Bipolar4LifeSupport

Service dogs for Bipolar Disorder:
Updated March 09, 2015.

Can those with psychiatric disorders such as bipolar disorder or depression benefit from interaction with animals? The answer is a resounding, “YES!” “There are an increasing number of dogs being trained to assist individuals with a range of disabilities, including seizure disorders, Parkinson’s disease, heart disease, and psychiatric disorders” (Sachs-Ericsson et al, 2002). Not only can those with bipolar disorder benefit from the love of and for a pet, but they are also permitted under the Americans with Disabilities Act to employ the assistance of a service dog.

The Benefit of Animals

According to Dr. Aaron Katcher of the University of Pennsylvania and Dr. Patricia Gosner of the University of Southern Alabama, animals offer benefits to those with mental illnesses through a number of venues (Lipton, 2001):
Pet Ownership – It is common knowledge, and supported by a large body of scientific research, that owning a pet is generally good for people. There are social and emotional benefits to loving and caring for another creature and having that affection returned.

Animal-Assisted Activities – Trained volunteers hold informal activities in institutional settings such as prisons, hospitals and nursing homes. These activities provide patients with the opportunity to hold, cuddle, pet and interact with animals such a rabbits or dogs or even pigs.
Animal-Assisted Therapy – This involves the use of animals in formal therapy sessions. The presence of a friendly animal helps to ease a patient’s anxiety. This involvement can also improve social interactions and decrease aggressive behavior.

Psychiatric Service Dogs – As noted by Dr. Gosner, “These dogs perform specific tasks that mitigate the negative effects of the person’s mental illness” (Lipton, 2001).

The Law Relating to Service Dogs
It is important to note that to qualify for the protections and allowances of the Americans with Disabilities Act, both the individual and the canine, must meet specific criteria. In short, an individual must have a disability and a service dog must be specifically trained to meet the needs of that disability.
To be protected by the ADA, one must have a disability or have a relationship or association with an individual with a disability. An individual with a disability is defined by the ADA as a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment. The ADA does not specifically name all of the impairments that are covered. (Department of Justice, 2002).
The ADA defines a service animal as any guide dog, signal dog, or other animal individually trained to provide assistance to an individual with a disability. If they meet this definition, animals are considered service animals under the ADA regardless of whether they have been licensed or certified by a state or local government. (Department of Justice, 1996).

The Role of Service Dogs
Joan Froling, a trainer and consultant with Sterling Service Dogs, provides a detailed list of tasks for which service dogs are trained to assist those with psychiatric disabilities. A few of the overall tasks include:
Assistance in a Medical Crisis – Service dogs are trained to retrieve medications, beverages and telephones. They can bark for help, answer a door bell, and even dial 911 on special K9 speaker telephones.
Treatment Related Assistance – These special animals can be trained to deliver messages, remind individuals to take medications as specific times, assist with walking as well as alerting sedated individuals to doorbells, phones or smoke detectors.
Assistance Coping With Emotional Overload – Service dogs can be taught to prevent others from crowding their owner. They can be taught to recognize a panic attack and nuzzle a distraught owner to help with calming.
Security Enhancement Tasks – These canines are often trained to check the house for intruders. They can turn on lights and open doors. They can assist with leaving a premises during an emergency.

In summation, service dogs are of considerable benefit to those with psychiatric disabilities. As noted in their study reviewing the benefits of assistant dogs, Natalie Sachs-Ericsson et al write, “Through clinical observation, anecdotal reports, and retrospective and cross-sectional studies, preliminary support was found for the conclusion that ADs have a positive impact on individuals’ health, psychological well-being, social interactions, performance of activities, and participation in various life roles at home and in the community” (2002).

Managing Weight Gain on Mental Health Medications:

Updated March 26, 2015.
One of the challenges faced by people with mood disorders is weight gain from their medications. I myself gained 80 pounds on psychotropic meds. In addition to being physically dangerous, weight gain is a stumbling block to good mental health, because being overweight is depressing!
We try — oh, how we try! — to lose the weight. Over the years I’ve tried walking 80 minutes a day for three months; a rigorous exercise program for ten weeks; the South Beach Dietfor a short time; and a $2,000 diet plan for three months.

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I lost weight for a time with South Beach but couldn’t handle the practical difficulties, and virtually no weight with any of the other programs. The most I lost on any of them was two pounds. My weight has been stable at 205 pounds for about a year. I looked great at 130 — and not so great at just 145.

If your meds have made you gain a lot of weight, your story is probably similar. You’ve tried and tried, and the weight just keeps creeping up. Maybe you’ve given up.

Well, there’s hope.

I recently viewed a presentation by Dr. Rohan Ganguli and Nurse Practitioner Betty Vreeland on this subject. Dr. Ganguli began by saying he had treated many obese patients for years without really thinking about their weight.

Then a colleague did a survey that found that of their patients diagnosed with schizophrenia, less than 20%were in the normal weight range, and fully 60% were obese.

He said that, unfortunately, “… it has been assumed that people with schizophrenia are socially unaware and that, unlike the rest of us, this really does not matter to them.” Yet when they asked these patients how they felt about their weight, a wide majority of the overweight and obese patients said they wanted and had tried to lose weight.

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And in another study, patients said the #1 worst thing about taking medications was weight gain. Clearly, the attitude that those with schizophrenia don’t care about their weight was completely wrong.
Dr. Ganguli and his fellows developed a program that clinicians could easily provide. It involved 14 weeks of group sessions with training in such areas as developing good eating habits, burning more calories, and changing snacking habits. Self-monitoring in the form of daily weighing and records of food eaten and physical activity was found to be very important.

They lost weight

The results after the 14 weeks were very encouraging — two-thirds of patients lost at least 3% of body weight and around 40% lost 5% of body weight or more. This may not sound like a lot, but for me, 3% would mean a little over six pounds in 2 1/2 months — a lot more than I’ve been able to do in all these years!

One of the program’s ideas was that of “wasting” food. Many people with schizophrenia eat at fast food restaurants because these are inexpensive and convenient. A key issue in their strategy was teaching people not to eat the entire meal — that it was okay to throw part of the food away.

Preventing weight gain

Finally, they tested the program with patients who were just starting on some of the medications that are known to cause weight gain, including Seroquel (quetiapine), Risperdal (risperidone), Clozaril (clozapine) and Zyprexa (olanzapine). In all cases, intervention was found to prevent weight gain in more patients than in the control group, although the success rate depended on the medication. In this small study, the most dramatic difference was with Seroquel, where more than 60% of the control group gained significant weight, while only about 10% of those in the intervention group gained.

Another successful program

Ms. Vreeland’s Healthy Living study was another test of intervention to promote weight loss in the mentally ill. In this program, the key points were:
Use the food label
Pay attention to portion size
Eat more slowly
Make healthy snack choices
Differentiate between stomach and psychological hunger
Reduce fast food intake
Keep food/activity diaries
Increase physical activity
Minimize soft drinks with sugar

This program, using patients with schizophrenia and schizoaffective disorder, resulted in an average 6.6 pound weight loss for those in the intervention group, with a 7 pound weight gain in the control group.

The message
First, mental health practitioners of all kinds need to pay more attention to the problem of overweight/obesity in their patients. We are not in a state where we don’t care. We care — a lot. And they can help. A doctor who just says, “Join Weight Watchers” isn’t getting it. Many of us aren’t up for going to meetings when depressed. Some, like me, are not “group” people. A therapy group, with people like me who have gained weight because of their psychotropic meds, would be different.

But just knowing what made these programs successful can help. Knowing that there is solid research to show it is possible to lose weight and still take my Seroquel makes a difference to me.

Now, I know keeping a calorie and exercise diary is no fun. The easiest way is to get software that has a food database that keeps being updated with more foods. But still, you have to figure out how much of a food you ate, and if the food isn’t in the list, you have to add it yourself from the food label. And you have to do it every day, every time you eat. It gets old, fast. (In the sidebar is an article about keeping a food diary if you don’t want to buy software.)

But it works better than anything else I’ve found. Having made a lot of diet changes already, I recently I started keeping such a diary. I find out what I eat that piles up the calories. And after learning that general housework burns about 240 calories an hour, I’m doing a lot more of that now as well.

My scale says I’ve lost four pounds as of this morning.

Weight loss for those of us on psychotropic meds isn’t going to be fast. But if I get tired of keeping a food/exercise diary, or just don’t want to wash the dishes, I have the encouragement of knowing it’s been proved possible to lose weight with this approach. I hope it helps you, too.

source unknown

Mental Health by the Numbers:

Prevalence of Mental Illness

Approximately 1 in 5 adults in the U.S.—43.7 million, or 18.6%—experiences mental illness in a given year.1

Approximately 1 in 25 adults in the U.S.—13.6 million, or 4.1%—experiences a serious mental illness in a given year that substantially interferes with or limits one or more major life activities.2

Approximately 1 in 5 youth aged 13–18 (21.4%) experiences a severe mental disorder in a given year. For children aged 8–15, the estimate is 13%.3

1.1% of adults in the U.S. live with schizophrenia.4
2.6% of adults in the U.S. live with bipolar disorder.5
6.9% of adults in the U.S.—16 million—had at least one major depressive episode in the past year.6
18.1% of adults in the U.S. experienced an anxiety disorder such as posttraumatic stress disorder, obsessive-compulsive disorder and specific phobias.7

Among the 20.7 million adults in the U.S. who experienced a substance use disorder, 40.7%—8.4 million adults—had a co-occurring mental illness.8

Social Stats
An estimated 26% of homeless adults staying in shelters live with serious mental illness and an estimated 46% live with severe mental illness and/or substance use disorders.9

Approximately 20% of state prisoners and 21% of local jail prisoners have “a recent history” of a mental health condition.10

70% of youth in juvenile justice systems have at least one mental health condition and at least 20% live with a serious mental illness.11

Only 41% of adults in the U.S. with a mental health condition received mental health services in the past year. Among adults with a serious mental illness, 62.9% received mental health services in the past year.8
Just over half (50.6%) of children aged 8-15 received mental health services in the previous year.12

African Americans and Hispanic Americans used mental health services at about one-half the rate of Caucasian

Americans in the past year and Asian Americans at about one-third the rate.13

Half of all chronic mental illness begins by age 14; three-quarters by age 24. Despite effective treatment, there are long delays—sometimes decades—between the first appearance of symptoms and when people get help.14

Consequences of Lack of Treatment

Serious mental illness costs America $193.2 billion in lost earnings per year.15

Mood disorders, including major depression, dysthymic disorder and bipolar disorder, are the third most common cause of hospitalization in the U.S. for both youth and adults aged 18–44.16

Individuals living with serious mental illness face an increased risk of having chronic medical conditions.17

Adults in the U.S. living with serious mental illness die on average 25 years earlier than others, largely due to treatable medical conditions.18

Over one-third (37%) of students with a mental health condition age 14­–21 and older who are served by special education drop out—the highest dropout rate of any disability group.19

Suicide is the 10th leading cause of death in the U.S.,20
the 3rd leading cause of death for people aged 10–2421 and the 2nd leading cause of death for people aged 15–24.22

More than 90% of children who die by suicide have a mental health condition.23

Each day an estimated 18-22 veterans die by suicide.24

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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.

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