Bipolar4LifeSupport

These pages explain what psychosis is and its possible causes and treatments. You will find them useful if you are affected by psychosis or if you have a friend or family member who is affected.
•Psychosis is a medical term used to describe hearing or seeing things, or holding unusual beliefs that other people do not share.
•Common examples include hearing voices or believing that people are trying to do you harm.
•You can experience psychosis for a wide variety of reasons. For example it can be due to having a mental illness such as schizophrenia or bipolar disorder. It can also be caused by drug use, brain injury or extreme stress.
•There is no one single cause of psychosis but researchers believe that genes, biological factors and environment may play a part.
•In the NHS, you should be offered medication and cognitive behavioural therapy (CBT) to help with your symptoms.
•To access treatment for psychosis, you usually need to have an assessment by specialist mental health services.
•If you are experiencing very severe psychotic symptoms you may need more urgent help such as going into hospital.
•If you are trying to communicate with a person experiencing psychosis there are communication methods you can try.
•There are different perspectives on how we should view and deal with psychosis. This includes listening to the voices or trying to understand the meaning of the unusual beliefs.

Tell yourself: STOP !

Take a Breath

Focusing on your breathing slows down the adrenaline response and the distressing thoughts.

Breathe mindfully and notice the sensations of breathing in your belly. You might find it helpful to count your breaths, or to breath in to a count of 4, and out to a count of 4.

Observe:

Your thoughts & feelings e.g…

I’m anxious

My body’s alarm system has been triggered

My mind is tricking me into believing I’m in danger

I’m feeling really tense and hyped up

Pull Back:

Is this really true or does it just feel that way?

Is this fact or opinion?

What would a friend say about this?

What advice would I tell someone else?

Even though it feels really bad, these physical sensations are a normal body response…it will pass

Practise what works:

Positive self-talk, e.g.

I can get through this – I’ve done it before

I’m stronger than I think I am

This will pass

I can do this

Visualise: Imagine breathing in blue or green, and breathing out red. (Colour breathing exercise). Or use your imaginary outdoor peaceful place

Will my information be kept confidential?

GPs have strict guidelines on confidentiality and information sharing which means they are not allowed to give information about you to third parties without your direct consent.

This means they will not give information to your partner, children or parents as well as your employer or other organizations. If information was shared without your permission, you could potentially take legal action against the GP or doctor.

Guidelines (General Medical Council’s Confidentiality Guidelines, 2009) state that your close relatives can provide information to GPs about you (for example, inform them about your mental health) and the GP could then use this information to inform your treatment and diagnosis. Professionals helping you can also share information about your mental health. Your Community Mental Health Team and your GP could also discuss your health.

Do mental health problems affect me working?

If you are a doctor, nurse, teacher or social worker, you may have to go through fitness to practice tests. If you are studying one of these professions you may need to as well. This is looked at when working in these professions and also when applying for courses to study in these areas.

If you tell your employer, college or university that you have a mental health problem, then your employer or study provider may ask your permission to contact your doctor. They would do this to get more information about your mental health and check that you are fit to practice. They would usually ask for a letter or report from your doctor. Your doctor would only share this information with your permission because of their duty of confidentiality to you. Having a mental health condition does not mean that you are automatically considered unfit to practice. Telling your employer that you have a mental health problem could protect you from illegal discrimination or lead to you getting extra support if you have a disability under the Equality Act 2010.

What if I have problems getting help?

Although all doctors should be trained to deal with mental health, when you go and see your GP they may not always be very understanding or able to see that you have a problem.

If this happens you should not give up and still try to seek help. You could make an appointment to see a different doctor at the surgery where you are registered who may be more understanding. Or you could speak to your local Patient Advice and Liaison Service (PALS), which is an organisation within the NHS that provides information and support to patients.

You can find your local service using the following link.

http://www.nhs.uk/Service-Search/Patient%20advice%20and%20liaison%20services%20(PALS)/LocationSearch/363

If you can’t get help through the GP and feel that your mental health problems are severe, you could try contacting the Community Mental Health Team (CMHT) yourself and asking for an assessment. Although many CMHTs will only accept referrals from GPs or social services directly, some accept self referrals.

If you can’t get any help or assessment, then you might find an advocate useful. An advocate can help you to understand the mental health system and help you to be fully involved in decisions about your care. An advocate is independent from mental health services and can help to make your voice heard with problems you may come across. They may be able to help with writing letters for you or attending appointments or meetings.

There may be a local advocacy service in your area who you can contact for support. You can search for a local organisation online.

If you continue to have problems getting an assessment or treatment, you could also consider making a formal complaint.

Can I get help without going to see my doctor?

You do not have to go and see your GP if you don’t want to. You can use self help and get treatment without going to see a GP. If you think you are experiencing anxiety and depression you could try:

•Paying for private therapy or counseling yourself

Many therapists operate a sliding scale of charging for treatment for people on lower incomes. It is a good idea to check if a private therapist is registered with an organization that regulates therapists. This means they have had to meet certain standards.

•Getting a private psychiatrist to prescribe medication

Private psychiatrists can be expensive. If you would like to find a private psychiatrist, your GP might know of a psychiatrist privately. Or you could look in a phone directory or online, or through private healthcare providers such as the Priory or Cygnet. You should check that any private psychiatrist is registered with the General Medical Council (you can check here: http://www.gmc-uk.org/doctors/register/LRMP.asp#View).

Self-help tools on the internet include:

http://www.beatingtheblues.co.uk%20– for depression

http://www.fearfighter.com%20– for anxiety

Both are computer based Cognitive Behavioural Therapy (CBT) packages that are available on the internet. They are available free through the NHS, but can also be purchased privately at a cost of around £400.

You could also try:

Get Self Help: http://www.getselfhelp.co.uk/

a free website containing CBT self-help resources

Moodjuice: http://www.moodjuice.scot.nhs.uk/

a free online self-help resource for a variety of mental health problems and symptoms

Moodscope: http://www.moodscope.com

a free, social networking tool that allows people to monitor their mood and receive support.

Living life to the full: http://www.llttf.com

a free internet self-help resource for a variety of issues.

You might be able to get help from a charity community organisation. Many charities offer therapy or one-to-one support. You could try finding out what is available in your area.

At Rethink Mental Illness we often provide psychological therapy, peer support groups or community services. Find out what is available here.

MIND – also provides local services, some of which provide therapy, support groups and other help. You can search for what is available locally.

http://www.mind.org.uk

Tel: 0300 123 3393

Anxiety UK: – Can help with low cost therapies if you have anxiety (you have to join the organisation).

http://www.anxietyuk.org.uk

Tel: 08444 775 774

Moodswings – gives practical support and help to people experiencing mood disorders.

http://www.moodswings.org.uk

Tel: 0845 1236050

If you are experiencing psychotic symptoms then the NHS may be a more effective route as they can offer more specialist NHS services.

If you have psychosis you might:

•See or hear things that other people do not. Doctors call these hallucinations.

•Believe unusual things. You might believe you are being watched or followed

•Have confused and disturbed thoughts

You may not realise that you are experiencing these symptoms. Doctors or professionals often call this ‘lack of insight’.

Top

Do drugs and alcohol cause mental health problems?

If you use drugs and/or alcohol regularly, this can cause problems with assessing and treating your mental health. This is because:

•Using alcohol or drugs unwisely can trigger mental illness in some people

•People sometimes use alcohol or drugs to help deal with the symptoms of their conditions. Doctors call this self-medication.

Alcohol or drugs can:

•mask mental health problems

•make medication less effective

•Sometimes cause other symptoms.

If you have a mental health problem in addition to alcohol and/or drug misuse, doctors call this dual diagnosis. You will probably need specialist help and treatment.

If you use alcohol or drugs unwisely you will be more likely to become unwell again. If you regularly use drugs or alcohol and believe that you may have a mental health problem discuss this with your doctor as soon as you can.

Medication – choice and managing problems

Medication can play a key role in treating mental illness. Unfortunately, sometimes people have problems with taking this medication that make them feel that it’s not right for them. This section considers ways of trying to resolve problems with medication. Here, the word ‘doctor’ means psychiatrists and general practitioners (GPs).
•Medication is a key part of the treatment of mental illness, but it is not the only treatment. A lot of people find ‘talking treatments’, self-help and complementary therapies helpful.
•People with schizophrenia, bipolar disorder, depression and anxiety disorders are normally offered medication by their doctor. However, not all illnesses are treated this way. For example, people with a sole diagnosis of personality disorder are not normally offered medication.
•Your doctor should explain the risks and benefits of taking your medication before you start taking it.
•You can expect to be given an opportunity to ask questions about your medication and to have these questions answered.
•Unfortunately, all medications carry a risk of side effects. It is important to try to find the right balance between reducing symptoms and managing side effects.
•If you have a problem with your medication, talk to your doctor about it. If you find this difficult, you might wish to ask a friend, relative or advocate to help you.
•You may have to try a few different medicines before you find the one that is right for you.
•If you cannot resolve disputes informally with your doctor you could try writing them a letter about our concerns or making a complaint.

This section covers:
•How do mood stabilisers work?
•Lithium
•Valproate
•Carbamazepine
•Lamotrigine
•Antipsychotics

How do mood stabilisers work?

It is not yet known exactly how mood stabilisers work. They appear to have the effect of stabilising swings between mania (feeling high) and depression.

What different types of mood stabilisers are there?

There are a number of mood stabilisers used both to reduce mania and depression, and in the long-term stabilise mood swings. Mood stabilisers are usually considered during an episode of mania or depression that appears, changes or worsens suddenly (you may hear this referred to as an acute episode). Long-term treatment is considered after two or more acute episodes.

Drugs used as mood stabilisers include:

Lithium

Lithium is widely used for the long-term maintenance and treatment of mania. It reduces both the number and severity of relapses. It is recommended by NICE guidance as a medication to treat episodes of mania and also as long-term treatment in bipolar disorder. If you have an episode of mania that comes on suddenly or becomes worse, lithium would usually only be started if your symptoms were not severe as it can take at least a week to take effect, which is slower than the other options available. Lithium has been found to reduce the risk of suicide.

In order for the lithium therapy to work, you must have a certain level in your blood stream. To make sure that the lithium is working properly and is not at a dangerous level, it is recommended you have regular blood tests to check the lithium levels in your blood every 3 months.

Lithium is sodium based, so changes to salt levels in the body can cause an imbalance. This can lead to increased levels of lithium. These levels can increase to a point where they are toxic to the body and cause poisoning. This risk can be increased by going on low salt diets, becoming dehydrated and interactions with certain medications. If you would like more advice about this, then please talk to your doctor.

Valproate

Valproate is an anti-convulsant medication used in epilepsy. In the UK, it is widely used in the form of sodium valproate, although it can come in other forms. It is licensed to treat mania.

NICE guidance for bipolar disorder recommends valproate as a first choice to treat episodes of mania and also for long-term treatment. However, it is not recommended to be prescribed to women of child bearing age (please see the section on Pregnancy).

You will also need regular tests, as valproate can affect how your liver works. NICE guidance recommends testing the functioning of your liver at the start of treatment and every 6 months after that.

Carbamazepine

Carbamazepine is an anticonvulsant medication used in epilepsy. In the UK, it is licensed to treat bipolar disorder in people who do not respond to lithium. NICE guidance does not recommend it as a first option to treat episodes of mania or as a long-term treatment. In order to be effective, carbamazepine has to reach a given level in the blood.

Lamotrigine

Lamotrigine is also an anti-convulsant medication used in epilepsy. In bipolar disorder, it may be used where depression is the main problem. NICE guidance does not recommend it to treat episodes of mania, or as a first option for long-term treatment of bipolar disorder.

Antipsychotics

As well as their antipsychotic effect, antipsychotic medication can also have mood stabilising properties. Some of the newer antipsychotics (sometimes referred to as atypical) can be used in bipolar disorder. In the UK, olanzapine, risperidone, quetiapine, aripiprazole and asenapine are licensed to treat mania. Olanzapine is probably the most widely used for this purpose.