Tag Archives: depression

Questions about Mood & Relationship Disorders?

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

Mood and Relationship Disorders.

Questions and Answers

1. What is a mood disorder?
2. What are the symptoms of a mood disorder?
3. Can a mood disorder be compared to a physical illness?
4. What should you report to your psychiatrist?
5. Will you have to go in and out of hospitals the rest of your life?
6. Why can’t you drink alcohol if you are not an alcoholic?
7. Why is mood disorder and addiction often found in the same individual?
8. Why is medication compliance so important?
9. How do you cope with the past?
10. Why are recreation, exercise and socialization so important?
11. What if you don’t feel motivated to do the things suggested here?
12. What are relapse warning signs?
13. What are the causes of relapse, regression and re-hospitalization?
14. When should you go to the hospital?
15. What do you do if you can’t sleep?
16. What is the role of the family in treatment?
17. What can family members do to minimize the risk of relapse?
18. How can family members learn to cope?
19. Who is responsible for your happiness?
20. What are the goals of treatment?
21. Why is psychiatric medication useful in controlling symptoms of mood disorders?
22. What if you are inconsistent in taking your medication?
23. What are the possible side effects of psychiatric medication?
24. What are the benefits and purpose of psychiatric medication?
25. What does one do if there is a medical emergency?
26. How does one learn to make healthy choices?
27. How to be well.

1. What is a mood disorder?

Mood disorders are considered a mental illness. They are biological/genetic problems that you inherited and are considered no different than the diagnosis of diabetes. These disorders are usually manifested in the teens or early twenties. I use two very different definitions of mental illness.
The first definition is as follows:
It is a lifelong disability, episodic in nature that causes chronic dysfunction, asocial behavior and hospital dependency. A breakdown of this definition is as follows:

Lifelong means there is no cure to date, though new medications, if taken as prescribed, have made symptoms very manageable.

Episodic means that sometimes the symptoms are worse than at other times.

Chronic dysfunction includes inability to manage day-to-day events, unemployment and often failed relationships.

Asocial Behavior is that behavior which is bizarre and inappropriate. This includes poor self-care. It may also include behavior that is harmful to oneself or others.

Hospital Dependency means that in some severe instances, frequent psychiatric hospitalization may result in a revolving door syndrome in which a person spends their life going in and out of hospitals.

The second definition is as follows:
Mental illness is a lifelong disability, episodic in nature that the individual can learn to manage with hope and with dignity.

The two definitions are separated only by education, psychiatric treatment and support. The key here is management of a disability. You manage it or it will manage you! How do you want to live your life? (See how to be well)

2. What are the symptoms of mood disorders?
A. Symptoms of Depression grief, loss panic and anxiety.
a. Lack of pleasure, loss of interest and energy
b. Lack of goal directed behavior
c. Inability to structure time, poor concentration,
d. Anger
e. Sleeping too much or too little
f. Overwhelmed with worry, sadness, low mood
g. Feeling guilty, stressed or hopeless
h. Poor self-care including hygiene
i. Aches, pains, dizziness, headaches, or stomach aches
j. Strained relationships, marital issues, loss of friends
k. Would rather be alone
l. Withdrawal, isolation, lack of close personal ties
m. Difficulty in getting along with people, irritable
n. Crisis prone, police involvement
o. Low sex drive
p. Thoughts of suicide, homicide

B. What are the symptoms of Bipolar Mood Disorder?
(These symptoms may also include some of the above)
a. Rapid mood fluctuations
b. Feeling high, euphoric or having elated mood
c. Irritability, hostility
d. Pressured, fast speech
e. Racing thoughts, skidding from subject to subject
f. Grandiose beliefs or behavior
g. Poor judgment
h. Poor self-control
i. Increased activity
j. Easily distracted, poor concentration
k. Increased sexual interest and drive
l. Thoughts of suicide, homicide

The above symptoms of 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 psycho education, symptom reduction, increased coping skills and management of other day to day stressors such as job loss, school failure and relationship issues. The psychiatrist, therapist, family, friends and of course, the patient must work together as a team to construct an effective approach to these disorders. The most important aspect of this is communication.

3. Can a mood disorder be compared to a physical illness?
It is helpful to think of someone you know who is diabetic and what it means to be a diabetic. Some years ago, a friend of mine named John had a heart attack. Fortunately, there was no damage to his heart. What was discovered, however, was that John’s blood sugar was very high. He was diabetic. When John moved out of intensive care, they began to teach him how to cope with his newly discovered disability. They taught him how to measure his blood sugar and give himself insulin injections. They taught him what he could eat and what he could not eat. They even taught him what to do if he had a reaction to a food or his medication. When he was discharged from the hospital, they had a nurse visit him at home several times a week for several weeks just to make sure that what he had learned in the hospital, he continued at home.

Mental illness and diabetes are comparable in many ways. Each is a lifelong, biological problem that requires daily attention, education and support. Medication, when taken as prescribed, stabilize each condition but knowledge and training play a very important role in healthy functioning. The comparisons demonstrate that mental illness, like other physical handicaps, can become a manageable handicap; not the global disability it is for some. It is a result of an imbalance in the chemistry of the brain. It is no one’s fault and no one is to blame. Mental illness is a lifelong disability, episodic in nature that one can learn to manage, with hope and with dignity.

4. What should you report to your psychiatrist?
The Doctor is part of the team. S/he needs your input to best help him to help you. If any of the following are problematic, report them to the doctor. Write things down.
1. Report on medication compliance
2. Changes in your Symptoms
A. Sleep patterns
B. Voices
C. Mood
D. Physical changes
3. Drug and alcohol use
4. Medication side effects
5. Social activity
6. Self-care
7. Physical activities, Hobbies, Chores
8. Money management
9. Unusual behavior
10. Threats to self or others

5. Will you have to go in and out of hospitals the rest of your life?
Typically, in severe cases, some people go in and out of the hospital their entire life. This is usually a case of non-compliance with medication or alcohol or substance abuse. Mood disorders can be a global disability or a very manageable handicap. Which one will you choose? Education, medication and ongoing supportive treatment are essential for maintaining healthy functioning.

6. Why can’t you drink alcohol if you are not an alcoholic?
It is well documented that alcohol and substance abuse make the symptoms of a mood disorder worse. Where mood disorders are concerned, use is the same as abuse! Alcohol is a depressant. Even casual use may affect your mood for days after you drink. I suggest you monitor your moods for the next several days after drinking. Alcohol also affects the usefulness of the medication. Antidepressants take weeks to build up to a therapeutic level. When you drink you affect those levels.  In addition, one should never use substances when taking prescription medication. This can be fatal.

7. Why is mental illness and addiction often found in the same individual?
The answers here are not completely understood. Some say that the sites in the brain that are affected by mental illness are the same sites affected by addiction. Regardless of the chemistry, just casual use of alcohol by a person with a mood disorder may eventually result in alcohol dependence. If you have a mood disorder, you can’t have any! The consequences are just not worth it.

8. Why is medication compliance so important?
The number one cause of regression and re-hospitalization is not taking medication as prescribed. In order for medications to work effectively, one must maintain a certain level in the body. When that level in not maintained, debilitating symptoms reappear.

9. How do you cope with the past?
Many people with mood disorders have difficulty coping with the past. Once this is explored with your doctor and therapist, I suggest one simply moves on. When one dwells on the past, they often have difficulty coping with the present. Yesterday is done; worry about today and tomorrow will take care of itself.

10. Why are recreation, exercise and socialization so important?
It is good to have fun. Have fun! People with mood disorders often become engrossed in their illness and problems. Recreation and exercise (especially walking) are good for depression and a great distraction when one is experiencing symptoms. Distraction from symptoms is an important coping skill. (Internet, video games, TV or reading don’t help with distraction.)

11. What if you don’t feel motivated to do the things suggested here?
Lack of motivation is a direct result of the disorder. If you wait to feel motivated, it may never happen. Walk 40 minutes per day at least 3-4 days per week. Do your chores and exercise on the days you have picked to do them. Plan to have fun. Have at least one social activity per week. (See how to be well.)

12. What are relapse warning signs?
Relapse Warning Signs reflect symptoms that include the following:
1. Thoughts about hurting oneself or others
2. Too much or not enough sleep, especially no sleep
3. Inability to concentrate, rapid speech, skidding
4. Rapid mood fluctuations, mania or depression
5. Poor judgment, risky behavior
These symptoms are typically a result of alcohol use, substance use or medication noncompliance.

13. What are the most common causes of regression, relapse and re-hospitalization?
1. Medication noncompliance
2. Alcohol and/or substance use
3. Social isolation
4. Family conflict

14. When should you go to the hospital?
When you are in danger of hurting yourself or someone else or when there is a medical emergency such as a medication reaction.

15. What do you do if you can’t sleep?
Stop drinking caffeinated beverages. Don’t nap during the day. Report it to your doctor.

16. What is the role of the family in treatment?
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 report on the following:
1) When the person does not take their medication as prescribed.
2) The use of alcohol, other substances or medications not prescribed by a doctor.
3) Behavior which may result in injury or harm to the individual, family or community.
4) The presence of any relapse warning signs, especially no sleep.
5) Social and leisure activities.
6) Unusual behavior

17. What can family members do to minimize the risk of relapse?
1. Monitor and report on medication compliance.
2. Monitor and report on the use of alcohol and drugs.
3. Avoid critical comments.
4. Avoid over involvement.
5. Avoid excessive pressure to achieve.
6. Avoid trying to help motivate.
These are frequent causes of family conflict and should be discussed with the doctor and therapist.

18. How can family members learn to cope?
1) Mental illness is no one’s fault. It is a biological problem. Avoid placing blame or guilt.
2) Provide opportunities to get away from each other. Check with your local AMI support group about meetings and their ongoing social activities.
3) Pursue other activities. Join the local YMCA or health club and get some exercise and social support.
4) Have outside interests and hobbies.
5) Walk at least 40 minutes on regularly scheduled days each week. In the winter, use a treadmill or walk the stairs. (Be careful; hold the handrail.)
6) Learn all you can about mood disorders but do not try to be a therapist.

19. Who is responsible for your happiness?
Who owns the problem? Don’t blame others for your illness or problems. Remember, a mood disorder is a biological problem like diabetes. If you don’t manage it, it will manage you. See how to be well.

20. What are the goals of treatment?
When dealing with a lifelong illness, it is important to understand the goals of treatment. Goals generally fall into six overlapping areas, they are as follows:
1 Medical
2 Social
3 Daily Living
4 Coping
5 Prevocational, vocational
6 Personal
As you will see, some goals can be placed under more than one area. A goal may remain as long as is necessary to ensure consistent compliance. Write down your goals and put them on the refrigerator. Some examples of Goals are as follows.
Medical
1 Take medication as prescribed
2 Report the presence of symptoms
3 Maintain abstinence from alcohol
4 Avoid caffeinated beverages
5 Maintain a healthy diet
6 Get medical and dental check-up annually
7 Keep psychiatrist appointments
8 Have blood work checked as directed by your doctor
9 Report less than 4 hours of sleep to your doctor
10 Report medication side effects to your doctor or ER

Social skills
1 Have at least one social activity per week
2 Try to avoid sleeping/ napping during the day
3 Call a friend
4 Make plans for the weekend

Daily Living Skills
1 Wash hair twice a week
2 Shower (daily)
4 Do your own laundry on Saturday (pick the same day each week)
5 Wear clean clothes

Coping Skills
1 Read goals daily, put a copy on the refrigerator at home
2 Be on time for work and appointments
3 See your doctor, especially when experiencing symptoms
4 Take a brisk walk 40 min every day (get Dr approval to exercise)
5 See your therapist regularly for support
6 Check in with family regularly
7 Work on a hobby 1/2 hour every day or when you are experiencing symptoms

Prevocational, Vocational
1 Bath daily
2 Dress appropriately
3 Look for a job on Monday (pick days)
4 Practice writing job applications
5 Attend school on assigned days
6 Do chores on assigned days
7 Do volunteer work on assigned days
8 Concentrate on chores at home (do a good job)
10 Be on time for appointments
11 Go to work

Personal
1 Make healthy choices.
2 Spend quality time with your family.
3 Improve self-esteem.

21. Why is psychiatric medication useful in controlling symptoms of Mood Disorders?
Mood disorders are considered bio-psycho-social disorders. It is a biological issue that affects thinking and behavior and often times creates relationship issues. Medication and Medication Management are typically essential in the management of the biology or the chemistry of the disorder. I consider this to be the foundation of treatment. It is difficult if not impossible to treat severe mood disorders without medication.
Therapy addresses the psychosocial treatment including identification and management of symptoms, daily living skills, coping skills and the relationship issues often accompanying these disorders.

22. What if you are inconsistent in taking your medication?
The key word here is consistent. The medication is extremely important to maintaining your mental health. If you are not consistent in taking the medication, you will have difficulty functioning effectively on a day-to-day basis. You may need to ask for assistance from family or friends. Always take the medication as prescribed.

23. What are the possible side effects of psychiatric medication?
Always read the medication information given to you by the pharmacist. If you have questions or concerns, direct your questions to the pharmacist and your doctor. Go to the ER for serious side effects.

24. What are the benefits and purpose of psychiatric medication?
A Mood disorders is disease very much like diabetes. It takes insulin to manage diabetes; it takes psychiatric medication to manage mood disorders. Some say you just have to be tuff. You just have to pull yourself up by your bootstraps
so to speak and try harder. This is false. In my opinion, the only way to successfully manage a mood disorder is with medication and treatment.

25. What does one do if there is a medical emergency?
Call 911 immediately!

26. How does one learn to make healthy choices?
Sometimes people do not recognize the choices they make may not be healthy. Others simply need ongoing supportive therapy. Together with your doctor and therapist, you can learn to manage your symptoms and cope with the day to day stress of a mood disorder. This is the reason that ongoing support of a doctor and therapist is essential for management.

27. How to be well.
Coping with mood disorders is no easy task! It takes professional support, medication, psycho education and experience to manage the debilitating symptoms. With the necessary supports and monitoring, persons with mental illness can learn to:
1. Control Symptoms
2. Remain stable
3. Have a network of friends and supports and
4. Maintain employment
I have also found that it takes an average of about one year to reach those goals but some people never reach all. In addition, most people will need some level of support their entire lives. The bottom line is you can’t do it alone! You need a psychiatrist to manage your medication and a therapist to provide ongoing support.

Ten elements necessary to cope with mood disorders.

1) Take the medication as prescribed by your doctor.
This is definitely a tough one. No one likes to have to take medication, especially, every day for the rest of your life but remember. Mental illness is a lifelong disease and it’s all about body chemistry. 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, drugs or alcohol, ever.
People with mental illness often have problems with sleep. I do not recommend using caffeine. It interferes with the sleep/wake cycle. I also don’t recommend working the night shift i.e., midnight to 8 AM. It is too hard to get adjusted to a night shift and it also messes up the sleep/wake cycle. Tell your doctor or your therapist if you are not sleeping.
As far as alcohol and substance use, it is as simple as it is hard. Don’t do it! Mental illness alters reality. Alcohol and substance use alter reality. There is a relationship between alcoholism, drug abuse, addiction, mental illness and relapse. The bottom-line is USE IS THE SAME AS ABUSE! Don’t use, ever! If you already have a problem, get professional help and go to your AA or NA meetings as often as it is necessary to maintain sobriety.

3) Take care of your physical health.
Be sure to have annual dental and physical exams.

4) Be social, outside of the family.
Mental illness tends to make people isolated and withdrawn. People need contact with other people to remain grounded in reality. Even family cannot take the place of social contact in its benefit concerning reality testing. People with mental illness cannot always trust what they feel, see or hear. They need to “check it out” with other people.
We all use our friends to test reality; you just don’t think of it in that way. For example, you call up your friend and say, “Do you know what happened today? I had an argument … She said… I said …” Who do you think was right?” It’s over simplified but you get the idea. People need other people for many reasons. For people with a mood disorder, reality testing or “checking it out” is just one of them. I recommend at least one social activity per week with people other than family.

5) Be active.
People with mood disorders tend to be sedentary. They need to walk and get exercise as much or more than any of us. I recommend taking a brisk walk, weather permitting, at least 3-4 times per week. Pick your days and stick to them as much as you can. It is widely accepted today that walking improves your mood so get out there and walk. Note: Always consult with your doctor before starting any exercise program.

6) Plan to have fun.
When you are a child, it doesn’t take much to have fun. You simply go outside and find some other kids and the party is on so to speak. As an adult, we need to plan to have fun. For example, if you had a boring weekend you might say to your spouse, “This was a lousy weekend. Next week we need to plan to get together with …” Get the idea? People with mental illness tend to become consumed with their symptoms. Planning is a very important part of meeting your social goals.

7) Work on a hobby daily.
A hobby is a wonderful way to cope when no one else is around or when you are hearing voices or depressed or just plain bored. The key word here is coping. People often complain about too much free time and yet they will say, “I don’t have a hobby,” but they will sit for hours ruminating about their symptoms. That is just not healthy. So don’t tell me why you can’t work on a hobby. Tell me what hobby you are going to choose and get to work. Hobbies should be worked on at least 1/2 hour every evening or any time you are having difficulty coping with your symptoms.

8) Do your chores on assigned days.
Household chores are also a way of coping with free time. First, list all your chores and make a schedule for each day of the week. Once written, tape it on your refrigerator or someplace where you will see it every day, and then, stick to your cleaning schedule. This is not about how you feel. If you felt good, you wouldn’t need this stuff. If it’s Monday and you are scheduled to clean the bathroom – do it. It is a coping skill and it also gives you the added benefit of a healthy environment in which to live.

9) Get at least 5 to 7 hours of sleep per night.
As I stated earlier, sleep is very important to maintaining your mental health. Too much sleep is not healthy. No sleep is a quick ticket to the psychiatric hospital. I could take just about anyone in the world; if I kept them awake long enough, they would loose touch with reality. Lack of sleep usually indicates that the person is not taking their medication as prescribed. Remember Goal # 1. Take the medication as prescribed by your doctor. If you’re still not sleeping, notify your doctor. It only takes a few sleepless nights to lose touch with reality and relapse back to severe symptoms.

10) Make healthy choices!
This is my generic one. This one may very well be different from person to person. What is a healthy choice for one person may not be healthy for another. For example, if you have a mood disorder, sleep and alcohol are mental health issues.

Issue 1 Sleep
Typical response: it’s not the caffeine. I like coffee. It doesn’t affect me. I’ve always drank coffee. Whether it’s coffee, soda or tea, caffeine interferes with sleep. It is the most obvious reason for poor sleep. I would certainly recommend discontinuing caffeine before asking the doctor for a sleeping pill. Avoid caffeine for one month and see if you don’t sleep better.

Issue 2 Alcohol
Typical response: 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.
Alcohol is a depressant. It may affect your mood for weeks. Don’t deny the obvious. This is just not a healthy choice.
So, remember, what is healthy for one person, may not be a healthy for you. Make healthy choices!

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.

Copyright 2012 all rights reserved

Psychiatric visit reporting form

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

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://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.

How can family help one with depression?

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

What to do when your spouse has 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.

  1. Abusing alcohol, substances or medications not prescribed by a doctor.
  2. Severely depressed, irritable, threatens violence or has thoughts of suicide or dying.
  3. Exhibits behavior which may result in injury or harm to the individual, family or community.
  4. Experiencing of any relapse warning signs, especially no sleep.
  5. Experiencing panic attacks, uncontrolled anxiety or restlessness.
  6. Acting on dangerous impulses.
  7. 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 medications.” 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.

Not in the Chicago Area! Now I can work via face time with anyone, anywhere in the country and it will still be covered by BCBS Insurance.

For those in the metropolitan Chicago area, I have offices in Millennium Park on Michigan Avenue, and near 22nd St and Wolf Road in Westchester. Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://jimdelgenio.com
http://family-institute.org
http://psychologytoday.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.

James E. DelGenio offers Tele-therapy with BCBS PPO Insurance accepted

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

James DelGenio LCPC is a senior staff therapist who offers teletherapy and accepts BCBS PPO Insurance.  Teletherapy is HIPAA approved via Zoom.com 

His services include Individual and family counseling, marital and premarital counseling, and treatment of mood disorders and dependence.

Locations:  Teletherapy anywhere via zoom.  HIPAA approved and accepted by BCBS PPO Insurance.

As a practicing Psychotherapist for over 40 years, I employ a variety of clinical approaches including Cognitive Behavioral Therapy (CBT) in the treatment of couples, families and individuals.

Individual Practice: Assessment and treatment of anxiety, stress, panic, trauma, anger, grief, depression, mood disorders, mental illness and alcohol/substance abuse.

Marriage and Family Practice: Lack of intimacy, infidelity, poor communication, conflict over finances, lack of trust, parenting and behavior issues, premarital and divorce issues.

Specialization: Treatment of couples, depression and its impact on relationships and the family.

Zoom!

Now I can work via Zoom with anyone, anywhere in the country and it is 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

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.

Weekly Review of Consistency for management of Depression!

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

How to build structure for consistency in management of mood disorders!

This form helps you monitor your progress towards goals each week. Consistency is key when you have a mood disorder. People with mood disorders need planning and structure to help manage their symptoms. You can also track your marital/relationship goals if you choose. This tool helps track progress toward goals by adding structure to your week. Make multiple copies. Modify as needed; feel free to add or delete goals. Rate mood 1 through 10. Ten is best – 1 worst. Place copy on your refrigerator or someplace where you can check it daily. Mark the goals each day so that you can see the week in review. Note alcohol/drug use and your mood rating in the 3 days after use. Being consistent in your goals makes a huge difference in managing your mood. Try it!

Week of _________________

Goal:                                      Mon       Tues        Wed        Thurs        Fri        Sat       Sun
Medication compliance
Cardio/walking
Social activity
Hobbies
Chores
Date night
Civility and respect
Sleep # of hours
Drug, alcohol use
AA/NA meetings
Time out called
Time out respected
Mood
Family meetings
Psychiatric appt

Note: Always consult with your doctor before starting any exercise program.

Zoom!  Now I can work via Zoom with anyone, anywhere in the country and it is currently 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    Highly 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.

What you need to know about depression and high expressed emotion?

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

What is High Expressed Emotion?
High Expressed Emotion (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 effects 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! No yelling, screaming, name calling, ever.

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

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 be well when you have depression?

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

Ten Steps to Better Mental Health

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 a tough one. 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. You wouldn’t like it but you would take the insulin injection. This is just chemistry.

2. No caffeine, substance use/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 caffeine free, 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 every day. It’s just one glass. It’s not like I’m an alcoholic.”

The second leading cause of relapse to symptoms of depression is alcohol and substance use. Some doctors and even therapists say that it is all right to have one or two drinks if you have no alcohol abuse or dependence issues. I still question this because alcohol is a depressant. Why would you take a depressant when you are already depressed?

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. Especially monitor the first three few days of being alcohol free. 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! Need help! Contact your doctor.

There is a negative correlation between the use of alcohol or drugs and symptoms of a mood disorder. Their is an increased chance of dependence and risk (70% to 90%) of relapse to the symptoms of your mood disorder. The consequences are just not worth it. Connect the dots! Denial or not! The essential point here 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 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 years or more 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 want to do 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!
• Do it to be more social.
• Don’t do it for a grade.
• Do it because you are interested in it.
• Do it to help manage your symptoms and to structure your free time.

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, paint by number, 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 ruminating 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 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://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.

How to manage Anger and Depression?

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

Anger and depression are the flip side of the same coin.

Anger and hostility are just the tip of the iceberg. In addition to anger, symptoms may include lack of civility and respect, lack of motivation, lack of goal directed behavior, sleep issues, too much or too little, overwhelmed with worry or sadness, inability to structure time, risky behavior, negative thoughts which seem to be on repeat and social withdrawal among others. This is unlikely to be managed without medication. As a therapist, I’m willing to try coping skills along with mindfulness to manage symptoms. If this doesn’t help, then we will need to consider medication.

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://takenotelessons.com   Effective online, one on one, SAT, ACT, GRE, standardized test preparation, via face time or skype and much more.

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 severe mental illness?

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

Symptoms of severe mental illness

1. Positive Symptoms: (characterized by their presence)
a. Impaired contact with reality.
b. Hallucinations, delusions (often paranoid).
c. Thought disorders.
d. Thoughts of suicide, homicide

2. Negative Symptoms: (characterized by their absence)
a. Lack of pleasure, loss of interest and energy
b. Lack of goal-directed behavior.
c. Blunted affect.
d. Lack of insight.
e. Poverty of speech.
f. Poor judgment.
g. Poor self-care including hygiene.
h. lack of motivation.
i. Inability to structure time, poor concentration,

3. Interpersonal Relations
a. Asocial behavior, bizarre and inappropriate.
b. Withdrawal, isolation.
c. Lack of close personal ties.
d. Difficulty in getting along with people, irritable, angry.

4. Family Conflict
a. Crisis prone, police involvement.
b. Over involvement, overly intrusive family in trying to help.

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 details.  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://takenotelessons.com   Effective online, one on one, SAT, ACT, GRE, standardized test preparation, via face time or skype and much more.

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 cope with depression, panic and anxiety?

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

How to distract yourself from your depression and anxiety?

Socialization, Exercise, Hobbies, and Chores!

Socialization is an important coping skill. It is good to have fun. Have fun! People with mood disorders often become engrossed in the past, their illness, and problems. They tend to isolate and withdraw. That is just not healthy and is a common symptom of depression. You should have at least 3-4 social events each month.

Exercise (especially walking) is good for depression and anxiety and is a great distraction when one is experiencing symptoms. Research suggests that a brisk walk for 4o minutes (with your doctor’s approval) will lift your mood and reduce anxiety. Don’t wait to feel motivated. Lack of motivation is often a direct result of a mood disorder. If you wait to feel motivated, it may never happen. Walk or do cardio work at least 4 times per week. Pick your days and let the day of the week make the decision for you. This will help to avoid, “I don’t feel like it today; I’ll do it tomorrow.” Unfortunately, tomorrow never comes. Any physical activity is likely to be helpful.

Hobbies can also be an important coping skill. A hobby can serve as a distraction when you are feeling low or anxious. Go to a hobby shop and pick something. I have had a lot of people choose paint by number sets. It’s the perfect hobby. You can pick up a paint brush and distract yourself and put it down and walk away when you need to. I had one man become a very good artist after starting with just a paint by number set. So, go to the hobby shop and pick something!

Chores can also be a great distraction. Many people with depression are overwhelmed by the thought of cleaning their entire living space. Again, use the pick a day method and choose one or two chores per day. Do your chores and exercise on the days you have picked to do them. Try to have at least one social activity per week. Plan to have fun. Adding structure to your life addresses many common symptoms of a mood disorder but especially lack of motivation.

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://jamesdelgenio.com
http://family-institute.org
http://psychologytoday.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.