Anyone who’s raised teenagers bears witness to the moodiness and angst that can surge during adolescence and into young adult years.
Being in that age group with depression or bipolar disorder, however, brings extra layers of challenge, says child psychiatrist Elizabeth Kastelic, who directs Hopkins’ Adolescent and Young Adult Mood Disorders Inpatient Service. Then, teenage moodiness and irritability become intense, even debilitating, and invite a host of other problems, from difficulty concentrating to a chronic irritable state that can be overwhelming.
Under Kastelic, however, the service has evolved tactics to provide patients with skills for managing such symptoms. “With the right tools,” she says, “they learn to cope with their illness at what’s often a high-stress time for anyone, well or mood-disordered.”
But before newly admitted patients can begin to think about disposition, they must first reach a benign-enough mood. So a clinical team works with them early on to fine-tune medication. At group meetings led by nurses and occupational therapists, patients learn about their illness. They also practice problem-solving, communication skills and the coping mechanisms that can manage symptoms and help prevent relapse.
During a therapy session, for example, a young woman might be led to realize that her constant lashing out at parents or friends in response to conflict or stress is really depression manifesting itself. “That leads us to discuss consequences of acting on this irritability,” says Kastelic. “We’d explore how that makes the parents feel.”
Asked to come up with healthier alternative behaviors, the patient might suggest requesting that the family take a 24-hour time-out from heated discussion.
Nurses and therapists also apply a behavioral activation approach – the idea that simply increasing activities in a patient’s day, particularly enjoyable ones, aids recovery. It’s not unusual in a mood disorder to withdraw from daily activities – school work, social life – and have irregular sleeping and eating patterns. “Depression,” notes Kastelic, “can wreak havoc on routines of daily living.” So patients spend time charting how they will spend their days after they are discharged.
Each day, Kastelic says, should have an anchor – a reason to get out of bed, like attending a class, working for an hour, even sticking to regular mealtimes. A critical part of the process, says Kastelic, is making a “pleasant events schedule” – listing activities that a patient finds enjoyable and marking times to do them.
Finally, as patients leave the program, they write a safety plan: a list of tactics to apply if they notice symptoms returning. If a patient notices his mood declining or starts having thoughts of harming himself, for instance, his plan might be to first listen to music for 20 minutes. If his symptoms remain, he’ll then talk to a parent. If that doesn’t help, he’ll call his doctor.
“It’s a protocol,” says Kastelic, “just as you’d have for any other medical illness.”
Basically, she explains, patients should leave the program understanding that their mood disorder is an illness. “It’s really a message of hopefulness. A mood disorder is a disease you can treat. It’s not who you are.”
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This article first appeared in the Summer 2010 issue of Hopkins Brainwise