Psychotic and Manic-Depression (Bipolar) Illnesses

General Information:

These mental health conditions can be serious and very disruptive to the life of the person suffering the illness as well as family and friends. If there are symptoms that suggest to you that someone, or yourself, is experiencing a psychotic or bipolar disorder you must not make this diagnosis for yourself. Assessment and diagnosis for these conditions requires the expert skills of a Physician, Psychiatrist or Mental Health Clinician and you should make priority contact with someone who will help for this purpose. As with other mental and emotional health conditions, the disorder can range in severity from mild to severe and it can fluctuate over time or in response to conditions in the person's lifestyle. Additionally, people will go through periods of remission and stability when they can be relatively symptom free. However, symptoms become active during acute phases of the illness that can do significant damage because of the loss of usual control over thinking, feeling and behaviour.

As with all mental and emotional health issues, the following criteria can act as a guide to give you information about how severe the condition is:

• Does the condition cause you problems with sleep?
• Does the condition cause a significant change in normal energy and ability to do normal things?
• Is there a significant change in your appetite or eating habits as well as other bodily functions?
• How much has the condition affected your ability to function in your normal daily roles and routines?
• Have others around you noticed or commented on changes they have seen in you?

Clinical Symptoms:

These disorders are characterized by a significant change in normal functioning and a loss of control over normal behaviour, thinking and feeling. These disorders most often require high priority help with a medical or psychiatric professional and generally respond best to the use of medication to manage the illness. Symptoms do not always appear fully developed, but usually start with small changes in the person and begin to build steadily towards more severe impairment. The person may not always be aware that they are developing an illness and changes and may be very difficult to convince that there is anything wrong. This lack of understanding generally becomes more resistant as the course of the illness progresses. It is very important to seek advice early on when there is a suspicion of the onset of illness. Often a useful guide in determining if a person is suffering a psychotic or manic-depression (Bipolar Disorder) is that these disorders tend to have a strong genetic link. Most people diagnosed with these disorders can think of a close relative who experienced similar symptoms in their life.

These are the illnesses that are most often thought of by people as having "lost touch with reality" and most people have a good sense of what that looks like when they see it in someone. Again, acting early to receive professional assistance and to begin treatment early in the course of the illness is important and relatives should not hesitate to contact a Physician or Mental Health Clinician to talk over their concerns.

Psychotic Disorders:

• Delusions: ideas or beliefs that may or may not have some small basis in truth or reality but generally become unbelievable or bizarre.
• Hallucinations: most commonly are voices that are heard and usually with a general commentary on the persons behaviour but sometimes with instructions or commands to the person.
• Disorganized speech: significant changes to both the manner of speaking and the content of what is being said. Generally also a reflection of the thinking process that can be disorganized, scattered and rambling.
• Negative symptoms: a lack of appropriate emotional response, emotional flatness, social withdrawal and isolation, lack of motivation and lethargy.
• Social & Occupational Dysfunction: reduced ability to carry on in the work environment, in social relations and often a deteriorated ability to look after oneself with hygiene and personal appearance.

Manic-Depression (Bipolar) Disorder:

This disorder is generally thought of as being characterized with rapid mood swings but this is generally not the case and typical mood swings do not usually indicated Bipolar disorder. Diagnosis is made both on the presenting symptoms at the time but also relies heavily on a report of historical patterns of mood stability or severe fluctuation. The disorder can occur with only manic episodes, with mostly depressive episodes or with mixed cycles of both manic and depressive episodes.

• Inflated self-esteem or grandiosity
  
• Decreased need for sleep
  
• More talkative than usual or pressure to keep talking
  
• Racing thoughts or flight of ideas
  
• Distractibility and poor attention
  
• Excessive involvement in pleasurable activities that have potentially damaging consequences, such as buying sprees, excessive sexual indulgence or foolish business investments.

• Changes in appetite or weight
  
• Sleep disturbances
  
• Changes in the level of daily activity
  
• Decreased energy
  
• Feelings of worthlessness or guilt
  
• Difficulty thinking, concentrating or making decisions
  
• May include recurring thoughts of death or thoughts of suicide

Inpatient Treatment - Myth and Misunderstanding:

• For those who may be suffering the onset of severe symptoms there are several false beliefs, or myths about these forms of illnesses. Most often people fear that if they disclose information about "voices", hallucinations, odd beliefs, suicidal thoughts or other things that indicate a loss of control, that they will be "locked up" in a mental hospital and admitted against their will. Although it is true that some people do get admitted to hospital against their will this is always because the severity of their symptoms is such that they are causing a high danger to themselves or others. People who are admitted almost always enter to hospital with their consent and agreement because they recognize the need for help and relief from the suffering that symptoms can bring. Most hospital admissions are brief and range from a few days to a couple of weeks. As patients begin to respond to treatment, which is usually the beginning of medication use and initial counselling, they are discharged to continue treatment and appointments as outpatients.

• Another old myth about Inpatient treatment is that patients are subjected to electric shock treatments. This is also a form of treatment that has been badly portrayed in television and movies. ECT has had benefits for many people. Although it is used rarely and generally when a person does not respond to medication therapy, it is carried out with the informed consent of the patient and the patient has a right to refuse such treatment.

• Daily routines in the Psychiatric Hospital are deliberately normal and patients are expected to function as normally as possible, caring for themselves and participating in daily activities. The old television and movie images of screaming patients, restraint, straight jackets and electric shock are not true of modern facilities. In Brandon, the Centre for Adult Psychiatry is a modern hospital ward with single person rooms and an environment that is supportive and encouraging to the person's recovery.

• Another commonly held belief is that a person will lose their driver's license if they reveal any symptoms of illness. Again, this is most often not true. Only under extreme circumstances of illness that caused very serious impairment to the person's ability to drive, might it be recommended that they temporarily lose their license. This is never a permanent situation however, and this is always done at the recommendation of the person's Physician or Psychiatrist.

• Most people who experience symptoms of a Psychotic or Manic-Depression Illness recover well and are able to resume functioning in normal routines and roles, although management of the illness with medication, counselling and stress and coping techniques is essential to good recovery and like many physical illnesses will be required life-long.

What Helps:

• Psychotic and Bipolar disorders can be very serious and in the course of the illness extensive damage can be done in many respects. It is important to try to obtain treatment early in the course of the illness so early contact with the Physician or Mental Health Clinician can be achieved for assessment, diagnosis and starting treatment services. Often in the early stages of illness, symptoms come and go or do not seem so severe. As a result many people delay the involvement of helping professionals and sometimes the problems become much more complicated. For the person with a serious onset of acute symptoms, fear is often present and acts as a barrier to receiving help, and this fear tends to grow as the illness becomes more pronounced. In most circumstances, the fear also exists with family and friends and this produces an uncertainty in terms of how to act and what to do.
• It is important and least complicating to be honest and clear with the person about what you are seeing and what you are concerned about.
• Be consistent in what you are saying and always express yourself with support, encouragement and in a caring manner. This is more likely to persuade the person with the illness to accept outside help than a manner that is commanding and aggressive.
  

What Doesn't Help:

• It is important not to minimize or deny the seriousness of what you might be seeing. Showing strength, caring and honesty in the face of serious mental and emotional health symptoms often is very helpful to the person experiencing the symptoms and assists them to draw on their own strength and honesty in dealing with the illness and the decisions to seek outside help.
• Sometimes, the person with the illness resists acknowledgement of an illness even after you have tried your best to persuade them to accept help. When this occurs, a decision must be made about whether the person is showing such severe effects of the illness that they have become a danger to themselves or others. If this is so in the form of committing an act of harm or by neglecting themselves so as to be at significant risk there are legal procedures available to provide the help and more information about this is included in the section under the Mental Health Act.

Additional Internet Resources:

• The Mood Disorders Association of Manitoba
• Canadian Mental Health Association
• The Canada Schizophrenia Society
• The National Institute of Mental Health