Welcome to Bipolar in Focus, I'm Jane Pauley.
Stability is the Holy Grail in bipolar. Avoiding relapse is the goal and having a plan is the key. Dr. David Miklowitz, author of the Bipolar Survival Guide is here.
A plan? A plan of what kind of action?
Jane, a relapse prevention plan really involves several different components. One is recognizing what are the early warning signs of a developing manic or depressive episode.
And then, there's the question of what do you do when those early warning signs appear. What do you do as a person with the disorder? What do your family members do?
What do you want your doctors, physicians, friends to do if they can all be involved?
It's a contract we're really after that involves recognizing and then treating the beginnings of an episode.
Early warning signs… How many of us patients know what the early warning signs are?
I've had clients that have given me very clear descriptions of what the manic episode feels like. They say their thoughts start to race. They have less of a need for sleep.
They feel angry easily or get irritated by little things and feel loaded with energy or alternatively, they feel slowed down as they're developing a depression.
Suicidal thoughts start to appear. Rumination, a fatigue over minimal physical activity and family members get very good at recognizing those signs, too.
So, little signs, little changes in the way the person behaves or speak or the volume, pitch, how much they use their hands when they talk, if they're moving around in their chair more
or they're slowed down or their speech seems to be slow and fatigued sounding or they have a morose quality to them.
Okay, so how this…, this early warning awareness factor into a prevention plan?
Okay, so -- the first thing we would do is work with the person and their family, to recognize what are those warning signs.
And then to say, "What are the three or four things you could do if one of those signs appear?"
You could call your physician and get your medication changed. You might have to go in and get your blood level checked.
You might be able to take a sleeping medication, if you're having trouble sleeping.
This might not be a good time to make financial decisions or to be making decisions that could affect your future.
What kind of coping skills are you learning in creating a prevention plan?
One coping skill is to learn that you have a role in directing your own treatment. And, people don't always know that they can call up their physician and say,
"I think I'm getting worse. Can we talk about my medications?"
Another is to recognize what are the triggers of your recurrences?
For some people, it is a psychosocial stress like a change in work hours. Recognizing what types of events tend to set off your episodes and learning to plan around those events.
It involves recognizing your thinking processes. Knowing that, for example, depression for you may involve a lot of pessimistic thinking and negative self-talk.
The person may be able to introduce a certain amount of cognitive restructuring during that time to be able to challenge their negative thoughts when they're starting to sink in depression.
That's a skill in itself, and learning about the disorder. Learning what are the triggers, when you need the importance of ongoing medication, its recurrent course, the importance of social supports.
If you recognized that you are relapsing, what should you do?
First thing you should do is first, continue taking your medication. Make sure you get in to see your psychiatrist to have your medication reevaluated.
Secondly, keep a mood chart. Keep track of where your moods are on a day-to-day basis. Give them a numerical rating.
Today, I'm on -- on the four on mania, and a three on depression. And if it starts to escalate more, you may need more intensive treatment.
Stay away from drugs or alcohol and over-the-counter medications that are likely to keep you up at night.
Making sure you get a regular sleep-wake cycle that you're going to bed at the same time and waking up at the same time. If you're not able to sleep, discussing with your doctor a sleep plan.
How does this plan help prevent a relapse?
Well Jane, relapses are often triggered by some environmental event. A changed sleep and wake hours, a stressor or something as simple as going off one's medication.
What you're doing by intervening is you're mitigating, you're mitigating the effect of that stressor, so that it's not going to have as strong an impact on the course of your symptoms.
Thank you very much. And thank you for watching Bipolar in Focus.