All posts by James DelGenio

Individual, Family, and Couples Counselor with over forty years of experience as therapist, author, and continuing education provider.

Issues to discuss before marriage?

By James E. DelGenio MS, LCPC

Issues premarital couples should discuss before marriage.  Check it out!

Finances
You may not realize it now, but this is a big one.  Do you know the extent of each other’s Assets? Debts?  How do you view the sharing of these assets? Do you have the same attitude toward saving?
Will one of you want to put into a pension while the other wants to buy a new car? How much are you saving for retirement?  Are there school loans? Credit card debt? Who will pay the bills?
Family Ties
What sort of relationship do you have with your extended family? Are they good at staying in touch? Are they local? Affectionate? Over-involved? Have you had any major falling out? How will you handle the holidays?
Children
Do you want children? How many? How do you want to raise your children? What sort of values do you want to pass on? Do you have opposing views about the benefits of state versus private education — and should you be thinking now about buying in a college savings plan for a good state school?
Religion
What are your religious views — do you agree on what religion you will bring up the children in? Church/mosque/synagogue? Once a week or once a year? Or no religion at all.
Leisure and fun
Do you like doing the same things in your spare time? Do you share common interests? Is your idea of a holiday lying flat on the beach for two weeks and your partner’s rock-climbing?
Lifestyle
What sort of lifestyle are you aiming for? Where do you want to live? Do either of you have a dream of downsizing at some point and living away from the city?
Spending
Do you have an expensive shoe or gadget habit? Does one of you think of a particular purchase as an essential that the other regards as a “discretionary spending”?  Do you have any other secret spending habits: handbags, chocolate, football?  Do you gamble, online or otherwise?  First, define what is discretionary.  Then, I recommend setting an amount that limits discretionary spending without consulting the other!  Typically, I say $150 to $200.  More than that should be discussed. I have also seen people spend $15 per day at the coffee shop and be unable to pay the rent.  Makes no sense!  Will spending be an issue?
Work
Are your respective career paths compatible, is either of you going to have to make compromises? Are you prepared to? Will you want to give up work when you have children? What does your partner think about this, and can you manage financially? What about part-time working?
Roles – traditional or modern?
Will you expect to live along traditional lines: woman as homemaker and man as breadwinner? Who will organize the finances? Will household responsibilities be shared equally? Who will assume responsibility for paying bills? Do you see yourselves as partners or equals, who generally share all responsibilities equally?
Honesty
Are there any old flames for whom you still hold a candle?  Debt that you have not disclosed.
Drug and alcohol
Are drugs and alcohol an issue? Is the person willing to get help? Are they in denial? If your intended is in denial, you should probably think twice about the viability of this relationship long-term?

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
http://takenotelessons.com    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.

Psychiatric Treatment – Help the Doctor Help You

James E. DelGenio MS, LCPC

How to prepare for your psychiatry appointment?

Help the doctor help you to avoid relapse to active symptoms of depression, anxiety or panic.  The Psychiatrist is an integral part of the treatment team. S/he needs your honest input to best help you. If any of the following are problematic, report them to the doctor. Write things down so you are prepared for your appointment.

Report any changes in your symptoms to your doctor including:

1. Changes in sleep patterns, little or no sleep.

2. Changes in Mood often accompanied with negative thoughts, seemly on repeat.

3. Poor concentration, poor short-term memory

4. Disturbing thoughts of self-harm or harm to others

5. Drug and alcohol use/abuse

6. Medication side effects or allergic reactions

7. Social activity or isolation

8. Poor self-care

9. Physical activities, hobbies, chores

10. Poor money management

11. Unusual behavior

Psychiatric Medication

Psychiatric medication is useful in controlling symptoms of mood disorders. Mood disorders are considered bio-psycho-social disorders. They affect thinking and behavior and often times create relationship issues. Medication and medication management are 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 a severe mood disorder without medication. You can’t build a solid house without a good foundation. Medication provides that solid foundation.

Therapy addresses the psychosocial treatment issues including identification and management of symptoms, daily living skills, coping skills, and the relationship issues which often accompany these disorders.

Refusal to take medication is a common issue. I do on occasion have clients who refuse medication. In the past, I have said, “I will work with you to see if we can make an impact on your symptoms.” If we do, that’s great. If not, I will try to deal with the denial and the refusal of medication.

What if I told you that you are a diabetic and will have to be on insulin injections the rest of your life? Of course, most people wouldn’t like it, but chances are, they would take their medication. Why is medication for a mood disorder any different?

Let me remind you that alcohol is a drug and if you are drinking, you are self-medicating with a depressant. This may lead to alcoholism or substance abuse and addiction. Wouldn’t it be wiser, safer, and more productive to let a doctor prescribe the correct medication to help you get on the path to recovery?

Medication and Support

Many people remain on medication their entire lives. Some people with mild depression or situational depression are able to use medication intermittently for periods of stress that cause their depression to re-emerge. Others don’t want those periods of regression in their life, so they chose to just stay on the meds. I encourage clients to consult with their doctor for recommendations.

Therapeutic support may also be intermittent or as needed after a time. Depending on the severity of the disorder and how well a person learns to manage, I recommend that my clients check-in at least three or four times per year. This is especially common for couples whose disorders affect their marriage.

Unfortunately, some people with severe mood disorders may go in and out of the hospital their entire lives if they remain in denial. This is usually a result of non-compliance with treatment and medication, combined with alcohol and/or substance abuse. Mood disorders and addiction can be global disabilities or manageable handicaps. Which one will you choose?

The number one cause of regression and recurrence of symptoms is not taking medication as prescribed. This is not like having a headache. When you have an ordinary headache, you take two aspirin and twenty minutes later your headache is gone. In order for antidepressants or mood stabilizers to work effectively, the drug must maintain a certain level in the body. When that level is not maintained, debilitating symptoms reappear. These medications take four to six weeks to reach their peak level of effectiveness. When you miss doses of medication, drink or use drugs, you negatively affect that level.

Medication Side Effects and Allergic Reactions

All medications have side effects. Even aspirin can cause ringing in the ears if you take too much. The pharmacy must list all side effects, but that does not mean you will experience any or all of them. Most of the common psychiatric medications for depression and mood disorders have very few, if any, side effects after the first week or so. First, ask your doctor about allergic reactions and possible side effects and what to do in the event of a serious reaction. Severe allergic reactions typically include but are not limited to rash, hives, and swelling (of the tongue). Always read the medication information given to you by the pharmacist. He or she is also a good source of information on medications.

The most common and less serious side effects are typically nausea, diarrhea, blurred vision, sleepiness, insomnia, dizziness, or headache. These usually go away in the first week or two. If any side effect becomes severe or you simply have concerns, contact your doctor or go to the ER. Know the possible side effects and allergic reactions of your medications. You should always know the name of your medication, frequency, and the dosage in milligrams. Carry a card in your wallet that will tell emergency personnel exactly what you are taking. If you have questions or concerns, direct your questions to your doctor or pharmacist. Dial 911 or go to the emergency room for serious allergic reactions and side effects. Ultimately, the more you know, the safer you will be.

Mental Illness is a disease very much like diabetes. It takes insulin to manage diabetes; it takes psychiatric medication to manage severe depression and other mood disorders. Some say you just have to be tough. “You just have to pull yourself up by your bootstraps and try harder.” This is false and it won’t work. The only way to successfully manage a mood disorder is with education, medication, structure, ongoing treatment and support.

Always contact the doctor when faced with positive (active) symptoms. Do not self-medicate. A doctor never operates on himself or his own family. Don’t play doctor! Remember, the leading causes of relapse are medication non-compliance and drug and alcohol use. The doctor can’t possibly medicate you properly if he does not know honestly what the patient is or is not taking including alcohol or substance use!

Rule of thumb: Never lie or withhold information from your doctor or therapist.

It is extremely important to learn to make healthy choices. Sometimes people do not recognize that the choices they make may not be healthy. Once stable and consistent, some people simply need to check-in with their therapist a few times per year. Others need ongoing supportive therapy every two to four weeks to remain stable. The frequency will depend on the individual and how well one manages their disorder. Together with your doctor, therapist, and ancillary supports, if necessary for dual diagnosis, you can learn to manage your symptoms and cope with the day-to-day stress of depression, mood disorder, or dual diagnosis. This is the reason that ongoing support from your doctor and therapist is essential for management.

You should call your doctor, 911 or go to the hospital if you are experiencing medication side effects or an allergic reaction. If you have thoughts of hurting yourself or someone else call your doctor and therapist immediately. If you are actively considering hurting yourself, call 911, go to the emergency room, or call the National Suicide Prevention Helpline, 1-800-SUICIDE (1-800-784-2433).

The Leading Causes of Relapse

The causes of relapse to active symptoms of a mental disorder have been well documented over the years. It’s no surprise that these reflect the relapse warning signs listed below.

They are:

  • Medication non-compliance (Not taking the medication as prescribed).
  • Alcohol and substance use and abuse.
  • Little or no sleep.
  • Lack of social support.

Non-compliance with medication and alcohol or substance abuse are by far the leading causes of relapse to symptoms. These are self-explanatory. However, little or no sleep and lack of social support may also need to be addressed.

Sleep is an important issue for most with mood disorders. People with Bipolar disorders usually report that they don’t need much sleep. They have a tendency to play with their sleep/wake cycle. They like the euphoric hypomanic feeling that lack of sleep creates. It is very much like the moth and the flame. There is an attraction to the high that one gets when they are sleep deprived. Unfortunately, you can take anyone in the world and keep them awake for two, three or four days, they will become actively psychotic or out of touch with reality. For people with a mood disorder, sleep is a mental health issue.

Social support is also very much a part of maintaining good mental health. Even if one is compliant with medication and not using or abusing alcohol and drugs, social isolation can create considerable stress and ultimately cause a relapse to symptoms. It is imperative that people with mental disorders, have an avenue to combat their tendency to isolate and withdraw from people. I encourage my clients to maintain regular social contact. This contact creates reality testing. We don’t think of socialization as reality testing, but it is. For example: You have an argument with your spouse; you call a friend and say here is what happened. What do you think? You get feedback on your situation and behavior. That is reality testing. Lack of social support may result in an inability to test the accuracy of what one is feeling or experiencing. This is obviously a very important component of maintaining good mental health.

Relapse Warning Signs

Be aware of relapse warning signs and symptoms. When one is taking medication as prescribed by the doctor, symptoms are largely under control and the client is stable. The reappearance of certain symptoms is an indication that the medication may need to be adjusted, reevaluated or changed. These symptoms may also be an indication that the medication is no longer being taken as prescribed or alcohol and substance use is interfering with the effectiveness of the medication.

Relapse warning symptoms include:

  • Thoughts about hurting oneself or others
  • Changes in one’s sleep/wake cycle, especially little or no sleep
  • Inability to concentrate, rapid speech, skidding from subject to subject
  • Rapid mood fluctuations, mania, or depression
  • Poor judgment, risky behavior, or lack of insight into one’s own behavior

These symptoms are reflected by poor daily functioning, lack of motivation, loss of interest and conflict. These are considered to be active symptoms and usually are caused by non-compliance with medication and use of alcohol or drugs. In many instances, the medication may need to be changed or the dosage adjusted by the doctor. This may also reflect the need for family members to monitor medication compliance and alcohol/drug usage. Relapse warning signs should be reported to the doctor and therapist immediately. Don’t wait!

Zoom!

Now I can work via zoom with anyone, anywhere in the country and it will 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   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.

Find the right medication for depression through genetic testing!

By James E. DelGenio MS, LCPC

Medication with supportive psychotherapy is most effective treatment of clinical depression. Most people go to a psychiatrist for their disorder and get on medication and in a two or three month process they feel significantly better.  As a therapist with over 35 years of experience, I have also seen some that struggle to find the right medication at the right dose for their disorder. I have seen this process take as long as 18 months.  This leads to frustration and possibly discontinuing treatment. Now psychiatry can take some of the guesswork out of the medication process. Genetic testing through GeneSight 866-757-9204 can help you and your doctor find the right medication for your body chemistry.  Call GeneSight for more information.

Note: I have no relationship with GeneSight; I just hate to see the struggle to find the right medication at the right dose.

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   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.

Q & A Mood disorders with substance abuse

By James E. DelGenio MS, LCPC

Mood Disorders and relationships disorders.
Questions and Answers

1. What is a mood disorder?
2. Why shouldn’t you drink alcohol if you are not an alcoholic?
3. Why are depression and alcoholism often found in the same individual?
4. What is dual diagnosis?
5. What is addiction?
6. What are the symptoms of a mood disorder?
7. What are the symptoms of addiction?
8. How do these disorders interact with one another?
9. Can a mood disorder be compared to a physical illness?
10. How does a mood disorder affect thinking and behavior?
11. What should you report to your Psychiatrist?
12. Will you have to be in treatment the rest of your life?
13. Why is medication compliance so important?
14. How do you cope with the past?
15. Why are recreation, exercise and socialization so important?
16. What if you don’t feel motivated to do the things suggested here?
17. What are relapse warning signs aka positive symptoms?
18. What are the negative symptoms of depression and mood disorders?
19. What are the causes of relapse and regression to symptoms?
20. When should you call your doctor, 911 or go to the hospital?
21. What do you do if you can’t sleep?
22. What is the role of the family in treatment?
23. What can family members do to minimize the risk of relapse?
24. How can family members learn to cope?
25. Who is responsible for your happiness?
26. What are the goals of treatment?
27. Why is psychiatric medication useful in controlling symptoms of depression?
28. What if you are inconsistent in taking your medication?
29. What are the possible side effects of psychiatric medication?
30. What are the benefits and purpose of psychiatric medication?
31. What does one do if there is a medical emergency?
32. Where does one go with questions about psychiatric medications?
33. Should the client or family adjust medication dosage if symptoms reappear?
34. How does one learn to make healthy choices?
35. How to be well.

1. What is a mood disorder?
Mood disorders are defined as people experiencing mild to severe depressive
disorders, bipolar disorders, anxiety disorders, phobias, personality disorders and
other disorders including alcohol or drug abuse or dependence. (Brown, Wang and
Safran, 2005)
Depression and other mood disorders have become more commonly accepted by society generally and thanks, in part, to high profile actors and professional athletes who have disclosed their disorders to the public. Clinical depression and mood disorders are biological/genetic problems that you most likely inherited and are considered no different than the diagnosis of other medical conditions such as diabetes or epilepsy. All require education, medication and ongoing treatment. These disorders are usually manifested in the teens and as late as mid 30’s.
I use two very different definitions to describe these disorders. The first reflects denial of a problem and the second reflects acceptance of what is. Which one will you choose?

The first definition is as follows:

A Mood Disorder is a lifelong disability, episodic in nature that may cause chronic dysfunction, asocial behavior and failed relationships. 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 people symptom free.
Episodic means that sometimes the symptoms are worse than at other times for no apparent reason though stressful life events can also have an impact on symptoms.
Chronic dysfunction includes inability to manage day-to-day events, unemployment and often failed relationships.
Asocial Behavior is that behavior which is irrational, inappropriate showing poor judgment and a lack of insight into one’s own behavior. This can include poor self care and appearance. It may also include behavior that is harmful to self or others. Failed relationships include: social dysfunction, isolation, withdrawal, marital conflict and divorce.

The second definition is as follows:

A Mood Disorder is a lifelong disability, episodic in nature that the individual can learn to manage with medication, if necessary, education and coping skills.

In some severe instances, denial of these disorders can create frequent psychiatric hospitalization which can result in a revolving door syndrome in which a person spends their life going in and out of hospitals.

The two definitions are separated only by education, psychiatric treatment and ongoing therapeutic 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?

2. Why shouldn’t you drink alcohol if you are not an alcoholic?
Where mood disorders are concerned use is the same as abuse! It impairs functioning and it affects thinking, behavior and relationships. Alcohol and substances such as marijuana and cocaine 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 heavily you affect that level. It may even precipitate a hospitalization. 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!

3. Why are mood disorders and alcoholism often found in the same individual?

The answers here are not completely understood. Some doctors have told me that the sites in the brain that are affected by mood disorders 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 abuse or dependence. If you have a mood disorder, you shouldn’t have any! The consequences are just not worth it.

4. What is Dual diagnosis?
Dual Diagnosis means that two or more independent disorders exist in the same individual. Specifically, for our purposes, when I speak of dual diagnosis, I am referring to mood disorder and alcohol dependence. Each exists independently of one another and yet each makes the other worse. Both are biological and psychosocial disorders with similar symptoms. They are lifelong disorders, which cause the person to be prone to relapse. Both require integrated treatment that includes psychiatric treatment, medication, psychotherapy, education, symptom management and additional supportive treatment such as Alcoholics Anonymous or Narcotics Anonymous.

5. What is addiction?
An Addictive Disorder is the preoccupation with acquiring alcohol and/or drugs,
compulsive use of alcohol and drugs despite adverse consequences and a pattern of relapse to alcohol and drug use despite the reoccurrence of adverse consequences (Miller, 1991).

6. What are the symptoms of Depression/Mood Disorder?
Depression and bipolar disorders is a biological disorder that can usually be traced through family history whether it was formally diagnosed or undiagnosed. Check the symptoms under A and B with a check mark. If you have five or more related symptoms, discuss these symptoms with your Psychiatrist or Therapist.

A. Symptoms of Depression
1. Lack of pleasure, loss of interest and energy.
2. Lack of goal directed behavior.
3. Lack motivation, lethargy.
4. Inability to structure time, poor concentration.
5. Anger, hostility, irritability.
6. Strained relationships, marital issues, divorce, loss of friends.
7. Withdrawal, isolation, would rather be alone.
8. Difficulty in getting along with people.
9. Sleeping to much or too little.
10. Anxiety, worry, sadness, low mood.
11. False beliefs, negative thinking, rumination.
12. Feeling guilty, stressed or hopeless.
13. Poor self care including hygiene and diet.
14. Aches, pains, dizziness, headaches, or stomach aches.
15. Unintentional weight loss, gain.
16. Crisis prone, police involvement.
17. Low sex drive.
18. Thoughts of suicide, homicide.

B. What are the symptoms of a 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..
These symptoms may also include some of the above and in addition;
1. Rapid mood fluctuations.
2. Feeling high, euphoric or having inflated self-esteem.
3. Irritability, hostility, aggressive or risky behavior.
4. Pressured, fast speech, more talkative than usual.
5. Racing thoughts, skidding from subject to subject.
6. Delusions of grandeur, grandiose beliefs or behavior.
7. Poor judgment, lack of insight, false beliefs.
8. Poor self control.
9. Little or no need for sleep.
10. Increased activity, sexual drive and impulsivity including spending.
11. Easily distracted, poor concentration.
12. Alcohol and substance abuse.
13. Bizarre dress and appearance.
14. 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 psycho-education, symptom reduction and management, 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 good communication.
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.
Bipolar II is characterized by milder swings of mania and depression and may have less serious effect on daily routines, relationships and employment issues associated. Both forms need treatment and medication to manage the symptoms well.

7. What are the symptoms of addiction?

Depression, anxiety and panic
Psychosis – hallucination, delusions, thought disorder
Irritability, mood changes, racing Thoughts
Memory Loss, confusion,
Drowsiness, slurred speech
Euphoria
Constipation, itching, hives
Restlessness, Insomnia, tremor
Diarrhea, cold sweats
Dilated pupils, tearing, nausea, vomiting

8. How do these disorders interact with one another?

Depression/mood disorder and alcohol and substance abuse do not interact well. In fact, each makes the other worse, especially when one is using and/or not taking medication as prescribed. One must manage both disorders simultaneously and treatment must be a collaborative effort with the level and the array of services necessary to maintain stability, sobriety and consistency.

9. 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 Mark had a heart attack.
Fortunately, there was little or no damage to his heart. What was discovered,
however, was that Mark’s blood sugar was elevated. He was diabetic. When Mark
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 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.

Mood Disorders, addiction 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
manageable handicaps; not the global disability it is for some. It is a result of
genetics, an imbalance in the chemistry of the brain. No one is at 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.

10. How does a mood disorder affect thinking and behavior?

The symptoms of mood disorder and addiction are very similar. In fact, the
treatment is also similar. Once medically detoxified, a person with mood disorder
may be prescribed the some of same medications as in the treatment of substance
abuse. It often takes a year or more of sobriety to determine if the person is
suffering the effects of addiction or mood disorder or both as in dual diagnosis. You
may have heard of the term dry drunk. This refers to someone who is alcohol free
but has not addressed the accompanying mood disorder. This includes irritability,
hostility and relationship issues.

11. What should you report to your Psychiatrist?

The Doctor is part of the team. S/he needs your honest input to best help you. If any
of the following are problematic, report them to the doctor. Write things down. See Stability, Symptoms, Medication, and Education Review)

Report on:

1. Medication education needed and compliance.
2. Changes in your symptoms including:
A. Sleep patterns
B. Mood
C. Concentration, poor short term memory
D. Disturbing thoughts
3. Drug and alcohol use.
4. Medication side effects or allergic reactions.
5. Social activity or isolation.
6. Poor self care.
7. Physical activities, hobbies, chores.
8. Poor money management.
9. Unusual behavior.
10. Thoughts of self harm or threats to others.

12. Will you have to be in treatment the rest of your life?
I would like to say no but many remain on medication their entire life. Therapeutic support may or may not be necessary after a time, depending on how well one learns to manage their disability. I have clients who see me a few times per year just to check in and reinforce their self management. Some people with severe mood disorders may go in and out of the hospital their entire life if they remain in denial. This is usually a result of non-compliance with treatment and medication combined with alcohol and/or substance abuse. I try to point out that though you are not sitting in a wheel chair; it is not as visually obvious a disability but if you have a mood disorder you do have a disability. Mood disorders and addiction can be a global disabilities or manageable handicaps. Which one will you choose? Medication and ongoing supportive treatment may be essential for maintaining healthy functioning.

13. Why is medication compliance so important?
The number one cause of regression and reoccurrence of symptoms is not taking medication as prescribed. This is not like having a headache. When you have an ordinary headache, you take two aspirin and twenty minutes later your headache is gone. In order for antidepressant medications to work effectively, one must maintain a certain level in the body. When that level in not maintained, debilitating symptoms reappear. These medications take four to six weeks to reach their peak level effectiveness. When you miss doses of medication you negatively affect that level.

14. How do you cope with the past?
Many people with mood disorders have difficulty coping with the past. Sometimes they appear to be living in the past, unable to get over some stressful life event. This needs to be explored with your doctor and therapist. Once this is done, 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.

15. Why are recreation, exercise and socialization so important?
It is good to have fun. Have fun! People with mood disorders often become engrossed in the past, their illness and problems. Recreation and exercise (especially walking) are good for depression and anxiety and are a great distraction when one is experiencing symptoms. Distraction from symptoms is an important coping skill. Internet, video games, TV or reading generally do not qualify as distraction or most individuals.

16. 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 with your doctor’s permission. Pick your days and let the day of the week make the decision for you. 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 mood disorder but especially lack of motivation. (See how to be well.)

17. What are relapse warning signs or positive symptoms?
Relapse warning signs are also known as positive symptoms. They are positive because they are present, active and uncontrolled by medication. These symptoms are typically a result of medication noncompliance or alcohol use. Without intervention these symptoms can have serious impact on thinking, judgment, and behavior and may also include: psychiatric hospitalization, self injury and harm to others or the community.

Relapse Warning Signs reflect symptoms that include:
1. Thoughts about hurting oneself or others.
2. Changes in one’s sleep/wake cycle, especially little or no sleep.
3. Inability to concentrate, rapid speech, skidding from subject to subject.
4. Rapid mood fluctuations, mania or depression.
5. Poor judgment and risky behavior.

18. What are the negative symptoms of depression & mood disorder?
They are the symptoms that are most often missing in the individual. They are characterized by the absence of:
1. Lack of motivation or goal directed behavior.
2. Lack of pleasure.
3. Lack of Insight.
4. Poor judgment.
5. Poor self care.
6. Poor hygiene, self care.
7. Lack of emotional expression.

These symptoms are only partially controlled by medications. They are often what are left when positive symptoms are controlled. It is for this reason that persons with a mood disorder still need education, psychotherapy and supportive therapy.

19. What are the most common causes of relapse and regression to symptoms?
1. Medication noncompliance
2. Alcohol and/or substance use or abuse
3. Little or no sleep
4. Social isolation
5. Family conflict

20. When should you call your doctor, 911 or go to the hospital?
Call your doctor or pharmacist if you are experiencing medication side effects or an allergic reaction. When you are thinking of hurting yourself or someone else call your doctor and therapist. If you are actively considering hurting yourself call 911, go to the emergency room, or call the National Suicide Prevention Helpline, 1-800-SUICIDE (1-800-784-2433).

21. What do you do if you can’t sleep?
Little or no sleep is a relapse warning sign. Depression, mood disorders and dual diagnosis cause sleep/wake problems. First stop drinking caffeinated beverages or foods containing caffeine. Don’t nap during the day. Take your medication as prescribed. Maintain abstinence from alcohol and substance abuse. Always discuss your sleep issues with your doctor. Insomnia can be a precipitating event for relapse to active symptoms and possibly self harm or harm to others. In this event, call 911 and/or your doctor.

22. 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 call a health care professional or the police immediately if you or a family member has any of the following symptoms, especially if they are new, worse, or worry you:

1. When the person does not take their medication as prescribed.
2. The abuse of alcohol, substance abuse or medications not prescribed by a
doctor.
3. Depressed mood, irritability, thoughts of suicide or dying
4. Behavior which may result in injury or harm to the individual, family or
community.
5. The presence of any relapse warning signs, especially no sleep.
6. Panic attacks, uncontrolled anxiety or restlessness.
7. Feeling very angry, agitated, or violent behavior.
8. Acting on dangerous impulses.
9. Unusual behavior that is out-of-character for this individual.
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. 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.

23. 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. Use “I feel” statements.
4. Avoid over involvement unless there is alcohol and substance abuse,
medication noncompliance.
5. Avoid excessive pressure to achieve.
6. Avoid trying to help motivate compliance.
These are frequent causes of family conflict and should be discussed with the doctor and therapist.
24. How can family members learn to cope?

Mental illness is no one’s fault. It is a bio-psycho-social problem.
1. Avoid placing blame or guilt.
2. Don’t enable! 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. Join a health club or walk at least 40 minutes on
regularly scheduled days each week. In the winter, use a treadmill or
stationary bicycle.
5. Learn all you can about mood disorders but do not try to be a therapist.
25. Who is responsible for your happiness?

Who owns the problem? Don’t blame others for your disorder or problems.
Remember, a mood disorder is a biological problem like diabetes. If you don’t manage it, it will manage you.
26. What are the goals of treatment?
The goals of treatment of mood disorders are typically as follows:
1. Be evaluated by a professional to identify if a disorder is present.
2. Have a psychiatrist identify the need for medication, if any
3. Take medication as prescribed.
4. Learn about the disorder and to recognize active of symptoms of the
disorder.
5. Learn symptom management.
6. Learn coping skills, especially distraction through structure. Structure
is created by having regularly schedule of activities, hobbies and social
support.
A. Encourage regular socialization.
B. Encourage regular exercise at least 4 times per week
Take a brisk walk at least 40 minutes.
C. Encourage hobbies and attention to daily chores.
7. Be consistent in the use of coping skills.
8. Learn to identify regressive symptoms, i.e., relapse warning signs and
triggers.
9. Learn how to make healthy choices.
10. Learn how to be well.

Generally goals fall into five overlapping areas:
See which ones may apply to you in addition to the ones described above:
1 Medical
2 Social skills and support
3 Coping skills
4. Daily living skills
5. Personal

1. Medical
1 Take medication as prescribed.
2 Report the presence of symptoms, suicidal or homicidal thoughts.
3 Maintain abstinence from alcohol and substance abuse.
4 Avoid caffeinated beverages, especially if sleep is poor.
5 Maintain a healthy diet and daily living skills.
6 Get medical and dental check-up annually.
7 Maintain psychiatric and therapeutic contact.
8 Have lab testing as directed by your doctor.
9 Report your sleep/wake cycle to your doctor.
10 Report medication side effects and allergic reactions to your doctor or ER.

2. Social skills and support
1 Have at least one social activity per week
2 Try to avoid napping during the day
3 Join a club, call a friend, take a class
4 Make plans for the weekend

3. Coping Skills
1 Read goals daily, put a copy on the refrigerator at home
2 Take a brisk walk 40 min at least 4 times per week.
Note: Always consult with your Doctor before starting any exercise regimen.
3 See your doctor, especially when you are experiencing symptoms
4 See your therapist regularly for support.
5 Check in with family and friends regularly and express your feeling
appropriately. Try to avoid conflict.
6 Work on a hobby a half an hour every day or when you are experiencing
symptoms as a distraction.

4. Daily Living Skills
1 Bathe daily
2 Dress appropriately
3 Do chores on assigned days
4 Do volunteer work on assigned days
5 Go to work, be on time
6 Manage your finances

5. Personal
1 Always maintain civility and respect
2 Make healthy choices.
3 Spend quality time with your family and friends.
4 Improve your self-esteem with your therapist.

27. What medications do you take?
You should always know the name of the medication, the amount of medication and the frequency of the dosage. For example: “I take 20 mg of Lexapro in the morning”. This will help to ensure that medications given by other physicians will not be contraindicated. In addition, you should always ask your pharmacist about possible drug interactions. A list of medications and dosages should also be carried on one’s person in the event of an emergency.
28. Why is psychiatric medication useful in controlling symptoms of Mood Disorders?
Mood disorders are considered bio-psycho-social disorders. They affect thinking and behavior and often times create 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 a mood disorder without medication. You can’t build a house without a good foundation. Medication provides that solid foundation.
Therapy addresses the psychosocial treatment issues including: identification and management of symptoms, daily living skills, coping skills and it addresses the relationship issues which often accompanying these disorders.

I do on occasion have clients who refuse medication. In the past, I have either chosen to discontinue treatment or say “we will have five sessions and see if it makes an impact on your symptoms.” If it does, that’s great. If it does not, I will try to deal with the denial. In my experience, I have found that men have more difficulty with the notion of taking medication then do women. What if I told you that, “you are a diabetic and will have to be on insulin injections the rest of your life? Of course, most people wouldn’t like it, but chances are they would take it. Why is this any different? I will also not hesitate to point out that alcohol is a drug and you are self medicating. This may lead to alcoholism or substance abuse and addiction. At some point, I may give up and discontinue treatment. That doesn’t happen very often because I can be very convincing but it does happen.

29. What if you are inconsistent in taking your medication?

The key word here is consistency. The medication is extremely important to
maintaining mental health. It is the foundation of treatment. If you are not consistent taking the medication, you will have difficulty functioning effectively on a day to day basis. This is not a headache. You take two aspirin and twenty minutes later your headache is gone. These medications don’t work that way. Remember, it takes four to six weeks to maximize the therapeutic effect of the medication. You have to build up to a therapeutic level. When
you miss medication, you affect that level. You may need to ask for assistance from family or friends. If you miss more than five pills a year, I consider you to be noncompliant. Always take the medication as prescribed. If you have concerns, contact your doctor.

30. What are the possible side effects of psychiatric medication?

Know that all medications have side effects. Even aspirin can cause ringing in the ears if you take too much. The pharmacy must list all side effects but that does not mean you will experience them. Most of the common psychiatric medications for depression and mood disorder have very few if any side effects after the first week or so. First, ask your doctor about allergic reactions and possible side effects and what to do in the event of a serious reaction. Always read the medication information given to you by the pharmacist. S/he is also a good source for questions about medications.

The most common and less serious side effects are typically: nausea, diarrhea, blurred vision, sleepiness, insomnia, dizziness, or headache. These usually go away in the first few weeks. If any side effect becomes severe or you simply have concerns, contact your doctor or go to the ER. Know the possible side effects and allergic reactions of your medications. You should always know the name of your medication, frequency and the dosage in milligrams. Care a card in your wallet which will tell emergency personnel exactly what you are taking. If you have questions or concerns, direct your questions to your doctor or pharmacist. Dial 911 or go to the Emergency Room for serious allergic reactions and side effects. Ultimately, the more you know the safer you will be.

31. What are the benefits and purpose of psychiatric medication?

Mental Illness is a disease very much like diabetes. It takes insulin to manage
diabetes; it takes psychiatric medication to manage depression and mood disorders.
Some say you just have to be tough. “You just have to pull yourself up by your bootstraps and try harder”. This is false. In my opinion, the only way to successfully manage a mood disorder is with education, medication, ongoing treatment and support.

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

33. Should the client or family adjust the medication if symptoms reappear?

Always contact the doctor when faced with positive (active) symptoms. Do not self
medicate. A doctor never operates on himself or his own family. Don’t play doctor!
Remember, the leading cause of relapse is medication non-compliance and drug and
alcohol use. The doctor can’t possibly medicate you properly if he does not know
honestly what the patient is or is not taking including alcohol or substance use!
Rule of thumb: never lie or withhold information from your doctor or therapist.

34. How does one learn to make healthy choices?

Sometimes people do not recognize the choices they make may not be healthy.
Once stable and consistent, some clients simply need to check-in with me a few times per year. Others need ongoing supportive therapy every two to four weeks to remain consistent. The frequency will depend on the individual and how well one manages their disorder. Together with your doctor and therapist and ancillary supports if necessary for dual diagnosis, you can learn to manage your symptoms and cope with the day to day stress of depression, mood disorder or dual diagnosis. This is the reason that ongoing support from your doctor and therapist is essential for management.

35. How to be well.

Coping with depression or 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 mood disorders can learn to:
1. Take your medication as prescribed.
2. Control symptoms.
3. Remain stable.
4. Have a network of friends and supports and
5. Maintain employment.
I have also found that it takes an average of about one year to reach those goals. In addition, most 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 and a therapist to provide ongoing support. The following is a brief summary of the 10 steps of How to be Well:

How to be Well

1) Take the medication as prescribed by your doctor.
This is definitely a tough one. Many people don’t like to take medication, especially, everyday for the rest of your life but remember, clinical depression 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, substance abuse or alcohol.
People with depression and mood disorders 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 wreaks havoc with 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 use it! Alcohol is a depressant. You are already depressed. There is a negative correlation between casual use of alcohol, drug use and mood disorder. The increased chance of dependence and risk of relapse to symptoms are just not worth it. 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 Alcoholics Anonymous or Narcotics Anonymous meetings as often as it is necessary to maintain sobriety.

Note: Some Doctors and even therapists say that it is OK 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 taking an anti-depressant under any circumstance?

If you chose to disregard my position, I strongly recommend that alcohol use be infrequent and on special occasions. The use of alcohol should be limited to one or two drinks at most. I suggest that you to monitor your mood in the days that follow. Look for increased depression, disturbing thoughts, anger or irritability. This will tell you if you can have one or two or none.

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) 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 mood disorders 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 two social activities per month 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 4 times per week for forty minutes. Pick your days and stick to them as much as you can. It is widely accepted today that walking reduces anxiety and 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 were a child, it didn’t take much to have fun. You simply go outside and find some other kids and the party is on, so to speak. As adults, 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 mood disorders 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 and help structure your day. When no one else is around or when you are experiencing negative thoughts, feeling low or just plain bored, a hobby fills the bill. 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 a half an hour 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 schedule. This is not about how you feel. If you felt good, you wouldn’t need to do this. 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 active symptoms or psychiatric hospitalization. I could take anyone in the world; if I kept them awake long enough, they would lose 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 to active symptoms.

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. For example, if you have a mood disorder, poor sleep, alcohol use, medication compliance and exercise are mental health issues. Remember! You manage it or it will manage you.

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 gradually discontinuing caffeine before asking the doctor for a sleep aid. Avoid caffeine for one week and see if you don’t feel and 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 days, even 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!

Issue 3 Medication Compliance:
Typical response: “I don’t miss often; maybe once per week.” This is not headache; for the medication to be effective it must be taken daily as prescribed.

Issue 4 Exercise:
Typical response: “I just don’t feel like doing it; you know I’m tired when I get home.” Walking or cardiovascular work for forty minutes at least four times per week or anytime you fell low or anxious lifts your mood and reduces anxiety. Take responsible for your wellness. Always check with your doctor when starting an exercise program.

Zoom!

Now I can work via zoom with anyone, anywhere in the country and it will 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 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.

Issues to discuss before Marriage. What you will learn in premarital counseling?

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

Premarital Counseling is a really good idea! 

Premarital counseling can help ensure that you and your partner have a strong, healthy relationship. This will give you a better chance for a stable and satisfying marriage. Premarital counseling can also help you identify weaknesses that may become larger problems during marriage. Good marriages don’t happen by accident. Many issues can be resolved prior to marriage with the help of a therapist. Common issues addressed may include work, finances, lifestyle, spending habits, credit card balances, student loans, savings, retirement planning, roles and responsibilities, children, parenting, in-laws, and leisure and fun. Marriage requires an understanding of yourself, your future spouse, and the tools and skills you need to make it work.

Does your significant other have a Mood Disorder?
Some moodiness is a part of everyone’s life; sometimes we feel happy, other times we are sad; some days we have lots of energy, while at other times we may be fatigued and unmotivated. When mood changes interfere with your ability to function, work or go to school, when they harm your relationships significantly, when they cause you to miss sleep, abuse drugs, or behave in ways you later regret, or when they lead to risky behaviors, thoughts of suicide, or losing touch with reality, your mood requires professional attention.

If this sounds like you’re intended. All is not lost. The key factor in this decision is Denial. If your partner tends to deny issues now, do you really think it is going to get better later?
I find that most premarital couples are well aware of their intended’s mood and alcohol/substance issues. My main questions are as follows:
Is he/she:
• Willing to seek help?
• In need of psycho-education and symptom management?
• Willing to take medication, if prescribed?
• Willing to honestly address alcohol and substance abuse issues?
• Willing to see a therapist for relationship issues and support?
It’s not going to get better if your intended is in denial. Get out while you still can!

Civility and Respect
Work on resolving conflicts in a civil and respectful way. Lack of civility and respect will eventually be the undoing of any relationship. It is possible to argue, resolve conflicts, and agree to disagree in a respectful manner. In order to do this, all couples need rules of engagement for conflict. It is important that couples express how they feel, but this needs to be done in a very caring and respectful manner. This definitely means there should be civility and respect when conflict occurs. That means no hitting (of course), no yelling, no swearing, no screaming or name calling or sarcasm. I encourage you to look at yourself and your relationship with your intended. Are you holding onto resentments? If so, you will need a therapist to help resolve this and teach you how to fight with civility and respect.

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

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.

Signs you are falling back into depression?

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

1. Negative rumination. Negative thoughts that feel like they are on repeat, over and over again.

2. High anxiety.   Feeling like you want to jump out of your skin. Inability to relax.

3. Isolation and withdrawal. Prefer to be alone, avoiding people in general and friends. Failure to return calls from friends and family.

4. Sleep issues. Unable to get out of bed. Sleeping too much or too little.

3. Poor hygiene.   Not showering, brushing teeth, combing hair or wearing clean clothes.

4. Tearful. No particular reason for crying. Feeling low.

5. Poor concentration.  Inability to concentrate on the simplest of tasks.

6. Poor short term memory. This goes hand-in-hand with poor concentration.

These are know as active symptoms and usually indicate that the medication is not being taken as prescribed or that the medication needs to be adjusted or changed. Alcohol or drug use may also render the medication ineffective. Contact your doctor immediately.

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

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 Benefits of Premarital Counseling?

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

The Benefits of Premarital Counseling.

Premarital counseling can help ensure that you and your partner have a strong, healthy relationship. This will give you a better chance for a stable and satisfying marriage. Premarital counseling can also help you identify weaknesses that may become larger problems during marriage. Good marriages don’t happen by accident. Many issues can be resolved prior to marriage with the help of a therapist. Common issues addressed may include: mental health issues, work, finances, drug and alcohol use, lifestyle, spending habits, credit card balances, student loans, savings, retirement planning, roles and responsibilities, children, parenting, in-laws, and leisure and fun. Marriage requires an understanding of yourself, your future spouse, and the tools and skills you need to make it work.

Does your significant other have a Mood Disorder?
Some moodiness is a part of everyone’s life; sometimes we feel happy, other times we are sad; some days we have lots of energy, while at other times we may be fatigued and unmotivated. When mood changes interfere with your ability to function, work or go to school, when they harm your relationships significantly, when they cause you to miss sleep, abuse drugs, or behave in ways you later regret, or when they lead to risky behaviors, thoughts of suicide, or losing touch with reality, your mood requires professional attention.

If this sounds like you’re intended. All is not lost. The key factor in this decision is Denial. If your partner tends to deny issues now, do you really think it is going to get better later?

I find that most premarital couples are well aware of their intended’s mood and alcohol/substance issues. My main questions are as follows:
Is he/she:
• Willing to seek help?
• In need of psycho-education?
• Willing to take medication, if prescribed?
• Willing to honestly address alcohol and substance abuse issues?
• Willing to see a therapist for relationship issues and support?

Rules of Engagement
All couples need rules for fighting. The most important rule is civility and respect. This, of course, means no hitting or throwing ever. If there is physical violence, you must call the police. Beyond that essential rules are no screaming, swearing, or name calling ever. This is destructive and may lead to your undoing as a couple. Couples need to work on resolving conflicts in their relationship with civility and respect so that bitterness and resentments can not build. It is possible to argue, resolve conflicts, and agree to disagree. In order to do this, all couples need rules of engagement for conflict. Establish your rules!

Finances and Spending
One of the biggest causes of problems in relationships is differences in values and goals and habits when it comes to money, and especially communication about money issues. That old saying is true …. money can’t buy you love, but it sure can tear it apart.

This makes a discussion of finances necessary before marriage. Learn how to talk about money, and align your financial goals such as retirement, savings, spending, debt, and disposable income. If you can do those two things, you’ve done more than most couples, and you’ve done a lot to start your relationship off on solid ground.

I therefore, recommend meeting with a financial planner to discuss issues such as spending, use of credit cards and financial goals. Goals should include the following: savings, pension contributions, retirement planning, debt, discretionary spending, school loans and the use of credit cards. How will you handle school loans and debt brought into the marriage? How much money can be spent without consulting the other. I usually recommend $100 to $300.

Family Ties and In-laws
A family is made up of many unique individuals, each with a range of thoughts and opinions on almost every subject and situation. Add to the mix extended family with their countless beliefs and personal opinions and there is no wonder there are disagreements from time to time. Conflict is simply the natural and healthy progression of any relationship

Some questions to explore – What sort of relationship do you have with your extended family? Are they local? Do they like your fiancée? Are they affectionate? Are they over-involved or critical? Have there been any major conflictual issues?

I suggest that couples begin to see themselves as their own family unit. When addressing family of origin, always say that “we” will have to discuss the event or holiday and that he or she should respond to their own family unit. This is especially true once children enter the picture. Now consider, if you want to see us come over………  This way the kids don’t have to get up open presents and get in the car! Now your doing what is best for family.

Religious Beliefs
This potentially contentious issue should always be discussed in premarital counseling. The first step is to seek a better understanding of your future spouse’s religious and spiritual background.
Topics to look into are:
• How to reconcile differing ideologies and practices
• How to observe and celebrate each other’s holidays
• How to raise children so that they are exposed to both partners’ traditions without being overwhelmed and/or confused
• How to integrate both extended families, especially during the wedding/holidays

Case Study:

Mark is not religious; Eileen is and expects to go to Church every week. What if they did marry and had children; would Mark go to Church then?
What if Mark is Catholic and Eileen is Jewish? Will one of you convert? Does it matter at all? What will the respective families say? That is a big question especially in regard to child rearing.

“What do you mean; you are not going to raise the baby Catholic? Jewish?” For some, the consequences of that decision may be long lasting or a deal breaker. It is clearly better to decide before marriage and tell both families about your decision. In discussions with the extended families, always use the phrase “we” have decided.

Children and Parenting
Do you want children? How many and when? Are there already children from previous relationships? Have you discussed blended family issues? What do you expect from your spouse regarding parenting/step parenting roles? When a problem arises, how does my partner communicate? What are the responsibilities of each parent in raising a child?

I strongly recommend that you have two to four years together as a couple before you have children. This time is critical, it gives you the opportunity to get to know one another as a married couple.

Children don’t bring you closer together; they create stress and sometimes distance especially if you and your intended are not on the same page regarding roles and responsibilities. And even more stress when ex’s and step in-laws are in the picture.

Blended families have a lot to discuss: the ex, custody issues, the in-laws, parenting, finances, loans, debt, child support, etc.. They especially need premarital counseling. I am surprised at how often these have not been fully addressed.

I believe that the children don’t come first; your relationship comes first. Now I know that is not true but if you divorce, it will be children that suffer most. Of course, my point is don’t forget to make time for your relationship after you have children. Planning for alone time or date night is a key component in addressing this issue. Take turns planning so the wife isn’t doing it all. But above all – Parent as a team! Be consistent with consequences. Discuss issues prior to discussing them with the children. What to say and how to say it.

Work, Lifestyle, Leisure and Fun
What sort of lifestyle do you want? Will you both continue to work when children are born? Do you have the same idea of what is fun? Where will you want to live?

Today most couples are comprised of two working parents. Couples want to maintain or improve the lifestyle they had going into the marriage. This is difficult in today’s economy and job market. For the first time in history, couples may not meet or exceed their parents’ lifestyle. The common expectations of employment today are long hours and work from home in the evening and on the weekend. This reduces quality time together. These forces necessitate compromise and making the most of the time you have together. Planning mutually enjoyable activities and social events and balanced with appropriate alone time is a key component in maintaining a strong relationship.

Final Thought
You may not feel you NEED premarital counseling, but it is still wise choice to consider. You may be on cloud nine with the impending marriage but counseling may help bring up and resolve some difficult topics. Better to discuss issues before marriage then with a divorce attorney later.

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

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

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

Have Anxiety? Learn a simple relaxation technique!

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

Learn how to relax!

Most people experience tension; knowing how to relieve that tension can help prevent or reduce anxiety, headaches, back pain, high blood pressure, and a number of other stress related symptoms.

Listed below are some simple techniques for reducing anxiety that gets in the way of your happiness.

Position: Find a comfortable chair, preferably a reclliner or chair with an ottoman and a headrest where you will not be disturbed for at least 10 minutes. Loosen any tight clothing you may be wearing. Assume a comfortable position; let your hands rest comfortable at your sides. Open your mouth slightly, let your lower jaw hang loose, drop your shoulders, let your chest collapse and your stomach stick out. Breathe slowly and smoothly. Close your eyes; do not fall asleep; do not cross your arms or legs.

Breathing: Inhale through your nose, exhale through your mouth. Become aware of your breathing. Allow your exhale to be slow and easy. As you breathe out, say the word “ one” to yourself. Repeat this for several minutes, thinking “one” on each exhale. Imagine that each slow exhale the tension is leaving your body. When you finish, sit quietly for a few minutes at first with your eyes closed before you get up.

Imagery: When you close your eyes, clear your mind. Go off on a mental trip to a pleasant peaceful place where you feel relaxed, safe, and free of worries or concerns. Stay there several minutes and savor the experience. You can imagine this trip to you restful retreat whenever you feel tense or anxious. It is your private tranquilizer.

Here are some ways to install relaxation practice in your daily routine:

1) Make your daily relaxation practice a ritual; select two regular times each day for about ten minutes at a time and stick to your plan.
2) For instant relaxation remind yourself by sticking a colored dot on your watch so each time you see it you will be reminded to relax.

Note: Using any relaxation technique takes practice; the more you practice the better you will get at this natural form of tension reduction. It is a safe, effective, drugless way to relax. Try it!

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 LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638 for more information.

http://manageyourmood.net
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.

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.