The term bipolar disorder is making its way into today’s culture – luckily I would add. This makes a further description almost superfluous in addition to those found everywhere.
To simplify everything by saying that it is the alternation of euphoric and depressive phases is an understatement. There are for example episodes or situations in which euphoria does not occur at all and dysphoria appears in its place . This term indicates an excess of bad mood that leads to even intense angry attacks that can be aggravated by the attempt to self medicate with alcohol or substances of abuse .
The bad news is that it is a cyclical disorder that can recur at any time in life. The good is that we have the healing tools.
Among these is the support for those who are next to a subject with Bipolar Disorder who can help him. “All happy families are alike, every unhappy family is unhappy in its own way,” wrote Tolstoy. How to blame him?
Each situation is a story in itself and it is not possible to formulate something that works always and for everyone. There is no miracle recipe to help people with bipolar disorder . However, we must not give up on some proven tips and strategies to help those who live next to these situations.
Rely on specialists experienced in the treatment of bipolar disorder
This consideration seems obvious but unfortunately the most appropriate path is often identified after many attempts.
The fear of stigma leads to the psychiatrist being contacted after many other alternative paths, taking precious time away from suitable treatment. The Bipolar disorder is a disorder that is pharmacologically treated at first and soon. The professional indicated is the psychiatrist . At a later time, other paths shared with the specialist can be inserted.
Just contacting the specialist is not enough. It is necessary to help the person with bipolar disorder to remember appointments, to be constant in taking therapies, to promptly communicate the first changes in the clinical status to the specialist.
Facilitate adherence to therapy to help those with bipolar disorder
If the disorder is in the critical phase, it may be necessary to accompany the patient to visits and to be close to him while taking the therapies. If necessary also to prepare the drugs to be taken (which in any case should never be administered secretly or without the patient’s knowledge).
Unfortunately, those with bipolar disorder tend not to follow treatment. In a depressive phase he believes that nothing can help. In manic phases, he thinks he feels great and does not need help. In the inter-critical phases, he thinks he has overcome the crisis and that it will never come again.
A further complication occurs when the patient is suffering from concomitant chronic organic diseases (eg diabetes, hypertension). The risk is that the therapies necessary to maintain physical balance are also interrupted and therefore it will also be necessary for the patient to be helped to manage these aspects.
Never underestimate that in order to optimize the treatment process and help those with bipolar disorder it is important on the part of family members or relatives not to discredit or devalue the specialist in the presence of the patient. If you have any doubts about the doctor’s work, you can express them directly to the doctor in person, by phone or by email.
Report all status changes to the care provider
We must learn to recognize, together with the person concerned, the first signs of entry into the new critical phase. Whether it is depressive (e.g. psychomotor slowdown, tendency to want to sleep a lot, altered nutrition, loss of interest or detachment from what surrounds it) or manic (e.g. increased energy level, grandiose planning, physical hyperactivity, irritability or intolerance to be disappointed, reduced need for sleep, excessive spending).
Changes in status should be encouraged to be communicated to the specialist as soon as possible, even if they may appear trivial.
Know the disorder
It is essential to avoid inserting terms such as “willpower” or similar that deny the existence of a disorder with its own characteristics and treatments.
The earlier the right tools are used, the better the picture will evolve. There is a lot of material available on the web. The advice I can give is to select only information that comes from qualified sources . Otherwise the risk is to come across confounding and misleading notions that make the situation even more difficult to manage and, more seriously, postpone the most suitable interventions.
There are many psychiatric structures, family and voluntary associations that organize psycho-education courses on bipolar disorder. Specialized and experienced operators help patients and family members to understand the disorder, treatments and ways of managing acute phases. Having clearer ideas on these topics helps provide answers to the legitimate and usual question: “What should we do?”
Person and disorder are not synonymous
The difficulty I find most in the treatment of these patients is that there are many expressions of the disease and many people in the same registry identity.
This is true during the first episodes but over time it is still possible to identify a stability of the patient who can become a sufficiently reliable interlocutor.
Even those close to the bipolar patient can learn to identify a single interlocutor with whom to relate. It will be possible to construct an image in which we understand that the person and the disorder are not the same thing.
We must actively work to identify the “person” so that we can understand and accept that there are no “culprits” responsible for mood swings. These derive from an anomaly in the functioning of the nervous system in its functional and structural elements. Phrases that refer to being bad or having a bad temper will no longer be appealed to.
This helps not to emphasize definitely unpleasant attitudes (opposition for example). It also leads the patient to avoid feelings of guilt when he becomes aware of his uncontrolled actions.
Talk to the person when they are fine
It is necessary to take advantage of the phases of well-being to negotiate with the person concerned some shared modalities with which those close to him can help him in the subsequent phase of decompensation.
Unfortunately, it is known that when crises improve, there is a tendency to experience the positive moment trying to put the crisis behind us. This is an understandable way, perhaps even necessary to take a breather, but not helpful in the long term.
The patient must be asked when he is better: “What can we do during a crisis to help you?”. In this way we begin to relate to the “person” and insert him into the work program which will have to be joint and which will last a long time. Unfortunately, crises can occur even if the treatments are followed flawlessly. The important thing is to understand that they are phases, with a beginning and an end.
Collaborate in building a regular lifestyle
More and more data confirm that lifestyle is a very important factor in many diseases. Both as a trigger and maintenance factor and as an element of treatment and prevention. The Bipolar Disorder does not deviate from this rule and has its own peculiarities.
First of all it is essential to maintain a regular sleep-wake rhythm : establish the times to go to sleep and wake up following the day / night cycle.
Not respecting these rhythms facilitates the risk of relapse. For this reason, it is preferable to avoid professional activities that involve night shifts and frequent intercontinental trips that involve significant time zone variations.
A healthy lifestyle is all about maintaining a certain regularity in everything. Regular physical activity (without excess), regular nutrition and hydration, avoiding excess of exciting substances (eg coffee) and absolutely avoiding the use of alcohol and drugs.
It would be of great help to fill out an agenda with things to do. It will help in trying to do those minimal things in the depressive phases and not to exceed the number of activities in the excited phase. This also applies to regularizing activities in the phases between one crisis and another
Offer the patient psychotherapy
The treatment of Bipolar Disorder is certainly an example of multi-professional work. A cognitive behavioral therapy may be indicated in all stages of the disorder, always in combination with drug treatment.
The benefits are many, not least the possibility of helping the affected person to cooperate in the long-term management of the disorder.
Avoid isolation
Sharing a problem with someone who has a similar direct experience eases the emotional burden of someone living with someone with bipolar disorder .
For this reason, groups for bipolar patients and family members have been activated in many situations . It is important for family members to avoid withdrawing into their grief and instead try to maintain social contact. It serves to fuel one’s mental health and to show the patient a positive and realistic model.
Seeing family members included in a social network and committed to living their lives indirectly helps the patient not to feel responsible for the discomfort of those around him. This can in fact lead to the extreme thought of having ruined his existence.
We know that it is not easy but in every way you have to continue to cultivate your interests and hobbies, to frequent people and places of interest. It is certainly one of the tools to keep our resistance to stress in good health.
Think of a form of protection in the most serious cases
Bipolar disorder more than any other disease can lead to extreme and potentially very harmful decisions.
The person suffering from bipolar disorder should be helped not to take drastic decisions that could create serious problems (even more so if there are minor children involved) and which they might regret in the future.
Unfortunately, those in a crisis often attack everything on several fronts ranging from work to romantic relationships. In this state a decompensated person could become a victim of incapacity circumvention . In these situations it can also be helpful to report the incident to the law enforcement officers (who have an interest in punishing offenders and those who take advantage of patients, NOT patients).
If the problem was the poor management of assets (spending too much, selling real estate or assets without any plans, making debts with banks or financial institutions and other similar) there is the possibility that family members and relatives can ask the figure of the judge to protect the appointment of a support administrator.
The support administrator is appointed by the judge, will be accountable to the administration and is responsible for helping the person manage the assets in a non-reckless way. If the patient should reward himself and maintain a good balance over time, managing to administer himself, the appointment of the administrator can be revoked.
