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