A. Self-awareness 1. I have a good spirit at night: Patients feel that the deeper the night, the better the spirit, the best spirit at 10 to 2 o’clock at night. It’s good, the time you grab today, but you overdraw tomorrow’s energy, tomorrow you still have to sleep most of the day? Sleeping late and waking up late strengthens hyper-vigilance, and hyper-vigilance strengthens manic episodes. People originally have a wake-sleep rhythm, to that point to sleep, this is the endogenous biological clock to remind you, but stay up past that point, the endogenous biological clock will no longer remind, you will not sleep, you “earned”? Today is “earned”, tomorrow and then “lost” it. 2, I enjoy this state: light manic episodes, there is inexhaustible energy and brain power, but also a happy mood, the patient of course enjoys this state, enjoy it and stay, stay and refuse to treat, but I tell you, inexhaustible brain and energy, is the brain overexcitation, brain overexcitation is harmful to brain cells, the professional term is called nerve cell excitatory apoptosis, is the nerve cell lean death, so, bipolar Emotional disorder recurrent, long duration of the patient, CT visible with brain atrophy, if you do not care about brain atrophy, then you continue to enjoy this state. 3, I hate family members exaggerating the condition: patients underestimate their manic symptoms, tend to talk too lightly about their manic symptoms, which is inconsistent with what the family members report. Since the family members stand in the third party position, the report is more objective and often adopted by the doctor, which aggravates the patient’s dissatisfaction with the family members. Patients should usually be aware of this, and can attenuate the dissatisfaction with family members when they report their medical history together. 4, my sexual interest is high: emotional personality of the emotional response is strong and persistent, their behavior than normal people tend to be governed by emotions, more hyper-sexual desire, tend to early love; tend to online love, tend to premarital sex, tend to prostitution, tend to premarital abortion, tend to marriage flash knot flash divorce, friendly to the opposite sex is easy to misjudge as a signal of love, and thus actively pursue the opposite sex, or even think that the opposite sex is passive willing and forced Have sex, resulting in the crime of rape. 5. I don’t want to take medication all the time: The patient will say, “I was a little unfit when (referring to mania) some time ago, but now I’m better. I’ll try to stop the medication and see, if it’s not good, then continue to take it, if it’s good, why bother to take it again?” But I tell you: “Mania is a recurrent disease, the standard duration of each manic episode is about 3 months, the standard duration of depressive episodes is about half a year to 2 years, implemented to each patient, the time may be scaled, to a certain time, even without treatment, will be spontaneously remitted; treatment is early remission. If the drug is discontinued after early remission and before the end of the natural course of the episode, there may be a rekindling in 2 to 3 days; if the drug is discontinued after the end of the natural course of the disease, there are no signs of rekindling when the drug is discontinued, you succeeded? Don’t be too happy, some problems are not exposed immediately, just like when you destroy the Yangtze River dam in autumn, there will be no flood immediately, but a flood in the next spring and summer. Your maintenance medication, equivalent to a permanent dam along the Yangtze River, is to prevent the next recurrence, and even if it doesn’t stop the next recurrence, it will thwart its momentum, resulting in what would have been a grand mal seizure, now only a transient mild seizure. If you don’t maintain the medication, you are defenseless, and when the next tide of mania or depression comes, it often takes the form of a grand mal seizure, often requiring hospitalization. If you don’t believe me, you can try it. Then you say, “Okay, even if you’re right, how long does it take to maintain medication?” “The first manic episode is maintained for at least six months, the second manic episode requires long-term maintenance medication, and the first manic episode is in adolescents, males, and those with severe mania tend to take medication for life.” 6, I want to psychological counseling: If the previous manic episodes, now is the game addiction, it is necessary to consider or manic self-control is reduced due to the mania, should strengthen the anti-manic drug treatment, and should not carry out pure psychological counseling. Generally speaking, for the level of psychological treatment of neurosis, psychiatrist > psychiatrist > neurologist; for the treatment of functional psychosis (including schizophrenia, mania, depression), psychiatrist > psychologist > counselor, and for the treatment of organic mental illness, neurologist > psychiatrist > psychologist > counselor, which is the knowledge structure of each specialty This is due to the limitation of each specialty’s knowledge structure and the level of discomfort. Therefore, clinically, psychologists more often than psychiatrists misdiagnose functional psychiatric disorders as mild psychiatric disorders (neurosis, stress-related disorders), while psychiatrists more often than neurologists misdiagnose organic psychiatric disorders (multiple sclerosis, hepatic-leguminous degeneration) as functional psychiatric disorders. From this point of view, mania is most suitable to see a psychiatrist, and it is okay to see a psychiatrist, but it is useless to see a counselor without prescription authority. 7. I don’t want to have a relapse during college: During the four years of college, the closer to the senior year the relapse is, it means that the stronger the compensatory ability of the disease is, and the greater the hope to graduate. On the contrary, if the first year on the relapse, the chances of relapse later is very high, the university has two opportunities for suspension, do not think that there are many opportunities, you do not supervise the medication, the patient will relapse every semester, if each relapse is hospitalized, hospitalization is bound to be suspended, the resumption of school will return to the previous relapse of the semester retake, so that the two opportunities for suspension, will soon run out. If you want to graduate from college successfully in four years, you should break the idea of stopping the medication before entering the school. After the first manic episode is relieved, no attention is paid to the maintenance medication, the second episode should always pay attention to it, the second episode still has a fluke, the third episode should always not try to fluke again, otherwise, I can only say that the relapse did not enable you to grow. Second, the emergency response 1, do not fight with: manic patients because of the will to enhance, and people must win the debate, or never stop, so when the family and his reasoning, do not fight with the fight, argue on. Manic patients will really hit people, especially family members, but the patient is generally issued a warning first, when the warning is not effective, then do it. Therefore, when the patient issues a warning, family members no longer squeak, which can reduce the chances of the patient’s attack. When the patient argues with you and looks directly at you, you should not continue to look at each other with him, which will make the patient feel that you are confronting him and easily cause impulsive behavior, on the contrary, if you avoid his gaze, eyes downward and do not speak, it is easy to be interpreted by him as submission, thus reducing the chances of being attacked. In fact, the manic patient is also bullying soft, really see 110 police came, he is also very cooperative, know in hard to lose. 2.Diversion: When the patient puts forward unreasonable demands, the more you refuse, the more he insists, and finally freezes there. Because the manic patient’s nerve mobility is large, attention has the characteristic of shifting with the situation, so you can change the topic with him and bring up the things he is usually interested in, he is less likely than ordinary people to insist on the original topic, thus following your topic to discuss another thing, so as to alleviate the deadlocked situation. 3, delay: manic patients often ask their families for too much money to buy things that are not urgently needed, for example, to buy a motorcycle, to buy a car, etc., be refused to make a big fight, punch smash, hit people, even if the family does not speak, can not calm the patient’s request, digression does not work, then you can take delaying tactics, for example, next month’s payday to buy. You should not worry about the next month, as long as the drug is being taken, by the next month, the patient’s condition has remitted, never mention the matter of asking for money. If the patient refuses to take the medication, say that next time you talk to the doctor, the doctor agrees that you can not take it; when you get to the doctor, the doctor will say that there is only one way not to take the medication, hospitalization. 4.Lee instead of peach: When the patient repeatedly makes trouble to buy a useless and expensive commodity, the above methods do not work, you can bargain with the patient, the economic loss of a small solution instead of the loss of a large solution. Similarly, when the patient refuses to take medicine, the above methods do not work, you can give up the secondary drugs, retain the main drug, better than a drug not to take; when the patient wants to drop out of school to do business, can not stop let the patient take a year off to keep the school; when the patient wants to resign to go to sea, can not stop let the patient stay without pay. 5.Speech cautiously: It is a normal thing for a family to joke together and say a few sarcastic and sarcastic words, both sarcastic and persuasive. However, the patient will take it seriously and hold a grudge, and the anger will be born from anger, hatred and hate. Therefore, family members should be cautious in what they say, do not casually joke with him. Patients in the manic episodes, family members speak cautiously is easy to do, but in the usual not manic, family members continue to speak cautiously, it is more difficult. 6, action caution: when the patient is in the manic passionate state, his judgment and control are reduced, so when you contact with him, the action should be slow, the amplitude should be small. If the action is fast and the amplitude is large, the patient will mistakenly think that you want to attack him and will issue an attack on you. For example, the mixed-phase patient dropped her cell phone and cried out, her mother persuaded her, her nails mistakenly touched her face, she thought her mother was going to grab her and bit her mother’s index finger hard. 7, on their own: Now the network is convenient, the patient will check the drugs prescribed to him by the doctor one by one online, and then self-judgment, think that does not meet their condition will not take, so that only selective implementation of medical advice, resulting in mania control incomplete, prolonging the disease treatment time. You say, “You adjust the medicine without permission, do the doctor know or do you know?” It is useless, when the mania self-confidence is enhanced, on its own, “the disease in me, is the doctor understand me, or I understand me? Third, the usual disposal 1, go to college: in the college entrance examination before the manic patients, even if it has been completely normal, the college entrance examination should not be enrolled in foreign schools, go to school in the region, even if you can not go to school in the region, but also to ensure that in the weekly can return home within the drive. Because (1) the road is far away can not really urge its medication; (2) the university dormitory is more noisy, for people who have suffered from mental illness, it is difficult to rest well; (3) conflicts in the dormitory is inevitable, once there is a conflict, there is not even a space to avoid; (4) once the full manic episodes, smashing phenomenon, often forced to hospital, parents rushed to the location of the patient, unfamiliar with the place, inevitably helpless. 2, medication during college: The patient is unwilling to maintain medication, and will give a reasonable reason to his family that the medication has adverse reactions, or worry about the adverse reactions of the medication, in fact, this worry is just an excuse, mainly because he does not believe in his heart that mania will relapse. There may be two reasons why family members cannot supervise the taking of medication, one is that they cannot reach the patient, for example, the patient is away at college, so the family cannot supervise even if they want to, and the second is that when the family sees that the patient is in remission and refuses to take medication, they will take a chance and let him go, in case he does not relapse. In fact, adolescent manic patients do not maintain medication, manic relapse is a matter of time, medication is a prerequisite for safe college, can not do this, rather not go to college. 3, mania during college: the order of treatment is: the first step, first coax him to eat into the medicine, and let him calm down, continue to go to school best; resolutely refuse to take the medicine, or take the medicine after the sedation does not come down, enter the second step, in the school leave or suspension, coax him to go back to his parents’ residence to rest, back to his parents’ residence, according to the need in the local outpatient or inpatient treatment; such as in the university can not control mania, also can not bring back to his parents residence, then enter the third part, inpatient treatment in the local area, which is convenient for the patient’s treatment, but inconvenient for the parents’ visit, and is the last solution. 4, once hospitalized to be suspended: If you go to college during the mania and hospitalized, generally have to be suspended for a year, the reason is: (1) hospitalization plus home after discharge to recuperate, it is impossible to keep up with this semester; (2) manic episodes to the extent of the need for hospitalization, the social network of classmates has been destroyed, after recovering from the disease and the same classmates continue to get along, there may be difficulties. 5, marital instability: when manic episodes are easy to remember old hatreds, easy to quarrel with the spouse, coupled with indiscriminate spending and day and night tossing, the spouse is unbearable and inclined to divorce. In the clinical impression, female patients seem to divorce more. As the patient’s parents, in order to reduce the divorce rate under the domination of this pathological mood, they should take more care responsibilities and reduce the burden of the spouse. The patient’s parents may say, “We can’t bear it even if she has a manic episode, but after all, a manic episode is not long, it usually ends in 3 months, and medication can shorten this time. So this burden is not endless, and there is usually significant relief in 1 to 2 months with adequate treatment. Fourth, treatment attention Overall, bipolar disorder is better treated than schizophrenia, the prognosis is also better, but if the frequency of recurrence is too dense, the duration of each episode is too long, the symptoms are too heavy, its social function damage is not smaller than schizophrenia for. How to suppress the frequency, length and severity of manic episodes? It mainly depends on effective medication. 1, must use drugs: manic episodes come fiercely, even if taking drugs, it is difficult to control quickly; electroconvulsive shock is also a good way to relieve acute manic episodes, but hospitalization is required. Such as relying on psychological counseling, practice yoga sedation, simply can not control, delayed drug treatment, the deterioration of the future course of the disease, resulting in a longer duration of manic episodes later, the symptoms are heavier, remission interval shorter. 2. Refusal to take medication: There are four ways to deal with refusal to take medication: (1) mania is very light, no treatment for the time being; (2) mania is serious, must be hospitalized; (3) dark medication: mental health law no longer allows this; (4) forced medication: for children, parents may force them to take medication, but afterwards may lead to impulsive aggressiveness. Mania has great variability in drug refusal compared to schizophrenia, because mania’s drug refusal is emotional, and once the emotion passes, medication may be taken immediately: a sentence may be said through, medication may be taken immediately; a condition may be promised, medication may be taken immediately. Family members should not easily give up the bargaining with the patient after a while or after a day, in order to avoid the patient’s emotional momentum. 3.Chinese medicine regulation? We believe that the adverse reactions of anti-manic drugs are limited, and psychiatrists dare to use it, so they know how to deal with the adverse reactions. If not specially ordered by psychiatrists, don’t go to see Chinese medicine doctors specifically, because Chinese medicine is not cheap either. 4, maintenance medication: after the first manic episode in adolescents, they tend to take medication for life, but the type and dose can be adjusted, and men do not affect fertility as long as it does not affect sexual function. Many patients and family members do not believe in the need for lifelong medication, but only after the second to third manic severe episodes, gradually realize that this is true. Even if lifelong maintenance, it is not no longer seizures, but only lighter seizures, fewer seizures, easier to control in time. If you do not take medication after mania remission, it is like walking a one-way bridge with open arms; if you take medication, you are still walking a one-way bridge, but with an extra handrail. 5, re-medication: when the manic patient is not remitted or partially remitted, because the will is enhanced, the patient may go to the field to work, the family no matter how to instruct, the patient will soon stop the medication without permission, the result is a complete manic episode, and then back to the family, the family will use the effective dose before stopping the medication again, do not know that the dose was previously added step by step, when the patient has adapted, now the patient has stopped the medication After a period of time, the drug adaptation back to the level before the use of drugs, suddenly then use such a large dose, the patient will not be able to eat, then you should contact the doctor, the doctor will start again from the starting amount. Relapse signs —- Sitting meditation or practicing yoga: Sitting meditation or practicing yoga is a self-treatment for unsettled mood. Mild mania and mild depression will be self-medicated by sitting meditation or practicing yoga. But mania or depression is like a tsunami, sitting meditation or yoga is a swimmer, who do you think is more powerful? Therefore, when family members see the patient sitting meditation or practicing yoga, they should go to the doctor to adjust the medication. V. Hospitalization concerns 1. Can I stay in an open ward? When a manic patient is hospitalized, can he live in an open ward? The answer is no, because if the manic patient is very light, his behavior does not affect others, and he takes medication consciously, he does not need to be hospitalized; if his symptoms are heavy, his behavior affects others, and he takes medication unconsciously, he usually needs to be hospitalized compulsorily, and since he is compulsorily hospitalized, he cannot live in an open ward. 2.Does it hurt him psychologically to live in a closed ward? Will the patient be alone in the hospital? Psychological distortion will be more? The patient is hospitalized, you do not worry about him alone, where like a club. Where there are people, there will be friends, other inpatients, as a subject, not as incoherent, as dirty, as violent, as idiotic as you think, the patient will not be psychologically distorted. 3.Can I be discharged early? If in the field, the patient is forced to be hospitalized due to manic episode, before being completely controlled, parents should not listen to the patient’s repeated assurance of discharge, and should not take the initiative to propose discharge to the doctor, because in the manic episode when the words are not counted, and discharge without the background of cure, parents can’t harness, and the patient not only refuses to take the medicine, but may also beat people.