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Coping Tips for Caregivers of persons living with Bipolar Disorder

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Hvovi Bhagwagar is a leading Psychotherapist and Panel psychologist with BipolarIndia. Her talk on BipolarIndia's WORLD BIPOLAR DAY Conference, Mumbai on March 30th, 2019 was on a very relevant topic. 'Helping someone live well with Bipolar Disorder'.
From understanding the nuances of the chronic condition to spotting red flags and how to deal with crisis situations..her talk was comprehensive.
Moreover, caregivers are a largely ignored community who themselves need help in coping. Self care tips were also covered.

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Coping Tips for Caregivers of persons living with Bipolar Disorder

  1. 1. HELPING SOMEONE LIVE WELL WITH BIPOLAR DISORDER Coping Tips For Caregivers Hvovi Bhagwagar, Clinical Psychologist World Bipolar Day, March 30th 2019
  2. 2. TOWARDS HOPE
  3. 3. Caregivers form the Social Support required for people with BD Social support refers to the individual’s perception as being of value within the context of the groups in which he or she participates.
  4. 4. CAREGIVERS CAN BE A PROTECTIVE FACTOR IN BD Assistance from family and friends seems to have positive effects in preventing a relapse, as well as on better treatment adherence and improved functionality of the individual (Studart et al 2015) Social support is positively associated with individual well-being, particularly if an intimate partner provides that support. (Boyers and Rowe 2018)
  5. 5. However Social Support In BD Has A Bi- directional Relationship Lack of help is a risk factor for symptom recurrence Social Support becomes problematic due to the dysfunctional symptoms
  6. 6. Caregiver burden in the families of the patients suffering from bipolar affective disorder, Gania, Kaur, Grover et al 2019 Bipolar disorder is associated with significant caregiver burden-financially, in family life, as well as physical and mental health Thus, the emphasis in psychiatric rehabilitation needs to shift from a patient-focused approach to a combined patient and caregiver-focused approach. For better outcomes of disease the primary caregivers require more psycho-education and counselling.
  7. 7. RECOGNISING TREATMENT OPTIONS
  8. 8. PHARMACOTHERAPY • Primary treatment • Mood Stabilisers and Anticonvulsants typically given • Combined with Anti Psychotics and Benzos • Anti-depressants given with caution • Blood tests to be done regularly • Episodes of mania increases risk of non- adherence. • Psychotherapy is adjunct to pharmacotherapy 8
  9. 9. PSYCHOTHERAPY: Teaches the benefit of adopting a rational stance when faced with difficult situations. If you are upset by your problems, you now have 2 problems: 1) The problem 2) Your upsetness. 9
  10. 10. RECOGNISING RED FLAGS
  11. 11. Everyday emotions such as joy, sadness or disappointment need to be distinguished from bipolar moods: Bipolar Moods: Last longer and are harder to change More intense and cause more disruption to the person’s daily life. Situational variables may not always be presentMisinterpreting mood fluctuations and behavior that are common to us all as being due to bipolar disorder can be hurtful and frustrating.
  12. 12. COMMON TRIGGERS INCLUDE: • Stressful negative or positive life events • Disruption to sleep patterns • Disruption to routine. • Too much stimulation from external sources • Too much stimulation from within the person. • Abusing alcohol or street drugs • Conflict and stressful interactions with people.
  13. 13. SUPPORT DURING EPISODES Your support matters
  14. 14. WHAT I NEED DURING AN EPISODE OF DEPRESSION Don’t tell me to ‘snap out of it’ Encourage small activity and small goals Try not to take over Encourage me towards a routine Offer me kindness even if I cant reciprocate Acknowledge the smallest achievements
  15. 15. WHAT I NEED DURING MANIC/HYPOMANIC EPISODE Create a calm environment. Keep me safe. Don’t participate in my various goals Set limits, gently but firmly Don’t AgitateMe. Answer questions briefly, quietly and honestly Do not agree to risky plans Remind me of the Two person feedback rule
  16. 16. DEALING WITH SPECIFIC CAREGIVING CHALLENGES
  17. 17. HOW TO HELP DURING CRISIS. Suicidal thoughts Hospitalization Risky Behaviour
  18. 18. HOSPITALIZATION When Treatment and support does not seem to help the person’s symptoms Voluntary and involuntary hospitalization In hospital, assist with treatment, be empathic to their vulnerability Advance Directives
  19. 19. ADVANCE DIRECTIVES These are written documents about how a person wishes to be treated for a mental illness in a situation where they do not have capacity to make decisions regarding the same. One can specify the treatment, care and support that they want and how they wish to be treated when they have a mental illness and are unable to care for themselves.
  20. 20. SUICIDE People with BD are a high-risk population Watch for signs Ask Directly. Take safety Measures Don’t handle alone, get help from a professional
  21. 21. RISKY BEHAVIOUR Safeguards for aggressive outbursts (furniture, safe room) Limit access to funds.- extra cash, credit cards, cheque books Seek financial Advice Recognise “signal events”/or “prodromes” Keep away alcohol. Learn to Say No and set firm limits.
  22. 22. THE BURDENS OF CARING “I should cure the person’s illness “I should be able to fix everything” “I should never feel angry or stressed” “I should always be perfectly supportive of the person.”
  23. 23. CAREGIVER BURDEN IS A PREDICTOR OF Significant levels of depressive symptoms (Coyne et al., 1987; Dyck et al., 1999; Struening et al., 1995). Worry, tension, and grief (Chakrabarti and Gill, 2002; Fadden et al., 1987, Reinares and Vieta, 2004). Sleep problems (Perlick et al., 2007), Use of tranquilizers and antidepressants (Dyck et al., 1999), Increased risk of medical hospitalization (Gallagher and Mechanic, 1996).
  24. 24. Between a rock and a hard place’: Family members’ experiences of supporting a relative with bipolar disorder. Barch et al 2018 1. ‘Not knowing: like being in a minefield’, 2. ‘It’s out of my control: sitting waiting for the next thing to happen’, 3. ‘Treading on eggshells’, 4. ‘Picking up on signs’, 5. ‘Times of crisis:between a rock and a hard place’, 6. ‘I have to make my voice heard
  25. 25. YOUR WELL-BEING • Delegate Tasks, be organized • Practice Self care, take breaks • Form a social group • Go for outings guilt free • Seek help from Government schemes • Professional disappointments • Maintain boundaries • Acknowledge your natural reactions • Support groups
  26. 26. MOBILE APPS iMoodJournal T2 Mood Tracker eMoods Medisafe Pill and Med Reminder
  27. 27. HELPLINES 2. Phone Apps- - Emotional Support Helpine Directory nULTA: Monday to Friday, 10:30 AM to 5:30 PM 3. Peer Support Groups: Bipolar India 1. HELPLINES  Vandrevala Foundation: 1860-266-2345, 1800-233-3330 (24 hour)  Samaritans +91 84229 84528 / +91 84229 84530 (3pm to 9pm) TISS icall • Telephone based counseling: 022-25521111 (Monday to Saturday, 8 AM to 10 PM) • Email based counselling: icall@tiss.edu
  28. 28. “It is not how much you do, but how much love you put in the doing.” — MOTHER TERESA
  29. 29. TAKE GOOD CARE! HVOVI BHAGWAGAR 9821321132 www.manashni.com

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