 About Bipolar DisorderWritten by Dr. Pamela Heilman, PsyD, LCPAbout Bipolar Disorder
In any given year, approximately 5.7 million American adults (about 2.6 percent of the population) have bipolar disorder (International Bipolar Foundation). It is estimated that people with bipolar disorder have an increased risk of suicide compared to the general population, with some research suggesting that up to 20% of individuals with bipolar disorder (especially if left untreated) end their life by suicide (Dome, Rihmer, & Gonda, 2019). Correct diagnosis of bipolar disorder is essential for developing an appropriate treatment plan. Proper diagnosis involves doing a thorough clinical interview which is likely to include various assessments and coordination of care with other providers. Bipolar I disorder is diagnosed when an individual meets criteria for at least one manic episode. When an individual meets criteria for at least one hypomanic episode and one depressive episode, bipolar II is diagnosed. More information on diagnosing bipolar disorder can be found in my Monday Facebook blog post. Evidence-based treatment for bipolar disorder involves a combination of medication and Cognitive-Behavioral Therapy. Other effective treatment interventions may include ACT and DBT strategies. Medication Some of the medications that have been found to be effective in treating bipolar disorder include: lithium, anticonvulsants, antipsychotics, antidepressants, and calcium channel blockers (Fast & Preston, 2006). It will be important to work with your doctor to determine what medication regimen will work best for you. Your therapist can work with you to help identify important questions to ask regarding your medication. Important facts about your medication include: what drugs you are taking, specific symptoms they are treating, recommended dosage, any potential interactions, and their side effects (Fast & Preston, 2006). Additionally, it is important to consult with your doctor prior to taking any supplements. There are certain over-the-counter supplements which can cause serious problems for individuals with bipolar disorder. For example, anything that reduces depression such as SAM-e and St.-John’s-wort, can potentially provoke a manic episode (Fast & Preston, 2006). Therapy Interventions When managing mental or physical health problems, lifestyle changes are often necessary. If an individual is diagnosed with diabetes or heart problems, it is important to develop a healthier lifestyle. The same is true when managing mental health issues such as depression, anxiety, or bipolar disorder. Cognitive-behavioral therapy (CBT) includes the following strategies: psychoeducation, identification of triggers, thoughts, feelings, and behaviors associated with symptoms, and implementation of proactive measures and coping strategies. Cognitive-restructuring is a CBT strategy that involves identifying distorted thinking that exacerbates problems. Your therapist will spend time helping you to develop more balanced, realistic thoughts. Significant time is also spent identifying and altering behavior that exacerbates symptoms. Development of a wellness plan is a preventive strategy that increases awareness of symptoms and how to manage them effectively. Items that are typically included are: symptoms, triggers, warning signs, medications, support system, and lifestyle changes. Once this plan is developed, your therapist may help you identify trusted individuals with whom you can share this plan. Many clients need the assistance of support people to help them recognize warning signs and problematic behaviors. Regular risk assessment is part of treatment for bipolar disorder. This includes assessing for suicidal thoughts, plans, or intentions, as well as self-harm urges or other risk-taking behaviors. Safety plans entail steps that can be taken when a client feels unsafe. These are often developed in treatment as part of the wellness plan. Various Acceptance and Commitment Therapy (ACT) strategies can also be useful in therapy. Clients can experience feelings of guilt and shame about what happens during various mood episodes. Learning and practicing self-compassion can be an important part of their treatment. Additionally, assisting clients in identifying their values and behaviors that honor those values can help clients adhere to their wellness plan. Clients often benefit from distress tolerance strategies. Urge-delay is a strategy that can be used to help clients refrain from engaging in self-destructive behaviors. The clinician may guide the client in creating a coping card containing healthy alternative behaviors. When a client experiences a self-destructive urge, they are instructed to set a timer, usually for at least 20 minutes, and then choose from the healthy behaviors listed on their card. Grief and Bipolar Disorder Many clients experience grief associated with their diagnosis of bipolar disorder. Part of treatment should allow clients to grieve losses associated with their diagnosis. These losses can be personal and professional. Individuals may mourn the loss of their former identity prior to the diagnosis. It can be daunting to receive a diagnosis of bipolar disorder. The good news is that it is very treatable. With the help of a proper medication regimen and treatment plan, individuals can lead productive and fulfilling lives. Resources Listed below are some resources that may help supplement treatment for bipolar disorder. Depression and Bipolar Support Alliance (DBSA): https://www.dbsalliance.org/ International Bipolar Foundation: https://ibpf.org/about-bipolar-disorder/ If you or someone you care about is thinking of harming themselves, it is imperative to seek immediate assistance. Options include:
References American Psychiatric Association. (2022). Bipolar and Related Disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Fast, J.A. and Preston, J. (2006). Take charge of bipolar disorder: A 4-step plan for you and your loved ones to manage illness and create lasting stability. Grand Central Life & Style Hachette Book Group. Healthline. (2022, July 26). Suicide and bipolar disorder: Symptoms, Treatment, and Prevention. https://www.healthline.com/health/suicide-and-bipolar International Bipolar Foundation (n.d.) What is bipolar disorder. https://ibpf.org/about-bipolar-disorder/  Assessment for an ADHD DiagnosisWritten by Erin Mitchell, MSW, LCSWWelcome to Neurodiversity Week! This week will be filled with information and tips regarding attention-deficit/hyperactivity disorder (ADHD). Webster’s Dictionary defines neurodiversity as the range of differences in individual brain function and behavioral traits, regarded as part of normal variation in the human population (used especially in the context of autistic spectrum disorders). Harvard Medical School further expands that definition to include other neurological or developmental conditions such as ADHD or learning disabilities.
ADHD stands for attention-deficit/hyperactivity disorder. As an aside, the use of the term ADD has been discontinued. It is now considered part of the broader ADHD term, and you do not have to experience hyperactivity to have ADHD. There are 3 different types of ADHD: hyperactive/impulsive, inattentive, and combined type. When people visualize someone with ADHD, they often picture a child (usually a boy) who cannot sit still in a classroom setting. While this can be one way that ADHD presents, it is not the only way it shows up in children. It can also show up as a child who needs to be reminded four times that they need to get their materials out of their backpack to start their day…every day. The diagnosis has nothing to do with a lack of attention. It is not a character flaw. It is a condition that individuals are born with that results in executive functioning issues (otherwise known as executive dysfunction). According to leading expert Dr. Russell Barkley, executive function can be described as:
Not every person with ADHD struggles as significantly in each area, but will have difficulty with most. If you are questioning the possibility of yourself or a loved one (including a child) qualifying for a diagnosis of ADHD then I hope to help you on this journey. Step 1: I highly recommend that you take a reputable online questionnaire to see if you or a loved one would qualify. I recommend taking this one: https://www.additudemag.com/symptom-checker/ Step 2: Save a copy of your questionnaire results somewhere you can access it again or print it out to take with you. Consider how long these symptoms have been a part of your life. Is this something you have always had trouble with? Or other similar areas? Step 3: Pursue getting formally diagnosed. This is helpful for seeking treatment (therapy and/or medication). Getting a diagnosis seems like it should be straightforward; however, it needs to be given by a medical doctor (like your primary care provider); a psychiatrist, or a psychologist. Psychologists/Neuropsychologists can perform comprehensive diagnostic testing to make or confirm a diagnosis (if you wish to use insurance for testing, ensure this is covered by your insurance provider). Getting a diagnosis is often one of the most difficult steps to get accomplished. Unfortunately, the medical community has varying levels of comfort with ADHD diagnoses. It may require seeing a psychiatrist. Being able to bring a copy of the ADHD questionnaire results with you may be helpful, but they may have you complete an assessment regardless. For Children: If you are seeking a diagnosis for a child, it will most likely require an assessment by a child psychiatrist. You can get a referral from your pediatrician (if they are not comfortable making the diagnosis themselves). This is a multi-step process, as they will try to get information from others in your child’s life (such as teachers, daycare providers, etc.). This can be very hard to diagnose in children that are not yet in school, but can be accomplished with persistence. Note that this can take some time to get the questionnaires completed by a teacher and back to the psychiatrist. This step will be followed by another appointment with your provider to discuss next steps. For Adults: It is likely that you will need to see a psychiatrist for an assessment. You may be able to just see your primary doctor, but don’t be surprised if they refer you out. Sometimes, this can take some advocacy as well. You will want to keep in mind what will fit best with your lifestyle. I know an individual who was diagnosed with ADHD, but was told by their doctor that they should quit their high stress job and find a personal assistant to help them get the tasks done that they were struggling with in their life because that doctor did not like to prescribe ADHD medication. To say that was not a feasible option was an understatement! Luckily, this person did not give up and was able to finally get the help they needed through a different provider. Unfortunately, there are still people, including professionals, that believe that ADHD is “not real”, “over-diagnosed”, “is something that everyone has”, or “something that you grow out of”. For some, it can seem like an uphill battle to get properly assessed, even though a correctly identified diagnosis can make such a positive difference in someone’s life. If you chose not to get formally diagnosed and just prefer to see a therapist, they can still help with behavioral interventions, but to get an official diagnosis may require one of the options mentioned above. After diagnosis, you have the option of getting medication and/or therapy. Medication alone can be helpful, but does not address the emotional aspects of ADHD, which is where therapy can prove beneficial. Neurodiversity reflects the reality that our brains all work in very different ways. Understanding the way that your brain works (or the brain of a loved one) can help you in your life in so many ways. One of the best comparisons that I have come across for ADHD is this: If you tell someone who is nearsighted to “just look harder”, they cannot. That person is not physically capable. That’s the same thing that happens when you tell someone with ADHD to “just try harder” or “it’s not that difficult”. They may not be capable of making that happen in the same way. Getting properly assessed and treated can be an important step in getting help. |
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