, granola, fruit or vegetable slices can give your body a boost and keep you from feeling hungry in the late afternoon and caving in to the urge to devour the entire contents of the vending machine after work!

5. Drowsiness is often a sign that you’re not getting enough water. Drinking more water throughout the day not only helps keep you awake, but also keeps you from feeling those hunger pangs that inevitably creep up in mid-morning. Taking a large sports bottle that you can drink from throughout the day is a great way to get your recommended eight glasses a day as well!

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Anonymous said...

Essential oils, roots and herbs can be used in a variety of ways to promote healthy living and stress cause. They are used to create natural remedies for treating ailments common to both people and animals, to add flavor to food, to make perfumes and to create environmentally friendly cleaning products.

You do not have to own a garden to tap into the benefits of plants, roots and herbs. A few herb pots located by a sunny window are enough to get you started. Then, all you need are some essential oils and you are ready to go.

For therapeutic purposes, only the purest oils will do. It is possible to be fooled into thinking that you are purchasing a pure oil. Often, a lesser quality blend of several oils is used to mimic the properties of the pure oil. Blended oils are acceptable for fragrance purposes such as for perfuming a room, but pure oils are a "must" for medicinal purposes.

A reasonable guide to the purity of an essential oil is its price. Pure essential oils are generally more expensive. Common oils such as lavender and geranium are much cheaper than frankincense and carnation oil. It is advisable to become familiar with essential oil prices and then rely on this knowledge when purchasing oils from unfamiliar sources. Keep in-mind that you will generally get what you pay for. A price list from a reputable dealer is a valuable resource when purchasing essentials oils.

Usually, pure essential oils cannot be applied directly to the skin and must be mixed in a base oil to reduce their strength. Base oils such as almond oil or wheatgerm oil are commonly used for this purpose. Base oils are generally derived from seeds, nuts or vegetables and allow you to create essential oil remedies that can be massaged into the skin.

So, what do you need to get started with essential oils and natural remedies?

Without a doubt, Lavender is one of the most useful and desirable oils. Not only does it work wonders on cuts, bruises and burns, it also aids sleep and helps with relaxation.

The Tea Tree and Eucalyptus oils are useful for treating a variety of respiratory ailments. These are excellent for the treatment of colds and coughs. They can be massaged into the chest or burned in an oil burner to help clear the airways and prevent congestion. Tea Tree oil is a natural antiseptic and can be dabbed on cuts, bites and stings. It is often used to treat spots and pimples and when diluted with water, acts as a mouth gargle (keep in-mind it should never be swallowed).

Another basic antiseptic is Geranium oil. With its distinctive perfume and pain relieving properties, it is a necessary inclusion when starting out.

Peppermint oil should also be purchased as it treats digestive complaints and may be used in preparations for freshening breath.

For fragrant perfumes and establishing ambience in a room, buy some Patchouli and Ylang-ylang oils. Often combined in scented candles and air fresheners, a few drops of each in an oil burner creates a wonderfully perfumed home. Orange oil mixed with Cinnamon oil is a lovely winter alternative that evokes seasonal, holiday smells. Besides their perfume qualities, all four of these oils have other properties. Patchouli treats eczema and dandruff. Ylang-ylang is reputed to relieve stress, palpitations and high blood pressure. Orange is used in natural remedies for depression and nervous tension and Cinnamon is excellent for warts and viral infections.

The herbs, Thyme and Rosemary can be grown in pots and used when needed. To create essential oils from herbs, stew some large amounts in pure water, collect the steam and cool it. The oil will rise to the top of the drained water and can be collected with an eyedropper. Alternatively, a "flower still" can be purchased to make the job easier. Thyme and Rosemary are both antiseptics and can be used in skin care preparations. They are also delicious when used in cooking.

Lemon oil and fresh lemons will purify water and, when mixed with honey, are effective remedies for colds and flu. Lemon and white vinegar are highly efficient cleaning agents that can be used for domestic cleaning tasks without damaging the environment. Use white vinegar as a natural disinfectant or mix it with water to clean windows and wooden floors. It is also handy to keep a bottle of white vinegar in your car if you swim in the ocean. It will bring instant relief from jellyfish stings.

Citronella oil is perfect in summer to keep the insects at bay. Another natural repellent is Garlic. Fleas will not bite a dog that has been eating garlic, so a few garlic capsules in the dog food are a cheap solution to your pet's flea problem. A soft collar soaked in Citronella will also do the job.

Garlic also helps to promote a healthy immune system when the weather turns cold and viruses begin to circulate. In fact, most of the oils and herbs listed above are effective in helping to prevent many common winter illnesses.

Whether you are looking for remedies or nature friendly products to use around the house, the oils and herbs suggested above should help get you started. You will be ready to make some healthy changes in your way of life!

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Lithium Carbonate Side Effects said...

My name is Jason Gorman and I am 45 years old. My wife was taking 1200mg of Lithium Carbonate daily prescribed by the doctor for over two years. During this time no lab work was ever ordered. It built up in her system over a period of time. She was taken to the ER where she almost died. Her pulse was down to 31 and her blood pressure as low as 43 over 17. She under went kidney dialysis continuously for over 30 hours in ICU. She spent a total of 5 days in the hospital. I strongly recommend against taking Lithium. At least have periodic Lab Work done. Also if you do take this medication look up the side effects on the internet.

My wife has experienced some of these side effects-
Dizziness, Vomiting, Diarrhea, Confusion, Tremors, Muscle Weakness, Loss of Bladder Control, Inability to talk

I hope this information will be useful to others,
Jason Gorman