picture copyright & courtesy of Christina Tsevis (crosti)

Bipolar disorder is a serious mental disorder that disrupts the emotional and social lives of people who suffer from it.

Patients with bipolar disorder experience intense periods of mania, where they tend to feel over optimistic or even grandiose, and often become overly social or even inappropriate in their contact with other people. This is something they usually regret and feel ashamed of later, but they have little control over their behavior when they are manic. They also tend to experience periods of depression, where they become withdrawn and isolate themselves. When they do not experience a mood episode, they tend to be fairly well and very likable and cherish the friendship of others, but the effects of their previous episodes persist. The mood episodes disrupt their social lives, and as a result they are often isolated. The lack of a supportive network of friends makes their lives even more difficult to bear, increases their risk to become unwell again, and delays their recovery.

Our BipolarLab eBuddy program aims to develop a network of BipolarLab eBuddies who will volunteer their time to befriend at least one bipolar patient who will be undergoing supervised treatment by a BipolarLab professional.

BipolarLab eBuddies will receive free training and supervision, and will be required to have 1 joint e-activity per week with a bipolar patient for a minimum period of 3 months. The activities may include befriending the patient via social networks (facebook, google+), playing electronic games, talking on the phone, becoming pen pals or any other joint e-activity that will be agreed with the therapist and the bipolar patient. eBuddies may live anywhere in the world, and are required to have an internet connection and speak English or Greek.

BipolarLab eBuddies do not need to have any particular training in mental health. All training, supervision, and ongoing support will be provided at no cost by the supervising therapist.

The program is an excellent opportunity for undergraduate psychology students who may wish to gain some experience with the field of clinical psychology and Bipolar disorder. A certificate of participation and a letter of recommendation will be provided to all volunteers at the end of their participation in the program.

The BipolarLab eBuddy Program is supported by Dr Yanni Malliaris, BSc., PhD who is the leading therapist and principal supervisor of the project.

In order to participate in the program, email BipolarLab (support@bipolarlab.com) a copy of your CV, and a brief (1 page) statement describing who you are, and why you wish to become a BipolarLab eBuddy. You are also welcome to join our Mailing List and our facebook group.

We would be grateful if you share this announcement with your friends and/or post it in your psychology department’s noticeboard/mailing list.

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BipolarLab.com is a pioneering private clinical practice that delivers specialist clinical services for Bipolar disorder and recurrent depression remotely across the world.

We wish you a very merry and cheery Christmas and a Happy New Year with a moodeat turkey recipe specially prepared for you to help you cope with the Christmas Blues.

We know it takes a lot more than a moodeat turkey, but every little thing you do helps!

Remember to prepare it with a group of supportive friends and loving family members.

MoodEat Turkey: Christmas recipe that will cheer us up!*

The Christmas turkey is a festive dish with many cheerful colors. Additionally, it contains ingredients that with a little special preparation may help to improve our mood!

MoodEat Ingredients

1 turkey (approx. 4 kilos)

For the marinade

4 liters of water, 1/3 cup sugar and 1 cup salt

For the filling

500 gr minced meat
5 tbsp olive oil
1 onion, chopped 200 gr
brown rice 400 gr boiled
chestnuts 300 gr
pitted prunes 70 gr
pine nuts ½
chili pepper 1 cup
red wine or 1/3 cup brandy 1 cup
chicken broth Salt and pepper Mixture for baking 200 ml
orange juice 200 ml red wine
2 tbsp balsamic vinegar
2 tbsp honey
2 tbsp brown sugar
Some rosemary and sage 5-6 bay leaves Cloves
2-3 cinnamon sticks
5-6 tbsp traditional butter

Preparation

Put the turkey into the marinade and refrigerate for 12 or more hours.

Before stuffing, remove from the water, rinse and dry thoroughly.

To make the filling, sauté the onion and minced meat in olive oil.

Pour the wine or brandy into the pan and then add all the remaining ingredients for the filling.

Allow to simmer until fluids are absorbed.

Remove from the heat and allow cooling.

Stuff the turkey and sew.

Rub on all sides with the butter, stuffing some underneath the skin and then pour the mixture for the baking in.

Put it in the oven at 180 degrees after covering with aluminum foil and bake for about 2 ½ hours.

Open the oven every 15 minutes and drizzle the turkey with pan juices.

In the last 20 minutes remove the foil and let it brown.

Remove from the oven and let rest for at least 15 minutes before carving.

The MoodEat ingredients of Happiness

The turkey contains white meat without much fat and is a good source of protein of high biological value. Most importantly it contains the amino acid tryptophan, an essential building block of serotonin, which regulates mood, quality of sleep and emotional stability.

Also, depending on the diet of turkey, the meat can contain higher or lesser amounts of omega-3 fatty acids, which are shown to improve mood and decrease depression. It is a good source of selenium, zinc and B vitamins which enhance neurological function and mood.

Brown rice that we chose for this recipe is very nutritious because it contains fiber, amino acids and B vitamins associated with euphoria and brain function. Moreover, complex carbohydrates such as potatoes and rice enhance the absorption of tryptophan and thus the action of serotonin in the brain.

Chestnuts are rich in monounsaturated fatty acids such as oleic acid and a good source of omega-3 fatty acids like pine nuts. Furthermore, they both contain many minerals like magnesium which plays a role in contraction and relaxation of muscles.

Chili has the ability to improve mood by stimulating nerves that give a signal to the brain to release chemicals called endorphins. Endorphins have the capacity to reduce feelings of pain and relieve the depressive mood.

Spices like cinnamon and cloves may offer euphoria through taste and smell, but it is also known that when consumed in large quantities they have similar effects to substances associated with feelings of euphoria.

Rosemary is often used in aromatherapy as relaxing. Its therapeutic use relieves stress, relaxes muscles, improves digestion and prevents heartburn and indigestion after a heavy meal. Also, a survey using placebo showed that sage also reduces stress, elevates mood and improves memory.

Finally, black pepper contains compounds called alkaloids. One of these is piperine which simulates pancreatic enzymes that break down proteins, accelerating the process of digestion. Piperine can dramatically increase the absorption of selenium, vitamin B and beta-carotene, and other nutrients. It also helps to increase endorphins in the brain.

A glass of red wine can perfectly accompany this meal and let us relax. However, we should pay attention to overeating and drinking… because the opposite effects are larking.

If you do try this special moodeat recipe at home with your friends and family, why don’t you let us know how you got on with it?

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*Article written and recipe prepared by Dr. Eirini Manthou, BSc, MSc, PhD., Nutrionist, BipolarLab.com Associate, http://www.moodeat.com

In other fields of medicine, this may not be the case, but in the mental health world, evidence based practice is a relatively new development.

“Evidence-based practice” means we conduct our clinical practice based on evidence that we’ve acquired from clinical research. Similar to drug research, your doctor will usually prescribe medications that’ve been tested thoroughly through many trials, and have been proven to benefit your health condition. Once upon a time, your therapy could’ve been based on Dr. Ego’s clinical expertise, big name or great insights, but thankfully these days such practices are slowly becoming a nightmare of the past (although, drug companies still invest on armies of Dr. Egos “aka opinion leaders” to influence your local doctor’s prescription practices).

However, evidence-based practice is a fairly recent development in the field of mental health, and especially in the field of psychotherapy. The rise of behavioral therapy in the 60s, partly as a reaction to the psychoanalytic status quo, and later its marriage with cognitive therapy, have given us a remarkable new tradition of true evidence-based psychotherapeutic practice.

The development of diagnostic manuals such as the DSM-IV, even though they are heavily criticised by many, have enabled us to quantify severe behavioral and emotional problems. We can now have large enough homogeneous groups of patients that allow us to try out different treatments, and be confident that the improvements we see are not due to chance, individual differences or simply a matter of time. Even when we focus on single patient cases, our diagnostic and measurement methods take this kind of work to a different level.

Clinical trial designs have become sophisticated enough to address almost all biases and errors that a single clinician is prone to make, with one patient or even a small group of patients, over his lifetime.

We now have the tools to quantify almost all clinical states. We can safely measure how depressed, manic, anxious a patient is, and so forth. Of course our tools are far from perfect, but they are improved study after study.

This quantification of human pain and distress, distasteful as it may sound to some, has enabled us to be able to evaluate properly all kinds of therapeutic interventions. Let’s even assume that some genius comes up with the wonderful idea that clapping your hands three times a day and jumping up and down your bed twice a day will cure your bipolar disorder. We can now evaluate and test whether this is true or not.

Nevertheless, despite this tremendous progress in mental health, we find that true evidence-based practice is only delivered through a few specialist university clinics, and only through their research trials. The lucky few patients who can enroll in these studies usually experience significant clinical benefits.

I grew up professionally in such a place, at the Institute of Psychiatry at King’s College London, the mecca of psychiatry. Day after day, trial after trial, that I worked my way up from a lowly research assistant to a PhD graduate, I couldn’t help but wondering why we cannot offer this level of care and quality of clinical work to everybody. My grandiosity, of course, to be able to deliver this level of care to all bipolar patients was fueled by my personal experiences with my father, who suffered for many decades by a treatment resistant bipolar disorder. He also suffered and paid dearly with his health, and later life, the inefficiencies of the greek mental health system. Patients at the time were treated fairly poorly, were not educated about their disorder, and treatment was most of the times coercive.

Hence, when the time was right I founded BipolarLab.com: the first private evidence-based clinical e-practice for bipolar patients in the world.

Of course setting up a true evidence-based e-practice is easier said than done. It took nearly 2 years (7 years including my PhD work) to develop our clinical services that are all based on data driven research, and it will take many more years of clinical work and refinement to achieve all the benefits this endeavour can really deliver.

It also takes patients who can understand and truly appreciate what’s on offer here. Time after time, my colleagues tell me we need to better communicate the novelty of BipolarLab. This is not just another private clinical practice, it’s not even another specialist clinical practice; it’s an evidence-based specialist clinical practice. It may not be the right kind of practice for everybody, but our ongoing evaluation of our services will demonstrate whether this approach is working or not.

It definitely feels great when well funded professors from Harvard approach you with similar ideas, and then you see them working hard to develop similar services, but I will feel much better when we manage to communicate the novelty and importance of this work to every single bipolar patient who visits our website. I will feel even better when we manage to deliver our services to enough patients to have our own effectiveness data.

So how do we do it?

Here is our secret recipe for everybody to copy:

1. We focus on a specific clinical population: Bipolar disorder.

In our case, we deliver our clinical services only to patients with Bipolar disorder and depression. It’s usually hard to separate the two given that most depressive disorders are often highly recurrent, and most bipolar disorders are dominated by depression. Hence, we will consider taking on any patient with a recurrent affective disorder.

2. We use cutting edge research instruments for the diagnosis and measurement of our patients.

We use research instruments like the SCID, HDRS, YMRS, NIMH-LCM and many others to accurately diagnose our patients and measure their status throughout all steps of our clinical care. Our patients also become fairly familiar with these research instruments, and learn to recognise how valuable they are in their ongoing clinical care.

3. We provide our services remotely across the world. We love e-health!

Being an e-practice helps us have a much wider pool of patients to carefully screen and decide whether they are suitable for our evidence-based services (we do have two local sites – one in London, UK and another one in Athens, Greece but we prefer the e-way). We also use many new technologies to help us deliver our services (we love google plus, actigraphy, pedometers, and electronic mood diaries – see MoodChart our recent addition to our e-arsenal – it’s open to the public). We bring our services right into your home, no matter where you live.

4. We use strict inclusion and exclusion criteria.

We provide our services only to bipolar patients who meet our specific inclusion criteria. We derive these criteria from the studies that each of our services has been based upon. It’s painful to exclude patients, but it’s even more painful to deliver services to patients we know aren’t going to benefit from them. Our initial consultation meeting will give us both a fairly good idea about our suitability for each other.

5. We have developed and provide services that are truly evidence-based.

We work hard to follow the protocols and methods of the trials all our services have been based upon. For instance our CBT therapy programme is based on the bipolar trial of Professor Dominic Lam at the Institute of Psychiatry, and is suited to bipolar patients who are currently fairly well (euthymic) or mildly symptomatic, and wish to prevent further relapses. For bipolar patients who are currently depressed, we use the CBT protocol of the STEP-BD trial that gave great results with this group, and also a new briefer behavioral treatment that I’ve been developing for bipolar depression (BATMAN: Behavior Activation Therapy for MANic Depressive illness) over the last few years.

6. We ignore the bipolar fairy tales.

We have developed our services based on the latest knowledge that we have about bipolar disorder – not on bipolar fairy tales. We like the bipolar fairy tales, they make people feel good, but in the long run they are anything but helpful. For instance, since the relapse literature demonstrates that mild bipolar symptoms are the best predictor of relapse, we take special care in explaining this to our patients and provide treatment for them, not more fairy tales about how helpful these symptoms are for their lives. Ignoring the fairy tales often makes us unpopular, and it’s bad for business (see the comments from my previous article) but we’re not a commercial enterprise, and definitely don’t run for the bipolar white house.

7. We collect data and evaluate the effectiveness of all our services.

We do this even more for pioneering clinical services, such as our Bipolar and Fit programme or our behavioral activation therapy for bipolar depression – both relatively new even in the clinical research world. Our symptom monitoring services have been designed to monitor the effectiveness of all our clinical interventions, and most importantly to give our patients a good indication of where they are with their therapy and current mood status.

8. We work as a clinical research group.

All our senior associates, psychologists and psychiatrists, have at least a research PhD that helps them appreciate and value this type of work, and gives them the necessary experience to deliver our evidence-based services properly. Mind you, we are a clinical e-practice of independent clinicians working together – not some major corporation, funded by pharma or guided by commercial interests. We have no association with any drug company!

9. We collaborate with local doctors and other local mental health professionals.

Many of our services have been designed to assist the work of local mental health professionals. For instance, our symptom monitoring programmes provide the most accurate and comprehensive measure of the daily, weekly, and monthly course of any recurrent affective disorder. This can help you and your psychiatrist to better evaluate the progress of your treatment, sometimes clarify your diagnosis, and have an ongoing bipolar thermometer in your life. Our CBT and Life Style Support programmes also work best along with medication treatments. All these are specialist services that can rarely be found locally, and psychiatrists who provide medication treatments don’t have the time, resources or training to offer them. Our small but growing network of local mental health professionals are grateful for the added value our services provide to the treatment of their patients.

10. Last but not least, we love our work, our patients and our results.

We are as maniacally enthusiastic as any clinical research team starting a new project. The glowing results of many clinical trials are always helped by this kind of attitude. We do our best to keep this research spirit alive! In many ways, we’re like the Apple of 1984, having a vision to put evidence-based services in every bipolar home.

We welcome you, whether you are a patient, relative or a mental health professional to join our cause!

• How mood regulates food

One thing that determines our enjoyment in life is mood. Mood changes from day to day, moment to moment. We may be happy, energized, have optimistic feelings, take part in enjoyable activities, feel loving; but we may also feel unpleasant, moody, irritable, anxious, tired and even depressed. We’ve all come across these feelings and have experienced the enormous impact they have on our psychological and physical wellbeing. However, as people tend to favor positivity and happiness, we try to regulate our bad moods by engaging in certain activities and routines such as eating, exercising, smoking, drinking, socializing, playing games, watching TV, etc.

According to research data, from time to time, at least one third of us turn to food when we’re in a bad mood. Think for a moment if this happens to you. When are you most prone to make bad choices, to break the rules of a diet and to choose some kind of “comfort food?”

This actually can happen when we’re happy – for example when we’re socializing and we combine food with nice company. But the time when we are most vulnerable to overeating and bad food choices is when we’re in a bad mood.

“Emotional eating” happens when bad moods are too heavy to carry and a shelter is needed, something that in the past made us feel good. This behavior creates a vicious cycle where we search for a mood fix, get a food fix as an easy solution and momentarily feel ok. However, the drastic changes in blood glucose can cause mood swings; thus, after a while we easily slip into a tired and remorseful mode and the cycle begins once again. Unfortunately, attempts to regulate mood through “emotional eating” are an important cause of being overweight. In the long term, if this cycle isn’t broken we may end up with chronic metabolic diseases.

How food regulates mood

The other side of the coin is that different foods affect our moods. Scientific evidence is very promising in this new direction of research. So, does this mean that that a piece of chocolate can make us smile, or that a cup of tea can pass positive energy to the drinker?

Science now possesses a huge list of food items and ingredients with at least some supporting information regarding their positive effects on memory, cognitive performance, brain health, mood, sleep, endurance, jet lag and prevention of cognitive decline.

Those foods shown to be the most promising include polyunsaturated fatty acids (PUFAs), vitamins and minerals, phospholipids, and some botanicals. Some are already marketed as herbal medicines and supplements; others as functional foods. Moreover, it is proven that brain chemicals (a.k.a neurotransmitters) such as serotonin, dopamine and acetylcholine that influence the way we think, feel and behave, can be affected by what we’ve eaten.

Foods that have the capacity to influence neurotransmitters are brown rice, sesame seeds, fish, eggs, bananas, spinach and many more. A lot of scientific research has identified that maintaining steady blood glucose by eating small and regular meals throughout the day is the ultimate weapon against mood fluctuations. Generally, keeping food consumption in moderation and making smart choices of ingredients, can guarantee your emotional well being.

Having this evidence in mind, the new trend in gastronomy cannot be perceived as excessively sophisticated. Restaurants around the world are now serving food according to the mood somebody wants to achieve. You can now order food that defies your depressive mood or drink refreshments that make you feel energized. Furthermore, new diet patterns have emerged through the scientific community that can make us happier with our outer and inner selves.

If we want to draw a conclusion about the connection between mood and food, clearly it’s far smarter to regulate your mood through your food rather than letting your mood regulate your food intake.

What’s your experience with your food and mood? 

• References

Robert E. Thayer. Calm Energy: How People Regulate Mood with Food and Exercise. ISBN-10: 0195131894, 2001.

Benton D. Carbohydrate ingestion, blood glucose and mood. Neurosci Biobehav Rev. 26(3):293-308, 2002.

Robin B. Kanarek, Harris R. Lieberman. Diet, Brain, Behavior: Practical Implications. ISBN-13: 9781439821565, 2011.

Acumentia. Cognitive Functional Foods – What can we expect to see on the market? Spring 2011

According to his talk, people with mood disorders, as well as in general mentally abnormal people, make better leaders — especially at times of crisis. He gave examples of many American and European political leaders who achieved “greatness,” and their psychohistory suggests also had a mental disorder – in most cases a bipolar disorder.

I have trouble digesting this argument; not for personal reasons, I also love my bipolar patients and wish to think and speak well of them, but for scientific reasons.

To continue with Dr Ghaemi’s argument, people with mood disorders make great leaders because depression and mania predispose one to have several advantages over other more “healthy” people. Depression helps one to be more realistic (see depressive realism literature) and more empathic. On the other hand, mania increases creativity and resilience.

Dr Ghaemi then went on to quote research by another psychiatrist, Roy Grinker, who identified a group of very normal individuals, the so called “homoclites” (from the Greek work meaning those who follow the norms, rules etc.) and concluded that even though these were nice people to be friends with, they just didn’t make it for being great leaders.

Apparently according to Dr Ghaemi the Nunemberg Nazis were failed homoclites, unlike Bipolar Hittler who was a great leader. Dr Ghaemi also quoted some of his research from 9/11 that apparently demonstrated that people with bipolar disorder were less likely to be affected and to develop PTSD — therefore they must be more resilient to stress as well.

He finally concluded that treatment is needed for the acute phases of the illness but not for the mild ones – as the mild states are the ones that confer all these great benefits.

I think that it is important for us to recognize the positive qualities of any disorder or disease. Indeed, our previous article by our junior psychologist, Valeria Kilaberia, discussed a recent study that highlights some of the more positive qualities of bipolar disorder — or at least what patients think is positive and advantageous with their bipolar disorder.

But if we wish to be realistic, our clinical experience and research suggest otherwise:

1. Most people with bipolar disorder cannot be great leaders at times of crisis. The majority of the life events literature (see the work of my dear professor Constance Hammen) suggest that this is most likely the case. During times of crisis, people with bipolar disorder are more likely to relapse, and whatever positive qualities their mild depressive or manic states may confer are taken over by the darkness of depression and madness of mania. Those who are leaders and also have a bipolar disorder need more support and help at such times.

2. Mild symptoms cannot and do not confer any significant benefits. At least two decades of relapse literature (and my painful five-year PhD thesis) actually suggests that mild bipolar symptoms (or otherwise sub-syndromal or subclinical) are the most important predictor for future relapses. They also reduce the quality of life and functioning of the majority of bipolar patients. We ought to help our patients to work towards reducing their risk for relapse, and to help them improve their lives — not praise what essentially troubles them and puts them most at risk.

3. Goal oriented attitudes and leadership related ambitions are significant risk factors for bipolar relapses. Cognitive therapy research (see the work of Dominic Lam) again has highlighted that it is exactly these goal-striving and leadership attitudes that make bipolar patients more likely to relapse, from a cognitive point of view at least.

In CBT therapy, we really work towards helping our bipolar patients to balance their needs and ambitions for success and to help them become lesser super heroes. Yes, I know it sounds bad, but I believe that the real bipolar super heroes are the ones who know their powers and weaknesses, and succeed in life to remain well while achieving greatness in any domain they cherish.

I could go on with many more arguments that are based on our clinical knowledge, and research which suggests, unfortunately, that bipolar disorder or mental abnormality in general cannot make necessarily great leaders. Any leader by default is an outlier but not necessarily mentally ill. I do not question the fact that there have been many great people who were also great leaders and had a bipolar disorder, but one should also recognize that these people suffered and worked at least twice as much than most people in order to be in such positions.

Some indeed made positive contributions, while others caused significant harm to many (see a forgotten book called “Brotherhood of Tyrants” that highlights the negative aspects of bipolar disorder and leadership and balances up the argument).

We should be working towards helping our patients based on what we know, and when it comes to matters of leadership, we should be cherishing leaders who make important contributions to our society irrespective of their medical history.

Are there any bipolar leaders out there who wish to share their experiences with us?

Even though the majority of research highlights the negative aspects of bipolar disorder, it is not uncommon to listen to patients who talk warmly about their experiences.

A new study conducted by Lobban, Taylor, Murray & Jones (2012) at the University of Lancaster, UK investigated the positive experiences of people who suffer from bipolar disorder.

The participants reported that they experience many positive feelings, including intensified abilities, such as higher academic abilities; acute senses, perceptual sensitivity, focus and clarity of thought. They also reported feeling more creative and productive.

The research indicated that a sub-group of people with bipolar disorder prefers to be with the condition as they experience invaluable feelings. Some of the participants work or worked in high professional positions and provided information concerning the times when it was incredibly easy for them to work hard. They felt that they could achieve high levels of productivity and were very ambitious.

Some of the participants stated that they felt “lucky” or “blessed” to have this disorder. They reported being grateful for having a bipolar disorder as it provided special opportunities for them in their life.

Dr. Fiona Lobban, who led the study, said: “Bipolar Disorder is generally seen as a severe and enduring mental illness with serious negative consequences for the people with this diagnosis and their friends and family. For some people this is very much the case. Research shows that long-term unemployment rates are high, relationships are marred by high levels of burden on family and friends and quality of life is often poor.

High rates of drug and alcohol misuse are reported for people with this diagnosis and suicide rates are twenty times that of the general population. However, despite all these factors researchers and clinicians are aware that some aspects of bipolar experiences are also highly valued by some people. We wanted to find out what these positive experiences were.”

She also indicated, “It is really important that we learn more about the positives of bipolar as focusing only on negative aspects paints a very biased picture that perpetuates the view of bipolar as a wholly negative experience. If we fail to explore the positives of bipolar we also fail to understand the ambivalence of some people towards treatment.”

There are definitely many bad times to be had by people with bipolar disorder, but there are also good and creative moments. Acknowledging the positive aspects of bipolar disorder without romanticizing it can only help our clinical work.

What are your positive experiences of bipolar disorder? We are looking forward to your comments.

Reference
Lobban, F., Taylor, K., Murray, C. & Jones, S. (2012). Bipolar Disorder is a two-edged sword: a qualitative study to understand the positive edge. Journal of Affective Disorders.

Early research by Julian Leff at the Institute of Psychiatry and David Goldberg at UCLA on schizophrenia focused on the role of “expressed emotion” in families. They coined this term to essentially describe a negative and critical communication style that appeared to characterize many of the families who had members suffering from schizophrenia.

The results from their early studies were indeed impressive. Patients who lived with family members who were overly critical of them and had a negative communication style relapsed more often and quicker.

These results have been replicated across almost all major mental disorders (except one)*, and of course bipolar disorder. Patients with bipolar disorder actually have the highest sensitivity levels to expressed emotion/criticism.

Interestingly enough, other research by Elizabeth Kuipers at the Institute of Psychiatry has indicated that the levels of expressed emotion are best predicted by the degree of “perceived responsibility” of the person who is most critical. In other words, people who may care most about you may also be the people who will cause the most pain.

More research by David Miklowitz at UCLA has also indicated that at least in bipolar disorder it’s not just the presence of expressed emotion that is most harmful, but the lack of positive communication. In other words, you may be mean to each other, but if you try to have some positive interactions, things may not be as harmful to you.

Of course the burden one experiences and also their own levels of anxiety and depression are the culprits here, but at the same time developing an overly critical communication style is a learned process that can be changed with psychotherapy.

What’s your experience of expressed emotion and criticism in your family and relationship?

How do you handle this?

What helps and what makes things worse?

* there is one disorder that research has indicated that high levels of expressed emotion may even have a protective role and another disorder that research has found that high levels of expressed emotion may lead to marital infidelity. If you find any of the two disorders we will be happy to offer to you a free Mood-pulse session!

Our mental symptoms effect us much more than the fleas to the dogs. I often meet and work with bipolar patients who have matured so much with their illness, and have managed to learn to cope so well with its ups and downs, that yes, at times they like having the experience of their symptoms.

I had a recent chat with Tom Wootton, who advocates this view, and from my understanding is trying to help people see through and over their symptoms. I guess when one can handle life or when one has managed to survive hell, then they can also learn to accept and live well with their symptoms.

The new-wave behaviorists have really adopted this acceptance philosophy. I guess my own acceptance concept is all about befriending bipolar disorder and all the things that come with it.

In the meantime, the situation in Greece is yet again spiraling out of control. My dear country has suffered so long with a bipolar political system that it almost appeared treatment resistant. The most recent attempt to introduce some level of treatment has been attacking the weakest citizens of the Greek society. Another Greek tragedy is taking place, but this time in front of our eyes.

People voted against a bipolar political system but the remaining members of it yet again are desperate to re-establish some kind of political bipolarism.

I guess we all have a degree of responsibility for what’s taking place, but the individual responsibility argument can go way too far, especially when people’s lives are at stake. Psychopaths are pretty good at advancing the individual responsibility argument and rationalizing that the harm they do to others is often for their benefit.

How far do we, and can we, let them take it?

Call it a seasonal effect, blame it on light or the forthcoming changes in our social routines, spring appears to be a period that every bipolar and their family should keep an eye on.

So what better time than now to write about our bipolar fleas – the early warning signs of manic and depressive relapses?

I recently had an incident with my lovely dogess Iano – a beautiful and proud royal boxer. We went to my sister’s country house and Iano as usual enjoyed her time there. This time, however, before our departure I noticed some insects running over her body. A sickly dog had been around our house and somehow he managed to pass quite a handful of fleas to her. She usually keeps herself so clean that it had never occurred to me that fleas could take over her perfect body.

I tried to remove her fleas one by one but the more I was staying there the more fleas kept on coming to her. So I put her in my car and drove her quickly down my flat – far away from any infected areas. On our way there we bought some anti-flea shampoo from a pharmacy and made plans about how to disinfect her.

Iano was beginning to get irritated by the fleas but she was still happy enough on her way back. I eventually managed to remove all her fleas (one by one), and to isolate her for a good few hours in a disinfected bathroom. The next day she was taken to our vet for a routine check-up, and I kept an eye on her for possible infections for the next week or so. She is better than ever now, and I think she even liked all the attention that she got that day.

During the entire incident, I couldn’t help thinking how similar fleas are to the bipolar symptoms that come just before manic and depressive relapses. For whatever reason, they just start cropping up on you, and if you don’t pay attention or your significant other does not pick them up, then what will usually happen is that they will start growing up on you. They will also start multiplying.

They like having company. It’s very unlikely that you will have only one symptom. The more you delay doing something about them, the worse they will get. You will eventually relapse and the consequences along with your available treatment options are likely to be far more painful than if you had been proactive about the whole situation.

Getting into the rush of doing something quickly may not be the easiest or the most pleasant thing to do. It may not even be the right time for you or your family. But if you wish to prevent your forthcoming relapse – it’s always the right time. Self-management definitely works – early on.

There are things that you can do just by yourself to take notice of your early warning signs and to calm them down, but getting help from your family and your treatment providers are important steps to consider, and when necessary, to take. Yes, you may not want to worry your family or your therapists with every mood change or every bad or very good day that you have, but keeping them in mind and getting to them quickly is important.

I couldn’t help thinking about the pain my dear Iano would have suffered if those bloody fleas had started to grow on her. And I am so happy to see that she got through the whole ordeal almost unscratched, that I wish for every bipolar patient to keep well and to keep well by acting quickly and by having the right people and resources in place to help manage their early warning signs before they relapse.

I won’t get into the science of the bipolar early warning signs in this article. As a matter of fact, we know quite a lot about your bipolar fleas but I would like to run a little survey with you to see what changes you notice in your behavior, thinking, or mood prior to any manic or depressive relapses (use this form here).

Try to describe them in your own words – there is no need to use any psychiatric lingo. Then we can see whether we are in agreement with the literature, and I will write a bit more on what we know about the early warnings signs of bipolar disorder. I am also looking forward to your comments in our comments section.

Until our next blog post enjoy your spring life and keep an eye out for any bipolar fleas.

Bipolarly yours,

Dr. Yanni Malliaris

It is with great pleasure that I welcome you to our new bipolar blog hosted by Psychcentral.com – Bipolar Trek: The Voyages of BipolarLab.

I met Dr John Grohol quite early in my online psychology days back in 1996 when he was starting Psychcentral.com, and I was beginning my psychology degree in rainy Scotland. Since that time a lot has changed and I was always happy to see Psychcentral’s tremendous growth driven by John’s passion and energy for mental health education.

So in 2012, I am really happy and grateful that John will be hosting our blog.

Coming from a relatively illiterate Greek culture (illiterate in matters of mental health) it always made so much sense to me to educate the public, and most importantly patients, about mental health and psychology in general. We have come a long way since 1996 in all fields of mental health and people across most countries are far more knowledgeable than before.

But there are always going to be new patients (unfortunately), and always members of the public in different countries who can benefit from our knowledge.

I am happy that our blog will be next to Dr Fink’s and Joe Kraynak’s Bipolar Beat blog and also Tom Wooton’s Bipolar Advantage blog. I have always found the Bipolar for dummies self-help book having the right amount of humour along with important practical advise – and Tom’s bipolar advantage psycho-educational approach an exemplary patient-led programme.

Our blog will also be about bipolar disorder but given our different backgrounds the focus will be different. We believe in evidence-based care - actually all our bipolar programmes and therapy services are based on data-driven research. We also love to use technology to help our patients to monitor themselves and our treatments.

We will try to write about clinical research with important clinical applications, new and old bipolar friendly gadgets (electronic mood diaries, activity monitors etc.), and occasionally some of us we may rant about the mental health situation in Greece (BipolarLab is mainly powered by mighty crisis proof Greeks).

I expect the greek posts to become quite popular given how tragic things are in Greece – we have a special word for actually describing such situations – “tragelafika” – meaning hilariously tragic (so tragic you can only laugh about it).

We would also be happy to occasionally answer a question or two based on our expertise. You can check more about our team here and direct all your questions or ideas about future posts to our email or simply make a comment in this post.

So without further ado we begin our Bipolar Trek.

We look forward to your emails and comments.

Dr Yanni Malliaris