- The Washington Times - Saturday, November 29, 2003

Bipolar disorder does not only affect the patient. It’s an illness that can become very destructive for family members, too, local psychiatrists say. “Family members will go through times when their wife or mom is staying up all night cleaning, then she goes out and spends too much money, then she wants a divorce,” says Dr. Jennifer Payne, psychiatrist and assistant professor in the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins School of Medicine.

Later, when the patients crash — go into a depression — they can become suicidal, she says.

To better cope with a loved one who has bipolar disorder, doctors recommend that family members get educated about the disease; seek therapy for themselves, if needed; go to support group meetings; and attend doctor’s appointments together with the patient.

“We frequently tell family that ‘you have to take care of yourself, too,’” says Dr. Francis Mondimore, also a psychiatrist and assistant professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins School of Medicine.

“But family members often feel they should have a bottomless source of sympathy and empathy, and then they start feeling guilty when they get frustrated,” Dr. Mondimore says. “A very helpful tool to get through this are the support groups.”

By attending doctor’s appointments, the family member can learn about the disease’s causes, symptoms and treatments.

“Understanding the disease is very important because it helps destigmatize it,” Dr. Mondimore says.

“Many family members carry with them the baggage of misconception about the disease. They may think the person should just try harder, just snap out of it, and that’s all they need to do,” he says. “It doesn’t work that way.”

Dr. Payne says learning the reasons behind the patient’s erratic, often hurtful behavior can help the family member abandon some or his or her resentments toward the patient for past transgressions.

“I think it helps smooth over relationships,” she says.

Having a family member at the appointment can also help the patient and the doctor, Dr. Mondimore says.

The patient benefits from family involvement in several ways: Family members in the know can help make sure medication is taken at the right time and that future appointments are kept.

“Ideally, you want family members involved as early as possible because it helps keep the patient on track,” Dr. Payne says.

There are also benefits for the physicians in having family members present at appointments.

The bipolar patient might have a difficult time being objective about how he or she is doing. A family member, however, can report behavior, moods and other developments in a more objective fashion, Dr. Mondimore says.

During their manic states, bipolar patients don’t need a lot of sleep and may feel “fine” with only a couple of hours of sleep each night.

“If I ask, ‘How is your sleep?’ the person who sleeps next to the patient will know the answer sometimes better than the patient,” Dr. Mondimore says.

Some family members need their own medical attention to cope with their bipolar loved one, Dr. Payne says. Some go through therapy to learn how to deal with and protect themselves against the hurtful behavior of the bipolar patient.

Others find comfort and help in attending support groups.

In these groups, family members whose loved ones have been diagnosed fairly recently can get helpful advice from people who have been in their situation for a long time, Dr. Mondimore says.

“It’s one thing to hear a doctor talk about what to expect, but hearing a family member talk about their experiences is much more powerful,” Dr. Mondimore says. “I tell them, ‘Hey I can go home. You are in this twenty-four/seven, so you need to make sure that you get the help you need.’”

MORE INFO:

BOOKS —

• “BIPOLAR DISORDER: A GUIDE FOR PATIENTS AND FAMILIES,” BY FRANCIS MARK MONDIMORE, JOHNS HOPKINS UNIVERSITY PRESS, 1999. THIS BOOK GIVES FAMILY MEMBERS ADVICE ON HOW TO HELP THE PERSON WITH BIPOLAR DISORDER AND THEMSELVES. IT ALSO DISCUSSES COPING WITH THE STIGMATIZATION OF PSYCHIATRIC DIAGNOSIS AND GIVES ADVICE ON PICKING A PSYCHIATRIST.

• “SURVIVING MANIC DEPRESSION: A MANUAL ON BIPOLAR DISORDER FOR PATIENTS, FAMILIES, AND PROVIDERS,” BY E. FULLER TORREY AND MICHAEL B. KNABLE, BASIC BOOKS, 2001. THIS BOOK IS A GUIDE TO ALL ASPECTS OF BIPOLAR DISORDER, AN ILLNESS FROM WHICH MORE THAN 2 MILLION AMERICANS SUFFER. IT IS WRITTEN FOR PATIENTS, FAMILIES AND THE PROFESSIONALS WHO TREAT THEM, AND DISCUSSES SYMPTOMS, RISK FACTORS, INSURANCE ISSUES AND THE LATEST MEDICATIONS. THE AUTHORS ALSO COVER SPECIAL PROBLEMS RELATED TO THE DISEASE, INCLUDING DRUG AND ALCOHOL ABUSE, MEDICATION NONCOMPLIANCE AND SUICIDE.

• “THE BIPOLAR DISORDER SURVIVAL GUIDE: WHAT YOU AND YOUR FAMILY NEED TO KNOW,” BY DAVID J. MIKLOWITZ, GUILDFORD PUBLICATIONS INC., 2002. THIS BOOK ATTEMPTS TO HELP INDIVIDUALS AND FAMILY MEMBERS COME TO TERMS WITH THE DIAGNOSIS, RECOGNIZE EARLY WARNING SIGNS OF MANIC OR DEPRESSIVE EPISODES, COPE WITH TRIGGERS FOR MOOD SWINGS AND MANAGE MEDICATION PROBLEMS. IT ALSO DISCUSSES WAYS IN WHICH PATIENTS AND FAMILY MEMBERS CAN LEARN TO COLLABORATE EFFECTIVELY WITH DOCTORS AND THERAPISTS.

ASSOCIATIONS —

• THE AMERICAN PSYCHIATRIC ASSOCIATION, 1000 WILSON BLVD., SUITE 1825, ARLINGTON, VA 22209; 703/907-7300. WEB SITE: WWW.PSYCH.ORG. THIS ORGANIZATION HAS MORE THAN 35,000 U.S. AND INTERNATIONAL MEMBER PHYSICIANS WHO WORK TOGETHER TO ENSURE HUMANE CARE AND EFFECTIVE TREATMENT FOR ALL PEOPLE WITH MENTAL DISORDERS. THE GROUP CAN PROVIDE INFORMATION ON BIPOLAR DISORDER AND HELP PATIENTS FIND PSYCHIATRISTS.

• DEPRESSION AND RELATED AFFECTIVE DISORDERS ASSOCIATION (DRADA), 2330 W. JOPPA ROAD, SUITE 100, LUTHERVILLE, MD 21093; 410/583-2919. WEB SITE: WWW.DRADA.ORG. THIS COMMUNITY ORGANIZATION PROVIDES EDUCATION ABOUT BIPOLAR DISORDER AND CAN GIVE INFORMATION ON SUPPORT GROUPS. IT AIMS TO HELP INDIVIDUALS AFFECTED BY A DEPRESSIVE ILLNESS, FAMILY MEMBERS, HEALTH CARE PROFESSIONALS AND THE GENERAL PUBLIC.

• NATIONAL ALLIANCE FOR THE MENTALLY ILL (NAMI), COLONIAL PLACE THREE, 2107 WILSON BLVD., SUITE 300, ARLINGTON, VA 22201; 703/524-7600. WEB SITE: WWW.NAMI.ORG. NAMI IS A NONPROFIT, GRASS-ROOTS, SELF-HELP, SUPPORT AND ADVOCACY ORGANIZATION OF CONSUMERS, FAMILIES AND FRIENDS OF PEOPLE WITH SEVERE MENTAL ILLNESSES. THE ORGANIZATION CAN HELP PATIENTS FIND SUPPORT GROUPS.

ONLINE —

• THE DEPRESSION AND BIPOLAR SUPPORT ALLIANCE (DBSA), A NONPROFIT ORGANIZATION, HAS A GRASS-ROOTS NETWORK OF MORE THAN 1,000 PATIENT-RUN SUPPORT GROUPS ACROSS THE COUNTRY LISTED ON THE GROUP’S WEB SITE: WWW.DBSALLIANCE.ORG. MORE THAN 55,000 PEOPLE ATTEND THE PEER-LED SUPPORT GROUPS EVERY YEAR, ACCORDING TO THE WEB SITE.

• THE NATIONAL INSTITUTE OF MENTAL HEALTH OFFERS INFORMATION ON THE LATEST RESEARCH ON BIPOLAR DISORDER AND PROVIDES A BOOKLET ON THE VARIOUS ASPECTS OF THE ILLNESS VIA ITS WEB SITE: WWW.NIMH.NIH.GOV.


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