Hvovi Bhagwagar is a leading Psychotherapist and Panel psychologist with BipolarIndia. Her talk on BipolarIndia's WORLD BIPOLAR DAY Conference, Mumbai on March 30th, 2019 was on a very relevant topic. 'Helping someone live well with Bipolar Disorder'. From understanding the nuances of the chronic condition to spotting red flags and how to deal with crisis situations..her talk was comprehensive. Moreover, caregivers are a largely ignored community who themselves need help in coping. Self care tips were also covered.

1. HELPING SOMEONE LIVE WELL
WITH BIPOLAR DISORDER
Coping Tips For Caregivers
Hvovi Bhagwagar, Clinical Psychologist
World Bipolar Day, March 30th 2019

2. TOWARDS HOPE

3. Caregivers form the Social Support required for
people with BD
Social support refers to the individual’s
perception as being of value within the context
of the groups in which he or she participates.

4. CAREGIVERS CAN BE A PROTECTIVE
FACTOR IN BD
Assistance from family and friends
seems to have positive effects in
preventing a relapse, as well as on
better treatment adherence and
improved functionality of the
individual (Studart et al 2015)
Social support is positively associated
with individual well-being, particularly
if an intimate partner provides that
support. (Boyers and Rowe 2018)

5. However Social Support In BD Has A Bi-
directional Relationship
Lack of help is a
risk factor for
symptom
recurrence
Social Support
becomes
problematic due to
the dysfunctional
symptoms

6. Caregiver burden
in the families of
the patients
suffering from
bipolar affective
disorder,
Gania, Kaur,
Grover et al 2019
Bipolar disorder is associated with significant
caregiver burden-financially, in family life, as well as
physical and mental health
Thus, the emphasis in psychiatric rehabilitation
needs to shift from a patient-focused approach to a
combined patient and caregiver-focused approach.
For better outcomes of disease the primary
caregivers require more psycho-education and
counselling.

7. RECOGNISING
TREATMENT
OPTIONS

8. PHARMACOTHERAPY
• Primary treatment
• Mood Stabilisers and Anticonvulsants
typically given
• Combined with Anti Psychotics and Benzos
• Anti-depressants given with caution
• Blood tests to be done regularly
• Episodes of mania increases risk of non-
adherence.
• Psychotherapy is adjunct to
pharmacotherapy
8

9. PSYCHOTHERAPY:
Teaches the benefit of
adopting a rational stance
when faced with difficult
situations.
If you are upset by your
problems, you now have 2
problems:
1) The problem
2) Your upsetness.
9

10. RECOGNISING
RED FLAGS

12. Everyday emotions such as joy, sadness or
disappointment need to be distinguished from
bipolar moods:
Bipolar Moods:
Last longer and are harder to change
More intense and cause more disruption to the person’s daily
life.
Situational variables may not always be presentMisinterpreting mood fluctuations
and behavior that are common to
us all as being due to bipolar
disorder can be hurtful and
frustrating.

13. COMMON TRIGGERS INCLUDE:
• Stressful negative or positive life events
• Disruption to sleep patterns
• Disruption to routine.
• Too much stimulation from external
sources
• Too much stimulation from within the
person.
• Abusing alcohol or street drugs
• Conflict and stressful interactions with
people.

15. SUPPORT DURING EPISODES
Your support matters

16. WHAT I NEED DURING AN EPISODE OF
DEPRESSION
Don’t tell me to
‘snap out of it’
Encourage small
activity and small
goals
Try not to
take over
Encourage me
towards a
routine
Offer me
kindness even if
I cant
reciprocate
Acknowledge
the smallest
achievements

17. WHAT I NEED DURING
MANIC/HYPOMANIC EPISODE
Create a calm
environment.
Keep me safe.
Don’t participate
in my various
goals
Set limits, gently
but firmly
Don’t
AgitateMe.
Answer
questions
briefly, quietly
and honestly
Do not agree to
risky plans
Remind me of
the Two person
feedback rule

18. DEALING WITH
SPECIFIC
CAREGIVING
CHALLENGES

19. HOW TO HELP
DURING CRISIS.
Suicidal thoughts
Hospitalization
Risky Behaviour

20. HOSPITALIZATION
When Treatment and support does not
seem to help the person’s symptoms
Voluntary and involuntary
hospitalization
In hospital, assist with treatment, be
empathic to their vulnerability
Advance Directives

21. ADVANCE DIRECTIVES
These are written documents about
how a person wishes to be treated
for a mental illness in a situation
where they do not have capacity to
make decisions regarding the
same.
One can specify the treatment, care
and support that they want and
how they wish to be treated when
they have a mental illness and are
unable to care for themselves.

22. SUICIDE
People with BD are a high-risk population
Watch for signs
Ask Directly.
Take safety Measures
Don’t handle alone, get help from a professional

23. RISKY
BEHAVIOUR
Safeguards for aggressive outbursts
(furniture, safe room)
Limit access to funds.- extra cash, credit
cards, cheque books
Seek financial Advice
Recognise “signal events”/or
“prodromes”
Keep away alcohol.
Learn to Say No and set firm limits.

24. THE BURDENS OF
CARING
“I should cure the person’s
illness
“I should be able to fix
everything”
“I should never feel angry or
stressed”
“I should always be perfectly
supportive of the person.”

25. CAREGIVER
BURDEN IS A
PREDICTOR OF
Significant levels of depressive symptoms (Coyne et al.,
1987; Dyck et al., 1999; Struening et al., 1995).
Worry, tension, and grief (Chakrabarti and Gill, 2002; Fadden
et al., 1987, Reinares and Vieta, 2004).
Sleep problems (Perlick et al., 2007),
Use of tranquilizers and antidepressants (Dyck et al., 1999),
Increased risk of medical hospitalization (Gallagher and
Mechanic, 1996).

26. Between a rock and a hard place’: Family members’
experiences of supporting a relative with bipolar
disorder.
Barch et al 2018
1. ‘Not knowing: like being in a minefield’,
2. ‘It’s out of my control: sitting waiting for the next
thing to happen’,
3. ‘Treading on eggshells’,
4. ‘Picking up on signs’,
5. ‘Times of crisis:between a rock and a hard place’,
6. ‘I have to make my voice heard

27. YOUR WELL-BEING
• Delegate Tasks, be organized
• Practice Self care, take breaks
• Form a social group
• Go for outings guilt free
• Seek help from Government schemes
• Professional disappointments
• Maintain boundaries
• Acknowledge your natural reactions
• Support groups

28. MOBILE APPS
iMoodJournal T2 Mood Tracker eMoods Medisafe Pill
and Med
Reminder

29. HELPLINES
2. Phone Apps-
- Emotional Support Helpine Directory
nULTA: Monday to Friday, 10:30 AM to
5:30 PM
3. Peer Support Groups:
Bipolar India
1. HELPLINES
 Vandrevala Foundation: 1860-266-2345,
1800-233-3330
(24 hour)
 Samaritans +91 84229 84528 / +91 84229
84530
(3pm to 9pm)
TISS icall
• Telephone based counseling: 022-25521111 (Monday
to Saturday, 8 AM to 10 PM)
• Email based counselling: icall@tiss.edu

30. “It is not how much you do, but how
much love you put in the doing.”
— MOTHER TERESA

31. TAKE GOOD CARE!
HVOVI BHAGWAGAR
9821321132
www.manashni.com