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EUFAMI Remission Survey for Families and Carers of People with Schizophrenia

The EUFAMI (European Federation of Associations of Families of People with Mental Illness) survey factsheet is available here. You will need Adobe Acrobat Reader software to view this factsheet. The software can be downloaded from www.adobe.com.

HUN Leaflet

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Bipolar Disorder: Separating Fact from Fiction

Bipolar disorder affects around one in one hundred people in the UK and is a long term condition. Together, a major mental health charity, supported by Janssen-Cilag hosted a meeting to discuss this condition at the BMA in Tavistock Square on June 21st.

Dr. Elizabeth Walsh, Consultant Forensic Psychiatrist from the South London and Maudsley NHS Trust described the likely symptoms experienced by people living with bipolar disorder. "People experience changes of mood, when they are happy or sad, in bipolar disorder those swings of mood between elation and sadness are more extreme", said Dr. Walsh.

She explained the major symptoms of people living with the disorder which include two phases, a manic phase, involving periods of high elation and a depressive phase, where mood is low and deeply depressed. In the manic phase people are in an exaggerated state of elation. Their thoughts are racing and rapid, hopping from one topic to another. They can be sexually and emotionally volatile in this phase of the disorder and can have unrealistic beliefs about themselves. It is common for people in a manic phase to spend money which they do not have on an extreme scale and some experience false ideas which suggest that they have great power and authority, often thinking they are an omnipotent figure, like a monarch or president. These ideas are called grandiose delusions. In this manic phase people are unlikely to appreciate that their thoughts are out of line with their normal experience and unlikely to appreciate that they might be unwell. If blocked or thwarted from actions in this phase, some people can become aggressive and defensive.

People can then swing from this highly excited state of elation into the depths of depression. Dr. Walsh explained that this depressive phase could involve feelings of guilt and that people can feel, "black, bleak and unworthy about themselves". In this phase people can lose all pleasure in everyday life and lose appetite, become lethargic and have major disruption in their sleep patterns. Some people experience extreme delusions, where they consider themselves worthless and may have ideas that convince them that suicide is their only option.

Dr. Walsh explained that this disorder affects men and women equally and is usually experienced in early adulthood, it is extremely rare before puberty. The causes are complex and Dr. Walsh suggested that there is a combination of causal factors including biological and psychological issues, as there is evidence that bipolar disorder can run in families, suggesting some genetic predisposition, and that the illness can also be triggered by major life events, such as bereavement or divorce. It can be difficult to diagnose effectively and treat. Dr. Walsh suggested that a thorough family history was important and that all people presenting with signs of mania should also have a thorough physical check to exclude physical conditions which can mimic mania, such as brain tumours or long term treatment on steroids. She went on to explain that the disorder costs the UK around £2billion a year, mainly through sufferers being unable to work and that the risk of suicide associated with the disorder are high.

Examining treatment of bipolar disorder Dr. Neil Hunt, Consultant Psychiatrist from Fulbourn Hospital, Cambridge stressed the need for a strong and trusting relationship between patients and health professionals as the basis for successful treatment.

Dr. Hunt said "mania and depression can co-exist and are not always opposite states." He cited many clinical studies showing that medication is proven as an effective element in treating people living with bipolar disorder. In the manic phase of the disorder doctors rely on a range of medicines including; atypical antipsychotics, valporate, carbamazepine and lithium. He explained that good compliance with medication, particularly lithium was crucial in recovering from mania and in preventing relapse. Dr. Hunt stressed that "recovery from a manic episode is slow and can take from two to three months." He explained that research shows that the majority of people who experience a manic episode are likely to suffer either a further attack or a swing into depression but that the disorder recurs in a variable way; there is no standard pattern of recurrence. Dr. Hunt felt that the cause of bipolar disorder was probably linked to genetic factors and that it was often found to run in families. He said that traditional psychotherapies alone were not particularly helpful.

In bipolar disorder the manic phase was talked about a lot because it is noticed by patients and families but stressed that depression was more common for patients to recognise and both phases needed effective treatment and management. Ongoing treatment with lithium helps about a third of people lower the frequency of mood swings, however, there are drawbacks to this treatment and if patients stop taking it suddenly they are likely to relapse to a worse state than they were in prior to taking lithium. People taking antidepressants alone were less likely to do well and the combination of lithium and appropriate antidepressants offered the best outcomes. Dr. Hunt said that it was important to understand the wishes of patients and in particular ideas and choices preferred during a manic or depressive phase, ideally discussed when patients are well. He suggested that good care involved educating patients and their family and carers about the recurrent nature of the disorder, particularly spotting early signs of relapse and seeking help quickly.

Joanna Squires, who works for Together and lives with bipolar disorder, discussed her personal journey. Jo first experienced problems in 2003, having entered the job market following university. Her initial diagnosis was depression and it was not until she experienced a manic episode that she received the correct diagnosis, which is a common experience for many people living with this condition. Jo explained "it was a relief to know that my problem had a name, though I do not usually like labels."

She described the painful nature of her depression, using words like "distressed", "debilitated", "numb", and explained that she started to harm herself as a consequence of low self worth. In her manic episode she took herself of on a world trip, ending up in New Zealand, where she was eventually rescued by her brother, having spent substantial sums of money which she did not have! This is a fairly common feature of a manic episode.

Jo described a process of trial and error over recent years, where she is seeking the right balance of medication to allow her stability and explained that she is seeking a second opinion on her medication, a right that all patients have. She went on to stress the importance of support from her family and her employer in making life manageable and good for her. Jo is using some complementary treatments alongside her medicines including relaxation techniques and acupuncture, which she finds helpful. Many people with bipolar disorder share her experience of the value of trying different approaches to living with the disorder.

She also explained that she ate a healthy diet, took regular exercise and tried to treat herself to a nice experience at least once a week. Jo said that she "was sad that mental illness, including bipolar disorder carried such stigma" and asked, "Why can't bipolar disorder be considered like any other long term condition, like diabetes?" Jo proved to be a living example of someone who is coping well living with the disorder, holding down a steady and successful job and enjoying a good quality of life. Throughout history people experiencing mood disorder have contributed greatly to society, including Alexander the Great, Vincent van Gogh, Sir Winston Churchill and Spike Milligan. Bipolar disorder, if properly diagnosed and treated with respect for individual treatment choice can be managed effectively.

Report by Dr. Ray Rowden, Director, Mental Health International Development.