Category Archives: Bipolar Mood Disorders

How to be well when you have a mood disorder?

By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University

How to be well when you have a mood disorder?
Coping with a mood disorders is no easy task!  It takes professional support, medication when necessary, psycho-education and experience to manage the debilitating symptoms. With the necessary supports and monitoring, persons with mood disorders can learn to have long-term stability and consistency.
I have also found that it takes an average of about one year to reach those goals. In addition, many people will need some level of support on and off for their entire lives. The bottom line is you can’t do it alone. You need a psychiatrist to manage your medication, if necessary and a therapist to provide ongoing support.

Ten Steps to Wellness
1) Take the medication as prescribed by your doctor.
● “I don’t miss often; maybe once per week.”
The number one cause of relapse to symptoms is medication non-compliance. This is definitely a tough one. In order for psychiatric medication to be effective, it must be taken daily as prescribed. I consider compliance to be missing no more than 5 pills per year! Many people don’t like to take medication, especially if it means daily for life. Let’s take one step at a time and see what it’s like to function to your capacity for a year or two before you make decisions about the rest of your life.
But remember, clinical depression is a lifelong illness and it’s all about a chemical imbalance. It is a biological problem first and foremost. It’s like being a diabetic: you must take the medication as prescribed in order to be well.

2) No caffeine, substance abuse, or alcohol.
● “It’s not the caffeine. I like coffee. It doesn’t affect me. I’ve always drank coffee.”
Whether it’s coffee, power drink, soda or tea, caffeine can interfere with sleep and create anxiety. It is the most obvious reason for poor sleep. With your doctor’s supervision to avoid anxiety and headaches, gradually reduce your daily caffeine use. Eventually, when you are consuming two cups per day, I believe, you will feel and sleep better.
I would certainly recommend gradually reducing caffeine use before asking the doctor for a sleep aid. Caffeine may interfere with your sleep/wake cycle. As far as your mental health, I recommend keeping caffeine to a minimum and before noon.
I also don’t recommend working the night shift i.e., midnight to 8 AM. It is difficult for your body to adjust. For a person with a mood disorder, this is not recommended. The back and forth between day and night shifts and the social isolation are risky to one’s mental health. It also wreaks night havoc with the sleep/wake cycle. Lack of sleep for a client with a bipolar disorder may bring about rapid mood fluctuations and jeopardize stability. Tell your doctor or your therapist if you are not sleeping. Wouldn’t it be better to reduce the caffeine rather than take a habit forming sleeping pill?
● “What? I can’t have a glass of wine with dinner? I don’t do it often. It’s just one glass. It’s not like I’m an alcoholic.”
The second leading cause of relapse to symptoms is alcohol and substance use. Some doctors and even therapists say that it is alright to have one or two drinks if you have no alcohol abuse or dependence issues. I still question this because alcohol and pot are depressants. Why would you take a depressant when you are depressed under any circumstance?
Alcohol may affect your mood for days, even weeks. At least track your mood on the calendar after you have been drinking to see if it has made your symptoms worse. As far as alcohol and substance use, it is as simple as it is hard. If it interferes with your life, your daily functioning or your relationships, don’t do it!
There is a definitely a negative correlation between the use of alcohol or drugs and a mood disorder. The increased chance of dependence and risk of relapse to the symptoms of your mood disorder are just not worth it. Connect the dots! The bottom line is that for many people USE IS THE SAME AS ABUSE!
I recommend you discuss this with your doctor. If you already know you have a problem, get into Rehab. It’s never too late to turn your life around. Get professional help and go to your Alcohol or Narcotics Anonymous meetings as often as it is necessary to maintain sobriety. Even if you are not dependent, alcohol or pot may not be a healthy choice for you. Don’t deny the obvious. So remember, the healthy use of alcohol is for one person, may not be a healthy for you. Make healthy choices!

3) Take care of your physical health.
Be sure to have annual dental and physical exams. Some medications require regular blood testing. Some physical ailments can cause depression. See your doctor regularly.

4) Exercise
People with mood disorders tend to be sedentary. They need to walk and get exercise as much or more than any of us. You don’t have to join a gym; all you need to do is take a brisk walk. You don’t have to run but you do have to hustle a little bit. Studies going back thirty plus years say that cardiovascular exercise lifts one’s mood and reduces anxiety. The more recent studies show that those old studies are true but the walk needs to be at least 40 minutes to get the full benefit toward lifting your mood and reducing anxiety.
Walk at least 4 times per week. I also recommend that you pick your days, otherwise you will say, “I don’t feel like it today; I’ll do it tomorrow.” Tomorrow comes and the same thing happens. If you make a schedule and stick to it (say, Monday, Wednesday, Friday and Sunday), the day of the week makes the decision for you. “Oh darn, today is Monday. I have to walk.” Remember, depression affects one’s motivation; if you wait until you feel like doing it, it may never happen.
Note: Always consult with your doctor before starting any exercise program.

5) Plan to have fun
It’s good to have fun; have fun! When my son was about four years old, I remember distinctly, it was a beautiful summer day. Our front door was open and he stood there and saw children outside playing. He said, “Dad, there are kids out there! Can I go out and play?”
My point is that when you are a child, all it takes is something as simple as finding other kids and the party is on! As an adult, it takes planning, especially if you have a mood disorder. You need to take time to plan to have fun. Join a bowling league, take a pottery class or cooking class, take ballroom dancing, or take a photography class at the local park district. Take an adult education class at your local community college or park district. It’s not about the grade so you can also skip the tests and homework. These are inexpensive and fun and a great way to meet your socialization goals!
● Don’t do it for a grade
● Do it because you are interested in it
● Do it to help manage (structure) your symptoms and your free time
● Do it to be more social

6) Make time to nurture your relationship.

Line up sitters so you can have time alone with your spouse or significant other. This may feel awkward at first, but keep it up anyway. Gentlemen, don’t let the wife be responsible for all the social and vacation planning. Do your share. Plan a date night. When you go to dinner, discuss your next date night, event, or do vacation planning. Don’t use the date night to discuss difficult issues. This is should be a fun time and a way to nurture your relationship. If you are going to have fun, you are going to have to plan ahead!

7) Be social
A common symptom of a mood disorder is social dysfunction or social isolation. Human beings are by nature social creatures, but unfortunately, a common symptom of mood disorders includes social isolation and/or withdrawal. Call a friend and make a lunch date. Have people over to play cards or watch a sporting event. If you don’t have a large social network, use the park district or local community college to meet people. Taking a class or joining the volleyball league at least gives you an opportunity to be with people and make a friend. While meeting strangers may seem intimidating, think of it this way: if you don’t know them to begin with, then you really have nothing to lose if things don’t work out. On the other hand, you never know when a stranger can turn into your new best friend, business partner, or love interest!

8) Hobbies

Try woodworking, sewing, knitting, crossword puzzles, gardening, toy trains, arts and crafts, or whatever you choose! Go to a hobby shop and look around but pick something and stick to it. Work on your hobby several times per week or when you are feeling low, negative, or worrisome. It is quite possible you will enjoy the activity so much that you will forget about your symptoms for a while. Hobbies are a great way to distract yourself from troubling thoughts when one else is around.

9) Chores

Most any physical activity is a good distraction from your negative thoughts and symptoms. Chores are another way to distract yourself and give you a clean environment. When you have depression, the idea of cleaning the entire house or apartment can be overwhelming. Break your chores down into one or two chores each day. For example:

● Monday is vacuuming
● Tuesday is bathroom cleaning
● Wednesday is washing the floor
● Thursday is cleaning the kitchen
● Friday is changing the sheets and towels day
● Saturday is laundry day
● Sunday is a free day. It is your reward for doing your chores all week long.

Chores are a great way to distract yourself from your symptoms. Most any physical activity will help. Make a schedule and stick to it. Try to come up with your own list of distraction activities. The more things you try, the less likely you will be a victim of your disorder.

10) Make healthy choices
This is my generic one. This one may very well be different from person to person. A healthy choice for one person may not be healthy for you. If you have a mood disorder, poor sleep, too much caffeine, alcohol or drug use, and social isolation are mental health issues. Remember! You manage it or it will manage you.

Zoom!  Now I can work via Zoom with anyone, anywhere in the country and it is currently covered by BCBS Insurance. Check with your carrier. Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://psychologytoday.com
http://takenotelessons.com    Highly effective on line, one on one, SAT, ACT, GRE, test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

How to manage Bipolar Disorder and Denial?

By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University


Denial is the biggest obstacle to management and recovery of Bipolar Mood Disorder.

People with bipolar disorders, in particular, seem to have the most issues with denial and are, therefore, the most difficult people to treat from a therapist stand point. Through self-deception, rationalization, justification, and excuse making, a person can deny that they have a problem when everyone around them sees that the problem is obvious. This seems to be most common with Bipolar Disorders.

Denial usual takes place around several key issues. They are: acceptance of the disorder, the use of medication in helping manage the disorder and the detrimental role of alcohol and substance use or abuse in achieving wellness.

When clinical depression is the disorder; it is biological. It is genetic in origin. One can usually trace it in family history. It may be a grandparent, parent, uncle or cousin, even if it was never formally diagnosed, the history is typically there. No matter how much one tries to pull themselves up by their bootstraps and try harder, they will not make a significant impact on managing their symptoms. Even a skilled CBT therapist, employing cognitive behavioral techniques will not make a significant difference in the management of the disorder.

This means that medication is indicated. Some women, generally more men will initially refuse medication. I often hear, “I won’t take medication.” I describe my view and experience in general terms. If that is not enough to convince them, I will agree to cognitive behavioral therapy for period of time. If there is still no impact on symptom management through clearly defined goals, I revisit the medication issue to encourage reconsideration. Ultimately, it’s your life; you can be a victim of your disorder or you can choose to manage it. It doesn’t happen often but I have discontinued treatment and offered some referrals to other therapists who are willing to treat the disorder without the help of medication. Personally, I just can’t do it at least not for very long.

This is also true around the use of alcohol and recreational drugs such a marijuana. Remember, alcohol is a depressant. When you are already depressed why make it worse. Initially it helps but then it slams you in the days that follow. That is why it is known as self-medicating.

Some clients, again mostly men will refuse to consider stopping the use of marijuana. Yet the reason they have initiated treatment is panic and anxiety. Duh! Though not addictive per se, marijuana is habit forming psychologically. Prolonged daily use may cause anxiety and panic for those with a mood disorder. Take medication or stop using. I encourage both.

Though denial can be an issue for both men and women, I have found that men especially do not want to admit that they have a problem. They are generally more resistant to seeking help, taking medication or facing dependence.

In my practice, I recognize that this is a trust issue. If I feel that this will be an issue, I will put the referral for a medication evaluation off for a time while building a therapeutic relationship. I also address this resistance as most therapists do by comparing mood disorders with other physical disabilities such as diabetes or epilepsy. All are physical issues with a genetic origin which affects thinking and behavior. If your doctor told you, “I’m sorry to inform you that you are diabetic like your father was”, you would not like it but would likely be willing to take insulin injections.

The same thought process regarding antidepressants or mood stabilizing medication should apply with a diagnosis of mood disorder. There really is very little difference! Until you can accept your issues and play the hand you were dealt by genetics, environment and personality traits, you will be unlikely to manage your life well.

This will affect your marriage, relationships, employment and your ability to cope with day to day life. There is no soft way to peddle this. A psychiatric evaluation will determine if medication is appropriate. Medication does the first 50% and is considered the foundation. Once on the right medication at the right dose, symptom management with a skilled therapist will likely be more successful. Once this is addressed, we are more likely to resolve relationship issues through individual, family or couples counseling.

Case Scenario
Case Scenario: Denial or Acceptance – Beth
Beth is a twenty something year old female who enjoys partying with friends. Her friends can drink, smoke pot and stay out until 4am without major negative impact on their life. Beth cannot. Her partying has made her medication ineffective.

She initially presented with severe anger issues. She reported that she would lose control, even become violent. She was already on an antidepressant but it wasn’t helping. The symptoms of clinical depression including her lack of motivation, poor sleep, poor concentration and tendency to withdraw and isolate have come to a head. She reported that her anger was out of control. In addition, she had no motivation and had difficulty getting out of bed. She was experiencing panic and anxiety and had thoughts of suicide.

Beth can’t do what her friends did almost every weekend. I encourage someone like this to track their alcohol and pot use in the days after to see if this can help her connect the dots. It’s tough when your friends can do it but you can’t. I always remind my clients that they do have a disability that they need to manage. This makes them different, not bad, just different. However, if she makes the connection then it becomes a choice. A choice to be a victim of her disorder or a choice to be well. You’re only to blame if you ignore it. Then you need to be held accountable.

Payment and Insurance:
Blue Cross and Blue Shield PPO insurance welcome. Cash, check, Visa, Master Card or American Express accepted.

Zoom

Now I can work via zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance.  Check with your BCBS representative for more information.

Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://psychologytoday.com
http://takenotelessons.com Highly effective online, one on one, SAT, ACT, GRE, standardized test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy.  Always share this material and your questions about this material with your doctor and therapist.

Denial  is the biggest obstacle to being well when you have a mood disorder.

James E. DelGenio MS, LCPC   Licensed Clinical Professional Counselor

What is the biggest obstacle to managing depression?

Denial is the biggest obstacle to management and recovery of a mood disorder or alcohol and substance dependence.  Through self-deception, rationalization, justification, and excuse making, a person can deny that they have a problem when everyone around them sees that the problem is obvious.

Denial usual takes place around several key issues. They are: acceptance of the disorder, the use of medication in helping manage the disorder and the detrimental role of alcohol and substances on achieving wellness.

When clinical depression is the disorder; it is biological. It is genetic in origin. One can usually trace it in family history. It may be a grandparent, parent, uncle or cousin, even if it was never formally diagnosed, the history is typically there. No matter how much one tries to pull themselves up by their bootstraps and try harder, they will not make a significant impact on managing their symptoms. Even a skilled Cognitive Behavioral Therapy (CBT) therapist, employing cognitive behavioral techniques will not make a significant difference in the management of the disorder.

This means that medication is indicated. Some women, generally more men will initially refuse medication. I often hear, “I won’t take medication.” I describe my view and experience in general terms. If that is not enough to convince them, I will agree to cognitive behavioral therapy for period of time. If there is still no impact on symptom management through clearly defined goals, I revisit the medication issue to encourage an appointment with a psychiatrist.

Ultimately, it’s your life!  You can be a victim of your disorder or you can choose to manage it. Lets not make life more difficult then it already is. Try the medication for six months and see if it helps.   At least go hear what the doctor has to say.

This is also true around the use of alcohol and recreational drugs such a marijuana. Remember, alcohol is a depressant. When you are already depressed why make it worse. Initially it helps but then it slams you in the days that follow. That is why it is known as self medicating.

Some clients, again mostly men will refuse to consider stopping the use of marijuana. Yet the reason they have initiated treatment is panic and anxiety. Duh! Though not addictive per se, marijuana is habit forming psychologically. Prolonged daily use may cause anxiety and panic for those with a mood disorder. Take medication or stop using. I encourage both.

Though denial can be an issue for both men and women, I have found that men especially do not want to admit that they have a problem. They are generally more resistant to seeking help, taking medication or facing dependence.

In my practice, I recognize that this is a trust issue. If I feel that this will be an issue, I will put the referral for a medication evaluation off for a time while building a therapeutic relationship. I also address this resistance as most therapists do by comparing mood disorders with other physical disabilities such as diabetes or epilepsy. All are physical issues with a genetic origin which affects thinking and behavior. If your doctor told you, “I’m sorry to inform you that you are diabetic like your father was”, you would not like it but would likely be willing to take insulin injections.

The same thought process regarding antidepressants or mood stabilizing medication should apply with a diagnosis of mood disorder. There really is very little difference! Until you can accept your issues and play the hand you were dealt by genetics, environment and personality traits, you will be unlikely to manage your life well.

This will affect your marriage, relationships, employment and your ability to cope with day to day life. There is no soft way to peddle this. A psychiatric evaluation will determine if medication is appropriate. Medication does the first 50% and is considered the foundation. Once on the right medication at the right dose, symptom management with a skilled therapist will likely be more successful. Once this is addressed, we are more likely to resolve relationship issues through individual, family or couples counseling.

Case Scenario
 Case Scenario: Denial or Acceptance – Mary
Mary is a twenty something year old female who enjoys partying with friends. Her friends can drink, smoke pot and stay out until 4 am without major negative impact on their life. Mary cannot. Her partying has also made her medication ineffective.

She initially presented with anger issues.  In addition, she had no motivation and had difficulty getting out of bed. She was experiencing panic and anxiety and had thoughts of suicide. The symptoms of clinical depression including her lack of motivation, poor sleep, poor concentration and tendency to withdraw and isolate have come to a head.

Mary can’t do what her friends did almost every weekend. I encourage someone like this to track their mood in the 3 days after to see if this can help her connect the dots. It’s tough when your friends can do it but you can’t. I always remind my clients that they do have a disability that they need to manage. This makes them different, not bad, just different. However, if she makes the connection then it becomes a choice, a choice to be a victim of her disorder or a choice to be well. You’re only to blame if you ignore it. Then you need to be held accountable.

Zoom!
Now for the first time, I can work zoom time with anyone, anywhere in the country and it may be covered by BCBS Insurance. Check with your BCBS carrier for details.  Call Jim at 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://psychologytoday.com
http://takenotelessons.com  Effective on line, one on one, SAT, ACT, GRE, standardized test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

Mood Disorder Terms

James E. DelGenio MS, Licensed Clinical Professional Counselor

Glossary of Terms for mood disorders.

The purpose of this glossary  is to begin to familiarize and educate you with psychiatric language. There are many web sites such as WebMD, National Institute of Mental Health (NIMH) and Substance Abuse and Mental Health Services Administration (SAMHSA) that offer more detailed information. There are also many support groups and web sites available via the internet.

Addiction is the preoccupation with acquiring alcohol and drugs, compulsive use of alcohol and drugs despite adverse consequences, and a pattern of relapse to alcohol and drug use despite the recurrence of adverse consequences (Miller, 1991). In other words, alcohol and drug abuse cause problems in your life and you continue to abuse them anyway.

Bipolar Mood Disorders include two types. They are Bipolar I and II. Bipolar I is the more severe of the two with more pronounced mood swings from depression to mania. Bipolar II has milder mood swings with manic phases known as hypomania. This, of course, means less extreme manic behavior.

Both are characterized by:

  • Thoughts or plans of self-harm or suicide
  • Inflated self-esteem or grandiosity
  • Hostile and aggressive behavior
  • Decreased need for sleep or no sleep
  • Unusually talkative, may be difficult or impossible to interrupt
  • Racing thoughts, skidding from subject to subject
  • Easily distracted
  • Agitation, inability to sit still
  • Poor judgment, lack of insight into one’s  own behavior
  • Buying sprees, reckless spending
  • Marked increased sexual activity or risky behavior

These symptoms, if severe, may result in hospitalization to prevent self-harm or harm to others. If you note 2-or more symptoms consult a psychiatrist and therapist and/or go to the Emergency Room at your local hospital.

Client versus Patient Psychiatrists, Psychologists and some Clinical Therapists refer to the people with whom they work as patients. As a Licensed Clinical Professional Counselor, I am very much aware of the negative stigma attached to people with mental health issues. Therefore, my preference has always been to refer to the people with whom I work as my clients.

Clinical Depression is a biopsychosocial disorder that requires psychiatric intervention (medication) along with therapy that includes education, the use of coping skills and supportive treatment. Depression is not simply a matter of “just pull yourself up by your bootstraps and keep on going.” Associated factors may include both genetic and environmental issues (your experiences growing up) and what was likely inherited by a parent or grandparent. There is usually a family history of depression, mood disorder or alcoholism even if it was never formally diagnosed. Though there may be periods of remission, clinical depression requires ongoing psychiatric treatment, medication, psychotherapy at the very least, on an intermittent basis most probably for life.

Couples may be married or unmarried, gay or lesbian. I believe that mood disorders and the accompanying relationship issues are for the most part universal.

Dual Diagnosis means that two or more independent disorders exist in the same individual. For our purposes here, mood disorder and alcohol, substance abuse complicate and exacerbate one another. Specifically, a mood disorder and alcohol and/or substance abuse exist independently of one another, but each makes the other worse. Both are bio-psycho-social disorders with similar symptoms. They are lifelong disorders which cause the patient to be prone to relapse to symptoms and alcohol or substance abuse. Both disorders require integrated psychiatric treatment, psychotherapy, a social support network and array of supportive services for effective treatment.

Delusions are false or irrational beliefs, psychotic in nature and are typically associated with severe and persistent mental illness such as with a diagnosis of schizophrenia. This includes illogical thinking, irrational negative beliefs and behavior often accompanied by grandiosity and suspiciousness. The person is out of touch with reality and no amount of reasoning, logic, begging or pleading will help the individual. The only appropriate intervention is regular psychiatric support and medication taken as prescribed. This is typically the active phase of a psychotic disorder that has yet to be treated or is caused by non-compliance with medication. Hospitalization may be necessary to ensure the safety of the client and the community.

Expressed Emotion (EE) Lack of civility and respect are known to have a detrimental effect on marital and family relationships. The expression of negative emotions toward or even in the presence of a person with a mood disorder is a major contributor of relapse to active symptoms. Negative expressed emotion includes critical comments, hostility, anger and conflict over involvement of relatives toward a person with a mood disorder in an attempt to help the individual in the management of the disorder. High EE, as it is known, is easily internalized and is known to cause family conflict, risking relapse to active symptoms and abuse of alcohol and substances.

Family Conflict refers to the disruption of family and other relationships due to depression and other mood disorders. “Though family conflict is not a symptom per se, it is present often enough that it be given symptom status”. (Samuel J. Keith, 1985) Mood disorders or dual diagnosis almost always affect relationships. As a consequence, a person afflicted may eventually become isolated without the support of a spouse, family or friends because the conflict created by the disorder becomes an obstacle to maintaining the relationship.

Hallucinations are a positive symptom (they are present and active) and refers to hearing, seeing, feeling, even smelling things that are not real. Auditory hallucinations (hearing voices), for example, is the most common symptom associated with a diagnosis of schizophrenia. These voices may warn of impending danger, tell a person what to do, and are typically critical of the person. Medication non-compliance is typically an issue for someone already diagnosed with the disorder who is experiencing hallucinations.

Thyroid refers to thyroid dysfunction which can have a major impact on mood. There are many other physical disorders which can also affect your mood. Check with your doctor and have yearly physical exams.

Lack of Civility and Respect includes yelling, screaming, swearing, name calling and sarcasm. This is a major cause of marital discontent and resentment. It undermines the foundation of a relationship.

Case Scenarios are used to show common symptoms and relationship issues. Any semblance to a real person, family or couple is purely coincidental.

Medication Non-Compliance means not taking the medication as prescribed. This is undoubtedly the most common cause of relapse to symptoms, possibly resulting in hospitalization and unfortunately increases the risk of dangerous behavior and suicide. Medication compliance means “I take my medication every day as prescribed.” If you have concerns or medication side effects, contact your doctor or go to the emergency room.

Medication Education is typically done by the psychiatrist and therapist and is designed to discuss:
1. The benefit of and reasons for the use of medication including the risks of not using medication.
2. Importance of medication compliance i.e., taking it as prescribed.
3. The possible side effects and the potential allergic reactions.
4. The importance of psychotherapy in conjunction with medication.
5. The effects of alcohol, substance use, nicotine and caffeine have on symptoms and medication.
6. Relapse Warning Signs indicating the presence of active symptoms (positive symptoms) usually controlled by medication. In this case, a reevaluation of the medication by the Psychiatrist is indicated.

Mood Disorder is a generic term for psychological disorders which include situational depression, mild to severe depressive disorders, bipolar disorders, anxiety disorders, phobias, and other disorders which include personality disorders and alcohol or drug dependence. Alcoholism and addiction are commonly associated with mood disorders. Sixty to 70% of those with a mood disorder are likely to have issues with alcohol and substance abuse. If you don’t currently have an alcohol issue, studies show you may be at risk with just casual use.

Negative Symptoms refer to those symptoms which are characterized by their absence. This may reflect the presence of chronic depression, mood disorder or severe mental illness. Psychotherapy which focuses on experiential learning, symptom management and coping skills is typically required. Negative symptoms are generally not as well-controlled by medication. It is for this reason that Individual and Family therapy is needed to address management of these symptoms. Manifestations include:
• Lack of goal directed behavior
• Lack of motivation
• Marital conflict
• Poor judgment
• Lack of insight into one’s own behavior
• Lack of pleasure
• Social withdrawal
• Lack of emotional expression

Precipitating Event This is the trigger not the cause of a mental disorder. It is the proverbial “straw that broke the camel’s back.” It is the stressful life event that triggers the onset of a disorder that was genetically inherited from birth and typically begins to show symptoms early in life but more identifiably between the ages of 18 and 35 years old. Some stressful life event occurs such as: death of a relative or friend, failure at school, alcohol and substance abuse, job loss, or marital conflict. Simply put, there is a multitude of life events that can trigger the onset of a mental disorder. It is human nature to attach your feeling to something that is going on in your life. “She is the cause of my unhappiness.” When in reality, a mood disorder that you inherited genetically is a major contributor to your relationship and social issues. I recommend a psychological assessment by a doctor or licensed mental health professional.

Psychoeducation also known as experiential learning. This is the process of learning the management of a mood disorder with the guidance and support of a skilled therapist. Psychoeducation should also be included in the treatment of marital and family issues associated with mood disorders. Knowledge of the disorder and its symptoms are essential in learning How to be well. I strongly recommend that one have a doctor for the chemical imbalance issues and a therapist for psychoeducation, management and support.

Psychotic Symptoms refer to thinking that is out of touch with reality characterized by positive symptoms or the active phase of severe mental illness (SMI) such as seen with individuals with a diagnosis of Schizophrenia or schizoaffective disorders. These symptoms include hallucinations, delusions and illogical thinking. Some severe cases of mood disorders may also include psychotic features.

Positive Symptoms also known as Relapse Warning Symptoms refer to symptoms that are characterized by their presence and are controlled only by medication. These are the active symptoms of the disorder and are typically a sign of relapse. They are:

1. Mood including low or highly elated mood (mania), negative thinking, rumination and thoughts of self-harm or harm to others.

2. Sleep/Wake difficulties include little or no sleep or reversed sleep wake cycle. Sleeping during the day and being up all night also contributes to the social isolation often seen with mood disorders. Protracted insomnia is the quickest way to relapse to symptoms or hospitalization. Take anyone, even without a mental disorder and keep them awake for two, three or four days and they will become psychotic, out of touch with reality. Significant sleep disturbances in individuals with mood disorder can be devastating. This phenomenon is most common with a diagnosis of bipolar disorder.

3. Poor Concentration means inability to focus or stay on task and may include poor short term memory issues. Relapse warning signs are typically a sign of medication noncompliance or the need to change or adjust the dosage of medication. Contact your prescribing doctor immediately. Positive symptoms cannot be controlled without medication.

Rumination refers to the negative thoughts that rerun over and over in one’s mind. This symptom can only be managed with medication.

Social Dysfunction refers to failed relationships, family conflict and marital issues associated with depression or other mood disorders. The most common characteristics of social dysfunction are:
• Hostility, irritability
• Conflict
• Withdrawal, Isolation
• Lack of close personal ties
• Relationship issues
• Employment issues

Situational Depression is a mood disorder that manifests itself typically around a specific loss or grief. This may include marital conflict, divorce, job loss, health issues and death of a relative or friend. This form of mood disorder requires therapy to work through the grief issues and may be helped by the use of antidepressants for a period of six to eighteen months.

Thought Disorder refers to confusion or the inability to concentrate on a single thought or subject. A person may be easily distracted or may jump from one subject to another (skidding). The speech pattern does not make sense, or the person may become unable to complete a thought (blocking). Short term memory may also be affected.

Work via zoom

Now I can work via zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance.  Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://psychologytoday.com
http://takenotelessons.com   Effective online, one on one, SAT, ACT, GRE, test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

Psychiatric visit reporting form

James E. DelGenio MS, LCPC

Doctor reporting form. Help the Doctor help you!

Copy and present this to the doctor at each visit. This list is not all inclusive; report anything which may be useful for your treatment. Call 911 in case of emergency or with difficulty breathing!

Name: ___________________________________  Date: ________________

Indicate areas (“X”) in which you feel you need training and education:
1.__ Depression, Mood Disorder, Serious MI
2.__ Use of Psychiatric Medication
3.__ Alcohol, Drug Abuse and Addiction
4.__ Medication Side Effects
5.__ Adverse Reactions
6.__ Dual Diagnosis – MI & Alcohol/Substance Abuse
7.__ Storage of Medication, Safe Guarding Medication
8.__ Medical Emergencies
9.__ Questions About Medications
10.__ Other____________________________________________________________________________________

Do you take your medication daily as prescribed?  __ Yes __ No
Have the benefits & purpose of medication been explained?   __ Yes __ No  Is additional training needed?  __ Yes __ No                                                                      Do you use alcohol and substances?  __Yes  __ No                                                                                                                Comments___________________________________________________________________

Fill in all boxes below with one of the following codes
NA = Not applicable, no problem noted
U = Unable to determine
X = Problem noted, see comments
S = Symptoms

Common Issues, Symptoms & Possible Medication Side Effects.  In case of an emergency or severe reaction call 911.
__ Mood, stability,
__ Swelling
__ Constipation,
__ Diarrhea
__ Anxiety, panic
__ Muscle cramps
__ Headache
__ Suicidal, homicidal thoughts, or plans (call 911)
__ Restlessness, inability to sit still, pacing
__ Abnormal eye movements
__ Dry mouth
__ Tremor
__ Blurred vision
__ Sexual dysfunction
__ Relationship issues, conflict
__ Menstrual problems
__ Urinary retention
__ Depression, mood swings
__ Anger, irritability, hostility
__ Appetite loss, increased appetite
__ Involuntary weight changes
__ Employment issues
__ Poor concentration
__ Poor short term memory
__ Social isolation, withdrawal
__ Eye photo-sensitivity
__ Poor Concentration
__ Hearing voices
__ Poor daily functioning
__ Skin photo-sensitivity
__ Sleep/wake cycle, poor sleep, no sleep
__ Difficulty swallowing or breathing, (call 911)
__ Negative rumination, (negative thoughts on repeat in your head)
__ Skin rash
__ Nausea, vomiting

Comments,_________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Additional comments and concerns: Include: (1) Alcohol and drug use (2) Medication compliance (3) Suicidal or homicidal thoughts or plan (4) Other issues, reactions, side effects or Questions?

Zoom!  Now I can work via zoom, with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative for more information.  Call for cash quote.  Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://psychologytoday.com
http://takenotelessons.com   Highly effective on line, one on one, SAT, ACT, GRE, standardized test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy.  Always share this material and your questions about this material with your doctor and therapist.

Depression and high expressed emotion

James E. DelGenio MS, LCPC

Depression and high expressed emotion.

High Expressed Emotion (High EE) or lack of civility and respect are known to have a detrimental effect on marital and family relationships. The expression of negative emotions toward or even in the presence of a person with a mood disorder is a major contributor of relapse to active symptoms. Negative expressed emotion also includes critical comments, hostility and overly involved critical family toward a person with a mood disorder. High EE, as it is known, is easily internalized and is known to cause family conflict, risking relapse to active symptoms and abuse of alcohol and substances.

Case scenario: Mary is 39 years old, and she has a severe mood disorder. She was sitting on the couch while her husband was arguing with his business partner on the phone. As the conversation became more heated, she began to shake with anxiety.

If you have a mood disorder, just being in the presence of high expressed emotion can have severe effect on the individual listening. Now imagine if that emotion was directed at her! The point is when a spouse or family member has a mood disorder, high expressed emotion or lack of civility and respect even if it is not directed at the individual will have a detrimental effect and may even lead to active symptoms. All the more reason to be civil and respectful!

Zoom

Now I can work via zoom with anyone in the country and it will still be covered by BCBS Insurance. Call 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://psychologytoday.com
http://takenotelessons.com

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

Mood disorders and alcohol don’t mix!

By James E. DelGenio MS, LCPC

When you have a mood disorder, the use of alcohol may be the same as abuse!

Where mood disorders are concerned use may very well be the same as abuse!  Alcohol impairs functioning and it affects thinking, behavior and relationships.  Substances also affect thinking and behavior.  Don’t do anything that would make you relapse to active symptoms.  It is known fact that alcohol and substance abuse make the symptoms of a mood disorder worse and vice versa.  Alcohol is a depressant; one drink at a family gathering may affect one’s mood for days.

Alcohol also “washes out” and therefore may negate the usefulness of the medication.  Remember, it takes four to six weeks to get the medication to a therapeutic level.  When you drink you affect that level. In addition, one should never use alcohol or substances when taking prescription medication. This can be fatal. It goes without saying that if you are an alcoholic you can’t have any alcohol. If you are not an alcoholic, check with your Dr. for approval of one or two drinks on very special occasions.  In the days after, monitor yourself to see if it has affected your mood. If it does, use is the same as abuse!

  • Drugs and alcohol make mood disorders worse and can lead to drug/alcohol dependence.
  • Conflict often related to alcohol use and mood disorders.
  • Two drinks, beer or wine only; never back to back days, no more then twice per week with doctor approval.
  • If the doctor approves of one or two drinks, monitor your mood in the days that follow. If your mood is off, you need to consider abstinence from alcohol.

Zoom! Now I can work via zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative for more information.

Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://psychologytoday.com
http://takenotelessons.com   Highly effective on line, one on one, SAT, ACT, GRE, standardized test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

What are the Symptoms of Bipolar Depression?

By: James E. DelGenio MS, LCPC
The Family Institute at Northwestern University

Symptoms of Bipolar Disorder

Bipolar Disorder formerly known as manic depressive disorder is a mood disorder in which people may have mixed episodes of mania and depression. This is a biological problem and will most likely require medication.

The biggest problem with managing this diagnosis is missing the high of mania. It is very much like a mouth to a flame. It is a very appealing state of mind but a very dangerous flirtation risking the stability of your mental health.

If you check even one or two of these symptoms, you should consider getting an evaluation by a psychiatrist and/or therapist. See how many of these symptoms listed below describe you.

__        Rapid mood fluctuations.

__        Feeling high, euphoric or having inflated self-esteem.

__        Irritability, hostility, anger.

__        Aggressive or risky behavior.

__        Pressured, fast speech, more talkative than usual.

__        Racing thoughts, skidding from subject to subject.

__        Delusions of grandeur, grandiose beliefs or behavior.

__        Poor judgment, lack of insight, false beliefs.

__        Poor self-control.

__        Little or no need for sleep.

__        Increased activity, sexual drive and impassivity including spending.

__        Easily distracted, poor concentration, short term memory issues.

__        Alcohol and substance abuse.

__        Bizarre dress and appearance.

__        Thoughts of suicide, homicide.

The above symptoms of depression and bipolar mood disorders are widely accepted. Since these disorders have a biological basis; a psychiatrist manages the medication while the therapist provides treatment and support. The therapist support often includes psychoeducation, symptom reduction and management, increased coping skills and management of other day to day stress such as job loss, school failure and relationship issues.

There is also an increased risk of substance abuse, dependence and alcohol issues.  Seventy to 90% of those diagnosed with a bipolar disorder also have alcohol and drug dependence. Research suggests that just casual use of alcohol with a bipolar issue may result in dependence over time.

There are two types of bipolar disorders. They are Bipolar I and Bipolar II. Bipolar I is considered the more severe of the two disorders and has more extreme episodes of mania or depression. It may also have psychotic features such as delusions and paranoia. This generally includes being out of touch with reality.

Bipolar II is characterized by milder swings of mania and depression and may have less serious effect on daily routine, relationships or employment. Both bipolar 1 and bipolar ll need ongoing treatment and medication to manage the symptoms well.

  • Most common symptoms of bipolar disorders are feeling high, risky behavior, rapid mood fluctuations and hostility.
  • Denial is a common symptom of bipolar disorder.
  • Bipolar disorders require psychiatric medication (typically a mood stabilizer), psychoeducation, ongoing therapy and additional supports when alcohol and substance dependence are also issues.
  • Alcohol and drug use should be avoided with this diagnosis.

Zoom!

Now I can work via zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative.  Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://psychologytoday.com
http://takenotelessons.com   Highly effective online, one on one, SAT, ACT, GRE, standardized test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

Symptoms of Depression and other mood disorders

James E. DelGenio MS, LCPC

Symptoms of clinical depression & symptoms of situational depression.

If left untreated, symptoms of depression, anxiety and panic may worsen and severely disrupt one’s life. These symptoms can cause untold suffering and possibly lead to hospitalization, strained relationships, divorce or even suicide. Recognizing the symptoms of a mood disorder is often the biggest hurdle to the diagnosis and treatment. I will list commonly recognized symptoms; see how many apply to you. Typically, if you recognize more than two or three from the checklist below you should consider getting an evaluation by a licensed professional.

Symptoms of depression, panic and anxiety checklist: Note the symptoms that apply to you.
__ Lack of pleasure, loss of interest and energy
__ Lack of goal-directed behavior, lack of motivation, lethargy
__ Lack of insight into one’s own behavior
__ Inability to structure time, poor concentration
__ Anger, hostility, irritability
__ Strained relationships, marital conflict, loss of friends
__ Withdrawal, isolation, would rather be alone
__ Difficulty in getting along with people
__ Sleeping too much or too little
__ Anxiety, worry, sadness, low mood
__ False beliefs, negative thinking, rumination
__ Feeling guilty, stressed or hopeless
__ Poor self-care including hygiene and diet
__ Aches, pains, dizziness, headaches, or stomach aches
__ Unintentional weight loss or gain
__ Crisis prone, police involvement
__ Low sex drive
__ Thoughts of suicide, homicide

Zoom!
Now I can work via zoom with anyone, anywhere in the country and it may currently be covered by BCBS Insurance. Check with your BCBS carrier for details.    Call Jim at 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://psychologytoday.com
http://takenotelessons.com    Highly Effective on line, one on one, SAT, ACT, GRE, test preparation, via face time or Skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

How can family help a loved one with depression?

By: James E. DelGenio MS, LCPC
Senior Staff Therapist
The Family Institute at Northwestern University

How can family help a loved one with depression?

The role of the family in treatment is simply to monitor and report. The family should observe the patient’s behavior and report anything that may be important to the stable functioning and health of the patient. The patient should not be interfered with directly unless, of course, s/he is a danger to themselves or others. The family’s role in treatment is a collaborative effort in communication. The family should think of themselves as team members. We are all on the same team! Keeping secrets from the doctor or therapist interferes with treatment and may ultimately have serious consequences. Families should call their doctor, therapist immediately or 911 if the patient has any of the following behaviors or symptoms, especially if they are new, worse, or worry you. Report when the patient is:

  1. Not taking their medication as prescribed.
  2. Abusing alcohol, substances or medications not prescribed by a doctor.
  3. Severely depressed, irritable, threatens violence or has thoughts of suicide or dying.
  4. Exhibits behavior which may result in injury or harm to the individual, family or community.
  5. Experiencing of any relapse warning signs, especially no sleep.
  6. Experiencing panic attacks, uncontrolled anxiety or restlessness.
  7. Acting on dangerous impulses.
  8. Exhibits unusual behavior that is out-of-character for this individual.

Family should:

  1. Avoid placing blame or guilt.
  2. Avoid enabling. You are not responsible for the patient’s wellness. S/he is!
  3. Make regular opportunities to get away from each other. Have outside interests, hobbies and social activities.
  4. Get regular exercise (doctor permitting). Join a health club or walk at least 40 minutes on regularly scheduled days each week. In the winter if needed, use a treadmill or stationary bicycle.
  5. Learn all you can about mood disorders but do not try to be a therapist.

In most cases I have treated over the years, I have seen the client get annoyed with friends and family when they say, “You seem crabby, did you take your medication today”? The typical response is “just because I’m angry or upset doesn’t mean I’ve skipped my meds”. The way I see it, if you have a history of noncompliance, you don’t have the right to be angry when asked! Take the medication as prescribed so your family doesn’t worry about compliance or need to be intrusive in your life. They should be relatively assured that you are compliant with medication and treatment. Regardless, it is the responsibility of the family to ask because the consequences of not taking it as prescribed can lead to injury and possibly suicide.

    • Monitor and report on medication compliance.
    • Monitor and report on the use of alcohol and drugs.
    • Avoid over involvement unless the person poses a danger to himself or others.
    • Avoid trying to help motivate compliance with treatment.

Zoom!

Now I can work via Zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative for more information. Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://jamesdelgenio.com
http://family-institute.org
http://psychologytoday.com
http://takenotelessons.com   Effective online, one on one, SAT, ACT, GRE, test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.