What is ABA or Applied Behavior Analysis?
ABA
(Applied Behavior Analysis)
History
Applied behavior analysis is the applied side of the experimental analysis of behavior. Its origin can be traced back to Teodoro Ayllon & Jack Michael's 1959 article The psychiatric nurse as a behavioral engineer.[13] The research basis of ABA can be found in the theoretical work of behaviorism and radical behaviorism originating with the work of B. F. Skinner.
Applied Behavior Analysis now encompasses treatments in applied settings in things as varied as leisure skills development, improving sports performance, cigarette smoking cessation, increasing exercise, and other areas.
Definition: "[ABA is] the design, implementation, and evaluation of environmental modifications to produce socially significant improvement in human behavior. ABA includes the use of direct observation, measurement, and functional analysis of the relations between environment and behavior. ABA uses antecedent stimuli and consequences, based on the findings of descriptive and functional analysis, to produce practical changeThis definition places emphasis on socially significant changes, but ABA can be used to alter virtually any behavior irrespective of its social relevance.
The components of any behavior are as follows: A.B.C
Antecedent: a verbal or physical stimulus such as a command or request. This may come from the environment or from another person, or even internal to the subject.
Behavior: the student's response
Consequence: What happens conditional to the behavior. In controlled situations the consequence is that the student receives something motivational to him/her: commonly food, rewards, praise, a toy, etc. Consequence could also include correction (or punishment, but this is rarely used).
The key aspects of ABA are
Observation of current behavior for topography (what the movement looks like), frequency, antecedents and consequences
Breaking down desired skills into steps
Teaching the steps through repeated presentation of discrete trials
Data on performance is tracked to show changes over time
Facts about ABA
ABA is one of the most common, and the only proven, method used to treat autism
Applied Behavior Analysis has been shown to be an effective means of intervention for adults and children with pervasive developmental disorder and is one of the most widely used with this population.
The ABA approach teaches social, motor, and verbal behaviors as well as reasoning skills.
ABA therapy is especially useful in teaching behaviors to children with autism who do not otherwise "pick up" on these behaviors on their own as other children would.
ABA teaches these skills through use of careful behavioral observation and positive reinforcement or prompting to teach each step of a behavior.
Generally ABA involves intensive training of the therapists, extensive time spent in ABA therapy (20-40 hours per week) and weekly supervision by experienced clinical supervisors known as a certified behavior analyst.[10]
An increasing amount of research in the field of ABA is concerned with autism; and it is a common misconception that Behavior Analysts work almost exclusively with individuals with autism and that ABA is synonymous with Discrete Trials teaching. ABA principles can also be used with a range of typical or atypical individuals whose issues vary from demonstrating developmental delays, significant behavioral problems or undesirable habits.
ABA is often confused as a table-only therapy. Properly performed, ABA should be done in the table and natural environments, depending on the student's progress and needs. Once a student has mastered a skill at the table, the ABA team should move the student into a natural environment for further training and generalization of the skills just learned.
Frequently, the Assessment of Basic Language and Learning Skills (ABLLS) is used to create a baseline of the autistic (or otherwise diagnosed) learner's functional skill set. The ABLLS breaks down the learner's strengths and weaknesses to best tailor the ABA curriculum to them. By focusing on the exact skills that need help, the teacher does not waste time teaching a skill the student knows. This can also prevent student frustration at attempting a skill for which he or she is not ready.
Discrete trials
Discrete trials were originally used by B. F. Skinner in his experimental studies with rats and pigeons to demonstrate how learning was influenced by rates of reinforcement. The discrete trials method was adapted as a therapy for developmentally delayed children and children with autism. For example, Ivar Lovaas pioneered the use of discrete trials for autistic children to help them learn skills ranging from making eye contact and following simple instructions to advanced language and social skills. Discrete trials involve breaking a behavior into its most basic functional unit and presenting the units in a series.
A discrete trial usually consists of the following: The antecedent, possibly combined with a prompt (a non-essential element used to assist learning or correct responding), the behavior of the student, and a consequence. If the student's behavior is what is desired, the consequence is something positive: food, candy, a game, praise, etc. If the behavior was not correct, the teacher offers the correct answer, then repeats the trial, possibly with more prompting if needed.
There is usually an inter-trial interval that allows for a few seconds to separate each trial, to allow the student to process the information, teaches the student to wait, and makes the onset of the next trial more discrete. Discrete trials can be used to develop most skills, which includes cognitive, verbal communication, play, social and self-help skills.
Techniques used in Applied Behavior Analysis
1. Chaining
Main article: Chaining
The skill to be learned is broken down into the smallest units for easy learning. For example, a child learning to brush teeth independently may start with learning to unscrew the toothpaste cap. Once the child has learned this, the next step may be squeezing the tube, and so on.
2. Prompting
The parent or therapist provides assistance to encourage the desired response from the child. The aim is to use the least intrusive prompt possible that will still lead to the desired response. Prompts can include:
* Verbal cues ie. "Take the toothpaste cap off" (Used the least as they are the hardest to fade)
* Visual cues ie. pointing at the toothpaste
* Physical guidance ie. moving the child's hands to unscrew the lid
* Demonstration ie. taking the cap off to show the child how it is done.
3. Fading
The overall goal is for a child to eventually not need prompts. This is why the least intrusive prompts are used, so the child does not become overly dependent on them when learning a new behavior or skill. Prompts are gradually faded out as then new behavior is learned. Learning to unscrew the toothpaste lid may start with physically guiding the child's hands, to pointing at the toothpaste, then just a verbal request.
4. Generalization
Once a skill is learned in a controlled environment (usually table-time), the skill is taught in more general settings. Perhaps the skill will be taught in the natural environment. If the student has successfully mastered learning colors at the table, the teacher may take the student around the house or his school and then re-teach the skill in these more natural environments.
5. Shaping
Main article: Reinforcing successive approximations
Shaping involves gradually modifying the existing behavior of a child into the desired behavior. If a child engages with a dog by hitting it, the child could have their behavior shaped by reinforcing interactions in which the child touches the dog more gently. Over many interactions, successful shaping would replace the hitting behavior with patting or other gentler behavior.
6. Differential reinforcement
Reinforcement provides a response to a child’s behavior that will most likely increase that behavior. It is “differential” because the level of reinforcement varies depending on the child’s response. Difficult tasks may be reinforced heavily whereas easy tasks may be reinforced less heavily. We must systematically change our reinforcement so that the child eventually will respond appropriately under natural schedules of reinforcement (occasional) with natural types of reinforcers (social).
7. Video modeling
One teaching technique found to be effective with some children is the use of video modeling (the use of taped sequences as exemplars of behavior). It can be used by therapists to assist in the acquisition of both verbal and motor resoponses, in some cases for long chains of behavior.[11]
Maintaining parental and professional relationships in the ABA approach
An adequate communication and a supportive relationship between educational systems and families allow children to receive a beneficial education. This pertains to typical learners as well as to children who need additional services. It was not until the 1960s that researchers began exploring Applied Behavior Analysis as a method to educate those children who fall somewhere on the autism spectrum. Behavioral analysts agree that consistency in and out of the school classroom is key in order for autistic children to maintain proper standing in school and continue to develop to their greatest potential.
Applied behavior analysis involves an entire team working together to address a child's needs. This team includes professionals such as speech therapists as well as the children's primary caregivers, who are treated as key to the implementation of successful therapy in the ABA model. The ABA method relies on behavior principles and a recommended curriculum that reflects an individual child's needs and abilities. As such, regular meetings with professionals to discuss programming are one way to establish a successful working relationship between a child's family and their school. When a caregiver can be the outlet source for the generalization of skills outside of school, it helps the child's therapy process by catering to the child's individual needs. In the ABA framework, developing and maintaining a structured working relationship between parents and professionals is essential to ensure consistency of thought and practice of behavioral methods.
Criticisms of ABA
Applied behavioral analysis has been criticized for several perceived failings.
Outcomes - The long term outcomes of ABA therapy have not been established, and there have been no investigations of improved quality of life in adulthood, as measured by criteria like the ability to maintain meaningful employment or relationships.[citation needed]. In the case of Auton (Guardian ad litem of) v. British Columbia (Attorney general), the Supreme Court of Canada ruled that since the outcomes of ABA were unproven and the treatment itself is still experimental, it could not be considered a "core treatment" (one for which the province is required to pay). The decision quoted the original trial judge, noting that "the trial judge found only that in “some cases” it may produce 'significant results'" [1]
Language - ABA and discrete trials are seen as less effective for improving 'functional language', the ability to use language to communicate effectively. Best practices for language learning now involve 'naturalized' teaching, mimicking the functions of language - requesting (manding), labeling (tacting) and obeying commands (receptive language).[12]
Objection from the autism rights movement - Autism rights activists oppose ABA for multiple reasons, ranging from its early dependency on aversives (in the original experiments the aversive was a cattle prod) to its goals of "extinguishing" even harmless autistic behavior such as stimming and rendering the child "undistinguishable from peers". Michelle Dawson, an autistic woman, filed an intervener factum in the Auton case challenging ABA on ethical grounds. [2]
Saturday, September 18, 2010
Saturday, August 14, 2010
Your Full Name
Your Address
SUBURB STATE POSTCODE
Telephone/Mobile Number
DATE
Mr/Ms (Name of your Boss/Manager)
Job Title
Company Name
Address number and street name
SUBURB STATE POSTCODE
Dear (Name of contact person), (if you don’t know who to address it to, use ‘Dear Sir or Madam’)
RE: Notice of Resignation
I wish to inform you that I will be resigning from my job as a (your job title), on (date), and I will conclude my employment (?) weeks from this date.
I have accepted another position that will further develop my skills. (you can give your reason for leaving but this is optional)
Working with the company has allowed me to gain important knowledge over the last (?) years (or how long you were employed).
I would like to take this opportunity to thank you for letting me provide my services.
Yours sincerely
(your signature)
(your name printed)
Your Address
SUBURB STATE POSTCODE
Telephone/Mobile Number
DATE
Mr/Ms (Name of your Boss/Manager)
Job Title
Company Name
Address number and street name
SUBURB STATE POSTCODE
Dear (Name of contact person), (if you don’t know who to address it to, use ‘Dear Sir or Madam’)
RE: Notice of Resignation
I wish to inform you that I will be resigning from my job as a (your job title), on (date), and I will conclude my employment (?) weeks from this date.
I have accepted another position that will further develop my skills. (you can give your reason for leaving but this is optional)
Working with the company has allowed me to gain important knowledge over the last (?) years (or how long you were employed).
I would like to take this opportunity to thank you for letting me provide my services.
Yours sincerely
(your signature)
(your name printed)
Tuesday, July 27, 2010
SACKS’ SENTENCE COMPLETION TEST
NATURE OF THE TEST
Dr. Joseph M. Sacks and other psychologist of the New York Veterans Administrative Mental Hygiene Service developed a sentence completion test designed to obtain significant clinical material in four representative areas of adjustment namely: • family • sex • interpersonal relationship • self-concept
It has felt that items included in this test present sufficient opportunities for the subject to express his attitudes so that clinical psychologist may infer his dominant personality traits/trends. Such information is useful in screening patient for therapy, which gives clues to content and dynamics of patients’ attitudes and feelings.
NATURE OF THE SCALE FAMILY The family area included three sets of attitudes namely: a) those towards mother, b) father, and c) family unit. It is hoped that even when the subject becomes evasive or cautious, at least one of the four items in each area will reveal significant response.
SEX The sex area includes attitudes towards woman and heterosexual relationship. The 8 items in this area allows the subject to express himself with regards to woman, towards marriage, and with respect to sexual relationship.
INTERERSONAL RELATIONSHIP The area of interpersonal relationship includes attitudes towards friends and acquaintances, colleagues at work or school, superior at work or school, and people supervised. The 16 items in this area affords the subject to express his feelings towards those.
SELF-CONCEPT The area of self-concept includes fear, guilt feelings, goals and attitudes towards one’s own ability, concept of himself as he is, he was and as he hopes to be. There are 24 items included in this area.
SCORING AND INTERPRETATION A rating sheet has been advised for the SSCT which brings together under each attitude, the four stimulus item and the subject’s responses to them.
For example:
Attitude towards Father items: 1. I feel that my father seldom works. 16. If my father would do better. 31. I wish that my father is dead. 46. I feel that my father is no good. Those four responses are considered together and interpretative summary is made that crystallizes the clinician’s impression of the subjects’ attitude towards in this area. In this case, the summary stated: “Extreme hostility and contempt or overt death wishes” A rating is made of the subject’s degree of disturbance in this area according to the following scale:
2 - SEVERELY DISTURBED Appears to require the therapeutic aid in handling emotional conflicts in this area. 1 – MILDLY DISTURBED Has emotional conflict in this area but appears able to handle them without therapeutic aid. 0 – No Significant disturbance rated in this area X – Unknown, Insufficient evidence
Sacks and Levy feel that it is more desirable to point out areas of disturbance and determine these through a constellation of response. The validity of the rating is dependent of course upon the clinical background of the examiner as well as upon materials produced by the subject.
The following are the summaries and ratings of the individual attitudes and outlines presented for a general summary of the SSCT findings. This includes the following:
1. Statement of those areas in which subject shows the most disturbed attitudes. This may provide significant clues for therapist. 2. A description of the interrelationships between attitudes with respect to content. This often illuminates dynamic factors in the case.
Certain influences on the subject’s personality structure case be made on the basis of the SSCT, such as: 1. The subject’s manner of response to impulse from within or to stimuli from the environment. 2. The subject’s nature of response to stress –impulsive or well-controlled. 3. The subject’s thinking content: realistic, artistic, and fantastic.
Interpretation Guide
Attitude towards Mother (14, 29, 44, 59) 2 = Completely rejects and depreciates mother whom he considers over demanding. 1 = Sees mother’s fault but accepts and tolerates differences. 0 = express only positive feelings towards the mother.
Attitude towards Father (1, 16, 31, 46) 2 = feels extreme hostility and contempt with overt death wishes. 1 = admires father but wishes that their relationship were closer. 0 = expresses complete satisfaction with father’s personality.
Attitude towards Family Unit (2, 27, 42, 57) 2 = feels rejected by the family which lacks solidarity and which has constantly contended with difficulties. 1 = aware that the family does not recognize him as a mature person but has no difficulty in relating with them. 0 = instability of the family domicile has had little effect on his favorable feeling towards them.
Attitude towards Women ( 10, 25, 40, 55) 2 = extremely suspicious, possible homosexual tendency 1 = high ideas but ambivalent feelings. 0 = only minor or superficial criticisms
Attitude towards Heterosexual Relationship (11,26,41,56) 2 = appears to have given up achieving good sexual adjustment 1 = deserved sexual experiences but reservation about his ability to maintain marital relationship. 0 = indicates satisfaction towards this area
Attitude towards Friends and Acquaintances (8,23,38,53) 2 = suspicious and apparently seclusive 1= seems to wait approval of others before committing himself emotionally 0 = express mutual relationship with friends and self
Attitude towards People Supervised (4,19,34,58) 2 = feels he can handle or control hostility in handling others 1 = feels capable of doing good supervisory but has misgivings about assuming an authoritarian role. 0 = feels controllable and well accepted by subordinates.
Attitude towards Supervisors at work or School (6,21,36,51) 2 = resents or fear authority 1 = mild difficulty in accepting difficulty 0 =
Attitude towards Colleague at work/school (13,28,43,58) 2 = feels rejected by colleagues, and condemns them 1 = has some difficulty at work and depends on colleagues 0 = expresses good mutual feelings
Fear (7,22,37,52) 2 = disturbed by the apparent fear of loving, possibility to control his feelings 1 = fear of self-assertion which is fairly common and not pervasive. 0 = lack of fear
Guilt Feelings (15,30,45,60) 2 = concerned with spiritual feeling and physical sex drives 1 = has regret over past and seems mildly disturbed by his failure to control his trouble. 0 = does not seem to be aware of guilt feelings
Attitude towards Own Ability (2,7,32,47) 2 = feels completely incompetent and hopeless 1 = feels he has a specific ability but tends to fear difficulty 0 = confident on his ability to overcome obstacles
Attitude towards Past (9,24,39,54) 2 = feels rejected and isolated 1 = 0 = feels well adjusted, no significant disturbance in the past
Attitude towards the Future (5, 20, 35, 50) 2 = pessimistic, no hope in his own resources for happiness and success 1 = unsure of himself but tries to be optimistic 0 = seems confident in achieving his goals
Goals (3, 18,53,49) 2 = lack of motivation for achievement 1 = desires material things for family as well as for himself 0 =
NATURE OF THE TEST
Dr. Joseph M. Sacks and other psychologist of the New York Veterans Administrative Mental Hygiene Service developed a sentence completion test designed to obtain significant clinical material in four representative areas of adjustment namely: • family • sex • interpersonal relationship • self-concept
It has felt that items included in this test present sufficient opportunities for the subject to express his attitudes so that clinical psychologist may infer his dominant personality traits/trends. Such information is useful in screening patient for therapy, which gives clues to content and dynamics of patients’ attitudes and feelings.
NATURE OF THE SCALE FAMILY The family area included three sets of attitudes namely: a) those towards mother, b) father, and c) family unit. It is hoped that even when the subject becomes evasive or cautious, at least one of the four items in each area will reveal significant response.
SEX The sex area includes attitudes towards woman and heterosexual relationship. The 8 items in this area allows the subject to express himself with regards to woman, towards marriage, and with respect to sexual relationship.
INTERERSONAL RELATIONSHIP The area of interpersonal relationship includes attitudes towards friends and acquaintances, colleagues at work or school, superior at work or school, and people supervised. The 16 items in this area affords the subject to express his feelings towards those.
SELF-CONCEPT The area of self-concept includes fear, guilt feelings, goals and attitudes towards one’s own ability, concept of himself as he is, he was and as he hopes to be. There are 24 items included in this area.
SCORING AND INTERPRETATION A rating sheet has been advised for the SSCT which brings together under each attitude, the four stimulus item and the subject’s responses to them.
For example:
Attitude towards Father items: 1. I feel that my father seldom works. 16. If my father would do better. 31. I wish that my father is dead. 46. I feel that my father is no good. Those four responses are considered together and interpretative summary is made that crystallizes the clinician’s impression of the subjects’ attitude towards in this area. In this case, the summary stated: “Extreme hostility and contempt or overt death wishes” A rating is made of the subject’s degree of disturbance in this area according to the following scale:
2 - SEVERELY DISTURBED Appears to require the therapeutic aid in handling emotional conflicts in this area. 1 – MILDLY DISTURBED Has emotional conflict in this area but appears able to handle them without therapeutic aid. 0 – No Significant disturbance rated in this area X – Unknown, Insufficient evidence
Sacks and Levy feel that it is more desirable to point out areas of disturbance and determine these through a constellation of response. The validity of the rating is dependent of course upon the clinical background of the examiner as well as upon materials produced by the subject.
The following are the summaries and ratings of the individual attitudes and outlines presented for a general summary of the SSCT findings. This includes the following:
1. Statement of those areas in which subject shows the most disturbed attitudes. This may provide significant clues for therapist. 2. A description of the interrelationships between attitudes with respect to content. This often illuminates dynamic factors in the case.
Certain influences on the subject’s personality structure case be made on the basis of the SSCT, such as: 1. The subject’s manner of response to impulse from within or to stimuli from the environment. 2. The subject’s nature of response to stress –impulsive or well-controlled. 3. The subject’s thinking content: realistic, artistic, and fantastic.
Interpretation Guide
Attitude towards Mother (14, 29, 44, 59) 2 = Completely rejects and depreciates mother whom he considers over demanding. 1 = Sees mother’s fault but accepts and tolerates differences. 0 = express only positive feelings towards the mother.
Attitude towards Father (1, 16, 31, 46) 2 = feels extreme hostility and contempt with overt death wishes. 1 = admires father but wishes that their relationship were closer. 0 = expresses complete satisfaction with father’s personality.
Attitude towards Family Unit (2, 27, 42, 57) 2 = feels rejected by the family which lacks solidarity and which has constantly contended with difficulties. 1 = aware that the family does not recognize him as a mature person but has no difficulty in relating with them. 0 = instability of the family domicile has had little effect on his favorable feeling towards them.
Attitude towards Women ( 10, 25, 40, 55) 2 = extremely suspicious, possible homosexual tendency 1 = high ideas but ambivalent feelings. 0 = only minor or superficial criticisms
Attitude towards Heterosexual Relationship (11,26,41,56) 2 = appears to have given up achieving good sexual adjustment 1 = deserved sexual experiences but reservation about his ability to maintain marital relationship. 0 = indicates satisfaction towards this area
Attitude towards Friends and Acquaintances (8,23,38,53) 2 = suspicious and apparently seclusive 1= seems to wait approval of others before committing himself emotionally 0 = express mutual relationship with friends and self
Attitude towards People Supervised (4,19,34,58) 2 = feels he can handle or control hostility in handling others 1 = feels capable of doing good supervisory but has misgivings about assuming an authoritarian role. 0 = feels controllable and well accepted by subordinates.
Attitude towards Supervisors at work or School (6,21,36,51) 2 = resents or fear authority 1 = mild difficulty in accepting difficulty 0 =
Attitude towards Colleague at work/school (13,28,43,58) 2 = feels rejected by colleagues, and condemns them 1 = has some difficulty at work and depends on colleagues 0 = expresses good mutual feelings
Fear (7,22,37,52) 2 = disturbed by the apparent fear of loving, possibility to control his feelings 1 = fear of self-assertion which is fairly common and not pervasive. 0 = lack of fear
Guilt Feelings (15,30,45,60) 2 = concerned with spiritual feeling and physical sex drives 1 = has regret over past and seems mildly disturbed by his failure to control his trouble. 0 = does not seem to be aware of guilt feelings
Attitude towards Own Ability (2,7,32,47) 2 = feels completely incompetent and hopeless 1 = feels he has a specific ability but tends to fear difficulty 0 = confident on his ability to overcome obstacles
Attitude towards Past (9,24,39,54) 2 = feels rejected and isolated 1 = 0 = feels well adjusted, no significant disturbance in the past
Attitude towards the Future (5, 20, 35, 50) 2 = pessimistic, no hope in his own resources for happiness and success 1 = unsure of himself but tries to be optimistic 0 = seems confident in achieving his goals
Goals (3, 18,53,49) 2 = lack of motivation for achievement 1 = desires material things for family as well as for himself 0 =
History
Herman Von Ebbinghaus is generally credited with developing the first sentence completion test in 1897.[1] Ebbinghaus’s sentence completion test was used as part of an intelligence test.[2]
Carl Jung’s word association test may also have been a precursor to modern sentence completion tests.
In recent decades, sentence completion tests have increased in usage, in part because they are easy to develop and easy to administer. As of the 1980s, sentence completion tests were the seventh most widely used personality assessment instruments.[3]
Another reason for the increased usage of sentence completion tests is because of their superiority to other measures in uncovering conflicted attitudes.[4]
Some sentence completion tests were developed as a way to overcome the problems associated with thematic apperception measures of the same constructs.[2]
Uses
The uses of sentence completion tests include personality analysis, clinical applications, attitude assessment, achievement motivation, and measurement of other constructs. They are used in several disciplines, including psychology, management, education, and marketing.
Sentence completion measures have also been incorporated into non-projective applications, such as intelligence tests, language comprehension, and language and cognitive development tests.[5]
Examples of sentence completion tests
There are many sentence completion tests available for use by researchers. Some of the most widely used sentence completion tests include:
Rotter Incomplete Sentence Blank (assesses personality traits; perhaps the most widely used of all sentence completion tests).
Miner Sentence Completion Test (measures managerial motivations).
Washington University Sentence Completion Test (measures ego development).
Data analysis, validity and reliability
The data collected from sentence completion tests can usually be analyzed either quantitatively or qualitatively.[6]
Sentence completion tests usually include some formal coding procedure or manual. The validity of each sentence completion test must be determined independently and this depends on the instructions laid out in the scoring manual.
Compared to positivist instruments, such as Likert-type scales, sentence completion tests tend to have high face validity (i.e., the extent to which measurement items accurately reflect the concept being measured). This is to be expected, because in many cases the sentence stems name or refer to specific objects and the respondent is provides responses specifically focused on such objects.
References
^ Rhode, A.R. (1957) The Sentence Completion Method. New York: The Ronald Press 1957; Lah, M.I. (1989). Sentence Completion Tests. In C.S. Newmark (Ed.), Major psychological assessment instruments, Vol II (pp 133-163). Boston: Allyn and Bacon.
^ a b Ibid.
^ Holaday, M., Smith, D.A. & Sherry, A. (2000). Sentence completion tests: A review of the literature and results of a survey of members of the society for personality assessment. Journal of Personality Assessment, 74, 371-383.; Lubin, B., Larsen, R.M. & Matarazzo, J.D. (1984). Patterns of psychological test usage in United States: 1935-1982. American Psychologist, 39, 451-454.
^ Lawrence C. Soley & Aaron Lee Smith (2008). Projective Techniques for Social Science and Business Research. Milwaukee: The Southshore Press.
^ Ibid.
^ Ibid.
Herman Von Ebbinghaus is generally credited with developing the first sentence completion test in 1897.[1] Ebbinghaus’s sentence completion test was used as part of an intelligence test.[2]
Carl Jung’s word association test may also have been a precursor to modern sentence completion tests.
In recent decades, sentence completion tests have increased in usage, in part because they are easy to develop and easy to administer. As of the 1980s, sentence completion tests were the seventh most widely used personality assessment instruments.[3]
Another reason for the increased usage of sentence completion tests is because of their superiority to other measures in uncovering conflicted attitudes.[4]
Some sentence completion tests were developed as a way to overcome the problems associated with thematic apperception measures of the same constructs.[2]
Uses
The uses of sentence completion tests include personality analysis, clinical applications, attitude assessment, achievement motivation, and measurement of other constructs. They are used in several disciplines, including psychology, management, education, and marketing.
Sentence completion measures have also been incorporated into non-projective applications, such as intelligence tests, language comprehension, and language and cognitive development tests.[5]
Examples of sentence completion tests
There are many sentence completion tests available for use by researchers. Some of the most widely used sentence completion tests include:
Rotter Incomplete Sentence Blank (assesses personality traits; perhaps the most widely used of all sentence completion tests).
Miner Sentence Completion Test (measures managerial motivations).
Washington University Sentence Completion Test (measures ego development).
Data analysis, validity and reliability
The data collected from sentence completion tests can usually be analyzed either quantitatively or qualitatively.[6]
Sentence completion tests usually include some formal coding procedure or manual. The validity of each sentence completion test must be determined independently and this depends on the instructions laid out in the scoring manual.
Compared to positivist instruments, such as Likert-type scales, sentence completion tests tend to have high face validity (i.e., the extent to which measurement items accurately reflect the concept being measured). This is to be expected, because in many cases the sentence stems name or refer to specific objects and the respondent is provides responses specifically focused on such objects.
References
^ Rhode, A.R. (1957) The Sentence Completion Method. New York: The Ronald Press 1957; Lah, M.I. (1989). Sentence Completion Tests. In C.S. Newmark (Ed.), Major psychological assessment instruments, Vol II (pp 133-163). Boston: Allyn and Bacon.
^ a b Ibid.
^ Holaday, M., Smith, D.A. & Sherry, A. (2000). Sentence completion tests: A review of the literature and results of a survey of members of the society for personality assessment. Journal of Personality Assessment, 74, 371-383.; Lubin, B., Larsen, R.M. & Matarazzo, J.D. (1984). Patterns of psychological test usage in United States: 1935-1982. American Psychologist, 39, 451-454.
^ Lawrence C. Soley & Aaron Lee Smith (2008). Projective Techniques for Social Science and Business Research. Milwaukee: The Southshore Press.
^ Ibid.
^ Ibid.
Sentence completion tests are a class of semi-structured projective techniques. Sentence completion tests typically provide respondents with beginnings of sentences, referred to as “stems,” and respondents then complete the sentences in ways that are meaningful to them. The responses are believed to provide indications of attitudes, beliefs, motivations, or other mental states. There is debate over whether or not sentence completion tests elicit responses from conscious thought rather than unconscious states. This debate would affect whether sentence completion tests can be strictly categorized as projective tests.
A sentence completion test form may be relatively short, such as those used to assess responses to advertisements, or much longer, such as those used to assess personality. A long sentence completion test is the Forer Sentence Completion Test, which has 100 stems. The tests are usually administered in booklet form where respondents complete the stems by writing words on paper.
The structures of sentence completion tests vary according to the length and relative generality and wording of the sentence stems. Structured tests have longer stems that lead respondents to more specific types of responses; less structured tests provide shorter stems, which produce a wider variety of responses.
A sentence completion test form may be relatively short, such as those used to assess responses to advertisements, or much longer, such as those used to assess personality. A long sentence completion test is the Forer Sentence Completion Test, which has 100 stems. The tests are usually administered in booklet form where respondents complete the stems by writing words on paper.
The structures of sentence completion tests vary according to the length and relative generality and wording of the sentence stems. Structured tests have longer stems that lead respondents to more specific types of responses; less structured tests provide shorter stems, which produce a wider variety of responses.
Sunday, June 20, 2010
Introduction: Bipolar Disorder
This booklet discusses bipolar disorder in adults. For information on bipolar disorder in children and adolescents, see the NIMH booklet, “Bipolar Disorder in Children and Teens: A Parent’s Guide.”
What is bipolar disorder?
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time. Bipolar disorder symptoms can result in damaged relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives.
Bipolar disorder often develops in a person's late teens or early adult years. At least half of all cases start before age 25.1 Some people have their first symptoms during childhood, while others may develop symptoms late in life.
Bipolar disorder is not easy to spot when it starts. The symptoms may seem like separate problems, not recognized as parts of a larger problem. Some people suffer for years before they are properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.
What are the symptoms of bipolar disorder?
People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called "mood episodes." An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.
Extreme changes in energy, activity, sleep, and behavior go along with these changes in mood. It is possible for someone with bipolar disorder to experience a long-lasting period of unstable moods rather than discrete episodes of depression or mania.
A person may be having an episode of bipolar disorder if he or she has a number of manic or depressive symptoms for most of the day, nearly every day, for at least one or two weeks. Sometimes symptoms are so severe that the person cannot function normally at work, school, or home.
Symptoms of bipolar disorder are described below.
Symptoms of mania or a manic episode include: Symptoms of depression or a depressive episode include:
Mood Changes
A long period of feeling "high," or an overly happy or outgoing mood
Extremely irritable mood, agitation, feeling "jumpy" or "wired."
Behavioral Changes
Talking very fast, jumping from one idea to another, having racing thoughts
Being easily distracted
Increasing goal-directed activities, such as taking on new projects
Being restless
Sleeping little
Having an unrealistic belief in one's abilities
Behaving impulsively and taking part in a lot of pleasurable,
high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments.
Mood Changes
A long period of feeling worried or empty
Loss of interest in activities once enjoyed, including sex.
Behavioral Changes
Feeling tired or "slowed down"
Having problems concentrating, remembering, and making decisions
Being restless or irritable
Changing eating, sleeping, or other habits
Thinking of death or suicide, or attempting suicide.
In addition to mania and depression, bipolar disorder can cause a range of moods, as shown on the scale.
One side of the scale includes severe depression, moderate depression, and mild low mood. Moderate depression may cause less extreme symptoms, and mild low mood is called dysthymia when it is chronic or long-term. In the middle of the scale is normal or balanced mood.
At the other end of the scale are hypomania and severe mania. Some people with bipolar disorder experience hypomania. During hypomanic episodes, a person may have increased energy and activity levels that are not as severe as typical mania, or he or she may have episodes that last less than a week and do not require emergency care. A person having a hypomanic episode may feel very good, be highly productive, and function well. This person may not feel that anything is wrong even as family and friends recognize the mood swings as possible bipolar disorder. Without proper treatment, however, people with hypomania may develop severe mania or depression.
During a mixed state, symptoms often include agitation, trouble sleeping, major changes in appetite, and suicidal thinking. People in a mixed state may feel very sad or hopeless while feeling extremely energized.
Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions. The psychotic symptoms tend to reflect the person's extreme mood. For example, psychotic symptoms for a person having a manic episode may include believing he or she is famous, has a lot of money, or has special powers. In the same way, a person having a depressive episode may believe he or she is ruined and penniless, or has committed a crime. As a result, people with bipolar disorder who have psychotic symptoms are sometimes wrongly diagnosed as having schizophrenia, another severe mental illness that is linked with hallucinations and delusions.
People with bipolar disorder may also have behavioral problems. They may abuse alcohol or substances, have relationship problems, or perform poorly in school or at work. At first, it's not easy to recognize these problems as signs of a major mental illness.
How does bipolar disorder affect someone over time?
Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of symptoms, but some people may have lingering symptoms.
Doctors usually diagnose mental disorders using guidelines from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. According to the DSM, there are four basic types of bipolar disorder:
Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person's normal behavior.
Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes.
Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior.
Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.
Some people may be diagnosed with rapid-cycling bipolar disorder. This is when a person has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year.2 Some people experience more than one episode in a week, or even within one day. Rapid cycling seems to be more common in people who have severe bipolar disorder and may be more common in people who have their first episode at a younger age. One study found that people with rapid cycling had their first episode about four years earlier, during mid to late teen years, than people without rapid cycling bipolar disorder.3 Rapid cycling affects more women than men.4
Bipolar disorder tends to worsen if it is not treated. Over time, a person may suffer more frequent and more severe episodes than when the illness first appeared.5 Also, delays in getting the correct diagnosis and treatment make a person more likely to experience personal, social, and work-related problems.6
Proper diagnosis and treatment helps people with bipolar disorder lead healthy and productive lives. In most cases, treatment can help reduce the frequency and severity of episodes.
What illnesses often co-exist with bipolar disorder?
Substance abuse is very common among people with bipolar disorder, but the reasons for this link are unclear.7 Some people with bipolar disorder may try to treat their symptoms with alcohol or drugs. However, substance abuse may trigger or prolong bipolar symptoms, and the behavioral control problems associated with mania can result in a person drinking too much.
Anxiety disorders, such as post-traumatic stress disorder (PTSD) and social phobia, also co-occur often among people with bipolar disorder.8-10 Bipolar disorder also co-occurs with attention deficit hyperactivity disorder (ADHD), which has some symptoms that overlap with bipolar disorder, such as restlessness and being easily distracted.
People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses.10, 11 These illnesses may cause symptoms of mania or depression. They may also result from treatment for bipolar disorder.
Other illnesses can make it hard to diagnose and treat bipolar disorder. People with bipolar disorder should monitor their physical and mental health. If a symptom does not get better with treatment, they should tell their doctor.
What are the risk factors for bipolar disorder?
Scientists are learning about the possible causes of bipolar disorder. Most scientists agree that there is no single cause. Rather, many factors likely act together to produce the illness or increase risk.
Genetics
Bipolar disorder tends to run in families, so researchers are looking for genes that may increase a person's chance of developing the illness. Genes are the "building blocks" of heredity. They help control how the body and brain work and grow. Genes are contained inside a person's cells that are passed down from parents to children.
Children with a parent or sibling who has bipolar disorder are four to six times more likely to develop the illness, compared with children who do not have a family history of bipolar disorder.12 However, most children with a family history of bipolar disorder will not develop the illness.
Genetic research on bipolar disorder is being helped by advances in technology. This type of research is now much quicker and more far-reaching than in the past. One example is the launch of the Bipolar Disorder Phenome Database, funded in part by NIMH. Using the database, scientists will be able to link visible signs of the disorder with the genes that may influence them. So far, researchers using this database found that most people with bipolar disorder had:13
Missed work because of their illness
Other illnesses at the same time, especially alcohol and/or substance abuse and panic disorders
Been treated or hospitalized for bipolar disorder.
The researchers also identified certain traits that appeared to run in families, including:
History of psychiatric hospitalization
Co-occurring obsessive-compulsive disorder (OCD)
Age at first manic episode
Number and frequency of manic episodes.
Scientists continue to study these traits, which may help them find the genes that cause bipolar disorder some day.
But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that the twin of a person with bipolar illness does not always develop the disorder. This is important because identical twins share all of the same genes. The study results suggest factors besides genes are also at work. Rather, it is likely that many different genes and a person's environment are involved. However, scientists do not yet fully understand how these factors interact to cause bipolar disorder.
Brain structure and functioning
Brain-imaging studies are helping scientists learn what happens in the brain of a person with bipolar disorder.14, 15 Newer brain-imaging tools, such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), allow researchers to take pictures of the living brain at work. These tools help scientists study the brain's structure and activity.
Some imaging studies show how the brains of people with bipolar disorder may differ from the brains of healthy people or people with other mental disorders. For example, one study using MRI found that the pattern of brain development in children with bipolar disorder was similar to that in children with "multi-dimensional impairment," a disorder that causes symptoms that overlap somewhat with bipolar disorder and schizophrenia.16 This suggests that the common pattern of brain development may be linked to general risk for unstable moods.
Learning more about these differences, along with information gained from genetic studies, helps scientists better understand bipolar disorder. Someday scientists may be able to predict which types of treatment will work most effectively. They may even find ways to prevent bipolar disorder.
How is bipolar disorder diagnosed?
The first step in getting a proper diagnosis is to talk to a doctor, who may conduct a physical examination, an interview, and lab tests. Bipolar disorder cannot currently be identified through a blood test or a brain scan, but these tests can help rule out other contributing factors, such as a stroke or brain tumor. If the problems are not caused by other illnesses, the doctor may conduct a mental health evaluation. The doctor may also provide a referral to a trained mental health professional, such as a psychiatrist, who is experienced in diagnosing and treating bipolar disorder.
The doctor or mental health professional should conduct a complete diagnostic evaluation. He or she should discuss any family history of bipolar disorder or other mental illnesses and get a complete history of symptoms. The doctor or mental health professionals should also talk to the person's close relatives or spouse and note how they describe the person's symptoms and family medical history.
People with bipolar disorder are more likely to seek help when they are depressed than when experiencing mania or hypomania.17 Therefore, a careful medical history is needed to assure that bipolar disorder is not mistakenly diagnosed as major depressive disorder, which is also called unipolar depression. Unlike people with bipolar disorder, people who have unipolar depression do not experience mania. Whenever possible, previous records and input from family and friends should also be included in the medical history.
How is bipolar disorder treated?
To date, there is no cure for bipolar disorder. But proper treatment helps most people with bipolar disorder gain better control of their mood swings and related symptoms.18-20 This is also true for people with the most severe forms of the illness.
Because bipolar disorder is a lifelong and recurrent illness, people with the disorder need long-term treatment to maintain control of bipolar symptoms. An effective maintenance treatment plan includes medication and psychotherapy for preventing relapse and reducing symptom severity.21
Medications
Bipolar disorder can be diagnosed and medications prescribed by people with an M.D. (doctor of medicine). Usually, bipolar medications are prescribed by a psychiatrist. In some states, clinical psychologists, psychiatric nurse practitioners, and advanced psychiatric nurse specialists can also prescribe medications. Check with your state's licensing agency to find out more.
Not everyone responds to medications in the same way. Several different medications may need to be tried before the best course of treatment is found.
Keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events can help the doctor track and treat the illness most effectively. Sometimes this is called a daily life chart. If a person's symptoms change or if side effects become serious, the doctor may switch or add medications.
Some of the types of medications generally used to treat bipolar disorder are listed on the next page. Information on medications can change. For the most up to date information on use and side effects contact the U.S. Food and Drug Administration (FDA).
Mood stabilizing medications are usually the first choice to treat bipolar disorder. In general, people with bipolar disorder continue treatment with mood stabilizers for years. Except for lithium, many of these medications are anticonvulsants. Anticonvulsant medications are usually used to treat seizures, but they also help control moods. These medications are commonly used as mood stabilizers in bipolar disorder:
Lithium (sometimes known as Eskalith or Lithobid) was the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) in the 1970s for treatment of mania. It is often very effective in controlling symptoms of mania and preventing the recurrence of manic and depressive episodes.
Valproic acid or divalproex sodium (Depakote), approved by the FDA in 1995 for treating mania, is a popular alternative to lithium for bipolar disorder. It is generally as effective as lithium for treating bipolar disorder.23, 24 Also see the section in this booklet, "Should young women take valproic acid?"
More recently, the anticonvulsant lamotrigine (Lamictal) received FDA approval for maintenance treatment of bipolar disorder.
Other anticonvulsant medications, including gabapentin (Neurontin), topiramate (Topamax), and oxcarbazepine (Trileptal) are sometimes prescribed. No large studies have shown that these medications are more effective than mood stabilizers.
Valproic acid, lamotrigine, and other anticonvulsant medications have an FDA warning. The warning states that their use may increase the risk of suicidal thoughts and behaviors. People taking anticonvulsant medications for bipolar or other illnesses should be closely monitored for new or worsening symptoms of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. People taking these medications should not make any changes without talking to their health care professional.
Lithium and Thyroid Function
People with bipolar disorder often have thyroid gland problems. Lithium treatment may also cause low thyroid levels in some people.22 Low thyroid function, called hypothyroidism, has been associated with rapid cycling in some people with bipolar disorder, especially women.
Because too much or too little thyroid hormone can lead to mood and energy changes, it is important to have a doctor check thyroid levels carefully. A person with bipolar disorder may need to take thyroid medication, in addition to medications for bipolar disorder, to keep thyroid levels balanced.
Should young women take valproic acid?
Valproic acid may increase levels of testosterone (a male hormone) in teenage girls and lead to polycystic ovary syndrome (PCOS) in women who begin taking the medication before age 20.25, 26 PCOS causes a woman's eggs to develop into cysts, or fluid filled sacs that collect in the ovaries instead of being released by monthly periods. This condition can cause obesity, excess body hair, disruptions in the menstrual cycle, and other serious symptoms. Most of these symptoms will improve after stopping treatment with valproic acid.27 Young girls and women taking valproic acid should be monitored carefully by a doctor.
Atypical antipsychotic medications are sometimes used to treat symptoms of bipolar disorder. Often, these medications are taken with other medications. Atypical antipsychotic medications are called "atypical" to set them apart from earlier medications, which are called "conventional" or "first-generation" antipsychotics.
Olanzapine (Zyprexa), when given with an antidepressant medication, may help relieve symptoms of severe mania or psychosis.28 Olanzapine is also available in an injectable form, which quickly treats agitation associated with a manic or mixed episode. Olanzapine can be used for maintenance treatment of bipolar disorder as well, even when a person does not have psychotic symptoms. However, some studies show that people taking olanzapine may gain weight and have other side effects that can increase their risk for diabetes and heart disease. These side effects are more likely in people taking olanzapine when compared with people prescribed other atypical antipsychotics.
Aripiprazole (Abilify), like olanzapine, is approved for treatment of a manic or mixed episode. Aripiprazole is also used for maintenance treatment after a severe or sudden episode. As with olanzapine, aripiprazole also can be injected for urgent treatment of symptoms of manic or mixed episodes of bipolar disorder.
Quetiapine (Seroquel) relieves the symptoms of severe and sudden manic episodes. In that way, quetiapine is like almost all antipsychotics. In 2006, it became the first atypical antipsychotic to also receive FDA approval for the treatment of bipolar depressive episodes.
Risperidone (Risperdal) and ziprasidone (Geodon) are other atypical antipsychotics that may also be prescribed for controlling manic or mixed episodes.
Antidepressant medications are sometimes used to treat symptoms of depression in bipolar disorder. People with bipolar disorder who take antidepressants often take a mood stabilizer too. Doctors usually require this because taking only an antidepressant can increase a person's risk of switching to mania or hypomania, or of developing rapid cycling symptoms.29 To prevent this switch, doctors who prescribe antidepressants for treating bipolar disorder also usually require the person to take a mood-stabilizing medication at the same time.
Recently, a large-scale, NIMH-funded study showed that for many people, adding an antidepressant to a mood stabilizer is no more effective in treating the depression than using only a mood stabilizer.30
Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin) are examples of antidepressants that may be prescribed to treat symptoms of bipolar depression.
Some medications are better at treating one type of bipolar symptoms than another. For example, lamotrigine (Lamictal) seems to be helpful in controlling depressive symptoms of bipolar disorder.
What are the side effects of these medications?
Before starting a new medication, people with bipolar disorder should talk to their doctor about the possible risks and benefits.
The psychiatrist prescribing the medication or pharmacist can also answer questions about side effects. Over the last decade, treatments have improved, and some medications now have fewer or more tolerable side effects than earlier treatments. However, everyone responds differently to medications. In some cases, side effects may not appear until a person has taken a medication for some time.
If the person with bipolar disorder develops any severe side effects from a medication, he or she should talk to the doctor who prescribed it as soon as possible. The doctor may change the dose or prescribe a different medication. People being treated for bipolar disorder should not stop taking a medication without talking to a doctor first. Suddenly stopping a medication may lead to "rebound," or worsening of bipolar disorder symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.
FDA Warning on Antidepressants
Antidepressants are safe and popular, but some studies have suggested that they may have unintentional effects on some people, especially in adolescents and young adults. The FDA warning says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. Possible side effects to look for are depression that gets worse, suicidal thinking or behavior, or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from normal social situations. Families and caregivers should report any changes to the doctor. For the latest information visit the FDA website.
The following sections describe some common side effects of the different types of medications used to treat bipolar disorder.
1. Mood Stabilizers
In some cases, lithium can cause side effects such as:
Restlessness
Dry mouth
Bloating or indigestion
Acne
Unusual discomfort to cold temperatures
Joint or muscle pain
Brittle nails or hair.31
Lithium also causes side effects not listed here. If extremely bothersome or unusual side effects occur, tell your doctor as soon as possible.
If a person with bipolar disorder is being treated with lithium, it is important to make regular visits to the treating doctor. The doctor needs to check the levels of lithium in the person's blood, as well as kidney and thyroid function.
These medications may also be linked with rare but serious side effects. Talk with the treating doctor or a pharmacist to make sure you understand signs of serious side effects for the medications you're taking.
Common side effects of other mood stabilizing medications include:
Drowsiness
Dizziness
Headache
Diarrhea
Constipation
Heartburn
Mood swings
Stuffed or runny nose, or other cold-like symptoms.32-37
2. Atypical Antipsychotics
Some people have side effects when they start taking atypical antipsychotics. Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include:
Drowsiness
Dizziness when changing positions
Blurred vision
Rapid heartbeat
Sensitivity to the sun
Skin rashes
Menstrual problems for women.
Atypical antipsychotic medications can cause major weight gain and changes in a person's metabolism. This may increase a person's risk of getting diabetes and high cholesterol.38 A person's weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking these medications.
In rare cases, long-term use of atypical antipsychotic drugs may lead to a condition called tardive dyskinesia (TD). The condition causes muscle movements that commonly occur around the mouth. A person with TD cannot control these moments. TD can range from mild to severe, and it cannot always be cured. Some people with TD recover partially or fully after they stop taking the drug.
3. Antidepressants
The antidepressants most commonly prescribed for treating symptoms of bipolar disorder can also cause mild side effects that usually do not last long. These can include:
Headache, which usually goes away within a few days.
Nausea (feeling sick to your stomach), which usually goes away within a few days.
Sleep problems, such as sleeplessness or drowsiness. This may happen during the first few weeks but then go away. To help lessen these effects, sometimes the medication dose can be reduced, or the time of day it is taken can be changed.
Agitation (feeling jittery).
Sexual problems, which can affect both men and women. These include reduced sex drive and problems having and enjoying sex.
Some antidepressants are more likely to cause certain side effects than other types. Your doctor or pharmacist can answer questions about these medications. Any unusual reactions or side effects should be reported to a doctor immediately.
For the most up-to-date information on medications for treating bipolar disorder and their side effects, please see the online NIMH Medications booklet.
Should women who are pregnant or may become pregnant take medication for bipolar disorder?
Women with bipolar disorder who are pregnant or may become pregnant face special challenges. The mood stabilizing medications in use today can harm a developing fetus or nursing infant.39 But stopping medications, either suddenly or gradually, greatly increases the risk that bipolar symptoms will recur during pregnancy.40
Scientists are not sure yet, but lithium is likely the preferred mood-stabilizing medication for pregnant women with bipolar disorder.40, 41 However, lithium can lead to heart problems in the fetus. Women need to know that most bipolar medications are passed on through breast milk.41 Pregnant women and nursing mothers should talk to their doctors about the benefits and risks of all available treatments.
Psychotherapy
In addition to medication, psychotherapy, or "talk" therapy, can be an effective treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:
Cognitive behavioral therapy (CBT) helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors.
Family-focused therapy includes family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. This therapy also improves communication and problem-solving.
Interpersonal and social rhythm therapy helps people with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
Psychoeducation teaches people with bipolar disorder about the illness and its treatment. This treatment helps people recognize signs of relapse so they can seek treatment early, before a full-blown episode occurs. Usually done in a group, psychoeducation may also be helpful for family members and caregivers.
A licensed psychologist, social worker, or counselor typically provides these therapies. This mental health professional often works with the psychiatrist to track progress. The number, frequency, and type of sessions should be based on the treatment needs of each person. As with medication, following the doctor's instructions for any psychotherapy will provide the greatest benefit.
For more information, see the Substance Abuse and Mental Health Services Administration web page on choosing a mental health therapist.
Recently, NIMH funded a clinical trial called the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). This was the largest treatment study ever conducted for bipolar disorder. In a study on psychotherapies, STEP-BD researchers compared people in two groups. The first group was treated with collaborative care (three sessions of psychoeducation over six weeks). The second group was treated with medication and intensive psychotherapy (30 sessions over nine months of CBT, interpersonal and social rhythm therapy, or family-focused therapy). Researchers found that the second group had fewer relapses, lower hospitalization rates, and were better able to stick with their treatment plans.42 They were also more likely to get well faster and stay well longer.
NIMH is supporting more research on which combinations of psychotherapy and medication work best. The goal is to help people with bipolar disorder live symptom-free for longer periods and to recover from episodes more quickly. Researchers also hope to determine whether psychotherapy helps delay the start of bipolar disorder in children at high risk for the illness.
Visit the NIMH Web site for more information on psychotherapy.
Other treatments
Electroconvulsive Therapy (ECT)—For cases in which medication and/or psychotherapy does not work, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe bipolar disorder who have not been able to feel better with other treatments.
Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse administered in ECT. On average, ECT treatments last from 30–90 seconds. People who have ECT usually recover after 5–15 minutes and are able to go home the same day.43
Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severely depressive, manic, or mixed episodes, but is generally not a first-line treatment.
ECT may cause some short-term side effects, including confusion, disorientation, and memory loss. But these side effects typically clear soon after treatment. People with bipolar disorder should discuss possible benefits and risks of ECT with an experienced doctor.44
Sleep Medications—People with bipolar disorder who have trouble sleeping usually sleep better after getting treatment for bipolar disorder. However, if sleeplessness does not improve, the doctor may suggest a change in medications. If the problems still continue, the doctor may prescribe sedatives or other sleep medications.
People with bipolar disorder should tell their doctor about all prescription drugs, over-the-counter medications, or supplements they are taking. Certain medications and supplements taken together may cause unwanted or dangerous effects.
Herbal Supplements
In general, there is not much research about herbal or natural supplements. Little is known about their effects on bipolar disorder. An herb called St. John's wort (Hypericum perforatum), often marketed as a natural antidepressant, may cause a switch to mania in some people with bipolar disorder.45 St. John's wort can also make other medications less effective, including some antidepressant and anticonvulsant medications.46 Scientists are also researching omega-3 fatty acids (most commonly found in fish oil) to measure their usefulness for long-term treatment of bipolar disorder.47 Study results have been mixed.48 It is important to talk with a doctor before taking any herbal or natural supplements because of the serious risk of interactions with other medications.
What can people with bipolar disorder expect from treatment?
Bipolar disorder has no cure, but can be effectively treated over the long-term. It is best controlled when treatment is continuous, rather than on and off. In the STEP-BD study, a little more than half of the people treated for bipolar disorder recovered over one year's time. For this study, recovery meant having two or fewer symptoms of the disorder for at least eight weeks.
However, even with proper treatment, mood changes can occur. In the STEP-BD study, almost half of those who recovered still had lingering symptoms. These people experienced a relapse or recurrence that was usually a return to a depressive state.49 If a person had a mental illness in addition to bipolar disorder, he or she was more likely to experience a relapse.49 Scientists are unsure, however, how these other illnesses or lingering symptoms increase the chance of relapse. For some people, combining psychotherapy with medication may help to prevent or delay relapse.42
Treatment may be more effective when people work closely with a doctor and talk openly about their concerns and choices. Keeping track of mood changes and symptoms with a daily life chart can help a doctor assess a person's response to treatments. Sometimes the doctor needs to change a treatment plan to make sure symptoms are controlled most effectively. A psychiatrist should guide any changes in type or dose of medication.
How can I help a friend or relative who has bipolar disorder?
If you know someone who has bipolar disorder, it affects you too. The first and most important thing you can do is help him or her get the right diagnosis and treatment. You may need to make the appointment and go with him or her to see the doctor. Encourage your loved one to stay in treatment.
To help a friend or relative, you can:
Offer emotional support, understanding, patience, and encouragement
Learn about bipolar disorder so you can understand what your friend or relative is experiencing
Talk to your friend or relative and listen carefully
Listen to feelings your friend or relative expresses-be understanding about situations that may trigger bipolar symptoms
Invite your friend or relative out for positive distractions, such as walks, outings, and other activities
Remind your friend or relative that, with time and treatment, he or she can get better.
Never ignore comments about your friend or relative harming himself or herself. Always report such comments to his or her therapist or doctor.
Support for caregivers
Like other serious illnesses, bipolar disorder can be difficult for spouses, family members, friends, and other caregivers. Relatives and friends often have to cope with the person's serious behavioral problems, such as wild spending sprees during mania, extreme withdrawal during depression, poor work or school performance. These behaviors can have lasting consequences.
Caregivers usually take care of the medical needs of their loved ones. The caregivers have to deal with how this affects their own health. The stress that caregivers are under may lead to missed work or lost free time, strained relationships with people who may not understand the situation, and physical and mental exhaustion.
Stress from caregiving can make it hard to cope with a loved one's bipolar symptoms. One study shows that if a caregiver is under a lot of stress, his or her loved one has more trouble following the treatment plan, which increases the chance for a major bipolar episode.50 It is important that people caring for those with bipolar disorder also take care of themselves.
How can I help myself if I have bipolar disorder?
It may be very hard to take that first step to help yourself. It may take time, but you can get better with treatment.
To help yourself:
Talk to your doctor about treatment options and progress
Keep a regular routine, such as eating meals at the same time every day and going to sleep at the same time every night
Try to get enough sleep
Stay on your medication
Learn about warning signs signaling a shift into depression or mania
Expect your symptoms to improve gradually, not immediately.
Where can I go for help?
If you are unsure where to go for help, ask your family doctor. Others who can help are listed below.
Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
Health maintenance organizations
Community mental health centers
Hospital psychiatry departments and outpatient clinics
Mental health programs at universities or medical schools
State hospital outpatient clinics
Family services, social agencies, or clergy
Peer support groups
Private clinics and facilities
Employee assistance programs
Local medical and/or psychiatric societies.
You can also check the phone book under "mental health," "health," "social services," "hotlines," or "physicians" for phone numbers and addresses. An emergency room doctor can also provide temporary help and can tell you where and how to get further help.
What if I or someone I know is in crisis?
If you are thinking about harming yourself, or know someone who is, tell someone who can help immediately.
Call your doctor.
Call 911 or go to a hospital emergency room to get immediate help or ask a friend or family member to help you do these things.
Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor.
Make sure you or the suicidal person is not left alone.
Citations
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2. Akiskal HS. "Mood Disorders: Clinical Features." in Sadock BJ, Sadock VA (ed). (2005). Kaplan & Sadock's Comprehensive Textbook of Psychiatry. Lippincott Williams & Wilkins:Philadelphia.
3. Schneck CD, Miklowitz DJ, Miyahara S, Araga M, Wisniewski S, Gyulai L, Allen MH, Thase ME, Sachs GS. The prospective course of rapid-cycling bipolar disorder: findings from the STEP-BD. Am J Psychiatry. 2008 Mar;165(3):370-7; quiz 410.
4. Schneck CD, Miklowitz DJ, Calabrese JR, Allen MH, Thomas MR, Wisniewski SR, Miyahara S, Shelton MD, Ketter TA, Goldberg JF, Bowden CL, Sachs GS. Phenomenology of rapid-cycling bipolar disorder: data from the first 500 participants in the Systematic Treatment Enhancement Program. Am J Psychiatry. 2004 Oct;161(10):1902-1908.
5. Goodwin FK, Jamison KR. (2007) Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, Second Edition. Oxford University Press:New York.
6. Constituency Survey: Living With Bipolar Disorder: How Far Have We Really Come? National Depressive and Manic-Depressive Association. 2001.
7. Bizzarri JV, Sbrana A, Rucci P, Ravani L, Massei GJ, Gonnelli C, Spagnolli S, Doria MR, Raimondi F, Endicott J, Dell'Osso L, Cassano GB. The spectrum of substance abuse in bipolar disorder: reasons for use, sensation seeking and substance sensitivity. Bipolar Disord. 2007 May;9(3):213-220.
8. Mueser KT, Goodman LB, Trumbetta SL, Rosenberg SD, Osher C, Vidaver R, Auciello P, Foy DW. Trauma and posttraumatic stress disorder in severe mental illness. J Consult Clin Psychol. 1998 Jun;66(3):493-499.
9. Strakowski SM, Sax KW, McElroy SL, Keck PE, Jr., Hawkins JM, West SA. Course of psychiatric and substance abuse syndromes co-occurring with bipolar disorder after a first psychiatric hospitalization. J Consult Clin Psychol. 1998 Sep;59(9):465-471.
10. Krishnan KR. Psychiatric and medical comorbidities of bipolar disorder. Psychosom Med. 2005 Jan-Feb;67(1):1-8.
11. Kupfer DJ. The increasing medical burden in bipolar disorder. JAMA. 2005 May 25;293(20):2528-2530.
12. Nurnberger JI, Jr., Foroud T. Genetics of bipolar affective disorder. Curr Psychiatry Rep. 2000 Apr;2(2):147-157.
13. Potash JB, Toolan J, Steele J, Miller EB, Pearl J, Zandi PP, Schulze TG, Kassem L, Simpson SG, Lopez V, MacKinnon DF, McMahon FJ. The bipolar disorder phenome database: a resource for genetic studies. Am J Psychiatry. 2007 Aug;164(8):1229-1237.
14. Soares JC, Mann JJ. The functional neuroanatomy of mood disorders. J Psychiatr Res. 1997 Jul-Aug;31(4):393-432.
15. Soares JC, Mann JJ. The anatomy of mood disorders--review of structural neuroimaging studies. Biol Psychiatry. 1997 Jan 1;41(1):86-106.
16. Gogtay N, Ordonez A, Herman DH, Hayashi KM, Greenstein D, Vaituzis C, Lenane M, Clasen L, Sharp W, Giedd JN, Jung D, Nugent Iii TF, Toga AW, Leibenluft E, Thompson PM, Rapoport JL. Dynamic mapping of cortical development before and after the onset of pediatric bipolar illness. J Child Psychol Psychiatry. 2007 Sep;48(9):852-862.
17. Hirschfeld RM. Psychiatric Management, from "Guideline Watch: Practice Guideline for the Treatment of Patients With Bipolar Disorder, 2nd Edition". http://www.psychiatryonline.com/content.aspx?aID=148440. Accessed on February 11, 2008.
18. Sachs GS, Printz DJ, Kahn DA, Carpenter D, Docherty JP. The Expert Consensus Guideline Series: Medication Treatment of Bipolar Disorder 2000. Postgrad Med. 2000 Apr;Spec No.:1-104.
19. Sachs GS, Thase ME. Bipolar disorder therapeutics: maintenance treatment. Biol Psychiatry. 2000 Sep 15;48(6):573-581.
20. Huxley NA, Parikh SV, Baldessarini RJ. Effectiveness of psychosocial treatments in bipolar disorder: state of the evidence. Harv Rev Psychiatry. 2000 Sep;8(3):126-140.
21. Miklowitz DJ. A review of evidence-based psychosocial interventions for bipolar disorder. J Consult Clin Psychol. 2006 67(Suppl 11):28-33.
22. Kupka RW, Nolen WA, Post RM, McElroy SL, Altshuler LL, Denicoff KD, Frye MA, Keck PE, Jr., Leverich GS, Rush AJ, Suppes T, Pollio C, Drexhage HA. High rate of autoimmune thyroiditis in bipolar disorder: lack of association with lithium exposure. Biol Psychiatry. 2002 Feb 15;51(4):305-311.
23. Bowden CL, Calabrese JR, McElroy SL, Gyulai L, Wassef A, Petty F, Pope HG, Jr., Chou JC, Keck PE, Jr., Rhodes LJ, Swann AC, Hirschfeld RM, Wozniak PJ, Group DMS. A randomized, placebo-controlled 12-month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Arch Gen Psychiatry. 2000 May;57(5):481-489.
24. Calabrese JR, Shelton MD, Rapport DJ, Youngstrom EA, Jackson K, Bilali S, Ganocy SJ, Findling RL. A 20-month, double-blind, maintenance trial of lithium versus divalproex in rapid-cycling bipolar disorder. Am J Psychiatry. 2005 Nov;162(11):2152-2161.
25. Vainionpaa LK, Rattya J, Knip M, Tapanainen JS, Pakarinen AJ, Lanning P, Tekay A, Myllyla VV, Isojarvi JI. Valproate-induced hyperandrogenism during pubertal maturation in girls with epilepsy. Ann Neurol. 1999 Apr;45(4):444-450.
26. Joffe H, Cohen LS, Suppes T, McLaughlin WL, Lavori P, Adams JM, Hwang CH, Hall JE, Sachs GS. Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism in women with bipolar disorder. Biol Psychiatry. 2006 Jun 1;59(11):1078-1086.
27. Joffe H, Cohen LS, Suppes T, Hwang CH, Molay F, Adams JM, Sachs GS, Hall JE. Longitudinal follow-up of reproductive and metabolic features of valproate-associated polycystic ovarian syndrome features: A preliminary report. Biol Psychiatry. 2006 Dec 15;60(12):1378-1381.
28. Tohen M, Sanger TM, McElroy SL, Tollefson GD, Chengappa KN, Daniel DG, Petty F, Centorrino F, Wang R, Grundy SL, Greaney MG, Jacobs TG, David SR, Toma V. Olanzapine versus placebo in the treatment of acute mania. Olanzapine HGEH Study Group. Am J Psychiatry. 1999 May;156(5):702-709.
29. Thase ME, Sachs GS. Bipolar depression: pharmacotherapy and related therapeutic strategies. Biol Psychiatry. 2000 Sep 15;48(6):558-572.
30. Sachs GS, Nierenberg AA, Calabrese JR, Marangell LB, Wisniewski SR, Gyulai L, Friedman ES, Bowden CL, Fossey MD, Ostacher MJ, Ketter TA, Patel J, Hauser P, Rapport D, Martinez JM, Allen MH, Miklowitz DJ, Otto MW, Dennehy EB, Thase ME. Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med. 2007 Apr 26;356(17):1711-1722.
31. MedlinePlus Drug Information: Lithium. http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a681039.html. Accessed on Nov 19, 2007.
32. MedlinePlus Drug Information: Carbamazepine. http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682237.html. Accessed on July 13, 2007.
33. MedlinePlus Drug Information: Lamotrigine. http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a695007.html. Accessed on February 12, 2008.
34. MedlinePlus Drug Information: Valproic Acid. http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682412.html. Accessed on February 12, 2008.
35. MedlinePlus Drug Information: Topiramate. http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a697012.html. Accessed on Febrary 22, 2008.
36. MedlinePlus Drug Information: Gabapentin. http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a694007.html. Accessed on February 22, 2008.
37. MedlinePlus Drug Information: Oxcarbazepine. http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601245.html. Accessed on February 22, 2008.
38. Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Keefe RS, Davis SM, Davis CE, Lebowitz BD, Severe J, Hsiao JK. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005 Sep 22;353(12):1209-1223.
39. Llewellyn A, Stowe ZN, Strader JR, Jr. The use of lithium and management of women with bipolar disorder during pregnancy and lactation. J Consult Clin Psychol. 1998 59(Suppl 6):57-64.
40. Viguera AC, Whitfield T, Baldessarini RJ, Newport J, Stowe Z, Reminick A, Zurick A, Cohen LS. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. Am J Psychiatry. 2007 Dec;164(12):1817-1824.
41. Yonkers KA, Wisner KL, Stowe Z, Leibenluft E, Cohen L, Miller L, Manber R, Viguera A, Suppes T, Altshuler L. Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatry. 2004 Apr;161(4):608-620.
42. Miklowitz DJ, Otto MW, Frank E, Reilly-Harrington NA, Wisniewski SR, Kogan JN, Nierenberg AA, Calabrese JR, Marangell LB, Gyulai L, Araga M, Gonzalez JM, Shirley ER, Thase ME, Sachs GS. Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program (STEP). Arch Gen Psychiatry. 2007 Apr;64(4):419-426.
43. Pandya M, Pozuelo L, Malone D. Electroconvulsive therapy: what the internist needs to know. Cleve Clin J Med. 2007 Sep;74(9):679-685.
44. Mental Health: A Report of the Surgeon General. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health. 1999.
45. Nierenberg AA, Burt T, Matthews J, Weiss AP. Mania associated with St. John's wort. Biol Psychiatry. 1999 Dec 15;46(12):1707-1708.
46. Henney JE. From the Food and Drug Administration: Risk of Drug Interactions With St John's Wort. JAMA. 2000 Apr 5;283(13):1679.
47. Stoll AL, Severus WE, Freeman MP, Rueter S, Zboyan HA, Diamond E, Cress KK, Marangell LB. Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Arch Gen Psychiatry. 1999 May;56(5):407-412.
48. Freeman MP, Hibbeln JR, Wisner KL, Davis JM, Mischoulon D, Peet M, Keck PE, Jr., Marangell LB, Richardson AJ, Lake J, Stoll AL. Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry. J Consult Clin Psychol. 2006 Dec;67(12):1954-1967.
49. Perlis RH, Ostacher MJ, Patel JK, Marangell LB, Zhang H, Wisniewski SR, Ketter TA, Miklowitz DJ, Otto MW, Gyulai L, Reilly-Harrington NA, Nierenberg AA, Sachs GS, Thase ME. Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatry. 2006 Feb;163(2):217-224.
50. Perlick DA, Rosenheck RA, Clarkin JF, Maciejewski PK, Sirey J, Struening E, Link BG. Impact of family burden and affective response on clinical outcome among patients with bipolar disorder. Psychiatr Serv. 2004 Sep;55(9):1029-1035.
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This booklet discusses bipolar disorder in adults. For information on bipolar disorder in children and adolescents, see the NIMH booklet, “Bipolar Disorder in Children and Teens: A Parent’s Guide.”
What is bipolar disorder?
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time. Bipolar disorder symptoms can result in damaged relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives.
Bipolar disorder often develops in a person's late teens or early adult years. At least half of all cases start before age 25.1 Some people have their first symptoms during childhood, while others may develop symptoms late in life.
Bipolar disorder is not easy to spot when it starts. The symptoms may seem like separate problems, not recognized as parts of a larger problem. Some people suffer for years before they are properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.
What are the symptoms of bipolar disorder?
People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called "mood episodes." An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.
Extreme changes in energy, activity, sleep, and behavior go along with these changes in mood. It is possible for someone with bipolar disorder to experience a long-lasting period of unstable moods rather than discrete episodes of depression or mania.
A person may be having an episode of bipolar disorder if he or she has a number of manic or depressive symptoms for most of the day, nearly every day, for at least one or two weeks. Sometimes symptoms are so severe that the person cannot function normally at work, school, or home.
Symptoms of bipolar disorder are described below.
Symptoms of mania or a manic episode include: Symptoms of depression or a depressive episode include:
Mood Changes
A long period of feeling "high," or an overly happy or outgoing mood
Extremely irritable mood, agitation, feeling "jumpy" or "wired."
Behavioral Changes
Talking very fast, jumping from one idea to another, having racing thoughts
Being easily distracted
Increasing goal-directed activities, such as taking on new projects
Being restless
Sleeping little
Having an unrealistic belief in one's abilities
Behaving impulsively and taking part in a lot of pleasurable,
high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments.
Mood Changes
A long period of feeling worried or empty
Loss of interest in activities once enjoyed, including sex.
Behavioral Changes
Feeling tired or "slowed down"
Having problems concentrating, remembering, and making decisions
Being restless or irritable
Changing eating, sleeping, or other habits
Thinking of death or suicide, or attempting suicide.
In addition to mania and depression, bipolar disorder can cause a range of moods, as shown on the scale.
One side of the scale includes severe depression, moderate depression, and mild low mood. Moderate depression may cause less extreme symptoms, and mild low mood is called dysthymia when it is chronic or long-term. In the middle of the scale is normal or balanced mood.
At the other end of the scale are hypomania and severe mania. Some people with bipolar disorder experience hypomania. During hypomanic episodes, a person may have increased energy and activity levels that are not as severe as typical mania, or he or she may have episodes that last less than a week and do not require emergency care. A person having a hypomanic episode may feel very good, be highly productive, and function well. This person may not feel that anything is wrong even as family and friends recognize the mood swings as possible bipolar disorder. Without proper treatment, however, people with hypomania may develop severe mania or depression.
During a mixed state, symptoms often include agitation, trouble sleeping, major changes in appetite, and suicidal thinking. People in a mixed state may feel very sad or hopeless while feeling extremely energized.
Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions. The psychotic symptoms tend to reflect the person's extreme mood. For example, psychotic symptoms for a person having a manic episode may include believing he or she is famous, has a lot of money, or has special powers. In the same way, a person having a depressive episode may believe he or she is ruined and penniless, or has committed a crime. As a result, people with bipolar disorder who have psychotic symptoms are sometimes wrongly diagnosed as having schizophrenia, another severe mental illness that is linked with hallucinations and delusions.
People with bipolar disorder may also have behavioral problems. They may abuse alcohol or substances, have relationship problems, or perform poorly in school or at work. At first, it's not easy to recognize these problems as signs of a major mental illness.
How does bipolar disorder affect someone over time?
Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of symptoms, but some people may have lingering symptoms.
Doctors usually diagnose mental disorders using guidelines from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. According to the DSM, there are four basic types of bipolar disorder:
Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person's normal behavior.
Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes.
Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior.
Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.
Some people may be diagnosed with rapid-cycling bipolar disorder. This is when a person has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year.2 Some people experience more than one episode in a week, or even within one day. Rapid cycling seems to be more common in people who have severe bipolar disorder and may be more common in people who have their first episode at a younger age. One study found that people with rapid cycling had their first episode about four years earlier, during mid to late teen years, than people without rapid cycling bipolar disorder.3 Rapid cycling affects more women than men.4
Bipolar disorder tends to worsen if it is not treated. Over time, a person may suffer more frequent and more severe episodes than when the illness first appeared.5 Also, delays in getting the correct diagnosis and treatment make a person more likely to experience personal, social, and work-related problems.6
Proper diagnosis and treatment helps people with bipolar disorder lead healthy and productive lives. In most cases, treatment can help reduce the frequency and severity of episodes.
What illnesses often co-exist with bipolar disorder?
Substance abuse is very common among people with bipolar disorder, but the reasons for this link are unclear.7 Some people with bipolar disorder may try to treat their symptoms with alcohol or drugs. However, substance abuse may trigger or prolong bipolar symptoms, and the behavioral control problems associated with mania can result in a person drinking too much.
Anxiety disorders, such as post-traumatic stress disorder (PTSD) and social phobia, also co-occur often among people with bipolar disorder.8-10 Bipolar disorder also co-occurs with attention deficit hyperactivity disorder (ADHD), which has some symptoms that overlap with bipolar disorder, such as restlessness and being easily distracted.
People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses.10, 11 These illnesses may cause symptoms of mania or depression. They may also result from treatment for bipolar disorder.
Other illnesses can make it hard to diagnose and treat bipolar disorder. People with bipolar disorder should monitor their physical and mental health. If a symptom does not get better with treatment, they should tell their doctor.
What are the risk factors for bipolar disorder?
Scientists are learning about the possible causes of bipolar disorder. Most scientists agree that there is no single cause. Rather, many factors likely act together to produce the illness or increase risk.
Genetics
Bipolar disorder tends to run in families, so researchers are looking for genes that may increase a person's chance of developing the illness. Genes are the "building blocks" of heredity. They help control how the body and brain work and grow. Genes are contained inside a person's cells that are passed down from parents to children.
Children with a parent or sibling who has bipolar disorder are four to six times more likely to develop the illness, compared with children who do not have a family history of bipolar disorder.12 However, most children with a family history of bipolar disorder will not develop the illness.
Genetic research on bipolar disorder is being helped by advances in technology. This type of research is now much quicker and more far-reaching than in the past. One example is the launch of the Bipolar Disorder Phenome Database, funded in part by NIMH. Using the database, scientists will be able to link visible signs of the disorder with the genes that may influence them. So far, researchers using this database found that most people with bipolar disorder had:13
Missed work because of their illness
Other illnesses at the same time, especially alcohol and/or substance abuse and panic disorders
Been treated or hospitalized for bipolar disorder.
The researchers also identified certain traits that appeared to run in families, including:
History of psychiatric hospitalization
Co-occurring obsessive-compulsive disorder (OCD)
Age at first manic episode
Number and frequency of manic episodes.
Scientists continue to study these traits, which may help them find the genes that cause bipolar disorder some day.
But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that the twin of a person with bipolar illness does not always develop the disorder. This is important because identical twins share all of the same genes. The study results suggest factors besides genes are also at work. Rather, it is likely that many different genes and a person's environment are involved. However, scientists do not yet fully understand how these factors interact to cause bipolar disorder.
Brain structure and functioning
Brain-imaging studies are helping scientists learn what happens in the brain of a person with bipolar disorder.14, 15 Newer brain-imaging tools, such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), allow researchers to take pictures of the living brain at work. These tools help scientists study the brain's structure and activity.
Some imaging studies show how the brains of people with bipolar disorder may differ from the brains of healthy people or people with other mental disorders. For example, one study using MRI found that the pattern of brain development in children with bipolar disorder was similar to that in children with "multi-dimensional impairment," a disorder that causes symptoms that overlap somewhat with bipolar disorder and schizophrenia.16 This suggests that the common pattern of brain development may be linked to general risk for unstable moods.
Learning more about these differences, along with information gained from genetic studies, helps scientists better understand bipolar disorder. Someday scientists may be able to predict which types of treatment will work most effectively. They may even find ways to prevent bipolar disorder.
How is bipolar disorder diagnosed?
The first step in getting a proper diagnosis is to talk to a doctor, who may conduct a physical examination, an interview, and lab tests. Bipolar disorder cannot currently be identified through a blood test or a brain scan, but these tests can help rule out other contributing factors, such as a stroke or brain tumor. If the problems are not caused by other illnesses, the doctor may conduct a mental health evaluation. The doctor may also provide a referral to a trained mental health professional, such as a psychiatrist, who is experienced in diagnosing and treating bipolar disorder.
The doctor or mental health professional should conduct a complete diagnostic evaluation. He or she should discuss any family history of bipolar disorder or other mental illnesses and get a complete history of symptoms. The doctor or mental health professionals should also talk to the person's close relatives or spouse and note how they describe the person's symptoms and family medical history.
People with bipolar disorder are more likely to seek help when they are depressed than when experiencing mania or hypomania.17 Therefore, a careful medical history is needed to assure that bipolar disorder is not mistakenly diagnosed as major depressive disorder, which is also called unipolar depression. Unlike people with bipolar disorder, people who have unipolar depression do not experience mania. Whenever possible, previous records and input from family and friends should also be included in the medical history.
How is bipolar disorder treated?
To date, there is no cure for bipolar disorder. But proper treatment helps most people with bipolar disorder gain better control of their mood swings and related symptoms.18-20 This is also true for people with the most severe forms of the illness.
Because bipolar disorder is a lifelong and recurrent illness, people with the disorder need long-term treatment to maintain control of bipolar symptoms. An effective maintenance treatment plan includes medication and psychotherapy for preventing relapse and reducing symptom severity.21
Medications
Bipolar disorder can be diagnosed and medications prescribed by people with an M.D. (doctor of medicine). Usually, bipolar medications are prescribed by a psychiatrist. In some states, clinical psychologists, psychiatric nurse practitioners, and advanced psychiatric nurse specialists can also prescribe medications. Check with your state's licensing agency to find out more.
Not everyone responds to medications in the same way. Several different medications may need to be tried before the best course of treatment is found.
Keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events can help the doctor track and treat the illness most effectively. Sometimes this is called a daily life chart. If a person's symptoms change or if side effects become serious, the doctor may switch or add medications.
Some of the types of medications generally used to treat bipolar disorder are listed on the next page. Information on medications can change. For the most up to date information on use and side effects contact the U.S. Food and Drug Administration (FDA).
Mood stabilizing medications are usually the first choice to treat bipolar disorder. In general, people with bipolar disorder continue treatment with mood stabilizers for years. Except for lithium, many of these medications are anticonvulsants. Anticonvulsant medications are usually used to treat seizures, but they also help control moods. These medications are commonly used as mood stabilizers in bipolar disorder:
Lithium (sometimes known as Eskalith or Lithobid) was the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) in the 1970s for treatment of mania. It is often very effective in controlling symptoms of mania and preventing the recurrence of manic and depressive episodes.
Valproic acid or divalproex sodium (Depakote), approved by the FDA in 1995 for treating mania, is a popular alternative to lithium for bipolar disorder. It is generally as effective as lithium for treating bipolar disorder.23, 24 Also see the section in this booklet, "Should young women take valproic acid?"
More recently, the anticonvulsant lamotrigine (Lamictal) received FDA approval for maintenance treatment of bipolar disorder.
Other anticonvulsant medications, including gabapentin (Neurontin), topiramate (Topamax), and oxcarbazepine (Trileptal) are sometimes prescribed. No large studies have shown that these medications are more effective than mood stabilizers.
Valproic acid, lamotrigine, and other anticonvulsant medications have an FDA warning. The warning states that their use may increase the risk of suicidal thoughts and behaviors. People taking anticonvulsant medications for bipolar or other illnesses should be closely monitored for new or worsening symptoms of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. People taking these medications should not make any changes without talking to their health care professional.
Lithium and Thyroid Function
People with bipolar disorder often have thyroid gland problems. Lithium treatment may also cause low thyroid levels in some people.22 Low thyroid function, called hypothyroidism, has been associated with rapid cycling in some people with bipolar disorder, especially women.
Because too much or too little thyroid hormone can lead to mood and energy changes, it is important to have a doctor check thyroid levels carefully. A person with bipolar disorder may need to take thyroid medication, in addition to medications for bipolar disorder, to keep thyroid levels balanced.
Should young women take valproic acid?
Valproic acid may increase levels of testosterone (a male hormone) in teenage girls and lead to polycystic ovary syndrome (PCOS) in women who begin taking the medication before age 20.25, 26 PCOS causes a woman's eggs to develop into cysts, or fluid filled sacs that collect in the ovaries instead of being released by monthly periods. This condition can cause obesity, excess body hair, disruptions in the menstrual cycle, and other serious symptoms. Most of these symptoms will improve after stopping treatment with valproic acid.27 Young girls and women taking valproic acid should be monitored carefully by a doctor.
Atypical antipsychotic medications are sometimes used to treat symptoms of bipolar disorder. Often, these medications are taken with other medications. Atypical antipsychotic medications are called "atypical" to set them apart from earlier medications, which are called "conventional" or "first-generation" antipsychotics.
Olanzapine (Zyprexa), when given with an antidepressant medication, may help relieve symptoms of severe mania or psychosis.28 Olanzapine is also available in an injectable form, which quickly treats agitation associated with a manic or mixed episode. Olanzapine can be used for maintenance treatment of bipolar disorder as well, even when a person does not have psychotic symptoms. However, some studies show that people taking olanzapine may gain weight and have other side effects that can increase their risk for diabetes and heart disease. These side effects are more likely in people taking olanzapine when compared with people prescribed other atypical antipsychotics.
Aripiprazole (Abilify), like olanzapine, is approved for treatment of a manic or mixed episode. Aripiprazole is also used for maintenance treatment after a severe or sudden episode. As with olanzapine, aripiprazole also can be injected for urgent treatment of symptoms of manic or mixed episodes of bipolar disorder.
Quetiapine (Seroquel) relieves the symptoms of severe and sudden manic episodes. In that way, quetiapine is like almost all antipsychotics. In 2006, it became the first atypical antipsychotic to also receive FDA approval for the treatment of bipolar depressive episodes.
Risperidone (Risperdal) and ziprasidone (Geodon) are other atypical antipsychotics that may also be prescribed for controlling manic or mixed episodes.
Antidepressant medications are sometimes used to treat symptoms of depression in bipolar disorder. People with bipolar disorder who take antidepressants often take a mood stabilizer too. Doctors usually require this because taking only an antidepressant can increase a person's risk of switching to mania or hypomania, or of developing rapid cycling symptoms.29 To prevent this switch, doctors who prescribe antidepressants for treating bipolar disorder also usually require the person to take a mood-stabilizing medication at the same time.
Recently, a large-scale, NIMH-funded study showed that for many people, adding an antidepressant to a mood stabilizer is no more effective in treating the depression than using only a mood stabilizer.30
Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin) are examples of antidepressants that may be prescribed to treat symptoms of bipolar depression.
Some medications are better at treating one type of bipolar symptoms than another. For example, lamotrigine (Lamictal) seems to be helpful in controlling depressive symptoms of bipolar disorder.
What are the side effects of these medications?
Before starting a new medication, people with bipolar disorder should talk to their doctor about the possible risks and benefits.
The psychiatrist prescribing the medication or pharmacist can also answer questions about side effects. Over the last decade, treatments have improved, and some medications now have fewer or more tolerable side effects than earlier treatments. However, everyone responds differently to medications. In some cases, side effects may not appear until a person has taken a medication for some time.
If the person with bipolar disorder develops any severe side effects from a medication, he or she should talk to the doctor who prescribed it as soon as possible. The doctor may change the dose or prescribe a different medication. People being treated for bipolar disorder should not stop taking a medication without talking to a doctor first. Suddenly stopping a medication may lead to "rebound," or worsening of bipolar disorder symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.
FDA Warning on Antidepressants
Antidepressants are safe and popular, but some studies have suggested that they may have unintentional effects on some people, especially in adolescents and young adults. The FDA warning says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. Possible side effects to look for are depression that gets worse, suicidal thinking or behavior, or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from normal social situations. Families and caregivers should report any changes to the doctor. For the latest information visit the FDA website.
The following sections describe some common side effects of the different types of medications used to treat bipolar disorder.
1. Mood Stabilizers
In some cases, lithium can cause side effects such as:
Restlessness
Dry mouth
Bloating or indigestion
Acne
Unusual discomfort to cold temperatures
Joint or muscle pain
Brittle nails or hair.31
Lithium also causes side effects not listed here. If extremely bothersome or unusual side effects occur, tell your doctor as soon as possible.
If a person with bipolar disorder is being treated with lithium, it is important to make regular visits to the treating doctor. The doctor needs to check the levels of lithium in the person's blood, as well as kidney and thyroid function.
These medications may also be linked with rare but serious side effects. Talk with the treating doctor or a pharmacist to make sure you understand signs of serious side effects for the medications you're taking.
Common side effects of other mood stabilizing medications include:
Drowsiness
Dizziness
Headache
Diarrhea
Constipation
Heartburn
Mood swings
Stuffed or runny nose, or other cold-like symptoms.32-37
2. Atypical Antipsychotics
Some people have side effects when they start taking atypical antipsychotics. Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include:
Drowsiness
Dizziness when changing positions
Blurred vision
Rapid heartbeat
Sensitivity to the sun
Skin rashes
Menstrual problems for women.
Atypical antipsychotic medications can cause major weight gain and changes in a person's metabolism. This may increase a person's risk of getting diabetes and high cholesterol.38 A person's weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking these medications.
In rare cases, long-term use of atypical antipsychotic drugs may lead to a condition called tardive dyskinesia (TD). The condition causes muscle movements that commonly occur around the mouth. A person with TD cannot control these moments. TD can range from mild to severe, and it cannot always be cured. Some people with TD recover partially or fully after they stop taking the drug.
3. Antidepressants
The antidepressants most commonly prescribed for treating symptoms of bipolar disorder can also cause mild side effects that usually do not last long. These can include:
Headache, which usually goes away within a few days.
Nausea (feeling sick to your stomach), which usually goes away within a few days.
Sleep problems, such as sleeplessness or drowsiness. This may happen during the first few weeks but then go away. To help lessen these effects, sometimes the medication dose can be reduced, or the time of day it is taken can be changed.
Agitation (feeling jittery).
Sexual problems, which can affect both men and women. These include reduced sex drive and problems having and enjoying sex.
Some antidepressants are more likely to cause certain side effects than other types. Your doctor or pharmacist can answer questions about these medications. Any unusual reactions or side effects should be reported to a doctor immediately.
For the most up-to-date information on medications for treating bipolar disorder and their side effects, please see the online NIMH Medications booklet.
Should women who are pregnant or may become pregnant take medication for bipolar disorder?
Women with bipolar disorder who are pregnant or may become pregnant face special challenges. The mood stabilizing medications in use today can harm a developing fetus or nursing infant.39 But stopping medications, either suddenly or gradually, greatly increases the risk that bipolar symptoms will recur during pregnancy.40
Scientists are not sure yet, but lithium is likely the preferred mood-stabilizing medication for pregnant women with bipolar disorder.40, 41 However, lithium can lead to heart problems in the fetus. Women need to know that most bipolar medications are passed on through breast milk.41 Pregnant women and nursing mothers should talk to their doctors about the benefits and risks of all available treatments.
Psychotherapy
In addition to medication, psychotherapy, or "talk" therapy, can be an effective treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:
Cognitive behavioral therapy (CBT) helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors.
Family-focused therapy includes family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. This therapy also improves communication and problem-solving.
Interpersonal and social rhythm therapy helps people with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
Psychoeducation teaches people with bipolar disorder about the illness and its treatment. This treatment helps people recognize signs of relapse so they can seek treatment early, before a full-blown episode occurs. Usually done in a group, psychoeducation may also be helpful for family members and caregivers.
A licensed psychologist, social worker, or counselor typically provides these therapies. This mental health professional often works with the psychiatrist to track progress. The number, frequency, and type of sessions should be based on the treatment needs of each person. As with medication, following the doctor's instructions for any psychotherapy will provide the greatest benefit.
For more information, see the Substance Abuse and Mental Health Services Administration web page on choosing a mental health therapist.
Recently, NIMH funded a clinical trial called the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). This was the largest treatment study ever conducted for bipolar disorder. In a study on psychotherapies, STEP-BD researchers compared people in two groups. The first group was treated with collaborative care (three sessions of psychoeducation over six weeks). The second group was treated with medication and intensive psychotherapy (30 sessions over nine months of CBT, interpersonal and social rhythm therapy, or family-focused therapy). Researchers found that the second group had fewer relapses, lower hospitalization rates, and were better able to stick with their treatment plans.42 They were also more likely to get well faster and stay well longer.
NIMH is supporting more research on which combinations of psychotherapy and medication work best. The goal is to help people with bipolar disorder live symptom-free for longer periods and to recover from episodes more quickly. Researchers also hope to determine whether psychotherapy helps delay the start of bipolar disorder in children at high risk for the illness.
Visit the NIMH Web site for more information on psychotherapy.
Other treatments
Electroconvulsive Therapy (ECT)—For cases in which medication and/or psychotherapy does not work, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe bipolar disorder who have not been able to feel better with other treatments.
Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse administered in ECT. On average, ECT treatments last from 30–90 seconds. People who have ECT usually recover after 5–15 minutes and are able to go home the same day.43
Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severely depressive, manic, or mixed episodes, but is generally not a first-line treatment.
ECT may cause some short-term side effects, including confusion, disorientation, and memory loss. But these side effects typically clear soon after treatment. People with bipolar disorder should discuss possible benefits and risks of ECT with an experienced doctor.44
Sleep Medications—People with bipolar disorder who have trouble sleeping usually sleep better after getting treatment for bipolar disorder. However, if sleeplessness does not improve, the doctor may suggest a change in medications. If the problems still continue, the doctor may prescribe sedatives or other sleep medications.
People with bipolar disorder should tell their doctor about all prescription drugs, over-the-counter medications, or supplements they are taking. Certain medications and supplements taken together may cause unwanted or dangerous effects.
Herbal Supplements
In general, there is not much research about herbal or natural supplements. Little is known about their effects on bipolar disorder. An herb called St. John's wort (Hypericum perforatum), often marketed as a natural antidepressant, may cause a switch to mania in some people with bipolar disorder.45 St. John's wort can also make other medications less effective, including some antidepressant and anticonvulsant medications.46 Scientists are also researching omega-3 fatty acids (most commonly found in fish oil) to measure their usefulness for long-term treatment of bipolar disorder.47 Study results have been mixed.48 It is important to talk with a doctor before taking any herbal or natural supplements because of the serious risk of interactions with other medications.
What can people with bipolar disorder expect from treatment?
Bipolar disorder has no cure, but can be effectively treated over the long-term. It is best controlled when treatment is continuous, rather than on and off. In the STEP-BD study, a little more than half of the people treated for bipolar disorder recovered over one year's time. For this study, recovery meant having two or fewer symptoms of the disorder for at least eight weeks.
However, even with proper treatment, mood changes can occur. In the STEP-BD study, almost half of those who recovered still had lingering symptoms. These people experienced a relapse or recurrence that was usually a return to a depressive state.49 If a person had a mental illness in addition to bipolar disorder, he or she was more likely to experience a relapse.49 Scientists are unsure, however, how these other illnesses or lingering symptoms increase the chance of relapse. For some people, combining psychotherapy with medication may help to prevent or delay relapse.42
Treatment may be more effective when people work closely with a doctor and talk openly about their concerns and choices. Keeping track of mood changes and symptoms with a daily life chart can help a doctor assess a person's response to treatments. Sometimes the doctor needs to change a treatment plan to make sure symptoms are controlled most effectively. A psychiatrist should guide any changes in type or dose of medication.
How can I help a friend or relative who has bipolar disorder?
If you know someone who has bipolar disorder, it affects you too. The first and most important thing you can do is help him or her get the right diagnosis and treatment. You may need to make the appointment and go with him or her to see the doctor. Encourage your loved one to stay in treatment.
To help a friend or relative, you can:
Offer emotional support, understanding, patience, and encouragement
Learn about bipolar disorder so you can understand what your friend or relative is experiencing
Talk to your friend or relative and listen carefully
Listen to feelings your friend or relative expresses-be understanding about situations that may trigger bipolar symptoms
Invite your friend or relative out for positive distractions, such as walks, outings, and other activities
Remind your friend or relative that, with time and treatment, he or she can get better.
Never ignore comments about your friend or relative harming himself or herself. Always report such comments to his or her therapist or doctor.
Support for caregivers
Like other serious illnesses, bipolar disorder can be difficult for spouses, family members, friends, and other caregivers. Relatives and friends often have to cope with the person's serious behavioral problems, such as wild spending sprees during mania, extreme withdrawal during depression, poor work or school performance. These behaviors can have lasting consequences.
Caregivers usually take care of the medical needs of their loved ones. The caregivers have to deal with how this affects their own health. The stress that caregivers are under may lead to missed work or lost free time, strained relationships with people who may not understand the situation, and physical and mental exhaustion.
Stress from caregiving can make it hard to cope with a loved one's bipolar symptoms. One study shows that if a caregiver is under a lot of stress, his or her loved one has more trouble following the treatment plan, which increases the chance for a major bipolar episode.50 It is important that people caring for those with bipolar disorder also take care of themselves.
How can I help myself if I have bipolar disorder?
It may be very hard to take that first step to help yourself. It may take time, but you can get better with treatment.
To help yourself:
Talk to your doctor about treatment options and progress
Keep a regular routine, such as eating meals at the same time every day and going to sleep at the same time every night
Try to get enough sleep
Stay on your medication
Learn about warning signs signaling a shift into depression or mania
Expect your symptoms to improve gradually, not immediately.
Where can I go for help?
If you are unsure where to go for help, ask your family doctor. Others who can help are listed below.
Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
Health maintenance organizations
Community mental health centers
Hospital psychiatry departments and outpatient clinics
Mental health programs at universities or medical schools
State hospital outpatient clinics
Family services, social agencies, or clergy
Peer support groups
Private clinics and facilities
Employee assistance programs
Local medical and/or psychiatric societies.
You can also check the phone book under "mental health," "health," "social services," "hotlines," or "physicians" for phone numbers and addresses. An emergency room doctor can also provide temporary help and can tell you where and how to get further help.
What if I or someone I know is in crisis?
If you are thinking about harming yourself, or know someone who is, tell someone who can help immediately.
Call your doctor.
Call 911 or go to a hospital emergency room to get immediate help or ask a friend or family member to help you do these things.
Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor.
Make sure you or the suicidal person is not left alone.
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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication 08-3679
Revised 2008
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Interview Technique: Difficult Interview Questions
Everyone knows you have to prepare fastidiously for job interviews; it’s just basic interview technique. You need to know everything you can about the job, the company, the industry, etc. The aim is to walk in there prepared for any question they might throw at you.
Of course this is impossible, there’s no way to prepare for every question a prospective employer might have, though there are some common ones they love to ask in the hope of getting you away from your prepared spiel and forcing you to improvise. In an effort to help you avoid the horrible awkward pause as you rack your brains for the right answer we’ve decided to list some of the most common, complete with some advice about how to answer.
Do you mind repetitive boring work?
A tricky one, this. You obviously can’t say ‘yes,’ without seeming disingenuous but you don’t want to seem like you think you’re above the less glamorous side of work life. A good answer would be one that shows you understand that routine is part of any job, but that you take all aspects of work equally seriously.
Are you a good leader?
They’re trying to size up your ability to manage people. Even if it’s not a management position you’re going for, this is important as they may be trying to gauge whether you have what it takes to advance up the ladder. It’s all very well saying yes but anyone can do that – try to think of some examples from your work or personal life when you’ve successfully employed people management strategies.
Why did you leave your last employer?
You’ve got to be honest here and, if at all possible, avoid criticising your former employers, this isn’t professional. A good interview technique is to frame everything in a positive light, even awkward things like redundancies or interpersonal problems. For instance, if you left because you simply hated the job, you could say that you needed to move on to fulfil your career ambitions.
What areas of the job appeal least?
Awkward one, isn’t it? This question is a trap, don’t buy into it. Say something like you can’t see any areas that you would find particularly unpleasant. If they push you, use it as an opportunity to talk about how much you want the job, something like, the reason I’m so excited about this position is that it matches my areas of interest so well.
Well, that’s a few specifics to remember, though obviously it’s not an exhaustive list. The thing to remember is always be positive, provide examples for any claims you make about yourself and show enthusiasm even when answering awkward questions. Remember this and you’ll be fine.
Everyone knows you have to prepare fastidiously for job interviews; it’s just basic interview technique. You need to know everything you can about the job, the company, the industry, etc. The aim is to walk in there prepared for any question they might throw at you.
Of course this is impossible, there’s no way to prepare for every question a prospective employer might have, though there are some common ones they love to ask in the hope of getting you away from your prepared spiel and forcing you to improvise. In an effort to help you avoid the horrible awkward pause as you rack your brains for the right answer we’ve decided to list some of the most common, complete with some advice about how to answer.
Do you mind repetitive boring work?
A tricky one, this. You obviously can’t say ‘yes,’ without seeming disingenuous but you don’t want to seem like you think you’re above the less glamorous side of work life. A good answer would be one that shows you understand that routine is part of any job, but that you take all aspects of work equally seriously.
Are you a good leader?
They’re trying to size up your ability to manage people. Even if it’s not a management position you’re going for, this is important as they may be trying to gauge whether you have what it takes to advance up the ladder. It’s all very well saying yes but anyone can do that – try to think of some examples from your work or personal life when you’ve successfully employed people management strategies.
Why did you leave your last employer?
You’ve got to be honest here and, if at all possible, avoid criticising your former employers, this isn’t professional. A good interview technique is to frame everything in a positive light, even awkward things like redundancies or interpersonal problems. For instance, if you left because you simply hated the job, you could say that you needed to move on to fulfil your career ambitions.
What areas of the job appeal least?
Awkward one, isn’t it? This question is a trap, don’t buy into it. Say something like you can’t see any areas that you would find particularly unpleasant. If they push you, use it as an opportunity to talk about how much you want the job, something like, the reason I’m so excited about this position is that it matches my areas of interest so well.
Well, that’s a few specifics to remember, though obviously it’s not an exhaustive list. The thing to remember is always be positive, provide examples for any claims you make about yourself and show enthusiasm even when answering awkward questions. Remember this and you’ll be fine.
Interviews and Reality
In all interview situations, one person is assessing another on the basis of a short conversation. On a psychological and philosophical level, the general question can be posed of how well we ever really get to know other people as a result of our interactions with them. How much we can ever understand their perceptions of reality and who they really are? This question becomes even more acute when it comes to interviews. Long after the interview, does it turn out that the employer chose the candidate who really knows how to get the job done? Did the police really find the true culprit? Did lots of people buy the newspaper? Did the patient get better? The proof of the interview technique pudding is really only in the eating.
In all interview situations, one person is assessing another on the basis of a short conversation. On a psychological and philosophical level, the general question can be posed of how well we ever really get to know other people as a result of our interactions with them. How much we can ever understand their perceptions of reality and who they really are? This question becomes even more acute when it comes to interviews. Long after the interview, does it turn out that the employer chose the candidate who really knows how to get the job done? Did the police really find the true culprit? Did lots of people buy the newspaper? Did the patient get better? The proof of the interview technique pudding is really only in the eating.
Job Interviews
Job interviewers hope to find the right candidate, while each candidate hopes to be the one. Many employers use psychometric assessments for potential employees. Nevertheless, the plethora of websites devoted to advice on job interview technique attests to the importance that is still placed on that vital first impression.
A lot of the advice is obvious yet sound. Before the interview find out everything you can about the company, speak to employees if you can, prepare questions that will highlight your understanding of the job. Have practice interview sessions with a friend, arrive on time, dress appropriately, make eye contact, don't fidget, don't make answers too long or too short, be positive, especially about yourself. Of course, problems for the interviewer may arise if too many candidates have read up on interview technique, and succeed in making a good overall impression. Then, the interviewers will have to develop their own technique in order to distinguish who is really the best candidate!
Job interviewers hope to find the right candidate, while each candidate hopes to be the one. Many employers use psychometric assessments for potential employees. Nevertheless, the plethora of websites devoted to advice on job interview technique attests to the importance that is still placed on that vital first impression.
A lot of the advice is obvious yet sound. Before the interview find out everything you can about the company, speak to employees if you can, prepare questions that will highlight your understanding of the job. Have practice interview sessions with a friend, arrive on time, dress appropriately, make eye contact, don't fidget, don't make answers too long or too short, be positive, especially about yourself. Of course, problems for the interviewer may arise if too many candidates have read up on interview technique, and succeed in making a good overall impression. Then, the interviewers will have to develop their own technique in order to distinguish who is really the best candidate!
As an employer what should your interview technique be?
If you are looking for the right kind of people to hire for your organization, an interview is an excellent opportunity to evaluate potential candidates before making a choice. On the other hand, the cost to the company for hiring the wrong person can be huge and not just monetary, but could also affect client relationships, goodwill of the company, etc. Use the right interview technique to ensure that you are not making the mistake of hiring the wrong candidate as well as to fill the open position quickly and effectively.
Mass interviewing Technique
This technique is usually used when there is little time to fill a position and a large number of applicants for the position. Mass interviewing can be very useful in filtering unqualified or unskilled applicants quickly. Usually, a mass interview is followed by quick one-on-one interviews with selected candidates and one of them gets selected for the job.
Behaviour Based Interviewing Technique
This is the most popular technique of interviewing across all industries. Candidates are encouraged to discuss their work, education and skills. They are asked hypothetical questions and are asked to describe their reaction in a given situation. Skills that are usually judged in these interviews include content skills, functional skills, and adaptive skills. This interviewing technique is used to gain insight into the candidate’s behavioural pattern so that his performance within the organisation can be predicted.
High Tech Interviewing Technique
In today’s world of immediate connectivity, high tech interviewing techniques are widely used, especially to interview candidates from remote locations. This technique is also used at very high levels when the candidate has time constraints and can also be used for very low levels to filter out unqualified candidates. Methods used in high tech interviewing techniques include telephone interview and even videoconferencing. These days even computer based candidate screening has become an effective technique of interviewing.
If you are looking for the right kind of people to hire for your organization, an interview is an excellent opportunity to evaluate potential candidates before making a choice. On the other hand, the cost to the company for hiring the wrong person can be huge and not just monetary, but could also affect client relationships, goodwill of the company, etc. Use the right interview technique to ensure that you are not making the mistake of hiring the wrong candidate as well as to fill the open position quickly and effectively.
Mass interviewing Technique
This technique is usually used when there is little time to fill a position and a large number of applicants for the position. Mass interviewing can be very useful in filtering unqualified or unskilled applicants quickly. Usually, a mass interview is followed by quick one-on-one interviews with selected candidates and one of them gets selected for the job.
Behaviour Based Interviewing Technique
This is the most popular technique of interviewing across all industries. Candidates are encouraged to discuss their work, education and skills. They are asked hypothetical questions and are asked to describe their reaction in a given situation. Skills that are usually judged in these interviews include content skills, functional skills, and adaptive skills. This interviewing technique is used to gain insight into the candidate’s behavioural pattern so that his performance within the organisation can be predicted.
High Tech Interviewing Technique
In today’s world of immediate connectivity, high tech interviewing techniques are widely used, especially to interview candidates from remote locations. This technique is also used at very high levels when the candidate has time constraints and can also be used for very low levels to filter out unqualified candidates. Methods used in high tech interviewing techniques include telephone interview and even videoconferencing. These days even computer based candidate screening has become an effective technique of interviewing.
Tuesday, April 6, 2010
Wednesday, March 3, 2010
Tuesday, March 2, 2010
Wednesday, January 20, 2010
....
Ayoko ko na sanang ilagay pa ito sa blog ko,, kaso muli na naman akong nasaktan, wala naman kasi akong mapagsabihan ng lahat ng sakit na nararamdaman ko...Nakatext ko siya ngayong gabi ang sabi nya sa Q.C daw sya at papunta na ng airport. Bigla kong tinanong kung sino ang aalis. Ihahatid nya daw sa airport ang boyfriend niya at kasama niyang maghahatid ang kuya ng bf niya...Inaamin ko, hanggang nayon hindi ko pa rin siya makalimutan, mahal ko pa rin siya magpasa hanggang ngayon...-con
Sunday, January 10, 2010
loneliness
Loneliness
Hurting inside, no one to talk to
to talk this mood through with,
I am used to this solitary introspection
but it still hurts.
After all this time of being alone-
all the months, seasons, people behind me
I still don't get used to the loneliness.
Shouldn't it be enough that I was loved
for a brief moment in time, wasn't I held
close in someone's heart, didn't I
feel the joy that only love can inspire, weren't
we one, if only for one long afternoon,
weren't we?
The familiar torrent of distant memories only brings me home
where my dreams unravel and my sleep is fitful
to this empty place where only I live.
no friend's laughter to cheer me up
nor sparkle in the mirror when I look at me
no love crackling in my veins
or passion kindling my heart.
I am alone
comfortless and cold
by Abby D.
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