Therapy of bipolar disorders
Important information for planning your discharge
After your crisis has improved following the stationary therapy, it is important to plan the discharge. There is a special danger of experiencing a manic or depressive relapse precisely because one is discharged too early or because no sufficient follow-up has been organised. Many persons with bipolar illnesses, especially when they have experienced their first therapy, have difficulties. Here, you will require support employing well-founded knowledge, so that you can actively collaborate with the planning of your discharge.
On the following pages, these subsequent questions will be answered:
- Do I consider myself to be sufficiently stable psychologically?
- Have I been stabilised well on my medication or on various medications?
- Have all physical illnesses been clarified and treated?
- Have all social questions been clarified?
- Do my family and I consider ourselves to be adequately informed?
- My plan for further treatment and therapeutic treatment form
- My weekly plan
- My crisis plan and crisis intervention form
Do I feel as if I am sufficiently stable psychologically?
Psychological stability is always relative. That which is no problem for one individual, can be a great problem for the other. Psychic stability refers not only to manic or depressive symptoms, but also to other symptoms which frequently occur in persons with a bipolar disorder, e.g. fear, psychotic symptoms like hallucinations or delusions, tension or thoughts of doing something to yourself. Take into consideration the fact that your will routinely experience more stress after discharge and that the remaining symptoms can subsequently become more intensive.
If you estimate a value of between 5 and 10 in the scales concerned with "How severe do you estimate your current mania to be?" or "How severe do you estimate your current depression to be?" or "How severe do you estimate your current fears to be?", or if you have filled out the questionnaire dealing with your subjective mental state and have reached a score of 60 points or fewer, speak with your therapist concerning whether the right point in time has already come for you to be discharged.
Important is also whether you have already had the chance to test your psychological stability at home, e.g. during daily visits or when you stay overnight at home. If this has not yet occurred up to now or you are not yet ready for visiting home, speak with your therapist concerning whether a first "test of stress" leave has already been planned or when you could try it out.
Also consider that psychic stability is very dependent on one's current mental state. Do not lose heart if you have simply had a bad day, the next good one will certainly come.
Have all physical illnesses been clarified and treated?
On average, persons with bipolar disorders have a higher risk of suffering from physical illnesses. Included among these are, particularly:
- Cardiovascular illness, like, for example, high blood pressure, tachycardia, arteriosclerosis, etc.
- The so-called metabolic syndrome, including, among other things, excessive weight, elevated blood fat levels (e.g. elevated cholesterol) and an increased waist measurement
- Diabetes mellitus
- Illnesses of the thyroid gland
Ask your doctor, whether there is any reason that the existence of these illnesses has to be clarified (e.g. excessive weight), and if so, whether or not they have already been clarified. Point it out to your doctor particularly if you have observed that you eat more or have already gained weight since beginning with your medication. If an additional physical illness has been diagnosed in your case, discuss with the doctor the possibilities of this being treated with medications and let yourself be transferred to a physician in private practice for further treatment. Should it involve severe medical problems, always let yourself be transferred to a specialist. Also discuss whether alternative modes of therapy are available, e.g. group programmes for controlling your weight, athletic or activity groups, diet counselling, etc. Take the problem seriously, before it becomes a serious problem!
Have all social problems been clarified?
People with bipolar illnesses frequently have social problems. Among these, there are:
- Financial difficulties
- Problems with administrative bodies
- Lack of living quarters
- Application for health-care services
- Problems in the university
- Applications for assisted living facilities
Consequently, psychosocial aid is an important task to make it possible for you and your family to enter health-care system facilities in the psychiatric-psychotherapeutic field as well as in those areas dealing with general medicine and rehabilitation.
Take it into consideration that you can discuss all important social problems with the social worker or social education worker, regardless of whether they may appear to you to be so difficult or so unpleasant, in order to find a solution together. Each unresolved social problem can bring about a larger amount of stress, which is once again associated with a higher risk of suffering from a manic or depressive relapse. Also ask about continuing social aid, since there are many such problems (e.g. financial problems) which cannot be resolved from one day to the next.
Do my family and I consider ourselves to have been sufficiently informed?
There still continues to be a clear difference between the existing knowledge concerning bipolar illnesses and the knowledge that is mediated to persons with bipolar illnesses and their families. For the persons affected and their families, this has considerable consequences:
- Persons who are affected can only conditionally cooperate in actively planning and designing their therapies.
- In relationship to the questions or problems regarding the illness, those who are affected and less cleared up become more easily stressed than those who are better informed; thereby, the danger of suffering from renewed manic or depressive phases increases.
- Those who are affected and who have not been cleared up sufficiently cannot react according to the best scientific recommendations, since they are not aware of them. As an example, consider merely the problems associated with the administration of drugs for those who are affected with bipolar illnesses.
Consequently, there is every indication that also speaks in favour of the fact that you and your family inform yourselves as well as possible. For this purpose, there are some important actions to take:
- Ask your therapist if you could arrange to have some personal, clarifying discussions between yourself and your family.
- Visit psychoeducational groups.
- Inform yourself about good informational brochures or books about psychoses. Be sure to see that these are current and easy to understand. Download appropriate brochures from this Website.
- Inform yourself about good Websites concerned with the topic of bipolar illnesses.
- Recommend to your family that they visit a group for relatives and acquaintances of those who are affected.
- Always be sure to ask questions when you are unable to understand something. Put your questions down in writing.
- Form an opinion on your own and discuss this with your therapeutic team.
- Visit a self-help group.
