Continued from Part 1...
--------------------------
3.10 What is Cyclothymia?
--------------------------

******************************************************************************

Diagnostic Criteria for Cyclothymic Disorder (DSM-IV, p. 365)

A. For at least 2 years, the presence of numerous periods with hypomanic
symptoms and numerous periods with depressive symptoms that do not meet
criteria for a Major Depressive Episode. Note: In children and adolescents,
the duration must be at least 1 year.

B. During the above 2-year period (1 year in children and adolescents), the
person has not been without the symptoms in Criterion A for more than 2 months
at a time.

C. No Major Depressive Episode, Manic Episode, or Mixed Episode has been
present during the first 2 years of the disturbance.

Note: After the initial 2 years (1 year in children and adolescents) of
Cyclothymic Disorder, there may be superimposed Manic or Mixed Episodes (in
which case both Bipolar I Disorder and Cyclothymic Disorder may be diagnosed)
or Major Depressive Episodes (in which case both Bipolar II Disorder and
Cyclothymic Disorder may be diagnosed).

D. The symptoms in Criterion A are not better accounted for by Schizoaffective
Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder,
Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

E. The symptoms are not due to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication, or other treatment) or a general medical
condition (e.g., hyperthyroidism).

F. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.

******************************************************************************

------------------------------------------------------------------------------
4.0 How can I best take care of myself?
------------------------------------------------------------------------------

If you've been diagnosed with a form of bipolar disorder, you'll probably
find no shortage of people (doctors, family members, members of support
groups) offering advice, whether you ask for it or not. :-)

And now here we are, getting in line behind all of those people.

The advice we're presenting here is GENERAL. Everyone with this
illness is a unique individual, and individuals respond in
unique and sometimes unexpected ways; use your best judgment and
common sense about whether this advice is right for you.

That being said:

The most important general guideline for self-care is to establish
a sound therapeutic relationship with one or more doctors: a
psychiatrist or psychopharmacologist for drug therapy, and, if you
prefer not to use this person for more traditional forms of therapy
but want a professional to talk to, a psychologist, licensed
clinical social worker, or similar licensed counselor.

Bipolar Disorder is a lifelong, chronic medical condition. It cannot
be cured, but it can in almost all cases be managed to at least some
extent.

Some more general guidelines, which mostly fall into the category
of common sense but bear repeating (and please note that these are
GENERAL statements, and that everyone is an individual--your mileage
may vary!):

-- Take responsibility for your own well-being.

You can have the finest medical team in the world working on "your case,"
but if you don't first accept that you *have* a chronic medical
condition and take responsibility for doing what it takes to manage
it, you're wasting time and money. Obviously, if you're in the
throes of an incapacitating depression or mania, this can be hard
if not impossible to do, and someone else may (temporarily) need to
make these sorts of decisions for you; also, people respond in
different ways to various kinds of medication and therapy.

But in general, remember: you're the boss, you're the one calling
the shots and deciding which resources to utilize (or not.)

The key thing to remember is that there's a LOT of help out there
if you want to get things under control--but you have to decide
to seek it out, and you have to decide that you will commit to a
healthy course of action.

-- Work with your doctors, not against them--and insist that they work
with you.

It's vitally important that you be able to communicate with the doctors
and health-care professionals that you choose to use as resources.

If you're not comfortable talking with someone, or if they don't listen
to you, look for another therapeutic relationship. Period. It's
*vital* that you and your doctor(s) listen to and respect each other.

-- Develop a survival mentality.

A few of us who start medical treatment for Bipolar Disorder are pretty
much asymptomatic afterwards--in other words, we never, ever have another
flare-up. A few of us don't seem to respond satisfactorily to ANYTHING we
try. Almost all of us fall somewhere in-between-- we get some measure of
control over our bipolar disorder, but we still experiences ups and
downs, and still have tough times that must be endured.

A "survival mentality" means, first of all, deciding that there's life
after diagnosis. Getting the news that you have a medical condition
that you'll be dealing with (in all probability) for the rest of your
life can be a major shock to the system! Recognize that there are
literally *millions* of people around the world dealing with this
disorder; you're not alone, and there are many resources available
to help you cope.

Second of all, it means that when times DO get tough, you do what
it takes to get through it. In extreme cases, this may involve
voluntarily checking yourself in to a hospital under a doctor's care.
This isn't an experience that most people would seek out for themselves,
but when things get badly out of hand, it can literally be a lifesaver.

Remember: your first goal is to *survive*--to take care of yourself.
Your secondary goal might be to contribute as much as you can
to the lives of your friends, family, loved ones, co-workers, etc... or
it might be something else entirely.

But if you don't take care of the first goal, the other ones are
utterly meaningless.

-- Become aware of your mood states.

At first glance, this seems like a really stupid thing to say. If
you're depressed, you know damn well that you feel awful... though you
may not identify "depression" as the cause at the time. Hypomania
and mania can be harder to recognize when it's happening to you,
but as you gain more experience in dealing with this disorder, you'll
become more sensitized to your moods and their cycles.

If you become more aware and conscious of your mood states, however,
you may find that you can spot trends earlier and head off potential
problems.

Many bipolar folks chart their moods on a calendar or in a diary;
this helps them understand their cycles better, and can also provide
important clues about possible environmental stimuli that might either
be causing problems or giving relief. For instance, if you note
that your mood is generally better for a day or two after you work
out vigorously, you might want to consider making exercise a regular
part of your coping strategy... or if you notice that you feel
especially depressed after a certain activity or eating/drinking
certain foods or beverages, you might consider limiting that sort of thing.

One simple way to do this is to choose some kind of arbitrary numeric
scale... let's say that "1" is severe depression, "5" is
"normal," whatever that means, and "10" is severe mania. Something
as simple as jotting down a number reflecting your own assessment
of your mood state *at roughly the same time every day* can give
you very important information about the length and quality of
your mood cycles.

Also, many folks establish "contracts" with trusted friends or
family members--they work out ways in which the trusted outside
observer can communicate to them, in a friendly, loving, and
nonthreatening way, that they think that you are becoming
depressed or (hypo)manic.

Finally, remember that even though you have a mood disorder, you're
almost certainly still prone to everyday, ordinary moodiness! If you
wake up in the morning feeling bad, it might be a precursor to
a serious depression, or you might just be having a bad hair day. If
you wake up feeling on top of the world, you might be getting
(hypo)manic, or you might just be having, um, a good hair day. ;-)
Watch the overall *trends* over time, and try not to watch yourself
under a microscope and obsess over the tiny details. ;-)

-- Structure your life to the extent possible.

Without becoming fanatical about it, many bipolar folks find that sticking
to as regular a schedule as possible of eating, sleeping, working, and
so forth is helpful in stabilizing their moods. Sleep deprivation can
DEFINITELY precipitate (hypo)mania, for one thing.

-- Educate yourself about this illness.

Ignorance and fear are the Big Enemies. Educate yourself about your
condition. At a minimum, know what your diagnosis is and what the
symptoms are, and know what meds you're taking and what the
side-effects are likely to be.

-- Exercise regularly and vigorously, if you're physically able.

Many readers and participants in ASDM and SSDM say that regular
exercise really helps them stay on an even keel.

-- Avoid artificial stimulants and depressants.

Some bipolar folks tolerate caffeine (stimulant) and alcohol (depressant)
just fine in moderation--though both substances can potentially
interact in nasty ways with commonly used medications, alcohol especially.

Some folks find that they need to avoid these substances entirely.

If you ARE going to drink espresso and Scotch (hopefully not at the
same time!) make sure that your doctor(s) know(s) about it, and
that you're not setting yourself up for a nasty drug interaction...

...and remember that moderation, as in so many things, is key, and
abstinence might very well be the best choice.

-- Enlist the support of family and friends.

The importance of having a good support structure cannot be overemphasized.

Sadly, sometimes friends and family members can't handle the idea of a
loved one with a "mental illness." This is usually ignorance and fear
talking, and often these people can be educated and brought around.

If there are people that you can really trust and talk to, let them
know about what's going on with you.

-- Join a support group.

Check the "Resources" section of the FAQ for information on how to find
a "real-world" support group near you... but don't neglect the many
online support groups that are available. :-)

-------------------------------------------
4.1 How can I assess my own mental status?
-------------------------------------------

Q: How can I tell if I am depressed or just in a bad mood?

A: Frequently, it is more obvious to those around us that we are depressed
than it is to ourselves. Distorted judgment is part of having a mood
disorder, so it is not uncommon for our family and friends to recognize
signs before we do.

This section and the next involve the Goldberg Mood Scales, by
Dr. Ivan K. Goldberg, M.D. They are reprinted with his permission.

The scales ARE NOT designed to diagnose any psychiatric disorder, nor are
they intended to replace evaluation by a qualified psychiatrist. They are
only intended to measure the severity of depressive and/or manic symptoms,
and thus to help the reader decide whether to seek a psychiatric evaluation.

The Goldberg Depression Scale, below, is a self-administered
questionnaire designed to measure the severity of depressive
thinking and behavior.

Goldberg Depression Scale
-------------------------
Copyright (c) 1993 Ivan Goldberg

Name______________________________________ Date__________________________

The items below refer to how you have felt and behaved DURING THE
PAST WEEK. For each item, indicate the extent to which it is true, by
circling one of the numbers that follows it. Using the following scale:

0 = Not at all 1 = Just a little 2 = Somewhat

3 = Moderately 4 = Quite a lot 5 = Very much
==========================================================================
1. I do things slowly. 0 1 2 3 4 5

2. My future seems hopeless. 0 1 2 3 4 5

3. It is hard for me to concentrate on reading. 0 1 2 3 4 5

4. The pleasure and joy has gone out of my life. 0 1 2 3 4 5

5. I have difficulty making decisions. 0 1 2 3 4 5

6. I have lost interest in aspects of life that
used to be important to me. 0 1 2 3 4 5

7. I feel sad, blue, and unhappy. 0 1 2 3 4 5

8. I am agitated and keep moving around. 0 1 2 3 4 5

9. I feel fatigued. 0 1 2 3 4 5

10. It takes great effort for me to do
simple things. 0 1 2 3 4 5

11. I feel that I am a guilty person who deserves
to be punished. 0 1 2 3 4 5

12. I feel like a failure. 0 1 2 3 4 5

13. I feel lifeless - - - more dead than alive. 0 1 2 3 4 5

14. My sleep has been disturbed---too little, too
much, or broken sleep. 0 1 2 3 4 5

15. I spend time thinking about HOW I might
kill myself. ~~~ 0 1 2 3 4 5

16. I feel trapped or caught. 0 1 2 3 4 5

17. I feel depressed even when good things
happen to me. 0 1 2 3 4 5

18. Without trying to diet, I have lost, or
gained, weight. 0 1 2 3 4 5

A score of 15 or higher on the depression scale indicates the possible need
for a psychiatric evaluation.

Copyright (c) 1993 Ivan Goldberg
---------------------------------

Q: How can I tell if I am manic or just unusually cheerful?

A: Much like depression, it is frequently more obvious to those around us
that we are becoming manic or hypomanic than it is to us. Impaired
judgment is every bit as much a part of mania as it is a part of
depression, and it is not uncommon for someone on a manic upswing to
think they simply feel so good because the damn depression is finally
over. Family and friends can usually tell the difference quite easily,
although convincing the manic subject of his/her mania can be quite a
different matter.

This section, like the last, involves one of the Goldberg Mood Scales
by Dr. Ivan K. Goldberg, M.D. Again, the scales ARE NOT designed to
diagnose any psychiatric disorder, nor are they intended to replace
evaluation by a qualified psychiatrist. They are only intended to
measure the severity of depressive and/or manic symptoms, and thus
to help the reader decide whether to seek a psychiatric evaluation.

The Goldberg Mania Scale, below, is a self-administered
questionnaire designed to measure the severity of manic
thinking and behavior.

Goldberg Mania Scale
--------------------
Copyright (c) 1993 Ivan Goldberg

Name_________________________________________ Date_______________________

The items below refer to how you have felt and behaved DURING THE
PAST WEEK. For each item, indicate the extent to which it is true, by
circling one of the numbers that follows it. Using the following scale:

0 = Not at all 1 = Just a little 2 = Somewhat

3 = Moderately 4 = Quite a lot 5 = Very much

==========================================================================
1. My mind has never been sharper. 0 1 2 3 4 5

2. I need less sleep than usual. 0 1 2 3 4 5

3. I have so many plans and new ideas that it is
hard for me to work. 0 1 2 3 4 5

4. I feel a pressure to talk and talk. 0 1 2 3 4 5

5. I have been particularly happy. 0 1 2 3 4 5

6. I have been more active than usual. 0 1 2 3 4 5

7. I talk so fast that people have a hard time
keeping up with me. 0 1 2 3 4 5

8. I have more new ideas than I can handle. 0 1 2 3 4 5

9. I have been irritable. 0 1 2 3 4 5

10. It's easy for me to think of jokes and
funny stories. 0 1 2 3 4 5

11. I have been feeling like "the life of
the party." 0 1 2 3 4 5

12. I have been full of energy. 0 1 2 3 4 5

13. I have been thinking about sex. 0 1 2 3 4 5

14. I have been feeling particularly playful. 0 1 2 3 4 5

15. I have special plans for the world. 0 1 2 3 4 5

16. I have been spending too much money. 0 1 2 3 4 5

17. My attention keeps jumping from one idea
to another. 0 1 2 3 4 5

18. I find it hard to slow down and stay in
one place. 0 1 2 3 4 5

A score of 20 or higher on the mania scale suggests the possible need for
an evaluation by a qualified psychiatrist.

Copyright (c) 1993 Ivan Goldberg
---------------------------------

BIPOLAR DISORDER FAQ 1.1 - FILE 2 OF 4

Continued in Part 3...