Bipolar Affective Disorder (manic depression): information for parents, carers and anyone who works with young people..

About this leaflet

This is one in a series of factsheets for parents, teachers and young people entitled Mental Health and Growing Up.

This leaflet gives some basic information about bipolar disorder and some advice on how to get help.

What is bipolar affective disorder?

What are the symptoms?
Bipolar disorder (BD) is a condition in which a young person has extreme changes of mood – periods of being unusually happy (known as ‘mania’ or ‘hypomania’), and periods of being unusually sad (‘depression’). It is sometimes called’ manic depressive disorder’,’ bipolar affective disorder’ or ‘bipolar mood disorder’.
The mood-swings are way beyond what would be considered normal for a particular individual, and are out of keeping with their personality.

Hw common is it?
Bipolar disorder is extremely rare in young children, but there are quite a few studies that suggest that it may start in teenage years and in early adult life. It affects about one in 100 adults.

The condition can be hard to recognise in teenagers because more extreme behaviour can be part of this stage of life.

In BD, a person can have:
manic or hypomanic periods (or ‘episodes’)
depressive periods
mixed periods.
Below is a list of the symptoms in each episode. A young person needs to have at least one manic or hypomanic episode to be diagnosed with BD.
Symptoms that can occur during a ‘high’ or manic episode

Symptoms that can occur during a depressive episode

feeling incredibly happy or ‘high’ in mood, or very excited
feeling irritable
talking too much -increased talkativeness
racing thoughts
increased activity and restlessness
difficulty in concentrating, constant changes in plans
over confidence and inflated ideas about yourself or your abilities
decreased need for sleep
not looking after yourself
increased sociability or over-familiarity
increased sexual energy
overspending of money or other types of reckless or extreme behaviour.

‘Hypomania’ is a milder form of mania (less severe and for shorter periods). During these periods, people can actually become very productive and creative and 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.

At the extreme end, some people also develop something called psychosis. This is when someone has strong, bizarre beliefs e.g. that they have superhuman powers or are being watched or followed.

feeling very sad most of the time
decreased energy and activity
not being able to enjoy things you normally like doing
lack of appetite
disturbed sleep
thoughts of self-harm or suicide.
On the milder end, you may just feel sad and gloomy all the time. Here too, at the extreme end, some people can develop psychosis.

Symptoms that can occur during a mixed episode
A mixture of manic symptoms and depressive symptoms at the same time.

What effects can bipolar disorder have?

Where can I get help?

The exaggerated thoughts, feelings and behaviours can affect many aspects of life and can lead to:
problems in relationships with friends and family
interference with concentration at school or work
behaviour that places the young person’s health or life at risk
a loss of confidence and a loss of the sense of control the person feel over their life.
The longer the condition continues without treatment, the more harmful it is likely to be to the life of the young person and to their family.

The first step towards getting help is to recognise that there might be a problem. Seeking medical advice early on is very important. If the bipolar illness can be identified and treated quickly, this reduces its harmful effects.

How is it treated?
You should contact your GP first. If necessary, they can then make a referral to your local child and adolescent mental health service (CAMHS), who can offer more specialist help.
In the short term, depending on whether you are high or low and how severe it is, you may need different treatments.

When you have severe symptoms, you may need medications and also sometimes admission to hospital to help your symptoms and also keep you safe.

In the long term, the goal of treatment is to help you have a healthy, balanced and productive life. This would include understanding the condition, controlling the symptoms and preventing the illness from coming back.

Medication

Medication usually plays an important role in the treatment of bipolar disorder, especially if episodes are severe. In the initial stages of the illness, medication helps to reduce the symptoms.

The choice of medication can depend upon the type of episode (manic or depressed). Everyone is different and so the type of medication that is recommended will also be different.
The three main types of medication that are helpful are:
antipsychotic medication: risperidone, olanzapine and aripiprazole are types of antipsychotics.
mood stabilizers: Lithium is a type of mood stabiliser.
antidepressants: fluoxetine is a type of antidepressant.

It is important that medications are not taken only when the problems are serious. If your child has had more than one severe episode of illness, staying on medication is important to reduce the risk of further episodes.

Medication may be needed for months or even years. Some people may, under medical supervision, be able to stop their medication when they have recovered and have felt well for a while.

They may need physical examinations and tests (like blood test) before starting or while on medication. It is important that if prescribed medication, you are regularly seen by your doctor or psychiatrist.
Side-effects of the medication can occur, some of which are quite serious. The psychiatrist will be able to advise about what they are and about what can be done to help. The risk of side-effects needs to be balanced against the risk of the damaging effects of the illness on a person’s life.
No young person should be taking medication unless they are reviewed by a health professional regularly. This is to monitor the dose of the drug and to check for side-effects.

Talking treatments (also known as ‘psychotherapies’)
It is crucial that drug treatments are combined with practical help for the young person and their family.
Help with understanding the illness (psycho education)

It is very important that the young person with bipolar disorder and their family are helped to understand the condition, how best to cope and what to do to reduce the chances of it recurring.

The young person and their family may notice particular ‘triggers’ to their episodes and/or early warning signs that an episode may be starting – being aware of these can help reduce the chance of episodes occurring, and getting help in the earliest stages of an episode can stop it from escalating.
Family-focused treatment

Stress at home can worsen the situation and can even trigger an episode of the illness. Talking therapy in which the whole family is helped to find ways of reducing stress, solving problems and communicating more effectively has been shown to help young people with BD get better, and stay well.
Cognitive-behavioural therapy (CBT)

This is another type of talking therapy in which the young person, sometimes with their family, learns to understand the links between their feelings and thoughts and how this affects their behaviour.

Some young people may need to go into hospital for intensive support if the symptoms are severe.

Recovery
It is important for the young person to recognise that they are not alone and to keep up hope.
Many people only have a few mood swings and then the problem goes away. For others, it becomes a lifelong pattern which they learn to live with and manage.

An episode of bipolar disorder can interfere with education because it is difficult to learn when they are unwell. An important part of recovery is to begin to plan returning to education or to think about working.

http://www.bipolar4lifesupport.co

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