So let's think about now,
when we have a manic depressive episode.
So, in other words,
we have elation and depression.
And it is usually over a period of 2
weeks where a person is feeling elated.
And then they go
into that depression.
What happens is that they have a loss of
pleasure after this very elated sense.
And then they are having
their sleep disturbances.
So it could be that
they can't sleep
or could be hypersomnia,
where they are sleeping too much.
They have an appetite
disturbance, so they don't eat
or they're eating too much.
You may have fatigue with the
depression symptoms that come along.
You might also have, instead of that
psychomotor activity, that's the agitation,
you suddenly have a slowing down or
retardation of psychomotor movements.
We also have issues
But unlike those flight of ideas, sometimes
with that depressive episode coming in,
it's difficult, it's like a foggy brain,
it's hard to concentrate on anything.
There is an overwhelming
sense of worthlessness
that the person might
feel, and guilt.
Guilt, shame, worthlessness.
This gives in to this
idea of killing oneself
or suicidal ideation,
it's very, very important.
That's a 911 call.
It doesn't matter if it
is a depressive episode,
if a person states that they are sad,
that they don't see any hope going on,
and that they have thoughts
of killing themselves,
it is important to get
immediate help for them.
They also may have
that irritable mood.
So when you have someone who's
having this manic depressive episode,
we're seeing the alternating
between that sadness and elation,
between someone who is
able to be very happy
and then suddenly extremely sad.
And it is one that actually the manic
depressive episodes, they alternate.
And they last each of them
last for about a week.
So let's take a look
at a client case.
If we have JJ coming
into our office,
and you notice JJ is
walking really slowly
and looking down.
And again, JJ is whispering, you have
the question that needs to be asked.
Now, when we look at this slide,
once again, I'm going to say,
you asked JJ to sit down,
then you sit down yourself.
You find out how is
the distance for JJ.
If he's whispering, it may be really
difficult to be able to hear JJ.
So you might want to say,
"Is this a good distance for you?"
And then you want to ask JJ,
"How long have you been feeling this way?"
If you remember,
these episodes are time sensitive.
And so when we find out that someone's only
been feeling this way for 4 days or a week,
we want to start thinking that maybe
it is one of those building blocks.
Maybe it is an episode.
And JJ says,
"I have taken some
medications for a bit but I,
I can't remember what it was."
We want to know if the person
has had a past history.
We want to know after the last time
whether or not it helped and what went on.
JJ says he began to feel
a little bit better.
But he stopped.
This happens a lot
Medications have some side effects
that people don't particularly like.
weight gain is one of them.
Impotence is another
for young men,
loss of sex drive is
another for young women.
And after they start feeling a
little bit better to have given up
these other things or
to have gained weight,
actually hasn't decided that
this may not be a good trade off.
So we need to be thinking
about the patient
and if the patient has any way that
they have been able to cope before.
So JJ says, I have been very
happy for a long time over a year,
with some periods where maybe it
was a little up and down, right.
But for the past 5 weeks,
it's not been very good for
He goes on each day and he worries about
what's going to happen with the next day.