Sunday, August 26, 2012

Taking Steps When You See Mental Illness Relapse Warning Signs

Now that you know the early warning signs of your loved one's relapse, what do you do when you see them?  First, realize that relapses in major mental illness often are connected to one (or more) of these three things:
  1. The person stops taking medication or treatment.
  2. The person is experiencing a high level of stress.
  3. The person is abusing alcohol or drugs. 
The first step to take is to talk about it. Meet as a family, if possible, with the person to explain why you are concerned. You'll need to be specific, explaining what changes in behavior you are seeing and for how long.  Together you can agree about whether this is a problem. If you have a relapse looming, you'll want to look for the three common causes.

Medication: Of course, you will ask if the person has been taking medication. But you may have to do more than just ask. If the person lives with you, you can start to count the pills in the bottle every day. If the person isn't taking the medication, you will need to talk together about why and how. You can help with increased monitoring and reminders. Again, this sounds a lot easier than it is.

Stress: Evaluating your loved one's stress level together can help.  Ask questions like these:
  • Has your loved one experience a recent life event that's stressful?
  • Has there been a significant change in routine over the last two weeks?
  • Has there been a change in the treatment team or plan?
  • Have there been conflicts with family, friends, coworkers or others?
  • Has there been a change in an important relationship?
  • Has there been an increase in responsibilities?
  • Has your loved one stopped participating in activities that he or she enjoyed? 
If your loved one's answers indicate that stress is building, work together to find a way to reduce it. You can reduce responsibilities, cut back on work hours, add more leisure time, and get or give a temporary loan to reduce any money problems.

Alcohol and drugs: Talk about this, and check for evidence.  If you live with your loved one, remove alcohol and drugs from your home.  You'll also want to contact the treatment team to discuss this.

In any case, you should call the psychiatrist and case manager to express your concerns and even suggest a medication adjustment.

Keep an eye on the situation, but do not let it consume your family life.  Keep to your regular routines and make sure you have fun as a family.  Just check back every day or two to determine: Is it getting better, worse or the same?

Friday, August 17, 2012

Early Warning Signs

Mental illness is episodic, so things get better and then things get worse and then things get better again. As we mentioned in the previous post on preparing a crisis plan, it's important to be aware of your loved one's early warning signs of a relapse so you can mitigate a full-blown crisis.

Looking at these early warning signs will help you, your loved one and his or her treatment providers minimize setbacks.

Generally speaking, it's hard for the people with the illness to fully recognize the warning signs. So often his friends and family will start to see problems first.  Here are some typical signs:
  • Increased irritability. 
  • More noticeable tension, anxiousness or worries.
  • Increased sleep disturbances (such as hearing your loved one being up all night and sleeping through the day).
  • Depression.
  • Social withdrawal in more extreme forms, such as refusing to leave his or her room even to eat.
  • Concentration problems (taking longer to do tasks, have trouble finding tasks, having trouble following a conversation or a TV show).
  • Decreasing or stopping medication or treatment (such as, refusing to go to the doctor or the case manager appointment, skipping the vocational program).
  • Eating less or eating more.
  • Excessively high or low energy.
  • Lost interest in doing things.
  • Poor hygiene or lost interest in the way he or she looks.
  • Saying that he or she is afraid that he or she is "going crazy." 
  • Becoming excessive in religious practices.
  • Feeling bothered by thoughts that he or she can't get rid of.
  • Feeling completely overwhelmed. 
  • Leaving bizarre voice mail messages, outgoing messages or writings.
Your loved one also may have other specific signs of relapse or crisis that she or he has told you about. Ask yourself as well:
  • Did any unusual changes in behavior take place in the weeks just before the last relapse?
  • Did your loved one do anything that seemed "out of character" just before the last relapse?
  • Have the same behaviors preceded other relapses? 
Next you move to activating a crisis plan.

Sunday, August 5, 2012

Creating a Relapse Prevention Plan

The best way to do crisis planning is to do crisis prevention planning. When you love someone who has a mental illness, that's called relapse prevention.

Mental illness, especially bipolar disorder and schizophrenia, is episodic, meaning that symptoms vary significantly over time.  One of the hardest aspects of living with the illness in the family is that you know that things could change dramatically on any given day.

That's why it's smart to get the family together, including the person with the illness if at all possible, to develop a plan for how to prevent a relapse that could lead to a crisis. Writing down the answers to the questions below will help you to prepare the plan. 
  1. Who should attend family meetings if warning signs occur?
  2. What are your relative's early warning signs of a relapse? What was the very fist sign of crisis? (Do not write down more than five signs. Only write down the earliest or most important signs.  Typical signs could include irritability, severe insomnia, depression, social withdrawal and refusing to go to the doctor.  We'll cover more of the typical signs in an upcoming post.)
  3. How will you evaluate whether your relative is taking medication regularly?
  4. If your relative is not taking medication regularly, what will be the plan to help him or her resume doing so?
  5. How will you evaluate whether your relative is abusing drugs and alcohol?
  6. If your relative is abusing drugs or alcohol, what will you do?
  7. What situations have been too stressful for your relative in the past?
  8. If your relative is overwhelmed with stress, what will you do? 
Complete the plan by writing down this information:
  • The nearest psychiatric emergency facility's address and telephone number
  • Suicide Hotline number
  • Psychiatrist name and number
  • Case Manager  name and number
  • Therapist name and number
  • Social worker name and number
  • Any other services you could use
Then finish by setting a date six months into the future for when the family will meet again to discuss this.

Although I have no experience with this, some people with mental illness do create advanced psychiatric directives. This gives them the ability, while they are healthy, to name a health care agent to make decisions for them in an emergency. The directive also can cover preferred hospitals, physicians, psychiatric medication, electroconvulsive therapy, emergency medical interventions, people to be notified if they enter a psychiatric facility,  and the care and temporary custody for any minor children.