In today’s world, mental illness and distress are common and these account for a significant burden of disability within our community. At the same time, there is a growing interest in understanding and enhancing positive mental health and wellbeing; particularly from developments in the fields of positive psychology and mental health promotion. Positive Psychiatry is a new term (Jeste et al 2016) that describes a dual approach to mental health, where we build strengths, supports and healthy lifestyles as well as treating illness and distress. In this course, we will explore different aspects of good mental health as well as provide an overview of the major kinds of mental disorders, their causes, treatments and how to seek help and support. The course will feature a large number of Australian experts in psychiatry, psychology and mental health research, and we will also hear from “lived experience experts”, people who have lived with mental illness, and share their personal stories of recovery. We take an evidence-based approach to a range of strategies that anyone can use to enhance their own mental health and that of others, from exercise and relaxation techniques through to the role of love, relationships and 'good' types of work. We cover topics from creativity and yoga through to psychiatric medications and psychotherapies.
Bipolar disorder
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Positive Psychiatry and Mental Health
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From the lesson
Module 4 - Mental Illness
In this module, we cover the major categories of mental illness: their symptoms, causes and treatments. This includes the more common conditions such as anxiety, depression and addictions, as well as less common mental illnesses such as psychosis, schizophrenia and bipolar disorder.
Meet the Instructors
Sonia KumarPsychiatry Course Coordinator
Brain and Mind Centre, University of Sydney
Thank you very much for the opportunity to participate in this community education
Module about bipolar disorder.
I have both a personal and professional interest in this condition.
I'm a youth mental health advocate, but
I'm also someone who's lived with bipolar from the age of 16.
In this module, I'll be interviewing Associate Professor Liz Scott,
a psychiatrist who is an expert in mood disorders.
I'll be asking your questions about the causes, the diagnoses and
the treatments for bipolar disorder.
We'll also be hearing from another young person about his
experience of living with bipolar disorder.
Everyone experiences ups and downs in their moods, and
sometimes we describe ourselves as hypo, or manic.
But I know from my own personal experience that bipolar disorder is very
different to that.
Liz, firstly, could you give us some information about bipolar disorder, and
in particular, how it's different from people's normal mood changes?
>> Firstly, while bipolar disorder can run in families, there is no single gene for
this condition.
In fact, there are probably multiple genes
involved that interact with factors in the environment to trigger the condition.
So this explains why the spectrum of bipolar disorder is so wide.
It varies from mild symptoms with a minor impact on a person's life to more severe
episodes of illness requiring hospital admissions.
Secondly, bipolar disorder is described as a mood disorder, but
really it's a disorder of energy and drive.
The best way to describe it is by thinking of the clock that sits in our brain.
This brain clock sets our sleep and wake times and
regulates the amount of activity we do.
Our brain clock is set to wind down our activity at night, switch on sleep, and
then wake us up in the morning so that we can be active during the day.
This clock is our master clock.
And it sets all our other body clocks.
And I'll come back to this later.
In bipolar disorder, the current evidence suggest that this clock is faulty.
When people are in a low mood or depressed state, they feel tired and
lethargic most of the time.
They report that they feel slowed down and it's an effort to get out of bed and
do things.
In this phase of the illness, people find it hard to get up and go to work, study or
socialize.
They often sleep a lot during the day and sometimes find it hard to sleep at night.
But no matter how much they sleep, they feel tired.
In this state, people can feel very low and depressed.
In severe episodes, people stop enjoying activity or socializing or relationships.
They may feel worthless of hopeless.
They may also feel that life is not worth living and suicidal thoughts are coming.
Sometimes, people can feel very agitated or irritable with friends and
family members.
In some cases, in what we term bipolar one disorder,
people may develop some unusual beliefs, or even hallucinate.
These psychotic type symptoms usually reflect the underlying mood.
For example, a person may feel extremely guilty and believe that they've done
something bad or wrong for which they're going to be punished.
Or they may hear voices telling them that they're worthless or bad.
These episodes of low mood and energy or depression can last for a very long time.
>> I know that in addition to episodes of low mood, I've also had times when I
feel really productive and confident, I have a lot of energy and a lot of ideas.
And at those times I don't need much sleep.
Everything seems to be going really fast.
Sometimes I get Irritated with people around me if I feel like they're moving or
thinking too slowly.
>> So, Rachel, that's a really good example of a hypermanic episode.
Hypermania is not just feeling really excited or happy for a few hours or days.
It's a state of sustained increase in energy or drive.
A person doesn't necessarily feel extremely happy in this state.
Often people can feel quite irritable and argumentative.
They can be impatient, restless and reckless.
In a hypomanical manic state, a person may take risks that they wouldn't normally
take, such as driving fast, drinking more alcohol or using drugs.
Spending money, buying things they don't need, and
taking more risks with social activity or sexual activity.
During this time, a person often sleeps less, but doesn't feel tired.
Eats less, takes less care themselves, they can often speak fast,
jump from subject to subject, and find it hard to organize themselves.
They'll often start tasks and
not finish them as they get distracted by something else.
>> What's the difference between hypomania and mania?
>> That's a really good question.
So hypomania is a less severe form of mania.
When a person is manic the increase in drive and energy becomes so extreme
that a person often has very little sleep and can't function in their usual roles.
In a manic phase, a person usually has no insight into their condition,
that is they don't know that they're unwell.
Unusual believes are common and reflect their mood.
If their mood is high, they have grandiose delusions, believe that they're rich or
famous or they've got special powers.
If they're irritable or agitated, they may feel more paranoid and believe, for
example, that people are trying to hurt or harm them.
In a manic state, a person would generally need to be admitted to hospital for
urgent treatment and to prevent harm to themselves.
And in some cases to others.
>> Liz, how do you treat bipolar disorder?
>> As with most medical conditions early intervention is critical.
Bipolar disorder usually starts between the ages of 16 and 24.
So if we can identify young people with unstable mood and other risk factors of
the illness and treat them early, we think that this could make a big difference.
Sadly, in many cases will be unwell for
many years before a diagnosis of bipolar disorder is made.
Early treatment involves improving sleep and activity patterns.
Helping people to maintain regular exercise and social routines reducing and
managing stress and recognizing the triggers for episodes.
Sleep deprivation changes, change of season, life events.
Drugs and alcohol infections or travel can trigger an episode.
So helping people to identify and manage their personal triggers is critical.
The holistic management of bipolar disorder includes behavioral and
psychological therapies, medication and family care support and education.
Behavioral therapies includes sleepless cycle or
social rhythm therapy with structured exercise and social activity.
Psychological therapy includes cognitive behavioral therapy for management of
anxiety and low mood and what we call dialectic behavioral therapy to help with
mood regulation, stress management, and help with impulsive or suicidal thoughts.
>> So Liz, tell us what kind of medications you use to treat bipolar
disorder.
>> So most people will also require a mood stabilizer at some stage to help them
manage more severe episodes and prevent a relapse of symptoms.
Lithium is a common treatment.
It has a direct effect on the brain clock.
Other medications used in the treatment of seizures disorders
are also used as mood stabilizers, such as the anticonvulsants lamotrigine and
sodium valproate or the antipsychotic mood stabilizers.
These medications may be used alone or sometimes in combination.
Antidepressants are used to treat depression, but
they are almost never used on their own.
Without a mood stabilizer, antidepressants can cause hypomania or unstable,
agitated mood, called a mixed state.
As the brain clock regulates the other body clocks, people with bipolar disorder
frequently experience other medical problems relating to their body clock.
These include weight gain, obesity, high cholesterol, heart disease or
diabetes, hormonal or immune problems.
These medical conditions need to be monitored and managed.
And medications used for the treatment of bipolar disorder should be chosen with
great care to avoid making these problems worse.
People with bipolar disorder are also more likely to misuse drugs or
alcohol particularly during episodes of illness, causing other medical and
psychological problems.
>> From my own experience, I know how important it is to take care of my mental
health, because it affects every part of my life.
Most importantly, I know that I need to make sure I maintain good sleep, so
that I'm not sleeping too much or too little, but
also that I'm going to sleep and waking up at the right time every day.
It's also really important that I keep a regular diet and exercise.
Now this doesn't mean being strict or excessive.
It simply means keeping regular meals and
regular activity because this helps regulate my mood.
And everyday I make sure that I take some time out for myself.
It helps to check in and see if I can recognize any warning signs, but
I also use this time to do something nice for
myself and remind myself why taking care of mental health is so important.
Liz is it true that there have been many famous people with bipolar disorder?
>> So yes, the evidence suggests that people with bipolar disorder
often have high IQs and high levels of creativity.
That they're able to see and think about the world in ways that other people can't.
They can also be extremely productive.
You only have to watch the documentary by Stephen Fry,
The Secret Life of the Manic Depressive to see this in action.
So bipolar disorder can be both a burden, but also a gift.
>> Thanks everyone for participating.
If you'd like to learn more, please visit Origin Youth Health, Beyond Blue, or
the SANE Australia website.
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