Question:
Does anyone know the address at Johns Hopkins of the people studying BP disorder among European Ashkenazy Jews? I have paperwork to send them but have forgotten the address!
Answer:
A DRADA educational meeting was held on July 8, 1999, at the Johns
Hopkins Hospital in Baltimore, Maryland, with about 100 people
attending. The speaker, Francis M. Mondimore, M.D., was warmly
introduced by Dr. J. Raymond DePaulo, Jr. Dr. Mondimore is a graduate
of the Johns Hopkins University School of Medicine and is the author of
a new book, Bipolar Disorder: A Guide for Patients and Families. He
titled his talk "Living with Bipolar Disorder"; another appropriate
title would have been "Relapse Prevention in Bipolar Disorder."
Using the analogy of the person who has a heart attack, then quits
smoking and starts exercising in hopes of preventing a second one, Dr.
Mondimore explained that people with psychiatric disorders must also
make lifestyle changes in order to live with their illnesses. He said
that each person with bipolar disorder has a particular pattern of
symptoms, and that no medication regimen works for everyone, yet
patients themselves--as providers of their own treatment--determine how
well treatment can work for them. For example, patients must take their
medication as directed, keep appointments with their health care
professionals, and get necessary lab work done to check blood levels of
medications. These responsibilities are similar to those of patients
with diabetes or high blood pressure, whose behavior likewise determines
their treatments' success.
Dr. Mondimore said that the first step in treatment is to accept the
diagnosis: patients must believe that they have bipolar disorder.
Patients who are in denial--those who do not accept their
diagnosis--will not follow treatment plans, because they believe
treatment is unnecessary. Dr. Mondimore said that people have an
"almost limitless capacity to explain away the obvious." This capacity
can keep patients in denial, making excuses for their moods.
Once patients accept their diagnosis, Dr. Mondimore said, the next thing
they must do is make a commitment to take charge of their own treatment,
live with the illness, and take action to reduce the risk of relapse.
The rest of his talk was devoted to the behaviors and behavioral changes
("mood hygiene") that patients must adopt to fulfill this commitment.
(The term "hygiene" actually means more than just its usual
interpretation, "cleanliness." It is the science of the establishment
and maintenance of health-the science of prevention.) Dr. Mondimore
defined mood hygiene as "the practices and habits that promote good
control of mood."
The goal of mood hygiene is relapse prevention--not having to endure
another episode. [Ed. note: Throughout his talk, Dr. Mondimore used the
term "relapse prevention" to denote the goal-not the sure consequence-of
the behaviors and behavioral changes he recommends for patients]. This
goal is particularly urgent because of a phenomenon called kindling,
which is observed as a progressive change in the relationship between
stress and relapse. Early in the course of the illness, stressful life
events may trigger the episodes of illness in susceptible people. Later
in the course of the illness, however, episodes can start spontaneously,
without the need for preceding stress. Also, the more episodes a person
has had, the more likely that additional episodes will follow this
pattern: the illness begins to have a life of its own. In the early
stages of the illness, preventing relapse is particularly important as a
measure to forestall kindling. (In research that may have implications
for clarifying their mode of action in humans, antiseizure medications
used to treat bipolar disorder, such as Depakote and Tegretol, have been
shown to have antikindling effects in animals.)
Relapse prevention involves adhering to many guidelines, some of which
are discussed below.
Medication. Taking every dose of medication, and taking it just as
directed, is the single most important part of relapse prevention. In
bipolar disorder, medication puts you, the patient, in charge of your
moods; without it, the moods can take charge of you, said Dr. Mondimore.
Management of stress and conflict. Seriously examining your life
situation for sources of stress will probably identify some. You must
then make fundamental life changes to eliminate them or at least reduce
the level of stress. Stress management is an important part of mood
hygiene.
Structure. Establishing and sticking to a steady
schedule-maintaining structure and regularity in your life-is important
in relapse prevention. You need to choose regular times for going to
bed, getting up, exercising, and other such activities, and then follow
that schedule. Procrastination can lead to stress and should be
avoided. Dr. Mondimore also suggested keeping a chart in which to rate
your mood at the same time every day. This mood chart can help your
doctor plan your treatment and recognize any premenstrual or seasonal
mood fluctuations.
Support system. Developing your support system, a process that may
include dealing with any current interpersonal problems, is another
important way of lowering stress and helping your treatment succeed.
Many people living with bipolar disorder have questions about disclosing
their diagnosis to others with whom they have a professional
relationship.
Dr. Mondimore suggested using criteria of "Who needs to know?" and
"Would disclosure be helpful?" in making these decisions. Certainly,
all your health-care providers need to know. Your attorney might need
to know. A decision about telling your employer should take into
account your individual situation.
Dr. Mondimore ended his talk with the subject of finding a balance
between not taking your illness seriously enough (denial) and taking it
too seriously (becoming a "bipolar victim" whose life revolves around
his or her illness). The biggest obstacle to finding balance is
stigma. Most patients have unconsciously adopted the general public's
negative view of people with mental illness, and so may have difficulty
in accepting their diagnosis. Patients can use education, support
groups, and counseling ef-fectively in overcoming their tendency to
stigmatize themselves.
After his talk, Dr. Mondimore spent 45 minutes answering various
questions from the audience. Topics included the following:
Resistance to medication treatment. There are probably many forms
of bipolar disorder, and only some of them seem readily treatable.
Patients must have the persistence to try different medications and
continue taking them long enough to truly test their effectiveness. Dr.
Mondimore believes that unless a patient is so ill that he or she is
disabled, medications should be given a 3- to 6-month trial.
Effectiveness may improve over time: people taking lithium fare better
in their second year on the drug than in their first. If the patient is
profoundly ill, Dr. Mondimore suggests trying combinations of drugs.
Impact of diet on mood stabilization. There are many theories about
dietary components that may help stabilize mood. Dr. Mondimore believes
that some may be useful, and, provided patients continue taking their
regular medication, he has no objection to their experimenting with diet
to see what might work for them.
Role of the family when the patient will not comply with directed
treatment. Dr. Mondimore said that in this situation, family members
must, above all, recognize their own helplessness. They cannot make the
patient compliant and need not, therefore, feel guilt at their inability
to do so.
In conclusion, Dr. Mondimore stressed that bipolar disorder looks
different from one week to the next, so continuity in care is
particularly important. Patients need to find a treatment team that
they like and trust and stick with that team. Bipolar disorder is an
illness that needs long-term management. Try looking here: http://www.med.jhu.edu/jhhpsychiatry/clinical.html
