Mental Health Goal #1

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Bipolar Anxiety or Bipolar and Anxiety

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Bipolar disorder is a mental illness marked by extreme mood episodes ranging from mania to depression.  Anxiety can be a symptom of bipolar disorder as stated by Dr. Emil Kraepelin, back in 1921.  The International Society for Bipolar Disorders (ISBD) also claimed that anxiety is a symptom of bipolar disorder in a Task Force report on “mixed states” in bipolar disorder.  They described this anxiety as:

  • General hyperarousal
  • Inner tension
  • Irritability/impatience
  • Agitation
  • “Frantically anxious”

Individuals in mixed states may feel increased energy and have racing thoughts while also experiencing hopelessness and despair.  They may have insomnia and increased risky behavior but also feel empty and blank inside and have unexplained crying spells.

While anxiety can be a symptom of bipolar disorder, it can also be a separate condition in addition to bipolar disorder.  Having more than one condition or disorder is referred to as “co-morbid” and basically means that the two conditions stand alone and are not a symptom of one or the other.

It is important to know the difference because if the anxiety is coming from the bipolar disorder then it should get better when the bipolar disorder gets better.  If not, then when the bipolar disorder is stabilized, the anxiety may still persist.

There are several types of anxiety disorders.  They include:

  • Generalized Anxiety Disorder (GAD)
  • Social Phobia
  • Panic Disorder (with or without Agoraphobia)
  • Post-Traumatic Stress Disorder (PTSD)
  • Obsessive-Compulsive Disorder (OCD)
  • Specific Phobias

Regardless of whether the anxiety is a symptom of the bipolar disorder or in addition to the bipolar disorder, mood stabilizers are recommended as first line treatment choice due to the potentially mania-inducing risk of antidepressants in patients with bipolar disorder.  Psychotherapy or cognitive behavioral therapy is sometimes then recommended even before antidepressants as well.

References:
http://psycheducation.org/diagnosis/mixed-states/anxiety-and-bipolar-disorder/
http://www.dbsalliance.org/site/PageServer?pagename=education_brochures_bipolar_disorder_rapid_cycling

When Panic Attacks Here is What You Can Do

Symptoms of a panic attack include:

  • Racing heart
  • Shallow, rapid breaths
  • Tunnel vision
  • Sweaty palms
  • Feeling faint
  • Nausea, vomiting
  • Fear of going crazy
  • Crying
  • Shaking, tremors
  • Irritability
  • Increased sensitivity to sound, lights, touch
  • Inability to focus or concentrate

There is usually a precipitating factor or something that has caused or is causing the panic attack to occur. Or fear about future events or a future incident can incite an attack. 

One way of dealing with it is to distract yourself from thinking about said event by reading a book, watching a show or playing a game. Draw, paint, listen to music or go for a relaxing walk. Find something to distract youself from your anxiety producing thoughts. 

Another way to cope is to take a short nap. Sometimes your brain just needs a break and it is okay to give it one. Just make sure not to overdo this one as it can become chronic and unhealthy. 

Talk to a trusted friend or professional to get the thoughts and feelings out of your head. Releasing them decreases the power they have over you. Also, problem solving ways to reduce anxiety is way more successful when you work on it with someone else. Keeping it to yourself only intensifies it. Trying to figure it out on your own only makes the anxiety worse. 

When possible don’t.do.anything.  Panic attacks are the body’s response to overstimulation. Resting in a quiet calming room may help tremendously. Experiment with what works best for you and take the time and breaks you need to let your system return to normal. 

Panic attacks are scary. Uncomfortable at best. Not your fault. Be kind to yourself when they come. Get through them the best you can and move on. Talk to a healthcare professional if they become chronic or significantly interrupt your life or cause you serious adverse effects.  There is medication and other treatment options that can help. You are not alone. 

Grief: A Meditation

For a time, sometimes a long time, grief can leave you in a fog.  Memories are all you have and the pain is gut wrenching as the sobs pull the breath from your lungs until they collapse in the dead weight of your chest.  

You don’t want to, but you get up everyday and you put one foot in front of the other and you move forward, resting often, sighing heavily, straining to act.

But, you are doing this a miniscule step at a time. Every inhale and exhale is a healing force. 

Where there’s breath there is hope. Where there is hope, I will create gratitude, for where there is gratitude, I will find peace. 

Finding Comfort Amidst Change – A Meditation

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Change is difficult for us sometimes.  Often we avoid it or fight it because it scares us. There is a sense of safety in maintaining the status quo even if it is unhealthy.

When positive change occurs it can bring on stress even though the change is good for us.  Sitting with the anxiety, feeling it run through our veins, through our heart, circle our mind again and again, letting it exhale through our breath can eventually allow us to become more comfortable with the stress. Like anything or anyone, the more time we really pay attention to the details of it, I mean really, really observe every nuance of something, the less threatening it will seem.

Today I will sit with my discomfort and get to know it by observing everything about it, including where I feel it in my body, my mind, and my spirit, and I will know peace.

Mental Illness is a Surmountable Obstacle

~ Guest post by Jackie Cortez

According to the World Health Organization, 1 in 4 people suffer from mental illness. And while treatment is available, it’s often underutilized.

For many people, mental illness can be something that troubles them periodically in life but never something that incapacitates them. For others, mental illness can be completely debilitating. What’s important is recognizing mental illness and treating it with the best approach for people so they may live healthy, productive lives.

Inner turmoil

While there are social stigmas attached to mental illness, it is the self-stigma that can be the most dangerous to a person’s overall well-being. A person with a mental illness may feel ostracized from his peers and turn to outward or inward destructive behaviors to cope. These may materialize as bursts of aggression, depression, or isolation or as reckless actions including sexual promiscuity and alcohol abuse and drug abuse. A mental illness makes it difficult to see past the negative aspects of today to the bright and beautiful possibilities of tomorrow. It is estimated that more than 90% of suicides are committed by persons with a diagnosable mental disorder. Approximately half of these individuals will struggle with drug or alcohol abuse before their death.

Physical self-care

If you’re struggling with a mental illness, you should take extra care to take care of yourself. Stress takes a toll on the body and can cause headaches, insomnia, muscle tension, upset stomach, and fatigue. These symptoms’ impact can be lessened through protecting your physical health. It is easier to maintain good mental health habits when your body – your foundation – is strong.

It is important to exercise daily. This may be done individually or in a group setting as exercise provides the body with natural stress relief hormones. Maintaining a balanced diet devoid of processed foods, including sugars, additionally goes a long way toward whole-person health. Sleep is essential and most adults require between seven and nine hours each night; a brief 30 minute nap in the early afternoon can also offer a person with a mental health disorder a bit of a boost. Most importantly, drugs and alcohol should be avoided completely as, despite common belief, these substances actually exacerbate stress and depression.

A mental illness will not go away overnight. However, many people find they are less affected when they practice these good mental health habits:

Avoid guilt

Negative emotions happen and it is important not to dwell on them or pass judgment. Understand that it is how you react to these emotions that matters. Recognize them but don’t get caught up in the moment.

Pay attention to the positive

Even in your deepest, darkest hour, positive things are going to happen in your day. It could be as small as a glimpse of the mountains or fresh ocean breeze. When they happen, pause and enjoy. It may help to keep a journal and write down one good thing that happens each day. You can go back and read about your happy days when you’re feeling sad or stressed to remind yourself that not everything in life is bad.

Find strength in numbers

There are virtually countless support groups in every city in every state for people struggling with mental illness. You can perform a quick online search for groups in your area. Know that you cannot solve things on your own and there are people out there who, like you, are dealing with invisible and taboo issues. Spending time with others will not only help you get things off your chest but will keep you connected to the world around you.

If you or someone you love is dealing with a mental health issue, such as depression or drug abuse, get help. Always remember there is no shame in asking for assistance from others, be they medical professionals, family, or friends. Tomorrow is a new day and a new opportunity to look at the world with a fresh set of eyes.

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~ Jackie Cortez works with The Prevention Coalition to identify and highlight resources on every aspect of substance abuse, ranging from prevention to addiction treatment. Her mission is to use her writings to help prevent drug and alcohol abuse.

Keep the Pace – A Meditation

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When it comes to mental illness, often our moods are “all or nothing.”  We are either on top of the world or in the pit of despair.  If we are not careful, our behaviors can reflect our emotions, leading to chaos in our lives and problems in our relationships with others.

When it comes to the emotional ups and downs of mental illness, we can fight the temptation to act on them by remembering the phrase “Keep the Pace.”  In other words, let’s keep doing what we do when we are stable.  Let’s keep showering and going to bed at a decent hour.  Let’s keep eating as healthy as we can and exercising moderately.  Let’s keep our social activities up, but not excessive, and our verbal and physical boundaries intact and closely moderated.  Let’s maintain an appropriate number of projects, neither dropping them all due to inertia nor starting too many.

When I feel myself slipping into either an elevated or a depressed mood state, I will remind myself to “keep the pace” and not feed into the insanity of my disorder by changing my behaviors too drastically.  Just like a marathon runner, who neither sprints nor ceases to run at all, I must pace myself to participate fully in the race, and then I will know peace.

Neuroimaging Shows Increased Activity in Bipolar Mania

In a recent study looking at the difference in neural activity between persons with bipolar I disorder who were experiencing mania, those with bipolar I disorder who were experiencing euthymia or a normal, non-depressed mood, and persons who did not have any psychiatric disorders and were considered “healthy controls,” researchers found some significant differences in two brain networks.

The first was in the Dorsal Attention Network (DAN), which is a group of regions in the brain that plays a large role in our internally motivated goals using our visual attention and short-term memory processes. In other studies, increased activity is evident in the DAN after the presentation of cues indicating where, when, or to what participants should direct their attention.

In this study, those individuals who were manic had significantly higher levels of activity in their DAN compared to the euthymic group and the healthy control group, possibly explaining the often apparent hyperattention, arousal and emotional response of those experiencing mania to external stimuli.

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This figure shows the increase of connectivity in mania (A) versus euthymia (B)

The second brain area assessed was the Default Mode Network (DMN), which is a group of brain regions that shows a lower level of activity when we are working on a particular mental task like paying attention, but higher levels of activity when we are doing more generic thinking tasks such as daydreaming, recalling memories, guessing about the future, monitoring the environment, speculating on the intentions of others – just thinking without any task-oriented goal in mind. Recent research has begun to find connections between the DMN and mental illnesses like anxiety and depression. Also, meditation is thought to be related to the DMN, which may be why its influence in well-being is significant.

Of particular note in this study, was the fact that those with bipolar disorder in a euthymic state showed hypo-connectivity in the dorsal nodes of their DMN compared to the mania group and healthy control group. The mania and healthy control groups showed the same connectivity.

Does this mean that the euthymic group was more relaxed, less worried about the past and future, less concerned about their surroundings and the behaviors of others than the other groups? Even the “healthy” group? I don’t know. The researchers didn’t comment on what this particular finding suggested other than the fact that this dorsal node is the exact location that corresponds to the target for transcranial magnetic stimulation (TMS) for the treatment of depression, even though they made sure to reiterate the fact that the euthymic group was not depressed.

The researchers pointed out the fact that their study’s results contribute to a body of growing evidence that points to bipolar mania as a behavioral pathology due not to circuit disruption but rather increased coherence (connectivity).

As far as the hypo-connectivity of the dorsal nodes of the DMN in the euthymic group goes, the researchers were not sure if this was due to a compensatory mechanism of the disorder trying to right itself or if it was in fact still part of the diseased state.

Of note:
– Diagnosis was determined using the Structured Clinical Interview for the DSM-IV (SCID)
– Limitations of the study included a small sample size of 23 manic, 24 euthymic, and 23 healthy controls.
– There were no significant differences in participant age, sex, and medications

Resources:

Differential brain network activity across mood states in bipolar disorder
Dorsal Attention Network
Dorsal and Ventral Attention Systems
Know Your Brain: Default mode network