The MoodGYM training program - Even Keel Support Association

Transcription

T
H
R
O
U
G
H
D
I
F
F
I
C
U
L
T
I
E
S
T
O
T
H
E
S
T
A
R
S
Even Keel
Our aim at Even Keel is to offer friendship, understanding, information and a
sense of hope to people living with Bipolar or other disorders.
A Quarterly Newsletter
Editorial
Support Groups
Michael our newsletter
editor asks the question
“How much does
nurture or nature
impact on sufferers of
bipolar?”
Page 2
Want to know when
and where our support
groups meet? Here is
our most up to date
and comprehensive list
of meetings and leader
contacts
Page 2
Winter 2012
How my black dog
helps me beat the
blues
Bipolar sufferer
tells of long
struggle
Act-Belong-Commit
release an app for
the iPhone
Vanderbilt professor
depicts son's
bipolar disorder
Chris Paine shares his
journey battling with
the black dog and some
things his real life four
legged friend Jethro has
taught him about how
to deal with it.
Pages 4-5
Norma Jean Wilkes, of
Winston-Salem, has
lived for decades with
bipolar disorder.
Pages 6-7
Act Belong Commit
App provides general
information and
guidance on how
people can stay
mentally healthy in
their everyday lives
Page 12
Charlotte Pierce-Baker,
a Vanderbilt
University professor,
has written a book
about her family's
struggles with her
son's bipolar disorder.
Page 13
The MoodGYM training program
• Knowing what makes you upset
• Assertiveness and interpersonal skills training
Want to get more out of life? Improve the way you handle
What will I get from MoodGYM?
relationships? Learn how to protect yourself from developing
emotional problems?
We would like to think that by the time you finish MoodGYM
you will have:
Feeling irritable? Worried, nervous or upset about little
things? Having trouble organising your priorities? Then
• An understanding of how emotions arise, and how
MoodGYM might be just the program for you.
they might be modified
• Learned how to modify your thinking so that you
MoodGYM goals
are less prone to get upset
• Picked up a few hints on managing stress
MoodGYM aims to:
• Learned a few things about what influences self• Help you identify and overcome problem emotions
esteem
• Show you how to develop good coping skills for
• Developed a better understanding of relationships
the future so that you can enjoy good mental health
and how they might be handled
• Developed some practical ways to help you cope
What's in MoodGYM?
with difficult events What you won't have learned
MoodGYM is a free, fun, interactive program consisting of a
• You won't have learned to suppress or deny your
number of different modules.
feelings.
• You won't have become a robot.
These are designed to be completed in order.
• You won't have learned to be helped forever, you
will need to keep up your mood exercises.
The modules explore issues such as:
• Why you feel the way you do
• Changing the way you think
• Changing 'warped' thoughts
Even Keel Bipolar Disorder Support Association Inc.
Interested in trying MoodGYM? (It is free).
Go to http://moodgym.anu.edu.au
1
T
H
FROM
R
O
OUR
U
G
H
D
I
EDITOR
Our Winter 2012 newsletter could be said to
take as its theme the discussion of whether
illness’s such as bipolar come down to nature
or nurture.
F
F
I
C
U
L
T
I
E
S
T
EVEN KEEL
BIPOLAR DISORDER
SUPPORT
ASSOCIATION INC
In an article on page 3 we read in the words
c/- June O'Connor Centre
of Dr Swann, "the differing biological
2 Nicholson Rd Subiaco WA 6008
properties of unipolar and bipolar depression
[email protected]
suggest that treatments that were originally
http://evenkeel.org.au/
intended for unipolar depression may not be
http://forums.evenkeel.org.au/
optimal for bipolar depression." To put it
(08) 9388 9869
another way Dr Swann is saying here that
the different natures of the individuals Open Mondays and Fridays 9.30a– 3.30p
requires different treatments for there We meet at:
different disorders.
SUBIACO
Other articles in the issue make links with
external nurture like substances such as June O’Connor Centre
gluten (page 7), pollen and exercise (pages 2 Nicholson Rd, Subiaco WA 6008
Friday 10:30a-11:30a
10 & 11).
Contact: The office on 9388 9869
But does it have to be a case of one or the
PERTH CITY
other? Could both nurture and nature lie at
the heart of the illness? In the previously Senior Citizens CitiPlace
mentioned article on gluten it does well to Perth Railway Platform (above Platform
write:9) 11.30a-1.00p the last Wednesday of
“The relationship between mental illness and
nutrition is complex and not well
understood. Mental disorders involve
biological, psychological and environmental
factors. Biological aspects include genetics,
medical issues and nutrition. Psychological
issues are related to childhood conflicts,
developmental
stages
and
internal
motivations. Environment, like biology,
often includes nutrition and other external
occurrences. Thus, understanding bipolar
disorder and gluten examines biological and
environmental aspects of the disorder.”
Whether bipolar comes down to nature or
nurture what we need to keep at the forefront
of our minds is that life throws up some
things we can control and some things we
can’t. Other articles in this issue give us the
tools to be able to know the difference
between the two (see the article on Moodgym
page 1 and page 14) and remind us that we
are not alone in this journey (see pages 4-7
& 13).
each month
Contact: Shirley on 9258 3241
RIVERTON (formerly O’Connor)
Riverton McDonalds Restaurant
363 High Road, Riverton
6-8p, 2nd Tuesday of each month
Contact : Lyn on 0404 022 902.
YOKINE
O
T
H
E
S
T
A
R
S
CANNINGTON
Masons Landing Marriamup St
Cannington 1-3p last Saturday of each
month
Contact Shirley on 9258 3241
MANDURAH
1-3p, 3rd Wednesday of each month
Contact: Glenys 0418 828 387 for
location.
ONLINE
http://evenkeel.org.au/
Avail 24hrs 7days
Contact: (08) 9388 9869
BUSSELTON
Salvation Army
94 Kent Street Busselton
PO Box 260 Busselton 6280
10.00am - 4.00pm, Every Wednesday
General Support Group 12pm
Specialized Groups 1.00pm - 3.00pm
(Booking Required)
Contact: Bob on 9751 5866
INPATIENT INFORMATION SESSION
SIR CHARLES GAIRDNER HOSPITAL
10.30am First Tuesday (Bi-Monthly)
Contact: Kate on 9388 9869
FREMANTLE HOSPITAL
Alma St Centre, Ward 51
10.30am 2nd Tuesday (Tri-Monthly)
Contact: Kate 9388 9869
ROYAL PERTH HOSPITAL
Yokine Community Centre
C287 McDonald Street, Yokine 1-2:30p, Ward 2K
3rd Saturday of Each Month
Contact: Shirley 9258 3241
Contact: The office on 9388 9869
BENTLEY HOSPITAL
ROCKINGHAM
Mills Street
June O’Connor Center
3rd Wednesday of each month
8 Baralda Court
Rockingham WA 6168
FRANKLAND CENTRE, GRAYLANDS
12p, 2nd Friday of Each Month
Contact: Ingrid (8a-8p) on 0412 522 387
9.30a 1st Thursday of each month
Contact: Office on 9388 9869
JOONDALUP
1/20 Mercer Lane, Joondalup 1p, 3rd
Possibly the best thing we can conclude is Thursday of each month Contact:
that supporting and encouraging as much Freddie on 0439 804 061
research as is possible on both nurture and
MIDLAND
nature’s role will go a long way towards
helping us understand this complex disease. In recess till further notice
PaRK Mental Health Service
Rockingham General Hospital
Elanora Dve
Contact: Ingrid (8a-8p) on 0412 522 387
Michael Hunt
2
T
H
R
O
U
G
H
D
I
F
F
I
C
U
L
Jaine Edge appointed as
Chairperson for Even Keel
T
I
E
S
T
O
T
H
E
S
T
A
R
S
Three quarters of respondents said their role as caregivers had
adversely affected their relationships with family and friends,
and 57 per cent said their financial situation had deteriorated.
Jaine Edge was recently appointed as Chairperson at our July The Wesley Mission's Dr Keith Garner says they were
20th AGM. We “held the presses” so she could share the shocked by the number of careers who are under the age of
following with us:
16.
To all our members and associates, I am very pleased to have been
appointed at our recent AGM as the new Chairperson for Even Keel
for the next year. In talking to Ingrid and other committee members,
it sounds like both an interesting and exciting time for the
Association.
At this time, I’d like to extend a special thank you to Ingrid, who
has done a fantastic job as Chairperson over the last 12 months,
along with her many other contributions & talents. I am very
pleased that Ingrid will be my Vice Chairperson and I am sure I will
learn many things from her as we work together for the benefit of
our community.
"Many that begin under the age of 16, who are actually caring
for parents, and we've used the term caring till it hurts, and
many of them have exactly that experience, "he said.
He says more effort needs to be made to identify young carers
in the community.
"It's not just about money, we've called them the unsung
heroes of our community, but it's about people being aware of
their situation and offering appropriate support," he said.
"So we've called upon health services, GPs and schools to be
more ready to identify the approach that might come to them
I look forward to meeting many of you over the next year & from young people who are deeply affected by it."
encourage you to attend meetings where you can, to contribute Dr Garner says the group is formulating an action plan to try
thoughts for the newsletter or to make suggestions on how you’d and address the issues identified in the report.
like to see improvements made.
"We're recommending that it's mandatory for teachers to be
provided with an understanding of the presenting issues for
children and young people who may actually be caregivers,"
As part of the Carers WA Education & Training program, he said.
Carers WA are holding a series of FREE workshops for family
carers in Mundaring. These workshops will cover all aspects Dr Garner says many carers do not seek help and there needs
of being in a caring role, from looking after yourself to to be more of an effort made to reach out to them.
Free workshops for family carers
communicating effectively. They are also a great opportunity "We're convinced that this Wesley report raises questions
for you to meet other carers in your area while relaxing and about the effect upon families and the fact that this actually
enjoying a delicious lunch on us!
carries long term cost, not only to them, but to our
community also," he said.
Dates of workshops (all Thursdays):
• 30 August
"It's a really urgent call to action."
• 20 September
• 11 October
• 8 November
• 29 November
For further information and to register for these workshops,
please contact the Carers WA Events team on 1300 CARERS
(1300 227 377).
Young mental health carers
'struggling to cope'
Source: abc.net.au, May 14, 2012
A survey has found a high number of children under the age
of 16 are caring for relatives with mental health problems, and
many of them are struggling to cope with the burden.
More than 1,000 Australians were interviewed for the Wesley
Mission report, which found 90 per cent of relatives of people
with a mental illness are suffering physically, mentally and
financially.
3
T
H
R
O
U
G
H
D
I
F
F
I
C
U
L
T
I
E
S
T
O
T
H
E
S
T
A
R
S
How my black dog
helps me beat the blues
This guy grappled with the black dog; heck he coined the phrase. And he did alright for himself. Spoiler alert: It's Winston Churchill
Source: news.com.au, by Chris Paine, May 4, 2012
LET me tell you about my two black dogs: Jethro and Oscar. Jethro's an actual dog. Oscar is "the black dog". I'll start with
Jethro.
He's a cocker spaniel. He's six. His jet-black hair smells funky, he rocks a dome-shaped head, and every so often he eats poo.
Like actual poo. More importantly, he's amazing. A happy, sweet, cuddle-bomb. He really is a man's best friend, my dad's, but
I'd like to think I'm a close second. And he helps me beat the blues - but more on that later.
Oscar is the other black dog. He's like an imaginary best friend, except that to me he's neither imaginary or a friend. I've
known him for 12 years and, put simply, he's an @#*%^$*!. He follows me around. Everywhere. He makes me cry. He makes
me doubt everything about everything. And he's turned me against the one person I need most: myself.
Let's put it this way - he's no Jethro. If you pitted the two of them in a death match in the Cage of Awesome, J-ro would
deliver victory with a fly-kick to Oscar's pants. I don't care that Oscar’s been de-sexed, or that he doesn't wear pants or that
he’s only a metaphorical dog - that's how it's going to go down. Life with Jethro is simple, fun and carefree. Jethro is just
Jethro. But Oscar isn't like that. Oscar isn't Oscar, Oscar is OCD. Not the glamorous As-Good As-It-Gets kind where you skip
over cracks in a flight of whimsy and flirt with Helen Hunt. No, Oscar is the boring, in-your-head-27-hours-out-of-24 kind of
OCD. I’m not saying one is better or worse than the other - but Howard Hughes wasn’t crazy and eccentric. He just had a
disease no-one, least of all himself, understood: OCD.
4
T
H
R
O
U
G
H
D
I
F
F
I
C
U
L
T
I
E
S
T
O
T
H
E
S
T
A
R
S
I didn’t ask Oscar to come when I moved to Sydney last year, Time for that stroll. I think I can trust Oscar to behave himself.
he just invited himself. Like I said: @#*%^$*!. Jethro’s still in
Brisbane but he’s taught me many things. The most
important? To get outside of my head and see life, in the
moment, for what it is. And I have to say, it's not half bad.
When I look at his oddly-formed face and his impossible
smile, I'm taken away from Oscar and into that moment
where I can just chase my own tail. Because it's my tail and I'll
chase it if I damn well please. And at times like that, I'm
reminded of the simple things we can all do to make our lives
a little bit better.
'Everyone's different, but here are five things that help me
deliver a Jethro-esque fly-kick to Oscar's pants between
sunrise and sunset. And beyond, if there's a Scrubs marathon
on Foxtel.
1. Don't go it alone. It can be hard but you need to tell
someone you're suffering. The best day of my life was the day
I bawled my way towards a diagnosis, drove home, and gave
Jethro the longest hug of all time. Tell your Mum, tell your
best friend, tell your GP. And please, if you're in crisis and
feeling overwhelmed, speak to Lifeline.
2. Know your enemy. If the first step is getting help then the
second is helping yourself. The only way I'm going to keep
Oscar in the doghouse is by learning from the best. It's a
continual process, so skill up. Google is your friend. So is
your Kindle. Whatever it takes, get reading. Ask questions.
Get involved.
3. Smile - inside and out. This isn't about putting on a mask.
Sometimes you're just going to have a bad day. That's fine.
Laughter might be the best medicine, it might not. But if I can
catch up with friends for a cheap Saturday lunch or sit down
to Q&A Family Guy after work, I'm going to be in good
spirits. As for smiling inside? Meditate. It's not just for
Buddhists and hipsters. It clears your mind, improves
concentration and boosts energy. It's legit. Google 'Inner Smile
Meditation' and it should explain why the tall ranga on the
Bondi Junction service is sitting bolt upright with his eyes
closed, wearing a smug grin.
People with bipolar disorder may
wait 13 years for diagnosis
Survey shows many sufferers treated for other conditions,
including depression, and are 20 times more likely to take
their own lives
Source: guardian.co.uk, by Denis Campbell, 27 June 2012
People with bipolar disorder wait for an average of 13.2 years
before they are diagnosed, and often spend years receiving
4. Log off. I live my life online and it not only keeps me
treatment for other conditions, a survey of sufferers has
connected - it pays my bills. But if you're too wired in you
found.
will burn out. Try this: I have a "no devices" rule during meal
times and episodes of Breaking Bad, much to the chagrin of Bipolar campaigners and psychiatrists say the delays are
my multi-tasking girlfriend. If you can't switch off you'll miss "staggering" and are worrying because those with the illness
out on what's happening around you. Take 30 minutes a day are 20 times more likely than the general population to take
to get outside - of your house and your head. That Nyan Cat's their own lives.
not going anywhere.
In a survey of 706 people with bipolar, it emerged that the
5. Sweat it out. If I have to peel myself off the gym floor and average wait until someone was correctly diagnosed was 13.2
carry my pasty, pre-pubescent excuse for a torso home and years. While 15% of participants did get diagnosed promptly,
collapse in a sweaty, broken heap, I call that a good start to the other 85% experienced difficulties in having their illness
the day. Exercise is a profound anti-depressant. It gives you identified.
energy, purpose, and even a little swagger. Maybe too much,
to the point where you're busted checking yourself out in the Most of those were wrongly told they had depression. Among
the 85% whose diagnosis was delayed, 71% said that their
elevator after lunch. Awkward.
symptoms had become worse as a result of receiving
5
T
H
R
O
U
G
H
D
I
F
F
I
C
U
L
T
I
E
S
T
O
T
H
E
S
T
A
R
S
inappropriate treatment, such as antidepressants or sleeping prescribing for the symptoms on the day of the appointment",
pills.
she added.
"A delay of this length has a significant impact for individuals
and families, with sometimes devastating consequences, as
bipolar has the highest rate of suicide of any psychiatric
illness," said Suzanne Hudson, chief executive of Bipolar UK.
It conducted the survey along with the Royal College of Norma Jean Wilkes, of Winston-Salem, has lived for decades
Psychiatrists and Bipolar Scotland in order to highlight the with bipolar disorder.
often lengthy delays in diagnosing the condition, to coincide Source: Winston Salem Journal, by Anna Keller, July 16, 2012
with Wednesday's first National Bipolar Awareness Day.
For most, finding a group of people to identify with is a
Bipolar disorder is one of the most common causes of lost comforting feeling. For Norma Jean Wilkes, it's vital to
years of life and health in those aged 15 to 44, ahead of war, keeping her stable. Over the past couple of decades, the 55violence and schizophrenia, according to the World Health year-old Winston-Salem resident has suffered from bipolar
Organisation. Research suggests that between 1% and 2% of disorder, swinging from animated, manic highs to paralyzing,
the population become bipolar at some point. As many as 1 in depressing lows.
20 people is on the bipolar spectrum, Bipolar UK says.
When in the throes of bipolar disorder, Wilkes experienced
Doctors and patients are both to blame, Hudson added. "It euphoric mania that made her feel especially productive and
could be GPs or psychiatrists that fail to diagnose when they creative, and those were times she enjoyed, though family
can. But a lot of the time it's patients themselves not telling members felt frustrated by her hyper-energetic behavior.
the doctor their full symptoms. If we're in a hypomanic state,
coming out of a stable phase and starting to get high, we The depressions, however, left Wilkes feeling lethargic and
rarely present to a GP then, which makes it more difficult," often suicidal. These lows were what eventually led Wilkes to
seek help.
she added.
Bipolar sufferer tells of long
struggle
Alison Cairns, chief executive of Bipolar Scotland, said people Only in the past 4½ years has Wilkes' disease been stable,
with the condition are more likely to visit a GP when they are thanks to the fact that she has finally discovered the right
depressed and not reveal the full extent of their mood swings. combination of medications and is relying heavily on both
professional help and the support of others dealing with the
Participants usually began to experience their first symptoms disease.
of bipolar disorder aged 23, while half said they first noticed
Knowing firsthand how debilitating this disorder can be,
signs of it when they were between 11 and 20.
Wilkes now serves as a peer specialist, working with people
Dr Danny Smith, a consultant psychiatrist, said that "getting who have less experience dealing with the effects of being
the diagnosis right in the early stages of bipolar disorder can bipolar.
be very challenging". Many survey participants felt that GPs
and other medical professionals needed more help in She says being able to act as a source of support for newly
diagnosed individuals has been satisfying, particularly
identifying it correctly, he added.
because she didn't have access to a mentorship relationship
A separate survey of 460 mental-health professionals carried when she was at a similar point.
out by the three organisations found that while 89% said they
screened those with symptoms of depression for any history "It's a way to connect people dealing with the same issue or
of mania as well, 43% never talked to a relative or carer to problem, and it's being there for someone who's still in a
struggling place with their bipolar disorder," she said. "I never
build up a full picture of the person's history.
had a peer specialist work with me, because I didn't know
One sufferer said: "I wasn't aware of bipolar until the age of about them when I could have used the support."
47, when a GP who was treating me for depression and a
severe episode started to reconstruct a history of behaviour These days, her disease is more stable and she doesn't reach
going back to my teens." Another said: "I hid my symptoms the extreme highs and lows anymore. However, Wilkes is
from my GP. I never revealed the true extent of my illness, quick to share, just because her bipolar disorder is now under
albeit I did not know what I was doing was necessarily part control doesn't mean it's not still affecting her life daily. She
of being ill. My partner intervened and explained things to isn't able to work, concerned that the stress of a job might
trigger an extreme mood swing. She is burdened with an
my GP, which resulted in an assessment referral."
extreme sense of anxiety. And, with her manic highs no longer
One patient's partner said a doctor had wrongly taken her present, Wilkes often struggles with a lack of energy and
partner's bipolar disorder to be a depressive disorder because creativity — as well as a worry that the disorder will rehe only visited his doctor when he felt suicidal. "If the doctor emerge.
had asked about any periods of high moods, agitation,
irritability and sleeping and eating habits, he would have had "There's the fear that the medication will stop working at
a clearer picture of my partner's overall moods rather than some point, and that I'll go down that path again," she said.
6
T
H
R
O
U
G
H
D
I
F
F
I
C
U
L
T
I
E
S
T
O
T
H
E
S
T
A
R
S
"You do tend to get acclimated to medication to the point that Environment, like biology, often includes nutrition and other
it won't work for you anymore, so I hope that by then there external occurrences. Thus, understanding bipolar disorder
will be new drugs I can try."
and gluten examines biological and environmental aspects of
the disorder.
And "that path" is a place Wilkes hopes to never travel again.
Before she found medication that worked for her (she tried WHAT IS BIPOLAR I DISORDER?
about 30 medications before finding a successful
combination), her bipolar disorder was controlling her life The Diagnostic and Statistical Manual of Mental Disorders,
the DSM-IV-TR, describes bipolar I disorder as the presence of
and affecting those around her in a significant way.
at least one manic or hypomanic episode. A manic episode
Sharon Azar, a friend of Wilkes' since the women were consists of periods of grandiosity, decreased need for sleep,
adolescents, became a rock for Wilkes during these years. She pressured speech, racing thoughts, excessive distractibility,
checked in on Wilkes frequently — in person, when the increased spending or promiscuous behavior, and agitation.
women both lived in Albuquerque, and then via phone calls A true manic episode will have at least four of these
once Azar moved to Montana and Wilkes had moved to components. Hypomania is defined as, literally, "little mania,"
North Carolina.
and consists of the above behaviors but to a less extreme
degree. Bipolar disorder may also include periods of
"The second Norma picked up the phone and said hello, I depression, but this is not a requirement for the disorder.
could tell where she was and what phase of the cycle she was
in," Azar recalled. "As time went on, it was the depression THE ROLE OF PROTEINS IN MENTAL ILLNESS
that was really, really bad. I knew this was a serious disease,
but for Norma I think there was a level of denial. After she'd Before exploring gluten intolerance and bipolar disorder, it is
come out of the depression, she'd convince herself that it important to understand what gluten is and how proteins
may play a role in mental illness. Gluten is defined as the
hadn't been as bad as it actually had been."
storage protein found in such grains as wheat, barley and rye.
Azar began tracking her friend's shifting moods on her Researchers are interested in how proteins in general affect
calendar, detecting a rhythm to the length of both the manic mental illness. In 2010, doctors in Australia at the Mental
and the depressed stages. She also started educating herself Health Research Institute in Victoria looked at how proteins
on the disease to best know how to communicate with Wilkes, are related to mental illness and published their findings in
particularly when she was experiencing severe depression.
the "Journal of Psychiatry Research." In exploring the way
proteins interact at the cellular level in individuals with
"I learned about her inner strength by watching her struggle schizophrenia and bipolar disorder, they found that there are
with bipolar disorder," Azar said. "I think she has an amazing alterations in presynaptic proteins that may lead to alterations
will to live. She's been a wonderful teacher to me about how in synaptic activity in both schizophrenia and bipolar
to love. I learned how to love her when the real Norma wasn't disorder. Synaptic activity refers to the ways in which cells
there."
send messages throughout the brain and central nervous
Wilkes, a former therapist focusing on eating disorders, has system. Given this data, the idea that gluten may play a role
become involved in public speaking engagements to spread in bipolar disorder becomes viable.
the word about what living with bipolar disorder is like. Her
talks have garnered positive feedback from attendees,
particularly family members of people with bipolar disease
who say hearing Wilkes' story helped them comprehend their
loved one's experience better.
BIPOLAR AND GLUTEN
The role of gluten intolerance has been researched in
schizophrenia to some extent, but not as much in bipolar
disorder. In 2011, scientists in Baltimore investigated gluten
intolerance in individuals with bipolar disorder by comparing
"It's really eye opening for people who haven't had the the level of sensitivity to people who do not have any history
disease themselves, and they say they feel they understand it of mental illness. The findings they published in a medical
more after hearing me speak," she said. "People can gain some journal dedicated to bipolar disorder were that individuals
hope from the fact that I was able to find some stability."
with bipolar disorder have increased levels of IgG antibodies
to gliadin, which is indicative of gluten intolerance. However,
the results were not significant enough to be conclusive and
the authors state that more research is needed.
GLUTEN INTOLERANCE AND
BIPOLAR
Source: livestrong.com. May 27, 2011 | By Nicolle Napier Ionascu
CHILDREN WITH GLUTEN SENSITIVITY
The relationship between mental illness and nutrition is
complex and not well understood. Mental disorders involve
biological, psychological and environmental factors.
Biological aspects include genetics, medical issues and
nutrition. Psychological issues are related to childhood
conflicts, developmental stages and internal motivations.
Children with bipolar disorder present unique challenges in
terms of diagnosis and treatment. Understanding nutritional
issues in these pediatric patients may help with long-term
care. Scientists at the Institute of Neurological Sciences in
Catania, Italy studied a group of 835 children who tested
positive for gluten sensitivity and published their findings in
7
T
H
R
O
U
G
H
D
I
F
F
I
C
U
L
T
I
E
S
T
O
T
H
E
S
T
A
R
S
What Are Support Groups?
Support groups are a place for people to give and receive both emotional and
practical support as well as to exchange information.
— Quisque Massa
Worldwide, self-help groups are becoming increasingly Rarely are support group members surprised by what they
popular. They are effective in providing mutual support and hear. You may hear other member’s relate experiences such
are good resources for discovering information.
as how they flew into a road rage, or went on a crazy
shopping spree or had a relationship breakdown.
Support groups are a place for people to give and receive both
emotional and practical support as well as to exchange If only our illness were as simple as popping pills in our
information. Support groups don’t work to a manual. They mouth! We know it’s not that simple, so we have to work on
are not a pity party, nor are they treatment or therapy. winning back our lives in as many ways as we can. Attending
Support groups can help us in our journey back to a fully a support group can be one of these ways. Fortunately, in the
functional life. Meetings can be quite liberating, and no one course of living with the illness, many members have picked
will say “You’re crazy” or “I’m going to increase your up a range of coping skills and tips that they are very happy
Seroquel.”
to share with the group.
If only our illness were as simple as
popping pills in our mouth!
It’s often hard for people with bipolar disorder to get out that
door to attend a support group meeting and join a group of
strangers for the first time. But you won’t know until you’ve
taken that difficult and courageous first step!
At a support group meeting you will hear about experiences
of others who are struggling with denial, medication, side
effects and how they are generally coping with bipolar. Often
this may be the first time someone has had to discuss their
illness honestly amongst people who actually understand.
8
T
H
R
O
U
G
H
D
I
F
F
I
C
U
L
a 2008 issue of the "Journal of Pediatrics." They examined the
group for neurological and psychological disorders and
found that the prevalence of neurological and psychological
illness in these children was low but slightly higher than that
in the control group. As with adults, it seems that there may
be some correlation between bipolar disorder and gluten
intolerance, but more research is needed.
Allergic reactions could worsen
mental illnesses
Source: dailyrx.com, June 27, 2012
T
I
E
S
T
O
T
H
E
S
T
A
R
S
21st Century science is seeking to measure the precise ways
that emotional experience, brain states, hormonal signaling,
and immune system reactions are interrelated. Dr. Partam Manalai and colleagues set out to investigate how
much of an effect that the high pollen season could have on
bipolar depression.
They examined 100 subjects experiencing either major
depressive disorder or bipolar disorder to learn how exposure
to pollen might change emotional state. The team's data
suggests that "the exacerbation of allergic symptoms
correlated significantly with a worsening in the depression
scores".
Do allergic reactions affect bipolar depression? Could an
immune reaction to pollen compromise one's mental health?
Manalai and colleagues write that "the findings of the current
A team of curious researchers has set out to find if there is a study suggest that worsening of depression in sensitized
connection.
individuals during peak pollen seasons is not related only to
severity of physical symptoms in allergic reaction, and thus is
There are a fair number of disorders and conditions unlikely to be a mere reaction to a physical illness".
associated with depression already: obesity, alcoholism,
stress, anxiety, diabetes, schizoaffective disorders and the like. While the study focused on the response of people with
bipolar disorder or major depressive disorder to the high
Pollen is not nearly so often suggested as a contributing pollen season, it is possible that people not suffering from
element or risk factor. Many people hardly notice pollen at all. these particular conditions who are exposed to high pollen
Consult with a ear-nose-throat specialist if your allergies act load could also experience more depression as well.
up.
These data are suggestive of a link between mood disorders
Pollen is of course well known as sometimes interfering with and the allergic immune response. While the actual
respiration. The itchiness and swelling and other symptoms mechanism by which breathing in pollen might make people
of allergies should be understood as the body's way of coping coping with bipolar depression more depressed is not
currently known, the emotional reactions to allergies may
with an influx of foreign bodies in the lungs.
turn out to be as important as the physical symptoms.
The immune system becomes activated and produces
chemical signaling, manifesting as symptoms such as sniffles While much remains to be learned, allergy sufferers would be
well advised to monitor how their emotional states may vary
and watery eyes to a feeling of reduced mental energy.
relative to pollen-triggered immune reactions.
While such reactions may be unpleasant, these symptoms
represent the body's immune system sending waves of special
molecules to recognize the invader as not part of the body,
and to envelop it using different systems. In other words, the
symptoms can be thought of as a sign of a healthy immune Source; livingstrong.com, By Erin Beck, September 2, 2010
response, though this can get out of hand and become
dangerous.
Bipolar disorder is a mood disorder found in about 2.6
percent of the U.S. population, according to the National
Why would respiratory and immune reactions be associated Institute of Mental Health. In most cases, bipolar disorder can
with bipolar depression?
be managed with medication and/or counseling. Exercise is
To understand how feelings of sadness and low energy might another recommended strategy for treating many mood
be related to breathing in airborne plant particles, it is worth disorders.
EXERCISE & BIPOLAR MOOD
DISORDER
knowing how modern views of health have evolved.
SYMPTOMS
Scientists are still teasing out many of the fascinating details
about the interactions of the immune system, the hormone
and endocrine signaling molecules of the body, and the brain.
An ambitious label for these would be "psycho-neuroimmunology", but the key point to remember is that mood
and emotion and psychological state are now believed by
many scientists and physicians to affect and be affected by
immune system reactions, such as allergies.
Bipolar disorder, or manic-depressive disorder, is
characterized by mood changes ranging from depression to
mania. Depressive symptoms can include loss of interest in
activities once enjoyed, changes in sleep and eating patterns
and lack of energy. Mania symptoms include a sense of
euphoria, heightened senses and increased energy. Bipolar
disorder has been divided into two types. People with Bipolar
I have at least one manic episode. People with Bipolar II
experience hypomania rather than mania. In hypomania,
10
Phone: 9388 9869
Please contact the office for further details.
Must book as limited places available.
T
H
R
O
U
G
H
D
I
F
F
I
C
U
L
manic symptoms are not severe enough to cause marked
impairment in normal functioning and do not create a need
for hospitalization.
T
I
E
S
T
O
T
H
E
S
T
A
R
S
Act-Belong-Commit now an app
on iPhone
IMPACT
Exercise can help improve mood, according to the Mayo
Clinic. Exercise can help motivate and energize you when
you're tired, and calm you when you're tense or stressed.
Exercise releases neurotransmitters and endorphins, brain
chemicals that improve depression symptoms. It also reduces
immune system chemicals that can worsen depression.
Physical activity also increases body temperature, which may
have relaxing effects. But most research on mood and exercise
has not looked at the specific effects of exercise on bipolar
depression and mania.
RESEARCH
A 2008 study published in the "International Journal of Social
Psychiatry" followed a group of people with severe mental
illnesses, such as bipolar or schizophrenia, and found that
those with more physical activity experienced more positive
mood.A 2007 study published by in the "Journal of Affective
Disorders" followed a group of patients with bipolar disorder
at a psychiatric unit and found that those who voluntarily
participated in a walking program showed improved
symptoms. Neither study proved that exercise caused
improved symptoms. People who already display improved
symptoms may exercise more. However, the studies did show The Act Belong Commit App provides general information
that future studies should further investigate the role of and guidance on how people can stay mentally healthy in
exercise in treatment of bipolar disorder.
their everyday lives.
MOOD CHARTS
Keeping a mood chart is a helpful way for those with bipolar
disorder to recognize mood patterns. People who keep mood
charts monitor symptoms, sleep, medications, meals, stressful
situations and exercise and try to determine what lifestyle
changes contribute to symptoms. If you're trying to determine
if exercise helps you manage bipolar symptoms, talk with
your health care provider about keeping a mood chart.
It provides background information on the campaign and
includes interactive features that encourage the user to:
Act – be mentally, physically and socially active
Belong - to groups and clubs, keep up friendships and social
networks
Commit – to things that bring meaning and purpose to life.
Support a good cause, volunteer to help others.
RECOMMENDATIONS
Users can take a self-assessment to rate their Act-BelongThe Mayo Clinic recommends that bipolar disorder sufferers Commit activity levels.
get regular exercise to help control symptoms. Anecdotal For residents of Western Australia, the app provides the
reports also suggest that it is beneficial. Those with bipolar Department of Sport & Recreation’s ‘Find a Club’ tool to find
disorder should not attempt to use exercise as a sole form of local groups and clubs in their area to join.
treatment, however. Exercise should be used in conjunction
with other treatments, including medication and It also provides a refined search tool, based on the Actpsychological counseling, to effectively manage symptoms of Belong-Commit website, for users to find local events and
activities to get involved in.
bipolar disorder.
Get started and be more mentally healthy today! To
download the app, search for ‘Act Belong Commit’ in the
iTunes App Store, or click on the link on the Act-BelongCommit website http://www.actbelongcommit.org.au/
12
T
H
R
O
U
G
H
D
I
F
F
I
C
U
L
Vanderbilt professor depicts son's
bipolar disorder
Charlotte Pierce-Baker, a Vanderbilt University professor,
has written a book about her family's struggles with her
son's bipolar disorder. 'It is a lifelong disorder,' she says. 'It's
cunning, and it reshapes your brain. It tells your brain what
you must do.'
Source: The Tennessean, by Terrance Dean, June 22, 2012
T
I
E
S
T
O
T
H
E
S
T
A
R
S
got in touch with my father, and he called us and left a
message. When we got back I called my father and he
informed me that something was wrong with Mark. When
my son called back later that evening he said, “Mom, they’re
watching me.” I said, “What do you mean?” And he said,
“They’re all around and they’re watching me.” My husband
and I said, well, maybe he’s been working too hard. But, in
my gut, I knew something weird was going on.
After your son was diagnosed as bipolar, were you or your
son in denial?
Q&A
When I discovered that my son had a mental disorder, I said,
Charlotte Pierce-Baker is a mother with a mission. She’s an “This can’t be.” I thought he was having a bad high because I
advocate, an activist and an award-winning Vanderbilt knew he smoked marijuana. But, truth is, I think all of us
University professor of women’s and gender studies and were in denial. Eventually I had to realize Mark’s illness was
a reality, and it was on my plate. I had to tell my parents and
English. She’s also an author.
others in our family.
Her newest book, This Fragile Life: A Mother’s Story of a
Bipolar Son, is a moving and ultimately hopeful account of a What people should know is that bipolar disorder consumers
family’s struggle to understand and accept their son’s bipolar are probably apt not to take their medications. They think that
once they take them and they feel better, then it’s OK to stop
disorder.
taking them, or they drift off the medicine. There is no cure
The Green Hills mother is stepping out of the shadows and for bipolar, and Mark was in denial about it because he felt
giving voice to an oftentimes shielded conversation on mental that he could eventually kick it. But it is a lifelong disorder.
health. Pierce-Baker’s world turned upside down one night It’s cunning, and it reshapes your brain. It tells your brain
when her then 25-year-old son’s bipolar disorder truly began what you must do.
to manifest itself. At the time, Mark was pursuing a
Mental health is something rarely discussed within the
postgraduate degree in film and living in California.
African-American community. Do you think or feel that a
Nothing prepared her for Mark’s unhinged emotional lot of people are not diagnosed and are being untreated?
outbursts, the uncertain highs and the violent lows, calls from
jail, pleas for money, drug relapses and continuous disputes I think in general people are being untreated and underabout how to live and not live. She documented the journey treated because we are not comfortable enough talking about
it. Every now and then you may see a front-page article about
in what ultimately became a memoir to help others.
someone in the military dealing with it, and sometimes they
Why did you decide to write this book?
are about women with postpartum depression, but often the
stories are titillating. There are people walking around with
It didn’t start out as a book. It started out as note taking. Our
mental illnesses who have jobs, and with families, and they
son became very ill. We were blindsided by the illness. I was
don’t say anything because of the stigma and being labeled.
taking notes to understand what was going on and what was
happening. We never heard of bipolar disorder. In the process It would be great if we could start groups within our
of taking notes, we learned more and more, and also about communities, and say, “Yes, my son, uncle, brother, sister or
the medicines to treat bipolar. I can’t pinpoint as to when I someone (has it)” without it being a stigma. We have to talk
began writing a manuscript. I do remember saying that I have about what’s in our closet, the secrets and the things we’ve
a series of stories here.
been hiding. I think we will get a lot of support all around.
We were alone in 1996 because we were so absorbed with
I knew I was writing it for my son, Mark, so he would have a
Mark on how to keep him alive, keep ourselves alive and our
chronicle of what had happened to him, and so he would
marriage. It would have made a difference if we had a
know the good parts of himself. Bipolar can be very ugly. I
community that was supportive.
wanted people to see the sweet of him.
In the African-American community we have been so beaten
When did you know that something was not right, and that
up that we don’t want people knowing the dirty laundry.
he needed to see a therapist?
And, if you are marginalized because of your color, then what
We didn’t know Mark was ill. He had not lived at home since happens when you add mental illness?
he was 18 years old. He went to college, and then he got a
full-ride fellowship for postgraduate work to study film. He
had been accepted to the University of Southern California.
It was in California when he hit rock bottom. He was 25 years
old. He called us, but we were out to dinner. He eventually
13
T
H
R
O
U
G
H
D
I
F
F
I
C
U
L
Maintaining or Rebuilding Your
Relationship
Source: Melbourne Bipolar Support Group Newsletter, June 2012
T
I
E
S
T
O
T
H
E
S
T
A
R
S
Don Ritchie, Angel of The Gap who helped save 500 people from
suicide - dies at 85
Bipolar disorder can challenge relationships and family life Source: news.com.au By Miles Godfrey May 14, 2012
and sometimes it takes a bit of time, patience and effort to
• Don Ritchie helped save 500 souls from suicide
maintain or rebuild them.
• Died peacefully at home, aged 85
Once the person is not so ill, you may be able to:
• MP: "One of our greatest Australians. RIP."
• Share enjoyable experiences that have nothing to do with
bipolar disorder.
THE "Angel of The Gap", Sydney's Don Ritchie, has died aged 85.
• Encourage giving and taking in your relationship. For
example, providing the person is not severely ill ask them
to help out at times and accept their support when it is
offered. Relationships that involve even a little giving as
well as taking can be less stressful and more rewarding for
both people.
Mr Ritchie spent 50 years coaxing desperate people back from
The Gap, the notorious cliff at Watsons Bay where hundreds
have died or thought about taking their lives.
He helped save 500 despairing souls - usually with little more
than compassion, a warm smile and a hot cuppa.
"Those who knew him knew he was a very strong person and
• Use good communication skills to help sort out difficulties
a very capable person," Mr Ritchie's daughter Sue said today.
in your bipolar relationship or in the family.
• When trying to sort out difficult problems in bipolar
relationships or in the family it can be useful to consult a
health professional who knows a lot about bipolar disorder
and counseling for relationships.
Federal MP Malcolm Turnbull, whose electorate includes The
Gap, added: "A true hero, one of our greatest Australians.
RIP."
Born in Vaucluse in 1926, Mr Ritchie died peacefully at home
on Old South Head Road, Watsons Bay yesterday.
• If you have a bipolar spouse or partner and they have lost
interest in sex due to bipolar depression, offer The former navy seaman turned life insurance salesman was
companionship and slowly start to rebuild an intimate never one to shout about his exploits.
relationship once the depression has subsided.
He helped because he could.
Family members sometimes respond very differently to
learning that there is bipolar in the family. Some people take Ms Ritchie said: "It was just something that he saw and that
more time to accept that their loved one has bipolar and may he had to do something about."
deny the illness or become angry. When possible it may help
New South Wales Mental Health Minister Kevin Humphries
to focus less on the illness and more on everyday family life
recalled when Mr Ritchie was named a Local Hero in the 2011
and enjoying activities together.
Australian of the Year Awards.
When possible, encourage family members to relate to the
"Upon accepting the award Mr Ritchie urged people to never
person with bipolar in ways that emphasize what they have
be afraid to speak to those most in need," he said.
in common (e.g. interests or hobbies) and their respective
roles ( e.g. parent and child, sister and brother). However, try "Always remember the power of the simple smile, a helping
not to make bipolar disorder a taboo topic in the family. hand, a listening ear and a kind word."
Informing family members about the illness, what different
mood states look like, ways to deal with them and help out Mr Ritchie's family asked for donations to be made to the
Black Dog Institute or to Lifeline.
may be useful.
14
T
H
R
O
U
G
H
D
I
F
F
I
C
U
L
Bipolar Depression
by John McManamy
Source: Melbourne Bipolar Support Group Newsletter, May 2012
"Bipolar depression has long been overlooked, but is more
pervasive and disabling than mania."
T
I
E
S
T
O
T
H
E
S
T
A
R
S
Notwithstanding these sad facts of life, Robert Post MD, head
of the Stanley Foundation Bipolar Network, pointed out in a
paper at the 2001 APA annual meeting that "[Bipolar
depression] has received relatively little systemic study." The
DSM-IV fails to distinguish between unipolar and bipolar
depression, though there may be subtle but critical
differences.
Alan Swann MD of the University of Texas, Houston at the
2000 APA annual meeting observed that those with bipolar
depression are more likely to manifest psychomotor
retardation and have atypical features (such as excessive
eating and sleeping) than patients with unipolar depression.
According to Dr Swann, bipolar depressions are characterized
by greater episode frequency, earlier onset, greater coAs Michael Thase MD of the University of Pittsburgh occurring substance abuse, and a more equal gender ratio.
observed at the 2002 American Psychiatric Association annual
meeting: "Although manic episodes are often more the Philip Mitchell MD of the University of New South Wales at
emergent and notorious phase of bipolar affective disorder, the 2003 Fifth International Conference on Bipolar Disorder
depressive episodes last longer, are typically harder to treat, cited a 2000 Australian study of 83 bipolar depressed and 904
unipolar depressed patients that found bipolar patients were
and result in the high ultimate risk of suicide."
more likely to be melancholic (69 vs 37 percent), and were
Bipolar Depression - A Major Concern A 2003 significantly more likely to demonstrate psychomotor
GlaxoSmithKline-funded study carried out by Robert disturbance and guilt.
Hirschfeld MD of the University of Texas in Galveston found
that those with bipolar disorder fared significantly worse in A 2001 study by Dr Mitchell of 270 depressed patients found
their depressions than those with unipolar depression. those with bipolar were less tearful than those with unipolar
According to the study, individuals with bipolar depression depression, but felt more worthless, exhibited greater loss of
"were more likely to report that they did their work poorly, pleasure, and experienced more subjective restlessness,
felt ashamed of their work, had arguments outside the home, leaden paralysis, and hypersomnia than their unipolar
felt upset, and never found their work interesting compared counterparts. Significantly, in the words of Dr Swann, "the
differing biological properties of unipolar and bipolar
to those with unipolar depression.
depression suggest that treatments that were originally
The bipolar depression group also reported significantly more intended for unipolar depression may not be optimal for
disruption in work, social and family functioning, and bipolar depression." These distinctions tend to be lost on the
significantly more symptom days versus those with unipolar average clinician.
depression." According to a Stanley Foundation Bipolar
Network survey of 258 of its bipolar patients, this population A survey by the Depression and Bipolar Support Alliance of
was depressed three times more than they were manic, 400 of its members found that of those who reported having
bipolar disorder, 60 percent disclosed that their initial
despite being treated with an average of 4.1 medications.
diagnosis was major depression. From a patient's perspective,
A 2002 NIMH study found that bipolar I patients were the implications are enormous. According to a study by S
depressed 32 percent of weeks over a 12.8 year period as Nassir Ghaemi MD of Harvard et al appearing in the October
opposed to being manic or hypomanic for nine percent of 2000 Journal of Clinical Psychiatry, it took bipolar I patients
weeks and mixed or cycling for six percent of weeks. For nearly six years and bipolar II patients 11.6 years from first
bipolar II patients, the same study found depression present contact with the mental health system to achieve a correct
in 50 percent of weeks over 13.4 years as opposed to one diagnosis.
percent of weeks for mania or hypomania and 12 percent of
Enter Homer Simpson. Close-up to the hand smacking the
weeks for mixed or cycling.
forehead a second time. The look on his face says it all. How
The same set of studies also found that dysthymia (minor could I have been so stupid? Bipolar depression. Even the
depression) and subsyndromal (not full-blown) depression experts can miss the obvious.
dominated, with bipolar II patients more likely to have major
depression and a more chronic course. Meanwhile, early data
from STEP-BD's first 500 patients has found 80 percent of
relapses were into depression. For bipolar II, Hagop Akiskal
MD of the University of California, San Diego found this
population spent an incredible 37 days for every one day
hypomanic.
Bipolar depression symptoms. Imagine for a second the
psychiatric profession personified as Homer Simpson, with
the trademark gesture of the hand smacking the forehead.
The collective "Doh!" you hear is the seemingly overnight
realization that depression rather than mania is the dominant
partner in manic-depressive illness (bipolar disorder).
15
Even Keel
Bipolar Disorder Support Association Inc
We meet at:
Online
http://www.evenkeel.org.au
Forum: http://forums.evenkeel.org.au/
Avail 24hrs 7days
Even Keel 2012 Membership Form
Amount:
Option
Subiaco
June O’Connor Centre
2 Nicholson Rd, Subiaco WA 6008
Support Group, 10.30am to 11.30am every Friday
Contact: 9388 9869
Office Open Monday & Friday 9.30-3.30pm
Contact: (08) 9388 9869
Perth City
Senior Citizens CitiPlace
Perth Railway Platform above Platform 9
11.30am to 1pm, last Wednesday of each month
O’Connor
Busselton
Caring Friends Support Group
Salvation Army Hall, 94 Kent Street Busselton
PO Box 260, Busselton 6280
Every Wednesday 10am-4pm.
Individual support 10am-12pm
Workshops and Group Meeting 1-3pm
Office (Wednesday only): 9751 5866
OR Contact: Bob A/H: 9755 4021
Email: [email protected]
INPATIENT INFORMATION SESSIONS
Sir Charles Gairdner Hospital
Waged
$20.00
Concession
$10.00
Corporate
$50.00
Make a donation
$______
All donations over $2.00 are tax deductible
Total:
Name
Address
Ward D20
Cancelled Contact: Lyn 9356 3383
Fremantle Hospital
Riverton
Alma St Centre, Ward 51
McDonalds High Rd Riverton
6-8pm, 2nd Tues of each month
Contact: Lyn 0404 022 902
Royal Perth Hospital
Age:
Ward 2K
Email
Yokine
Mills Street
C287 McDonald Street, Yokine
1-2pm, 3rd Saturday of each month
Contact: 9388 9869
Rockingham
For Details
Contact: Ingrid 0412 522 387
Joondalup
1/20 Mercer Lane, Joondalup
1pm, 3rd Thursday of each month
Contact: Freddie 0439 804 061
Midland
In RECESS
Fremantle
Coming Soon!
35+
Method of Payment
Receive Newsletter via
Graylands Hospital
Cheque
Post
Frankland Centre
Cash
Email
Rockingham General Hospital
PaRK Mental Health Service, Elanora Dve
Invoice Me (Corporate)
Carer or Friend’s Name:____________________________________
We aim to:
•
provide understanding, awareness and
education for people diagnosed with a
mental illness, their family/friends/carers,
with a focus on mental health and
emotional wellbeing
•
To promote awareness in the community
in order to increase understanding and
assist with the elimination of stigma
•
To provide an information centre comprising of literature obtained from national and
international sources
Mandurah
1pm-3pm, 3rd Wednesday of each month
Contact: Glenys 0418 828 387 for location.
18-34
Mobile
Bentley Hospital
Cannington
Masons Landing Marriamup St Cannington
1pm to 3pm, last Saturday of each month
Phone Number
Membership Includes:
•
•
Quarterly newsletter
Access to library resources and
borrowing facility
Permission to Contact: Yes/No
Phone No/Email: _________________________________________
Even Keel Bipolar Disorder
Support Association Inc.
C/O June O’Connor Centre
2 Nicholson Rd Subiaco WA 6008
Phone: (08) 9388 9869
Fax: (08) 9388 2298
E-mail: [email protected]
Website: http://www.evenkeel.org.au

The MoodGYM training program - Even Keel Support Association

Transcription

Similar documents

Understanding Bipolar Disorder Melvin McInnis, MD

Myths and Facts about Depression and Bipolar Disorder

BIPOLAR DISORDER

Kids and Teens with Mood Disorders

Winter 2009.pub

Minding the Mental Health of Our Kids

a copy

Summer 2013.pub - Bipolar Scotland