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.
Thursday, October 20, 2005
The depressed child - By Julia Nielsen
Twenty million children in the United States alone suffer from clinical depression. What is happening and how can we help?
All kids feel sad some time in their childhood, whether it be from a friend moving away or a pet that died. Nevertheless, there is also an estimated two million children who are clinically depressed--scary numbers for parents and doctors. In researching for this article, I have come away with some sobering statistics in this, the beginning of the twenty-first century.
1.Depression in children is rising. In a study done at the National Institute of Mental Health, it was concluded that depression onset is occuring earlier in life than that of the past, and that children who suffer from depression will turn either to alcohol or to crime and will at least attempt suicide in adulthood, if they don't get the necessary treatments now. My eyes grew wide when I learned of this report.
2. Suicide is the third leading cause of death among children between the ages of 10-24.
3. If you, as a parent have suffered anxiety or depression, your child has a greater than fifty percent chance that they too will develop anxiety or depression.
4. It is estimated that half of the children who have depression will never get the proper help they need.
5. Depression can lead to poor grades, poor health and poor communication skills with children.
6. By the time children who have not gotten help, reach adulthood--they will have more health problems than those who sought out help when they were children.
7. Often times, parents think the child will just, "snap out of it." Those children never get help, and therefore end up in far worse circumstances.
8. Depression is treatable. By finding the right doctor and treatment for your child, depression can be controlled and even cured.
So, what is depression and more importantly, what can we, as parents do to prevent it from occurring in our children?
Depression is characterized as having imbalances in the brain's neurotransmitters, the chemicals that allow communication between nerve cells. The neurotransmitters, Norepinpherne and Serotonin, are two chemicals whose low levels are thought to play an important role. Some doctors believe depression is heridatary, in that if parents or grandparents suffer from it, their children most likely will to. No one knows for sure why the chemicals are deficient; it could stem from genes, traumatic events, like a death or a move or from illness. Whatever the reason, depression in children is not normal. Kids need not be sad all the time. The question is, can depression be cured, before it causes major problems in the family?
According to the National Institute of Mental Health, depression can be controlled or cured, if we catch the signs early.
· Frequent vague, non-specific physical complaints such as headaches, muscle aches, stomachaches or tiredness
· Frequent absences from school or poor performance in school
· Talk of or efforts to run away from home
· Outbursts of shouting, complaining, unexplained irritability, or crying
· Being bored
· Lack of interest in playing with friends
· Alcohol or substance abuse
· Social isolation, poor communication
· Fear of death
· Extreme sensitivity to rejection or failure
· Increased irritability, anger, or hostility
· Reckless behavior
· Difficulty with relationships
If your child exhibits these signs, talk to a counselor as soon as possible. The earlier parents get help, the better. Children do not need to suffer needlessly nor do they need to feel as if they are alone.
There are all sorts of treatments out there for adolescent depression, but before you call a psychiatrist or stock your medicine cabinet with drugs, talk to your child and your doctor. Not all drugs are right for children and some can make the depression worse or have bad side effects. The most important thing you can do for your child is to discuss treatment options. The more the child feels in control of their depression, the better. If they are hesitant about medication, listen to why they are afraid and then come to a decision that will benefit everyone. Not all depressed children need drugs; some just need someone to listen to, someone they can relate to and someone who will understand and accept what they are feeling. The same with psychiatrists; children have different needs. It is vital that you pick someone that the child will feel comfortable talking with and expressing their feelings. Get on the Internet and research medications; if you feel that is the route, you would like to take.
The worst thing a parent can do is give up on their child. They need their parents more than anything. Often times, children do not know why they are feeling sad and they are scared. If the depression is because of a friend or loved one who has died or the fact that someone is bullying then in school, make it a point to talk to the school counselor and even the principal. Let them know what is going on so they can be aware and help the child.
I do not think we can necessarily prevent depression from ever entering out child's life. Just by watching the news or reading the newspaper, children get a sense of the real world around them and the things that make them fearful. In depressed children, these feelings can be overwhelming. We can help by not setting their feelings aside. We can be there for them; we can strive to help them have self-confidence and self-esteem. We can listen to their fears, hopes and dreams.
I still feel--and this is my opinion--that children need to be heard. Talk to them; find out what could be the reason that they are sad. If they are hesitant about speaking to you, or just do not want to, have a close relative or friend try to talk to your child. Sometimes, anxious parents can be a deterrent for children when they are feeling sad. We, as Parents mean well, but we could be the reason they are depressed. Children need to feel that by talking to us they will not feel as if we are judging them or making them feel bad for feeling the way they do.
Depression among adolescents is rising; let's do something before it gets out of control and help kids become kids again.
Written by Julia Nielsen - © 2002 Pagewise
All kids feel sad some time in their childhood, whether it be from a friend moving away or a pet that died. Nevertheless, there is also an estimated two million children who are clinically depressed--scary numbers for parents and doctors. In researching for this article, I have come away with some sobering statistics in this, the beginning of the twenty-first century.
1.Depression in children is rising. In a study done at the National Institute of Mental Health, it was concluded that depression onset is occuring earlier in life than that of the past, and that children who suffer from depression will turn either to alcohol or to crime and will at least attempt suicide in adulthood, if they don't get the necessary treatments now. My eyes grew wide when I learned of this report.
2. Suicide is the third leading cause of death among children between the ages of 10-24.
3. If you, as a parent have suffered anxiety or depression, your child has a greater than fifty percent chance that they too will develop anxiety or depression.
4. It is estimated that half of the children who have depression will never get the proper help they need.
5. Depression can lead to poor grades, poor health and poor communication skills with children.
6. By the time children who have not gotten help, reach adulthood--they will have more health problems than those who sought out help when they were children.
7. Often times, parents think the child will just, "snap out of it." Those children never get help, and therefore end up in far worse circumstances.
8. Depression is treatable. By finding the right doctor and treatment for your child, depression can be controlled and even cured.
So, what is depression and more importantly, what can we, as parents do to prevent it from occurring in our children?
Depression is characterized as having imbalances in the brain's neurotransmitters, the chemicals that allow communication between nerve cells. The neurotransmitters, Norepinpherne and Serotonin, are two chemicals whose low levels are thought to play an important role. Some doctors believe depression is heridatary, in that if parents or grandparents suffer from it, their children most likely will to. No one knows for sure why the chemicals are deficient; it could stem from genes, traumatic events, like a death or a move or from illness. Whatever the reason, depression in children is not normal. Kids need not be sad all the time. The question is, can depression be cured, before it causes major problems in the family?
According to the National Institute of Mental Health, depression can be controlled or cured, if we catch the signs early.
· Frequent vague, non-specific physical complaints such as headaches, muscle aches, stomachaches or tiredness
· Frequent absences from school or poor performance in school
· Talk of or efforts to run away from home
· Outbursts of shouting, complaining, unexplained irritability, or crying
· Being bored
· Lack of interest in playing with friends
· Alcohol or substance abuse
· Social isolation, poor communication
· Fear of death
· Extreme sensitivity to rejection or failure
· Increased irritability, anger, or hostility
· Reckless behavior
· Difficulty with relationships
If your child exhibits these signs, talk to a counselor as soon as possible. The earlier parents get help, the better. Children do not need to suffer needlessly nor do they need to feel as if they are alone.
There are all sorts of treatments out there for adolescent depression, but before you call a psychiatrist or stock your medicine cabinet with drugs, talk to your child and your doctor. Not all drugs are right for children and some can make the depression worse or have bad side effects. The most important thing you can do for your child is to discuss treatment options. The more the child feels in control of their depression, the better. If they are hesitant about medication, listen to why they are afraid and then come to a decision that will benefit everyone. Not all depressed children need drugs; some just need someone to listen to, someone they can relate to and someone who will understand and accept what they are feeling. The same with psychiatrists; children have different needs. It is vital that you pick someone that the child will feel comfortable talking with and expressing their feelings. Get on the Internet and research medications; if you feel that is the route, you would like to take.
The worst thing a parent can do is give up on their child. They need their parents more than anything. Often times, children do not know why they are feeling sad and they are scared. If the depression is because of a friend or loved one who has died or the fact that someone is bullying then in school, make it a point to talk to the school counselor and even the principal. Let them know what is going on so they can be aware and help the child.
I do not think we can necessarily prevent depression from ever entering out child's life. Just by watching the news or reading the newspaper, children get a sense of the real world around them and the things that make them fearful. In depressed children, these feelings can be overwhelming. We can help by not setting their feelings aside. We can be there for them; we can strive to help them have self-confidence and self-esteem. We can listen to their fears, hopes and dreams.
I still feel--and this is my opinion--that children need to be heard. Talk to them; find out what could be the reason that they are sad. If they are hesitant about speaking to you, or just do not want to, have a close relative or friend try to talk to your child. Sometimes, anxious parents can be a deterrent for children when they are feeling sad. We, as Parents mean well, but we could be the reason they are depressed. Children need to feel that by talking to us they will not feel as if we are judging them or making them feel bad for feeling the way they do.
Depression among adolescents is rising; let's do something before it gets out of control and help kids become kids again.
Written by Julia Nielsen - © 2002 Pagewise
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