Supporting Family Members with Bipolar Disorder: A Guide for Caregivers

How to support the family members of patients with bipolar disorder?

Hello doctor, my brother has been struggling since around January when our father had a stroke, which added to his work stress, leading to insomnia.
By February, he started exhibiting exaggerated speech and compulsive shopping behaviors, after which he quit his job.
In late February, we took him to see a doctor (partly convincing him), and the doctor diagnosed him with bipolar disorder.
However, he refused to take medication, claiming he wanted to commit suicide or run away from home, and we were hesitant to force him to take the medication.

In March, although he still had odd speech and insomnia, his mood seemed relatively stable.
In April, he went missing one morning and was later found in the hospital, where his mood was even more unstable.
He was then involuntarily admitted to a psychiatric facility, where he started taking medication.
Initially, the medication caused him to be excessively sleepy, gain weight, and exhibit a blank stare, along with unsteady walking.
However, his mood appeared to improve.
We later discussed with the doctor about reducing his medication, which resolved the walking imbalance.
Not long after, a patient in the next bed (who was there for alcohol withdrawal) was discharged, and my brother expressed a desire to leave as well.
We discussed this with the doctor, mentioning that he sometimes lies.
Ultimately, he was discharged after only two weeks.
However, after returning home, he again struggled with insomnia and began pacing outside, claiming to see unclean things (which we suspect are hallucinations).

Not long after, he attempted to throw away household items.
Last week, we took him to another hospital, where he voluntarily admitted himself.
Now, he wants to leave again, but we are concerned that his condition is still unstable (as he tends to lie).
The nurses mentioned that he is active inside the facility, speaking clearly but still having rapid thoughts.
We are worried that if he is discharged, his condition may worsen, and we are unsure how to handle it.
I would like to ask the doctor why my brother, despite taking his medication regularly at home, still experiences episodes.
Did we wait too long to seek medical help and start him on medication? Why does it take so long for him to have an episode? I have also heard that some people can manage their condition.
Could you please clarify this for us? Thank you.

Xiao Mei, 30~39 year old female. Ask Date: 2006/05/15

Dr. Wang Chongren reply Psychiatry

Dear Ms.
Wang,
Regarding your description of your brother's manic episode, although he has completed treatment, it appears that he has not fully achieved remission after discharge from the hospital.
This may be due to a longer duration of the manic episode and insufficient hospitalization time to alleviate his symptoms, resulting in ongoing emotional instability post-discharge.

It is recommended that he undergo further inpatient treatment and consider the use of two lines of mood stabilizers (such as lithium or divalproex sodium) or antipsychotic medications.
Since we are unaware of his specific symptoms, it is advisable for you to discuss medication options with his attending physician during hospitalization.
The Tainan Hospital of the Department of Health cares about your health!

Reply Date: 2006/05/15

More Info

Supporting a family member with bipolar disorder can be a challenging yet rewarding experience. It is essential to understand the nature of the disorder, the importance of treatment adherence, and the role of family support in the recovery process. Your brother's situation, as you've described, involves a complex interplay of emotional and psychological factors, particularly following the stressors of your father's stroke and the subsequent changes in your brother's life.

Bipolar disorder is characterized by extreme mood swings, including manic episodes (where individuals may feel overly energetic, euphoric, or irritable) and depressive episodes (where they may feel sad, hopeless, or lose interest in activities). The symptoms can vary significantly from person to person, and the disorder often requires a comprehensive treatment plan that includes medication, therapy, and lifestyle adjustments.

Understanding the Treatment Process
1. Medication Adherence: It is crucial for your brother to adhere to his prescribed medication regimen. Medications for bipolar disorder, such as mood stabilizers and antipsychotics, can help manage symptoms and prevent episodes. However, side effects like drowsiness, weight gain, or cognitive dulling can occur, which may lead patients to discontinue their medication. Open communication with healthcare providers about these side effects is vital. If your brother experiences intolerable side effects, discussing alternative medications or dosage adjustments with his doctor can be beneficial.

2. Therapeutic Support: In addition to medication, therapy can provide your brother with coping strategies and emotional support. Cognitive Behavioral Therapy (CBT) is particularly effective for individuals with bipolar disorder, as it helps them recognize and change negative thought patterns and behaviors. Family therapy can also be beneficial, as it fosters understanding and communication among family members.

3. Monitoring Symptoms: Keeping a mood diary can help track your brother's mood changes, sleep patterns, and triggers. This information can be invaluable for healthcare providers in adjusting treatment plans. Encourage him to share this diary with his therapist or psychiatrist.

Family Support Strategies
1. Open Communication: Maintain an open line of communication with your brother. Encourage him to express his feelings and concerns without fear of judgment. Listening actively can help him feel understood and supported.

2. Educate Yourself: Understanding bipolar disorder will enable you to provide better support. Familiarize yourself with the symptoms, treatment options, and potential triggers. This knowledge can help you recognize when your brother may be experiencing a manic or depressive episode.

3. Encourage Healthy Habits: Promote a healthy lifestyle, including regular exercise, a balanced diet, and adequate sleep. These factors can significantly impact mood stability. Encourage your brother to engage in activities he enjoys and to maintain a routine.

4. Crisis Planning: Develop a plan for potential crises. This plan should include emergency contacts, a list of medications, and strategies for managing acute episodes. Knowing what to do in a crisis can reduce anxiety for both you and your brother.

5. Seek Professional Guidance: If your brother is resistant to treatment or if his condition worsens, it may be necessary to involve mental health professionals. They can provide guidance on how to approach your brother about his treatment and may suggest interventions such as hospitalization if he poses a risk to himself or others.

Conclusion
Supporting a family member with bipolar disorder requires patience, understanding, and a proactive approach to treatment. While it can be distressing to witness your brother's struggles, your support can make a significant difference in his recovery journey. Encourage him to stay engaged with his treatment plan, and do not hesitate to seek professional help when needed. Remember, recovery is a process that takes time, and your involvement can be a crucial part of that journey.

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