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Moving an individual with Alzheimer’s into a facility such as a nursing home or assisted living can be traumatic for everyone involved. A recent study by the Rush Alzheimer’s Disease Center has found that there are things which can be done to help with the move. The study, published in the June issue of the American Journal of Psychiatry, finds that prior experience in adult day care may help individuals suffering from Alzheimer’s make the transition from home to facility much smoother.

In general, seniors moving from their home into any type of facility or downsizing to a smaller home need special attention and assistance. With an Alzheimer’s patient, the stress of moving is far greater. Taking them out of comfortable surroundings into a totally unknown environment appears to increase the rate of cognitive decline.

This is consistent with clinical reports of increased confusion and behavior problems so common with those suffering from dementia during acute hospitalization or when traveling away from home.

The answer appears to be a gradual transition by starting with adult day care and then moving into a facility once the individual is comfortable with the change. “It makes perfect sense as we get feedback in the form of reviews from people who have put loved ones into assisted living facilities and nursing homes. After reading this study and reflecting back on comments left, it does seem to correlate that individuals who have made the transition slowly, using adult day care and home health care seem to have fewer complaints.”

It appears that individuals who spend more time in day care experience less cognitive decline once they move into a facility full time. This means that if a person goes to adult day care between 3 - 5 times per week, they will not experience an accelerated cognitive decline. A person who goes less, such as 1-2 times per week will experience a faster decline, but will still get some of the benefits over a person who goes directly from a home environment to an assisted living facility or nursing home.

The best situation may be to find a nursing home or assisted living facility which also has an adult day care component built in. This way, the individual can slowly get used to his or her new surroundings and will make the transition much easier.

The research was supported by grants from the National Institutes on Aging, which leads the federal effort supporting and conducting research on aging and the medical, social and behavioral issues of older people, including Alzheimer’s disease and age-related cognitive decline.

Ok, so now you’ve been told that you’ve got Bipolar Disorder. One of the first things you want to know is “What is it?” Bipolar Disorder is both a physical (biochemical) and a mental condition.

Physically, the disorder is a chemical imbalance of the brain. Compare it to diabetes, which is an insulin imbalance of the body. Like the diabetic who takes Insulin to control his condition; you, too, will take medication to control your chemical imbalance.

However, Bipolar Disorder is also a mood disorder, marked by extreme mood swings - there will be times when you will enter a depressive mood (extreme sadness), and other times when you will experience mania (extreme euphoria). These are called bipolar episodes.

Although you will continually go back and forth between these two extremes, in between episodes, you can go months (or even years) with normal moods. Most people only have 8-10 episodes in their entire lives. Some, however, may have more.

Then you may ask yourself, “How did I get this?” as if it were a common cold, something contagious that you caught by someone coughing on you - or from someone in your family passing it down to you. The latter is the more accurate. Bipolar Disorder does run in families; however, just because one person in the family has it does not guarantee that it will definitely be passed to the next person.

Someone with Bipolar Disorder said, “Bipolar is not contagious, but it does affect everyone involved with the person that has it.”

What you really want to know is, “Is this my fault (that I got Bipolar Disorder)? Is it something I did/didn’t do?” And the answer to that is a simple one. NO. It is NOT your fault. And there is absolutely nothing you could have done to prevent it. It just happens.

And now the big question. “Is there a cure?” Unfortunately, at this time, there is still no cure for Bipolar Disorder. However, there is treatment. And with effective treatment, you can live a happy, healthy, productive, “normal” life.

Treatment consists of medication, therapy, diet, exercise, regular sleep, and a healthy lifestyle, making good decisions, etc. It will mean changing your lifestyle in a major way, but millions of people have done it before you and are living happy, healthy lives.

So what’s the catch? The catch is that you have to want to do it. YOU have to be willing to make the necessary changes, and you have to do all the work (although you will develop a support system to help you). And it will be work! Because this is a very dangerous disorder (it can even be fatal), and it will take hard work on your end to manage it. You start with education. Read everything you can get your hands on about the disorder. That’s the beginning -Knowledge is power, and will also help you accept the reality of the diagnosis.

Have you ever tried quitting a bad habit, such as smoking? Or have you ever been on a diet? Have you ever been told, “You didn’t get this way overnight, you aren’t going to get better (change) overnight?”

Every change takes TIME to become a permanent change. And in the process of change, you may have to try several different things in order for the change to take place.

Consider what one supporter said:

“Not all strategies work for all people, or every time, be open to suggestions try something, if it doesn’t work try something else…This is a living on going process, after all bipolar is an ever changing evolving disorder.”

–D. Bahn, PA

When your loved one was first diagnosed, they were put on certain medications. I bet they aren’t the same medications they’re on now, though, are they? In the beginning, especially, medications have to be changed, rearranged, dosages need to be adjusted, etc. It takes TIME to find the right medications and in the right dosages.

Lifestyle changes must be made in the beginning and, as your loved one progresses, again as they go along their journey toward becoming a high functioning person with bipolar disorder. This also takes TIME.

It takes TIME to learn to eat well, plan an exercise regimen, get enough good sleep, learn stress reduction techniques and relaxation exercises, keep a mood chart and journal, and all the other little things that make up that lifestyle change.

It takes TIME to find a good doctor, therapist, psychiatrist, and other staff to make up your medical and psychiatric support team.

It takes TIME to find a good support group, and even more TIME to feel comfortable among them; possibly even more TIME before you begin sharing in front of them.

It takes TIME to build a good support system.

It takes TIME to build good strategies for future episodes, and TIME to live those out.

It takes TIME to make mistakes, pick yourself up, and try something else - finding out what works and what doesn’t work for you in the process.

It takes TIME to become a high functioning person with bipolar disorder.

The expression, “Anything worth doing is worth doing well,” certainly applies here. It takes TIME to be able to do what is worth doing well. And learning to become a good supporter is worth the TIME it takes to do so.

In my experience, whether by talking to the thousands of people that I’ve talked to, or by reading all the many thousands of emails people have sent me, I’ve noted several mistakes that supporters make in coping with a loved one who has bipolar disorder. In this article, I’ll just go over the top ten.

1. Being in denial.

Being in denial is the biggest mistake that supporters make because it will cause you to miss the signs/symptoms of your loved one going into a bipolar episode. It’s so important, first of all, that you know all the signs/symptoms of an episode, so that you can recognize when your loved one is heading for one. That takes education on your part. That’s the easy part. But recognizing them may be a little harder, and takes more work on your part, because sometimes it’s hard to tell the difference between which is the disorder and which is your loved one. However, if you’re in denial, it won’t help either way.

2. Taking things personally.

NEVER take things that your loved one says or does personally! They will say or do things in an episode to hurt you that they might never otherwise say, but chances are, they won’t even remember it afterwards. And if you take it personally, you will be the one left with hard feelings, while they won’t even know what they’ve done to hurt you. Your loved one may not be in control of what they say or do, but you can be in control of your own feelings. So don’t take it personally, no matter how much or how loud they are yelling at you.

3. Not taking action.

You know I talk about this all the time, because taking action can mean the difference between your loved one having an episode or not having one. If you’ve noticed the signs/symptoms, but don’t do anything about it because you’re scared of a confrontation, for example, you’re only setting them up for an episode. Maybe talking with them didn’t help last time, but at least try - maybe this time it will work. Or, if they won’t listen to you, call their psychiatrist and tell him what’s going on, so he can advise you what to do. Either way, take action!

4. Being reactive instead of proactive.

The difference between being reactive instead of being proactive is in taking action. People who are reactive are not particularly good at taking charge of themselves and their own lives - which they tend to spend reacting to events, circumstances, and situations around them instead of shaping and creating them, which is what a proactive person would do. Someone who takes action is proactive. Your being proactive can mean the difference for your loved one between whether they have an episode or not.

5. Procrastinating

All of us procrastinate at some time or another, some over little things, and others over big things. But if you procrastinate over something to do with your loved one’s bipolar disorder, it could mean them going into an episode. For example, if you’ve noticed they’ve seemed a little “down” lately and sleeping more than usual, well, that’s two of the biggest symptoms of a depressive episode. But if you’ve been busy, and you haven’t had time to talk to them about it, well, you are procrastinating, and the next thing you know, you have a major depressive episode on your hands. Use some time management skills and don’t let this happen to you.

6. Becoming too complacent

Perhaps it’s been a long time between episodes…say, your loved one has been stable for a long time - so long, in fact, that you’ve become complacent. If so, you are in a very dangerous place. It’s not a matter of if they will go into another episode, but a matter of when. It doesn’t matter how long they’ve been stable. At some point, they will have another episode, and if you’ve let your guard down and become too complacent, you won’t be prepared. I know someone who didn’t have an episode for 12 years, but then she had a major manic episode, and her family was not prepared for it at all! They had become complacent and thought just because she hadn’t had an episode for 12 years that she would never have one again! Don’t let yourself fall into that trap. Always be prepared for the next episode, whenever it comes.

7. Believing this will all “blow over” or get “fixed” by itself

This kind of goes along with complacency and denial as well. It’s like you turn your head the other way and pretend that everything is fine, and that your loved one will get better all by themselves. You ignore what is staring you right in the face. I know, because that’s what we did with my mom for so many years. It didn’t work for us, and it won’t work for you. Your loved one’s bipolar disorder will NOT blow over or get fixed by itself - it will take lots of hard work on both your parts - and a good treatment program, including medication and therapy, along with time. Believing it will all go away magically by itself, with no work on your parts, is going right back to mistake #1 - denial.

8. Not taking care of yourself

If you don’t take care of yourself, how are you going to take care of your loved one? Yet that’s the very mistake that many supporters make. They put so much time and energy into their loved one and their bipolar disorder, that there’s nothing left over for themselves. And that is the recipe for burn-out. You must take care of yourself - meet your own needs - first. Make sure you are getting enough sleep, eating right, exercising, etc. Also make sure you are scheduling time for your own relaxation, as well as some fun time (off-time) away from your loved one.

9. Accepting unacceptable behavior

This is one of the biggest problem areas I’ve seen with supporters. They let their loved one’s bipolar disorder be an excuse for their unacceptable behavior. This includes abusive behavior - anything from emotional abuse (just yelling at you) to physical abuse (actually hurting you). Just because your loved one has bipolar disorder does NOT give them license to hurt you! You DO NOT have to stand for unacceptable behavior. Talk to your loved one between episodes about their behavior. Set standards. Set limits. Set boundaries. Tell them that you will not tolerate their unacceptable behavior. Tell them that you will not allow them to cross certain lines, or you will do something about it. Then follow through.

10. Being an enabler (codependent)

Sometimes a supporter can become so engrossed in their loved one’s bipolar disorder that it’s almost like they “catch” it, like the common cold - they get so drawn up into it that bipolar disorder seems to rule their lives, and the line of separation between them and their loved one becomes blurred. Be careful of this, as this is called codependency, and you don’t want it to happen to you. What you want is for your loved one to take responsibility for their OWN behavior, just as you take responsibility for yours. This is where bipolar disorder is no longer an excuse for them for anything. This is where you stop helping them do things that they can very well do for themselves. This is where you have your OWN life, separate from theirs.

It was estimated that every year the amount of people who suffer from panic attacks is increasing. Panic attacks are the very first symptoms of a panic disorder. There are many approaches to a panic disorder. But one thing is clear a panic disorder is a very serious physical problem accompanied by panic attacks (a sudden increase of fear that comes without any obvious reasons). During panic attacks a sufferer feels very tense and scared and may have the following symptoms: intensive heartbeat, hurried pulse, giddiness, sickness, sweatiness and at last fear that almost paralyses all the organs. All these symptoms may appear all of a sudden and take a sufferer aback.

There are no clear scientific explanations of panic attacks. However people with a genetic inclination are more liable to them. Still panic attacks do not deprive people of life but at the same time spoil it to a great extent. Panic attacks bring sufferers humiliation and misery, they made an influence on the rate of suicides as well. Fortunately, panic attacks are treatable. There exist certain antidepressants that have been officially approved. Paxil is one of such antidepressants. (or paroxetine hydrochloride) is usually prescribed to cure panic disorders, depression, anxiety disorder and others. Thorough research of Paxil proved the effectiveness of this drug in the process of panic attack treatment. Paxil turned out to be very efficient, first of all because it returns the sufferer the lost chemical balance in the brain. In other words, Paxil helps to increase the amount of serotonin which is deadly needed for the cell-to-cell message transmission. While taking Paxil you should be constantly examined be your physician as some side effects might happen, such as allergic reactions, mood change, anxiety, insomnia, aggressiveness, loss of appetite, yawning and others. Moreover before taking Paxil it is necessary to consult specialists provided that a patient might have liver or kidney disease, epilepsy or bipolar disorder. In such a case it would be not safe even dangerous to use Paxil. While being in the course of Paxil treatment you mustn’t drink alcohol, you mustn’t combine Paxil with other medicines (aspirin, dislofenac, piroxicam etc.) Such combinations may lead to stomach bleeding. So you see that you really need to consult your doctor regularly. As for schedule Paxil is taken once a day usually in the morning, either in tablets or liquid form. It is forbidden to take a double dose even if you missed one.

Paxil

As an alternative you can use herbs that cope with depression - phyto-antidepressants. The most available and popular among them is St. John’s wort perforated (pierced and so on. The name of the plant comes from Kazakh ‘gerabai’ which means ‘healing wounds’-not every aesculapius accepts such a title!)

It goes without saying that many people manage to get over panic attacks on their own. Nevertheless it takes lots of time and affords. It is highly recommended for all the sufferers who are no so strong-willed to consult the doctor. At least you see that there are various medicines like Paxil which is harmless but helps a million to overcome a disease very quickly and without pain.

Just before Christmas, small-business groups joined big businesses to help defeat a Congressional provision that would have expanded existing law, forcing group health plans to treat mental health coverage the same as medical coverage in companies with more than 50 employees. The legislation, promoted by Sens. Paul Wellstone (D-MN) and Pete Domenici (R-NM), would have forced group health plans to charge patients the same copayment for visits to general physicians and therapists, among other provisions.

Passage would have benefited employees, but business groups saw it as an intrusion that would have removed cost controls such as annual limits on the number of visits to a therapist. “It’s another government mandate at a time when we’re already experiencing health-care inflation,” says Kate Sullivan, health-care policy director for the U.S. Chamber of Commerce.

Although plans for companies with fewer than 50 employees would not have been affected, National Small Business United president Todd McCracken also opposed the bill’s passage. As the bill passed the Senate but not the House of Representatives, he expects another attempt to expand the regulations in 2002.

A call to your congressperson’s office should determine where he or she stands on the issue. A check of your insurance coverage will let you know whether you’ll be affected.

Residents of a secure mental health unit may experience special problems in attempting to cope with their diabetes, explained Elaine Emmerson, Diabetes Specialist Nurse at King’s Mill Hospital, Sutton in Ashfield.

Elaine described her experience of working in a private, women-only unit in which five of the 38 residents have type 2 diabetes. She spoke about four individuals between the ages of 28 and 52 years.

Common factors between the women include the following:

* Obesity

The women are often sedated, thus making the possibility of them taking exercise less likely. Weight control is therefore even more of a problem in this group.

* Generally poor control

Altered mood states and a lack of motivation make control difficult. In addition, self-abuse, both physical and in relation to their insulin, is common.

* Poor concordance with treatment

The secure unit represents a very restrictive environment in which peer pressure from residents can make it especially difficult for individuals to behave in any way that makes them perceived as being ‘different’ from the rest.

* Underlying mental illness and the use of antipsychotic and atypical antipsychotic drugs

Antipsychotics and atypical antipsychotics have in the past been linked with causing diabetes. At present, however, this remains unproven.

Elaine stressed that as a DSN she could play a key role in improving the ability of this vulnerable group of people with diabetes to manage their disease.

Working as part of a multidisciplinary team

By working as part of a dedicated team alongside the psychologist, diabetologist and GP–and by attending regular multidisciplinary meetings–the person with diabetes can be encouraged to recognise and take control of important aspects of their disease management:

* A facilitator could be put in place to encourage exercise and weight loss.

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* Blood glucose monitoring should be encouraged even if it is only twice a week.

* Better records need to be kept. Some individuals already keep food diaries.

* Unit staff require training and education in diabetes care.

Only by confronting the problems created by a combination of their own attitudes and by the surroundings in which they live will these women be helped to self-manage their disease.

Contemporary Mental Health Issues Among African Americans

Harley, D. A., & Dillard, J. M. (Eds.) Alexandria, VA: American Counseling Association 2005, pp. 336, $54.95

As can be noted by the title of this book, its aim is exactly that: to provide the reader with current mental health issues affecting and related to African Americans. Harley and Milton have edited this text, which sheds new light on contemporary issues pertinent to the promotion of positive mental health of African Americans in a variety of contexts with pragmatic applications for counselors and other mental health professionals.

This text is arranged into four sections: Current Issues, Special Issues, Community, and Application. The Current issues section begins with a chapter by Dillard that sets the aim and theme of the text. Dillard (2005) states “our aim in this book is to promote positive mental health among African Americans” (p. 13), which, after review, has been clearly and thoroughly achieved. This section goes on to include topic areas of family, men, women, and marital status of African Americans. The Special Issues section includes focused discussions on HIV/AIDS; substance abuse; bi/multiracial identity; lesbian, gay, and bisexuals clients; and mental health issues pertinent to elderly populations. Topics covered under the area of Community include important considerations of African Americans communities: public and mental health, violence, gangs and crime, the Black church, cultural considerations (e.g., characteristics of African American populations relevant to service providers and factors related to counseling this population), and views of mental health counseling by members of the African American community. Section IV, Application, discusses how to apply the aforementioned concepts into practice through the topic areas of community mental health services, interventions for counseling African Americans with disabilities, children and adolescents, ethics, and spirituality/religion in the counseling process. Dillard concludes the text with summary statements and suggestions for future research.

Wide differences, up to a twofold difference, in the type of health service used for mental health reasons are found among the provinces, according to a report in the Canadian Journal of Psychiatry (Oct. 2005), “Service Use for Mental Health Reasons: Cross-Provincial Differences in Rates, Determinants, and Equity of Access.”

Based on Canada’s first national survey on mental health and well-being in 2002, the report shows that:

* The primary care general medical system is the most widely used service for mental health.

* Need is the strongest predictor of use, when a mental disorder is present.

* Different sociodemographic variables played a role in service seeking within each province, suggesting different attitudes toward common mental disorders and toward care seeking among the provinces.

* The general medical system was the most used for mental health reasons and the voluntary network sector was the least used.

* No difference was observed in the rate of service use between specialist mental health and other professional providers.

* The general medical system was the most used for MH reasons. Barriers to access, such as income, were not identified in all provinces.

Health service use for mental reasons in Canada was 9.5%. The highest rates, on average, were found in Nova Scotia 11.3% and British Columbia 11.3%. The lowest rates were observed in Newfoundland and Labrador 6.7% and Prince Edward Island (7.5%; 95%CI, 5.8% to 9.3%).

The report was prepared by Helen-Maria Vasiliadis, Alain Lesage, Carol Adair, Richard Boyer of Laval University.

The absenteeism rate is down a fraction from last year, but the average cost is up; two out of three no-shows aren’t physically ill.

The latest CCH Unscheduled Absence survey found 65% of absences are due to reasons like family issues (21%), personal needs (18%), entitlement mentality (14%) and stress (12%). Both of the latter went up over the past two years. Morale was a factor; the rate of unscheduled absenteeism was twice as high at companies with poor or fair morale. This report says traditional sick leave programs that only allow time off for illness are clearly out of sync with the times. Paid leave banks and buy-back programs, where employers “buy back” in cash or vacation time all or some of an employee’s unused sick time, were shown to be most effective in controlling absence; paid leave banks are up from 59% in 2003 to 67% this year; buy-back programs increased by 20% and are now at 58%. The report warns that with workloads so high and the labor market opening up, employees may be feeling less insecure and taking the mental health breaks they feel they deserve. The average number of work-life programs was up slightly. Those called most effective at curbing absenteeism: flu shot programs, alternative work arrangements, leave for school functions, telecommuting, compressed workweeks and onsite childcare.