My Support - September 28, 2009

CBF's Wish List :-)

Can you help with a tax deductible donation? CBF is in need of the following:

• office space (office large enough for desk, chair, & book shelves)
• copy machine
• fax machine

We are also looking for pro bono services including:

• Public Relations work
• Web Master

Thank you!

New Sibling Support Groups Forming Now - FREE

Two new Sibling Support Groups are forming now. If you are interested in having your son or daughter join a support group, please contact us. Two groups forming in October; grades 3-5 and 6-10. Groups meet once a month and are facilitated by a licensed clinician.
Reply to TKelly@CaliforniaBipolarFoundation.org

NEW; South Bay Caregiver Support Group

Chula Vista Library Conference Room 365 F Street, Chula Vista 91910
September 30, 2009 from 5-7pm.
(Full schedule to be announced soon)
Please contact Andrea to RSVP:
CBF_andrea@mail.com

YMCA Teens in Motion

Teens in Motion is an after school program designed to provide supervision and support to high school students with disabilities and special needs. Teens in Motion provides after school activities that will encourage physical, emotional and social development. Students who enroll in this program will participate in classroom activities such as art, cooking, table games, sport activities as well as having opportunities to be included in after school activities on campus and participating in YMCA camps. Teens in Motion is open during the school year, as well as the spring, winter and summer breaks.

We have two locations, One in the San Diego School District at Clairemont high school and one in the Grossmont School District at Vahalla high school. We have many students from all over the districts that come to our programs. We are currently reaching out to more schools in the San Diego School District and the Grossmont school district to see if our program can fit the after school need for more students.

For more information or to arrange a visit, please contact Melanie Garcia at 619-474-4707 ext. 1433, or 619-972-0678 or mrgarcia@ymcacrs.org

North Coast Consortium for Special Education, FREE Programs

SH101: Developing Communication Skills for Children 9/23-24 8:30 - 3:30AM

IEP102: Web-Based IEP Workshop 9/24, 10/7, and more.. 1:00 - 3:30PM

IEP 104: Special Education Law for GE Administrators 9/29 1:00 - 2:30PM

IEP105: Managing the Special Education Paper War 9/30 12:30 - 3:30PM

More info here! http://www.nccse.org/home/educators/professional-and-parent-development....

Child & Adolescent Bipolar Foundation opens web site to all

Starting in January, 2010, access to the entire CABF website, including online support, will no longer be tied to a family's ability to pay a membership fee. This means that a far greater number of families will be able to benefit from the vital information and support provided by CABF. Go to www.bpkids.org

Mental Illness Touches The Whole Family

By Erika Krull, MS, LMHP
You can't have mental illness in a family without it touching everyone. It's like a mobile that hangs above a baby's crib. You touch one part and the rest of it starts to move around. When one person in a family changes for the worse, the others can't help but react differently.
Everyone has expectations, memories, and rhythms unique to themselves. Family members get used to these over time. When these patterns change, families have more conflict, more emotional distance, more confusion, more pain, and a lot of adjustment. This usually causes people to do what they can to not only keep the family somewhat functional but to also reduce pain for themselves. The tension from this adjustment is often palpable.

The family tries to remain functional, but there is something deeply wrong under the surface. If the family group does not successfully address or manage the problem, these adjustments could continue for years and have a lasting impact. And even if the family does communicate honestly and address the problem, the adjustments can continue throughout the process.

Imagine that you are a kid with a brother who is just a couple years older than you. For years, you were each other's playmates. Then over a period of months, he changed from an outgoing energetic boy to a sullen irritable boy who liked to keep to himself. He used to laugh with you, now he snaps and seems angry when you try to talk to him. Not only have you lost a playmate but you have also lost some camaraderie with a sibling to relate to within the family.

You now feel somewhat lonely and show your sadness by hanging out by yourself and not showing your usual energy. Your parents are now concerned not only for their older son who has become very different, but now their younger child seems down and less interested in spending time with the family.

This creates another loop of worry and adjustment for both parents. Your choice to isolate more also means your brother has fewer social experiences. In his mind, it confirms his loneliness. As you can see, just one person in a family having symptoms of a mental illness can set off a web of reactions that affect everyone. Even the older boy's isolation ends up coming back to haunt him by making him more alone.

If this scenario is caught and addressed quickly, sometimes just formal mental health treatment for the individual will be enough to make things better. Some family conversations at home can also help everyone understand what happened and how they have improved. But if this goes on for a many months or years, family counseling might be necessary.

Mental illness adjustments may have been around so long they have become ingrained habits. For complicated situations, restoring a family's collective mental health can take some time. It's well worth the effort but it's easy to get impatient or think nothing is working. Just remember - these problems didn't show up overnight, and they won't get better overnight either.

Twice Exceptional Children Gifted Students with Disabilities

What do you do when your school doesn't support gifted students who are struggling? Some schools have programs to support gifted high achievers but do little to support gifted strugglers. Many parents write us to say that schools are denying IEPs and 504 plans on the basis of high test scores or good grades. Their children are struggling because their "gift" seems to get in the way of receiving the help they need.

In this issue of the Special Ed Advocate you'll find a new page at Wrightslaw about Twice Exceptional Children that includes articles, resources, book recommendations, free publications, and a short list of information and support groups. http://www.wrightslaw.com/nltr/09/nl.0922.htm

The Informant! - Whitacre Feels It's an Accurate Portrayal of His Bipolar Disorder

The movie The Informant! starring Matt Damon is based on the real-life story of Mark Whitacre, the 1990's whistleblower in the infamous Archer Daniels Midland price-fixing conspiracy. What you may not know is that Mark Whitacre, the FBI's key informant in the case, has bipolar disorder. Rebecca Murray, About.com's Guide to Movies, summarizes the plot, "What was Mark Whitacre thinking? A rising star at agri-industry giant Archer Daniels Midland (ADM), Whitacre suddenly turns whistleblower. Even as he exposes his company's multi-national price-fixing conspiracy to the FBI, Whitacre envisions himself being hailed as a hero of the common man and handed a promotion." "The movie shows how, after Whitacre informed the FBI of the company's dealings, bipolar disorder got the better of him, causing him to spin increasingly elaborate lies. Whitacre was convicted of fraud and tax evasion and spent more than eight years in prison," reports Eric Robinette, staff writer with Dayton Daily News. Whitacre told Robinette that he feels the dark comedy of the movie was the best way to handle the story and he is quite happy with Matt Damon's portrayal. He shares, "The movie's a lot about the mental illness. Bipolar disorder gets worse when you're under pressure ... I did a lot of crazy stuff, and they're showing that bizarre stuff." I haven't seen the movie yet myself, but it is definitely on my list. I am particularly curious about how his family stuck with him through this. He and his wife are still married today. About.com

Children With Bipolar Often Receive Diagnosis Late

by Marcia Purse About.com

That's the conclusion of a new study that examined age at diagnosis versus age when symptoms first appeared. The study, conducted in Spain, found that only about 25% of children with bipolar disorder were diagnosed within 7 months of symptom onset. For another 50%, it took a year and a half to about three and a half years to be diagnosed correctly. The final 25% took even longer. Almost all of the children in the study had multiple disorders; the most common comorbid illness was ADHD. Many of them were first diagnosed either with one or more of those accompanying disorders or one or more (up to four) disorders later ruled out. A 2005 study by the same researcher found that pediatric bipolar disorder was diagnosed far less in Europe than in the United States. Whether that tendency influenced the late diagnosis of the children in the study is yet to be determined. Diagnosing bipolar disorder in children isn't the easiest thing in the world. The symptoms in children are not the same as in adults. In the United States, psychiatrists use specific standards from the Diagnostic and Statistical Manual of Mental Disorders to arrive at a diagnosis of any mental illness. The criteria used to diagnose a child are still being studied as our knowledge about pediatric bipolar disorder increases.

Stress and bad decisions

Since poor judgment and exaggerated confidence are hallmarks of mania, these recent findings from Bangor University in Wales might be of interest: When we are stressed and need to make a decision, we are more likely to ignore past experience of negative outcomes and give extra weight to rewarding memories.

Psychologists Jane Raymond and Jennifer L. O'Brien of Bangor University in the United Kingdom wanted to investigate how cognitive stress affects rational decision making. In this study, participants played a simple gambling game in which they earned money by deciding between stimuli--in this case, two pictures of different faces. Once their selection was made, it was immediately clear if they had won, lost, or broken even. Each face was always associated with the same outcome throughout this task. In the next stage of the experiment, the volunteers were shown each face individually and had to indicate whether they had seen those faces before. Sometimes volunteers were distracted during this task while other times they were not.

The results, reported in the current issue of Psychological Science, a journal of the Association for Psychological Science, reveal that distractions significantly impact decision making. When volunteers were not distracted, they tended to excel at recognizing faces that had been highly predictive of either winning or losing outcomes. However, when they were distracted, they only recognized faces that had been associated with winning.

The authors note that when we are stressed and need to make a decision, we are "more likely to bear in mind things that have been rewarding and to overlook information predicting negative outcomes." In other words, these findings indicate that irrational biases, which favor previous rewards, may guide our behavior during times of stress.

Psychological Science is ranked among the top 10 general psychology journals for impact by the Institute for Scientific Information. For a copy of the article "Selective Visual Attention and Motivation" and access to other Psychological Science research findings, please contact Barbara Isanski at 202-293-9300 or bisanski@psychologicalscience.org
Source: Association for Psychological Science

Author:Newswise

Changes in Mental Health Services

County of San Diego HEALTH AND HUMAN SERVICES AGENCY
August 10, 2009

Dear Valued Clients and Client Families,

San Diego County wants to keep you and your caregiver informed of potential changes in mental health services. You may have received the Notice of Reduction in Medi-Cal Benefits from the California State Department of Health Care Services. These reductions are related to the State budget difficulties. The State Budget problems will have a direct impact on our county and may affect our ability to provide the same level of mental health services that are currently available.

Although there have not been any final decisions, we are now studying the impact of possible reductions in services and determining what changes will occur. Medication services, provided by a psychiatrist, will not be affected by the changes. If you are currently seeing a psychiatrist and receiving medication, those services will NOT be changed. If you are seeing a psychologist, MFT, LCSW, or other mental health professional, it is possible that those services will be reduced or terminated. If that happens, we will do our best to help you find good community-based options.

At this time, however, your current services or your child's services will continue to be provided. United Behavioral Health (UBH) will also continue to perform authorizations for services. Effective August 10th, when your current authorization comes to an end, if you and your provider think you need additional services, your provider will be able to request up to 13 additional sessions if you are under 18 years of age and up to 8 additional sessions if you are 18 years and older. The authorizations for additional services will be monitored closely and will be based on your level of need and the ability to benefit from these services. If you have any specific questions about your current authorization period, please contact your provider directly to discuss. If there are going to be any changes to your services, you or your caregiver will receive an official letter detailing the decision.

We understand this letter may cause you to feel concern about how your mental health services may change. Be assured that the County of San Diego Department of Health and Human Services will make every effort to support your well-being in the days ahead. In the meantime, if you are a client or client family member:

• You can call the Warm Line at (619) 295-1055 if you want to talk.
• If you are a parent, talk with your child's provider, your child's teacher or other supportive community members.
• In addition, meetings and forums conducted by the Peer Liaison Team are listed on the Network of Care (www.sandiego.networkofcare.org).
   

Sincerely,

ALFREDO AGUIRRE, LCSW, Director
Mental Health Services

Children with Special Needs and their Pets

Maximizing Play, Communication and Behavior Regulation

Participants completing the program can earn Certificate of Completion for Service or Therapy Dog Training, as well as Service Dog Rights, and the AKC CGC Test and Award Certification.

This program will be facilitated by Michelle Handrop, who is a Lead Area Pet Training Instructor, a Canine Good Citizen Evaluator from the American Kennel Club, a Guide Dog Puppy Raiser and a Therapy Animal Certified Handler, and Speech & Language Pathologist consultation. For further information, email Michelle: TrainingServiceDogs@yahoo.com or call 858 695 9415

YMCA Free swimming

The Ecke YMCA (Encinitas) offers a free "Special Olympic Swim" program for physically and mentally challenged participants 8 years and older where they are coached through a swim workout to promote physical fitness and confidence.

Saturdays 11 am to Noon
YMCA # 760-635-3050 (Registration)
Address: 200 Saxony Road, Encinitas, CA 92024

Bipolar Psychosis 101

by Julie A. Fast

Comprehensive examination of bipolar psychosis, including signs, symptoms, causes and treatments of psychosis in bipolar disorder. Plus stories of living with bipolar psychosis.

Part 1: What is Bipolar Psychosis?
Bipolar disorder is an illness that affects a person's ability to regulate their moods. The two main mood swings are mania and depression and most people familiar with the illness have at least a basic understanding of these two symptoms. But when it comes to bipolar psychosis, knowledge can be limited and this very complex and very normal part of bipolar disorder is often underreported or missed until it's too late. One reason for this is that there are still many people who don't know that psychosis is common for people with Bipolar I (one) during manic and depressive episodes and is often present in Bipolar II (two) depression as well. But the main problem is that the general public has such a distorted view of psychosis, it's difficult to find real and helpful information regarding this fascinating and often very destructive symptom of bipolar disorder.

About
This section covers the topic of psychosis and how it relates to bipolar disorder. The first section gives a technical description of psychosis. The second section offers more information regarding the relationship between psychosis, mania and depression. The final section explains the medications used to treat bipolar psychosis. If you are not familiar with bipolar disorder and its treatment, my article The Gold Standard for Treatment of Bipolar Disorder gives a full account of the illness along with medication and management plan information. As with all of my articles on HealthyPlace.com, my colleague and co-author, Dr. John Preston, provided the technical information found in this article. You will see his quotes throughout the article. The statistics for the rates of psychosis is bipolar disorder are from the book Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression by Goodwin, F.K and Jamison K.R. (2007) Oxford University Press: Oxford and New York.

Basic Facts about Bipolar Psychosis

• Bipolar psychosis is always attached to either mania or depression. It doesn't exist on its own.
• Bipolar psychosis is common in bipolar mania. Up to 70% of people in a full blown manic episode experience psychosis. (People with Bipolar II hypomania rarely experience psychosis.)
• Though studies vary, it's estimated that 50% of people with bipolar depression experience psychosis. Though it's more common in severe depression, it can be present in moderate depression as well.
• Bipolar psychosis causes a break with reality, loss of reasoning and ultimately, resistance to treatment when it goes too far without medications.
• Bipolar psychosis can be very disruptive and cause significant work and relationship problems due to misperceptions and false beliefs.
• Most people are very confused and puzzled by psychosis. I have experienced and studied the topic for years and it can still be an enigma! It's very easy to confuse the thoughts, feelings and behaviors caused by manic and or depressive mood swings with those caused by psychosis. The goal of this article is for you to easily recognize the difference and then see if you or the person you care about experiences psychosis.

Bridges To Recovery: Bipolar Disorder

Bipolar Disorder is a serious psychological disorder that tends to be chronic and disabling despite significant advances in pharmacological treatment. Many patients experience recurrence of their symptoms even when they take their medication as prescribed. According to an article written by David J. Miklowitz, Ph.D. (on CBF's Scientific Advisory Board) and published in the most recent American Journal of Psychiatry (September 2008), most patients suffering from Bipolar Disorder experience greater improvement in the course of their illness when psychotherapy is added to drug treatment. Dr. Miklowitz reviewed 18 randomized trials of different types of treatment including psycho-educational (individual, group, and integrated care programs), family, cognitive-behavioral, and interpersonal.

Overall, the treatments reviewed were associated with 30% to 40% reduction in relapse rates over 1 to 2 ½ years. Those treatment modalities that taught the patient and/or the family how to identify early warning signs of significant mood symptoms and achieve medication compliance appeared more effective in reducing manic symptoms. The treatment modalities that emphasized the enhancement of skills for managing interpersonal or family relationships (such as family therapy and cognitive behavioral therapy) appeared more effective for the reduction of depressive symptoms. The effects of the specific treatment modality also differed according to the clinical condition of the patient at the onset of treatment. Interpersonal therapy, family therapy, and integrated care program were most effective in preventing relapse if the patient started the treatment after an acute episode. Cognitive-behavioral therapy and group psycho-education appeared most effective with relapse prevention when started during a recovery period.

This review highlights the importance of psychotherapy as an adjunct to medication in the treatment of bipolar disorder and suggests that patients may benefit most from involvement in the specific treatment modalities that best address their specific symptom concerns and phase of illness.
Ref: Miklowitz, DJ. (2008). Adjunctive psychotherapy for bipolar disorder: State of the evidence. The American Journal of Psychiatry, 165, 1408-1419.

US prisons: the new asylum for the mentally ill

By GSerrano
Amidst the fiery and clamorous health care debates presently raging in the US, the sordid reality of mental illness in US prisons has not found itself as an issue or topic. It is dumbfounding to find out that 'the mentally ill have come to make up more than half of the US prison population.'

Unfortunately, 'long term psychiatric facilities have all but disappeared throughout the US and the under-funded and over-crowded public hospitals can offer only short term services.'
Psychiatric hospitals in the US currently house fewer than 40,000 Americans. However, '30 times that number - 1.25 million mentally ill people - are serving time in US prisons.' The jails and prisons in the US have become the veritable new asylum for the mentally ill. In each of the over 3,000 counties in the United States, 'the jail has more mentally ill people than the hospital.'

"It is really a travesty that we would take mentally ill people and cycle them through incarcerations. They're just cycled through there as big human warehouses," says Bill Kleiber, a former inmate with bipolar disorder.
In these penal institutions, direct contact with a doctor may be rare. However, prescription medications pour in 'through the corrections system without a problem.' The facilities are understaffed and overmedicated.

The crux of the dilemma is whether the jail system should help or punish those mentally ill who happen to break the law.

AstraZeneca's Seroquel XL wins green light for bipolar depression

22 September 2009
UK patients with bipolar disorder experiencing major depressive episodes can now be treated with AstraZeneca's blockbuster antipsychotic Seroquel XL after the drug's license was extended allowing its use for both poles of the disease.

The drug is already approved to treat manic episodes of bipolar disorder and with this licence extension has now become the only once daily atypical antipsychotic licensed in the UK to treat both poles of the condition, "thereby streamlining and simplifying therapy for patients and physicians", according to the company.

The availability of Seroquel XL (quetiapine prolonged release) represents "a major advance" in therapy for bipolar depression, as in the absence of any therapy specifically approved for the condition doctors were using an 'unlicensed' mix of mood stabilisers and antidepressants, which can cause treatment emergent manic episodes and thus have a detrimental effect on the course of the illness, AstraZeneca said.

As Seroquel XL is associated with a relatively low incidence of treatment emergent mania - 4.4% in people taking 300mg versus 6.4% with placebo - experts hope that the drug will offer an effective and licensed alternative to antidepressant treatment for bipolar depression.

By Selina McKee

Can a manic episode look like a tantrum?

Asked by Sharon, Clinton Township, Michigan
My friend's 20-year-old daughter has been diagnosed as bipolar. I have seen the depressive effects, but can you tell me how someone who is having a manic episode would behave? This girl yells, screams, swears, kicks the walls, uses inappropriate language to her parents and it usually happens when she is not getting her way. It looks like a temper tantrum to me

Medical Expert Dr. Charles Raison; Emory University

Dear Sharon,
You have done a nice job of describing how one type of manic episode looks, but in suggesting that what you see might be a temper tantrum you have also identified the challenge that faces us every time we try to give a name to psychiatric troubles. The challenge is this: God didn't create psychiatric disorders when he was naming the fish of the sea and the creatures of the land. Whether or not we can lay psychiatric suffering at the feet of God is too philosophical a question for this blog, but wherever mental illness comes from, the names we give it, the categories we use to describe it, were created by men and women, not nature.

This is simple enough to say, but the ramifications of this fact are huge and often overlooked by both the lay public and the medical world. In regards to your particular question, bipolar disorder (also known as manic depression) is nothing but a description of a certain pattern of symptoms. In the case of bipolar disorder, the pattern requires the presence of at least one manic episode and usually also includes episodes of depression. Keep in mind that because mania is only a word we use to describe certain types of behavior and emotions, there is no clear answer to your question of where mania stops and a temper tantrum begins.
However, having said all this, let me rush to affirm how useful many psychiatric diagnostic categories are. They help us understand what we are seeing, they suggest treatment options, and they tell us a lot about what is likely to happen to a person in the future. So it is of utmost importance, actually, that we try to ferret out what is most likely going on with your friend's young daughter.

Let's try to sort things out by considering two extreme cases. Let's suppose your friend's daughter was always a quiet, gentle girl who did what she was told and caused no trouble. Then a few months ago she began to radically change. Over the course of several weeks she began to become unreasonably irritable and violent. She stopped sleeping much. She randomly curses people out on the street. She throws things whenever her will is crossed. Just to make it really easy let's suppose she begins telling people that she is enraged because the spirit of Jesus when he threw the money changers out of the temple has entered her body and now controls her.

Given this scenario, every single one of us -- except the poor young woman herself -- would recognize that she is not herself, that something is very wrong, that she has an illness. She has developed bipolar disorder because she is clearly having a manic episode.
Now let's consider a very different scenario. Suppose this young woman had a difficult childhood and has never done well. From an early age she's been repeatedly in trouble, first at school, later with the authorities. She has always been moody, quick to anger and impulsive. She has very brief periods of elation when something good happens, but mostly she is unhappy and anxious. A year ago she had a full depressive episode. She is doing better now, but she is back to herself, which is to say that she is short-tempered and violent.
What do we think now? If she has always shown symptoms that could fit under the rubric of mania, should we call this mania or a really bad personality problem? In this scenario we'd probably be better served to consider her as having something like borderline personality disorder with a history of major depression. But if next year we caught her talking a thousand miles an hour about being the Virgin Mary, not sleeping and running down the street naked, we'd have to say that we were probably wrong and that the behavior we're seeing now was a preamble to full bipolar disorder, not really a personality problem. Why does it matter? Well, data suggest that women with borderline personality disorder tend to improve with age, whereas bipolar disorder tends to worsen with age.
Hopefully you can use the examples I've given to think through for yourself how best to conceive of your friend's daughter's very disturbing behavior. Whatever we call it, the biggest mistake we could make is not to try to get someone in her condition good psychiatric care. I don't need to tell you that this young woman's road through life is likely going to be disastrous if she doesn't get the help she'll need to change her emotions and behavior.