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THE BIPOLAR DISORDER SURVIVAL GUIDE What You and Your Family Need to Know DAVID J. MIKLOWITZ, PHD © 2002. The Guilford Press A Divislos of Guilford Publications, tne Spring Sipe, New Yok, NY 10012 Lexan sn gi All rights reserved The infrmation in this volume os not inteaded 48 2 subsite for consultation with healthcare ywatessinnals, Fach indivicual’s hale concerns should be cvaluste by a quulified professions. [No ya of rhis book may he reprodneed wanslated, sired m 8 retrieval system. or temusiteed, in say form ur by any mans, lectronin, achanwcal, photseepying, icraiing, recording, corherence, wthant writen permtason fram the Publisher, Printed in che nated Stes of America Ths busk fs printel on acilree paper 6 Last digit i print somber: 9 ibwary of Congress Cataloging-hy Publication Data ildewsite, Davkt fay, 193 Thi: Pipalae dlsowder survival guide: what sen and yur Family net te knoe ? avid J. Mildowitz pen Includes Iibfingraphia! references and inde ISBN 1572307129 (clotl)—ASBN 1-57230525-8 (phke} 1. Manisatapreasice illness —Popitar works, 1 Tite RESUE M352 2001 616.89" —de21 2001040037 Contents Preface, PART 1 The Diagnosis and Course af Bipolar Disorder 1 Why 130 t Need this Book? 2 What Bipatar Disorder Leaks Like to You, 10 the Dacturs, and 10 Fveryane Flse 3 Into the Doctor's Cow what 10 Fxpect from the tagnostie Pracess 4 Is Tt on Ilness or Is Tt Me’: Tips om Coping, with the Diaygusis PART I] Causes and Treutmonts 3 Where Does Bipolar Disorder Came From?: Genetics, Biology, and Stress 6 What Can Medication and Psychotherapy Do for Me? 7 Coming to Terms with Your Medication Goma, PART 11D Self-Management 8 How Gan I Manage My Disorder? Practical Ways to Maintain Wellness What Cun I Dy IFT Think Fm Getting Manic? 1 What Can 1 Do if T Think Fm Geiting Depressed? 11 Dealing with Suicidal Thoughts and Feelings 12 Coping Effectively in the Family and Work Settings Resources lor People with Bipolar Disorder References ndes About the Author Preface | first became imeresied in bipolar disorder in 1982 when, as a Tredocroral psychology intern at the University of Calvtornia, Los Angeles {UCLA} Medical Center, 1 supervised a bipolar support group with « fellow intern, The assignment was a challenge, bur 1 was immediately struck by how the members of the group—men and women ranging in age [tot 19 to 50— had discovered, quite independently, how to deal wth their Mlness. They had deatned to ask for medical wad social suppost whem the carly sigins of recut renees first speared, 10 tely on their significant others for emotional suppor, anil to separate theniselves [rom the disorder and fight ils stigma. All of them turdersiood that lealing fulfilling lives required more than just 1aking «medica tion, The experience inspired me 10 choose a PHD dissertation nm shis disorder, specilically abou family relationships among late adolescenes and yng adults who were recently out of the hospital. In the 15 years sce, L have med for, or amervised the care ol, several hundred people with bipolar disor- ler and their families in the context of my research studies and cluucal prac- rive. People have come to my office in a vanety of clinical states, each person with his or her own unique expression of the disorder and «ique belies about how it should be treated, the factors in his or her genetic, biologeeal, or tumily background that catsed it, and what it meant for the future. Many have hada love-hate relationship with the illness: they have cherished the intensity of the emotional experiences that mania provides but hive detested the tow periods, the dliserder’s unpredictability, and the emotions, practical, sod fi- ramcial dumage done t0 their Lives wi Pee My long-term collaboradon {1979-1997) with the Yate Michael Goldstein, PHD, of UCLA resulted in the development of family-focused therapy, an edu- cational intervention tht assists people with the disorder and their family members in coping dtnng the petiods after an illness episode. My expenmen- lal studies al che University of Colorady, and those of my UCLA cullewgnes, showed that people who receive Gamily-Tocustd therapy and medivation have lower rates of relapse and less Severe symptoms than peuple who receive inch- vidual supportive care and medication. Their improvements can be observed. for up to two years after [hey began family treatment, These stuches, finnded by the National institute of Mental iTealth and the National Allistice for Research on Schizophrenia and Depression, have inchueléd more than 150 people. The participants have ranged in age froin teenagers to retirees; from penpke experi- encing their firse manic ar depressive episnde.co those who have heen ill for rose of their lives; from peuple far whom the disorder poses only occasional lite problems to those who are chronically in and out of hospitals; and people in a wide variety of icing situations and fomily contests Liwrote this book to respond to a need voiced by virtually everyone with schons | have worked, along wich their family members. People with the disorder wish for more understanding from relatives, friends, and coworkers. Uheir family members, in turn, want (0 know how hest to help thew bipolar relative seithout becoming angry. contolling, or overprotective. Both ask the core question dus book atteinpts to answer: How can people with the disorder achieve beter mood stability sand keael more Fulfilling tives, while taking medication and dealing with the realities the illness imposes? tis iny strong belie! that people who do best with the disorder are those who thave learned ta recognize Uiggers for their mand egclgs and how ro uninic rilze the impact of these triggers. They are people who scay close to their rec- ommended medication tegimens and have. good relationships with their phy- sicians. They have regular therapists. nr gn co support groums, They have earned as much as they can about the ness. go to conferenees where the latest findings about the disorder are presented, ralk with athers wha have the illness, and read books and articles concerning the latest treatments. They hhave learned to accepr the disorder but do not unnecessarily limt their per- somal gouls because of i At that bipolar support group ycars ago, Twas impressed by the members! ability and veillingness to take care of cach other as well as themselves, One gfonp member regularly made trips to the local hosputal mpatient unit 10 tell parients with the disorder aboue the advantages of oblaining medical and psychosocial treatment at the UCLA Alleclive Disordets Clinic, When a cem- ber of the geoup starled lo cycle into an episode, olhers were quickly able lo Meo recognize the early wating signs and olfer assistance, Members were some- fimes blunt with each orher but would sey chings thar needed 11 be sai. ¥ like co think of this book as performing the same function as chat suppore group. Ic is my sincere hope thar after reading, it, yor will feel less alone in your struggles, realize thar there are effective rreatments available, and have at your fingertips strategies to prevent mond swings frem ruling ‘your life. | hope this hoole will tell you che things thar need ro he smd and that you'll use them to your benefit, even if you dow't always want co hear them, Mose of all, | hope you and your family members will become eon vvinced that yeu cam lead « full life and achieve many of your personal goals despite having the disorder. A Word of Thanks Many people deserve my lkeartfelt appreciation for suppurting me in writing this hook. feel especially grateful to my collaborators, Ellen Frank, PhD, and David Kupfer, MD, af rhe University of Pittsbangh Schaal of Medicine, for their clinical wisdom and their encouragement of my research. ‘The iliness management tools ourlined in this book—educarion, relapse prevention, ef fective communication and problem solving, relving on social supports, and social rhythm stabslization—in many ways reflect a synthesis of family- focused therapy principles and their interpersonal therapy approach to help- ing people cope more eflectively with lnpolar disorder, Many tachers and clase colleagues have been inspirational throughout my carcer and have strongly influenced how L think about clinical problems: Michael Goldstein, PAD, lan Falloun, MD, Keith Nucchtlein, PRD, Rasmond Knight, PhD, Connie Hammen, PAD. W. Edvard Craighead, PRD, Gary Sachs, MD, Michiel Thase, MD. Steve Carter, PAD, Lyman Wynne, MD. Robert Liberman, MDD, Michael Gitlin, MP, and Kay Jamison, PhD, My graduare sti denis and posidoctaral fellows at che University af Colorado are ofien the firs losuggest clinical scrategies for working, with individuals ar families, and their research has often influenced the direction of my ovm. They have inchaded Elizabeth George, PhD, Tei Simoneau, PRD, Dawn ‘Tayler, PhD, Jeff Richards, MA, ‘Tina Goldstein, MA, Naralie Sachs Encsson, PhD, Jennifer Wendel, MA, Kristin Powell, PhD, and Apama Kalhag, PhD. Colleagues with, schom [ collaborated at UCLS hold a special place in my heart, mcladng, Margaret Rea. PAD, Angus Strachan, PhD), Marrha Tompson, PhD. fine Mintz, PHD, Amy Weisman, PAD, attd Sun Twang L would like to extend special appreciation to several (ciends and ool- x foc Teagues who commented on early drafts of the manuscript and, in many casts, suggested addtionat material; Lon Allshulér, MD and Richard Suddalh, MD (notably for their help with the medication chaptots), Sher! fohason, PhD, Joseph Goldberg, MD, Greg Carey, PHD, Daniel Barth, PhD, and Robert Spencer, Phi? ‘Many thanks go to memibers of my family— Mary Yaeger, my dangheer ‘Ariana, and my brother, Baath Miklowitz, aud his family—all af whom have, ‘brought me gresr joy and reminded me that life is not just about work. My mother, Gloria Miklowite, who has published ever 50 books, has heen a source of inspivarion during the often difficult process of writing, this bok, The memory of nay father, Jalius Miklowitz, a professor who taught me. the value of research, hard work, ond a Ife of learning, has guided me throughout my academic Kile Tinally, L would like lo express my sincere gratitude to two of the most talemed, patienl, and kaowhedgeable editors in Uke universe—Kitty Moore anid Chris Benton of The Guilford Press, Their imprint appears throughout the book. Without their encouragestent, tenacity, and support, unis project would gver have come to fruition. Thave enjoyed writing this book and wish you success in your personal journey through the ups and downs of bipolar disorder Davin J. Mutowrz, PXD PART | The Diagnosis and Course of Bipolar Disorder