Hypomania

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Beneath the Surface: Exploring Mental Illness.

DSCN0356Mental illness, it’s invisible. There are no bandages, no casts, no crutches, no external wounds. How do you know someone is suffering from one? We, the afflicted, talk about feeling bad, talk about our depression and anxiety woes. You, our friends, look at us with bewildered eyes. You think to yourself “This person is all put together, she has makeup on, is dressed well, there are no signs of illness. I don’t understand.”

It’s not easy to explain mental illness to people who don’t have it. You can’t show them anything that is broken, or any flulike symptoms, or anything visible at all.

The key is listening, trying to understand where your mentally ill friend is coming from, what your mentally ill friend feels like, what they are trying to explain to you. And many will not even explain anything, because of the stigma, because they don’t want to appear “crazy” or abnormal.

Yes it’s confusing. I’ve had bipolar disorder since 1985, and sometimes it’s still confusing for me, so don’t anyone beat themselves over this. Basically the only empirical thing you have to gauge mental illness by is behavior. For example, in mania, people talk a lot, have very high energy, don’t sleep much, may have delusions of grandeur, may have a lot of anxiety. In depression, they have no energy, may sleep a lot, or not, are in a downcast mood, hopeless, and may also have a lot of anxiety. Paradoxically, in hypomania (the stage before going into full blown mania), we can actually get a lot accomplished, we are energetic, focused, not over the edge yet. This might be considered the “industrious” phase of bipolar disorder.

So the way your friend is behaving, a departure from their normal self, is a clue to their mental illness. What they are saying and how they’re saying it is as well. Are they being grandiose, talking non stop, switching from subject to subject (flight of ideas,) these are all clues.

In schizophrenia, people can have auditory hallucinations, where they hear voices, that’s definitely a clue, if they tell you, if they are aware that this is happening and admit to it… Yet most of the time, looking at a mentally ill person, you’d never know anything was wrong at all. It’s all below the surface, in their brain. Just like in a sea, where the water looks still and calm but a savage riptide is flowing under the surface.

Signs and signals, feelings and observations, those are clues to understanding mental illness. Just being an observant and understanding friend who listens and tries to comprehend what is being said and shown to them, that my friends is what is needed to understand the illusive nature of mental illness.

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Impulsivity is a symptom of mania or hypomania!

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One very important reason to take the correct dose of the correct medication is shown below from the article: “Impulsivity and Risk Taking in Bipolar Disorder and Schizophrenia” published in Neuropsychpharmacology in September 2013. Here is the reference if anyone would like to read the whole article: http://www.nature.com/npp/journal/v39/n2/full/npp2013218a.html

Basically what this article is saying is that impulsiveness, which is defined as risky decision making, high risk attitudes, acting without planning, poor inhibition of risky actions, high risk attitudes, and rapid decision making (which basically means making decisions without thinking them through). Please understand that these are symptoms of mania. Once you are in a manic phase, you are going to do this. In a hypomanic phase, you are also going to do this but to a much lesser degree, your actions will not be as risky to your life or health. Please also understand that the only way to stop this from happening is to NOT go into a manic or hypomanic phase. The way to do that is to take the right amounts of the right medication as you doctor had prescribed. And if you feel like your mood is slipping towards mania or depression, to call your doctor and let them know. This is a BIOCHEMICAL disease involving levels or metabolism of neurotransmitters. All these neurotransmitters have certain effects on the brain. When their activity or levels of these neurotransmitters are high, we become impulsive. So, just take the right dose of your medication and head these problems off at the pass, nip them in the bud, stop them before they happen. If you don’t, this disease WILL ruin your life, it will destroy your peace of mind, it will destroy your relationships, it will destroy your friendships, it may even take your life. That is as bluntly as I can put it. I am definitely on the therapeutic dose of lithium and I’m staying on it for the rest of my life, I am not allowing this mood disorder to control my life or take days away from me or most importantly take my family or beloved friends away from me.

Not me, not now, not ever again! I hope you too will make a commitment to your health and sanity and your life, and follow your doctor’s advice to the letter.

Below in quotes are passages from the above mentioned article.

“Impulsiveness is a clinical feature of bipolar disorder. Broadly, impulsivity refers to a predisposition toward unplanned reactions without consideration of consequences and can include risky decision making, self-reported high-risk attitudes, poor response inhibition, and rapid decision making. 

Bipolar disorder is often characterized by impulsive behavior and increased tendency to work toward a reward, often without sufficient planning. Although risky-impulsive behavior is a diagnostic criterion for mania and bipolar patients consistently show abnormalities on self-report measures of impulsivity, they do not consistently show deficits on behavioral tasks that require planning and forethought. These differences may reflect the multi-faceted nature of impulsivity, or the measurement tools used to assess the construct.

Finally, some of the mixed findings in bipolar disorder and schizophrenia regarding impulsivity and risk taking may be attributable to the types of medications patients are taking. The neurochemical basis of impulsivity and risk taking involves dopaminergic, serotonergic, and other neurotransmitter systems, and these systems are affected by antipsychotic (AP) medications. Some studies find a reduction in impulsiveness associated with AP medications, whereas others find no such effect in psychotic samples. Thus, it is important to consider the role of AP medications on measures of impulsivity and risk taking.

This is one of the first studies to examine both self-report and behavioral measures of impulsivity in bipolar disorder and schizophrenia. The study had two goals. The primary goal was to conduct a careful analysis of impulsivity using multiple approaches across three groups: bipolar disorder patients, schizophrenia patients, and healthy controls. The secondary goal was to compare subgroups of bipolar disorder patients who differed in terms of AP medications and history of psychosis on measures of impulsivity and risk taking.”

 

 

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FYI: Phases in Bipolar disorder.

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Different phases of Bipolar disorder.

Full blown manic phase: No sleeping, weight loss, talking a lot, flight of ideas (switching from none topic to another,) shopping sprees, excessive involvement in pleasurable activities, such as sex, inflated self esteem, grandiosity, distractability, anxiety, if left untreated leads to psychosis ( loss of touch with reality.) Once at the psychotic point, major tranquilizers have to be administered.

Depression: Sleeping too much, depressed mood, weight gain, loss of interest in normal activities, anhedonia, (loss of positive feelings), agitation, thoughts or attempts of suicide, if left untreated, can also lead to psychosis.

Hypomania: Talking a lot, little sleep, grandiosity, excessive involvement in pleasurable activity, such as sex, irritability, weightless. This is the phase that precedes the full blown manic phase. If treated with mood stabilizers such as lithium, won’t progress to full blown mania. 

Mixed Phase: Unfortunately taking antidepressants for people who have bipolar disorder causes them to have mixed phases. This phase has elements of both depression and mania, and enormous amounts of anxiety. The phases can alternate many times in a day, such as manic, normal, and depressed. This is called rapid cycling. Or the phases can alternate in longer cycles, which may be days or weeks. This can lead to full blown mania or depression if not treated with mood stabilizers such as lithium, Depakote, Seroquel, and others. 

And the most coveted is the Normal phase 🙂

Also anything that helps stabilize mood like meditation, yoga, exercise, good nutrition, all this helps the symptoms of bipolar d/o.