Bipolar Disorder

Bipolar disorder is a mental health condition associated with significant disability and difficulties in many areas of life. 

In this episode, Dr Mucheru Wang'ombe, a consultant psychiatrist with over two decades of experience in clinical practice, unpacks the condition and its impact on social and occupational functioning. 

https://linktr.ee/MentalWellnessPodcast

Transcript

SPEAKER_01 0:16

Welcome to yet another episode of the Mental Wellness Podcast. Today we're going to discuss an interesting mental illness. It's common to see someone being referred to as someone who has mood swings, you find them in good moods today, you have a very good discussion with them. Next thing you find them very irritable, you ask yourself, is it the same person I spoke to? And quite irritable at times. This is a condition known as bipolar tuples of mood. It's a significant cause of disability worldwide. According to WHO statistics, one in every 200 people, or around 37 million people across the globe, suffer from bipolar. In Kenya, it's among the top 10 mental illnesses according to the 2020 Mental Health Task Force report. With me is a very senior psychiatrist with 20 years experience in both public and private, who'll be taking us through what exactly is bipolar. Welcome, Doctor.

SPEAKER_00 1:21

Thank you very much for having me here. It's my pleasure to discuss this important condition. I'm known as Dr. Musheru Angombe. I'm a psychiatrist with uh two decades of experience in psychiatry and quarter century in medical practice. I practice at a healthy mind consultants, a one-stop shop for your mental health needs. And I also work at Mathari National Teaching and Referral Hospital. And I'm privileged to be part of this conversation as regards mental health promotion. And the topic today is bipolar mood disorder. Thank you.

SPEAKER_01 2:08

Okay. So we look forward to an interesting or unpacking exactly what bipolar is. How does it present? What are the symptoms that we normally see at the clinical setting? How do they impact the lives of these people? And what are the treatment options? Well, how do we treat this condition? One in every, I think, 10 patients we see at the clinic setting, perhaps five to six will actually have bipolar or even less or more. Okay? Yeah. So I think the first thing that I normally see personally at the clinic setting is you pick the symptoms, you realize this is actually a chronic condition that affects their mood and their lives. And now you have to unpack it and explain to them what exactly it is that you're dealing with. So I think the question is what exactly is bipolar disorder?

SPEAKER_00 3:01

Bipolar mood disorder is classified as a mental disorder. There are two modes of classification. We have the diagnostic statistical manual. We are currently at version 5, text revised. Yes. That's the American Psychiatric Association classification. Then we also have ICD 11, which is the international classification of diseases, which is by the World Health Organization. So bipolar is a condition that is characterized by more than mood swings. Most of what is out there is about swings between extremes of happiness and extremes of sadness. But indeed, it has more than that because you need um expansive, irritable mood, and other symptoms, which include easy distractability, impulsivity, grandiosity, meaning the client may feel more important than they actually are. And this we call delusions of grandeur, where the patient or the client feels and starts acting like they're actually that person, an important person who in real life they are not. So, and that is within the period of the episode. And in addition to that, they do talk a little bit too fast. So there's the ex the flight of ideas. So they will be describing something, they will say this before they finish, they pick up another plot, they pick up another idea, another idea, and they end up excessively talking about many things that they quite don't finish. Then they will talk about a lot about something, about the circumstance, so then they will have some circumstantiality. They will also be involved in a lot of activity, goal-directed activity. For example, someone may be cleaning all night. They might be walking from for long distances without necessarily getting tired. This is something that is a goal-directed activity, but now it's being done. Too much of it is being done. They have difficulties with sleep because they have decreased need for sleep, and that makes them probably be awake when others are asleep. And in addition to that, um sleep deprivation can also be one of the triggers of this condition.

unknown 6:03

Okay.

SPEAKER_00 6:03

And overall, all those symptoms I've described should occur within the majority of them within a certain time. They should occur together and they should cause social or occupational dysfunction. What do I mean by that? If it's at work and you're rubbing shoulders with everyone because probably you're so irritable, something small makes you upset. If it's at home, you're having trouble with addressing your children, you're having trouble with addressing probably the domestic manager with your spouse. That is what we call social dysfunction. In addition to that, you may have occupational dysfunction where you're not able to either go to school if you're a student, whether you're a student as a child or as an adult, or you might not be able to do your work. Whether you're working from home or working on-site, you might find you have problems coordinating that. So that is what brings the client to us, the fact that they're not able to function socially or occupationally.

SPEAKER_01 7:18

Thank you very much. I think listening to you, I just something played in my mind. So it's quite common in the clinic setting for someone to be brought by a relative or someone who's a caregiver, first time perhaps they explain to you and the symptoms actually match that. But then a common thing I've seen is when you're explaining the symptoms, the person next to the patient actually like jolls and like, okay, why is whatever the doctor is describing seems to also connect with me. Um, how often have you come across a point where a patient has been brought? You assess, and then you find that these symptoms are actually much bipolar, but the person next to them also matches the same kind of symptoms.

SPEAKER_00 8:12

Um I would say it's quite a common occurrence because then bipolar does have a genetic predisposition. And probably before I leave the symptoms of bipolar, the kind of symptoms I was describing were one pole, the extreme happiness.

SPEAKER_02 8:31

Yes.

SPEAKER_00 8:32

There's also the other pole, the extreme sadness, where then this patient will have difficulties sleeping, will have so either they sleep too little or sleep too much, they'll be overly sad nearly every day or every day for a period of at least two weeks. They will lack interest in pleasurable activities, somebody who liked uh watching TV, listening to music, now is in bed all day, lacking energy. The person may not be able to concentrate. Um, the person may actually have suicidal ideations. They may talk about how life is worthless, or probably how they would like to die or have attempted to end their lives. Then there is also the aspect of psychomotor retardation where they tend to be slow. If it's somebody who used to be vibrant and talk, you'll find the I mean the talking has slowed down, the walking has slowed down. So this person also suffers from guilt. Guilt is described as a situation where you're you're feeling like you have done something wrong. Well, there is nothing according to society that is necessarily wrong, but you have now that guilt in you and it keeps bothering you. So this person who has brought either a relative or probably they have brought somebody who is close to them, if they are genetically related, there is a five to tenfold risk or increase in the probability that they may also have had similar problems or maybe predisposed to those. And maybe the difference is that there is no trigger. Because I would like us to talk about the predisposition, which is the genetic aspect, and also the fact that biologically there are some chemicals in the brain that have been associated with bipolar mood disorder, there is serotonin, there is dopamine, and there is the aspect of a trigger, like for example, a traumatic event. It could be an entry event, which means you're now getting, you have a promotion, you're now dating someone. Those are good things in life, but they can trigger an episode. Then we have um exit events, like you may have lost a loved one, you may have lost a job, you may have lost property in floods or something, and that can also trigger an episode. In addition to that, you may have used a substance, a substance like alcohol, a substance like cannabis, which cocaine, name them, which can then trigger. They can actually lead to someone who is predisposed developing the I mean the the it can lead to the onset or even subsequent relapses. Subsequent occurrences of the same symptoms, we call them relapses.

SPEAKER_01 12:10

Okay, yeah. So basically, to try and summarize it for the audience is that we have two extremes of mood. One is extreme happiness, the other one is extreme sadness. And so it's like at some point you have a collection of certain characteristics or symptoms that match the excessive happiness and one that matches the excessive sadness. So do we have names for these two extremes?

SPEAKER_00 12:35

Yes, we do. Yeah. So we have the manic episode, which is what I described earlier in terms of this person who is overly excited, is charged, is wired, and has all this energy. Then there is the depressed episode, or or rather the sadness extreme. So this person would be most likely suffering from bipolar one. Okay. If you've had a manic episode, then that the classification is that of bipolar one. But there are patients who come to us because of depressive episodes. But in between those depressive episodes, they have what is called hypomania. So unlike mania, which needs like a duration of seven days of those symptoms, or one day is enough if it warranted an admission. Now, hypomania would be about four, four days of those episodes. And usually the people around you are the ones who notice, hey, this person is talking a lot, or this person is more excited than usual. But what makes you dysfunctional is usually the depressive uh episodes, and that is what brings the patient to hospital. Okay. Uh, in addition to that, we have cyclothymia, which is a mini bipolar two.

unknown 14:08

Okay.

SPEAKER_00 14:09

So that you have symptoms of bipolar two, but they do not meet the criteria, full criteria for bipolar two. Where in adults, they run for about two years. In children, they run for one year. So, but these are diagnoses that can be made by your psychiatrist once you're able to seek help. But would like as much as possible that people have the information, not to confuse them, just to let them know that these conditions do exist. And in addition to that, bipolar symptoms can be brought about by use of medication.

SPEAKER_02 14:50

Okay.

SPEAKER_00 14:52

Like antidepressants prescribed to someone who has bipolar mood disorder when they're in a depressed episode, can actually tip them to mania. Then medications also like steroids. Steroids are used for common conditions. Some may be used for chest congestion, some may be used for uh conditions that uh probably you have antibodies against your body. And some of those can also trigger manic symptoms. There are medical conditions that can trigger uh manic symptoms or depressive symptoms, like for example, hypothyroidism. Thyroid is a butterfly-shaped gland in front of your neck, and whenever the levels are excessively high, people present with anxiety. Those who have low levels of thyroid levels or hormones, they do present with depression. So it's important that we also look at the other causes of bipolar symptoms. Acute agitation can also be described as bipolar, especially when we don't have enough information in the clinical setting. Then we have unspecified bipolar to describe those uh symptoms that do not quite meet the full criteria of bipolar, but the patient presents with acute agitation and they need the necessary attention.

SPEAKER_01 16:34

One of the things that I've previously not here, of course, or have had you discuss this illness, is the time duration. Where in a year, there are periods in which they're probably in the very high excited period, and then it's like there's a switch between this. So, what period are we normally looking at from a clinical perspective?

SPEAKER_00 16:58

Um, we talk about rapid cycling, where this client will oscillate between extremes of happiness, extremes of sadness at least four times in a year. That is a rapid cycler. And some of those rapid cycling um patients tend to have issues with substance use, probably non-compliance to medication, and they would they would have more social occupational dysfunction. So then they need more attention when it comes to the rapid cycling.

SPEAKER_01 17:37

Okay. So for someone listening, they've actually gotten to understand the symptoms and what exactly how they affect their functioning. And you've also gone into the causes of bipolar from the medication, from the medical conditions such as the hypothyroidism or hypothyroidism, the fact that it's actually genetic, um, there's that genetic vulnerability. So it's passed down around families based on the genetics, which means a family history of bipolar previously would mean then that there's a chance that um the siblings, no, sorry, the children of some of a parent with bipolar would also suffer from bipolar. Is there any age of onset for bipolar disorder?

SPEAKER_00 18:16

Yes, indeed. Um the age of onset is late adolescence or early uh adulthood. So that gives an average of age of about 25 to 35 years. So then those are the kind of patients we are looking at. But we do have um early onset where we have as early as nine. Yes, so where we have a mood dysregulation disorder in children.

SPEAKER_01 18:48

So it's you've you've talked this one actually has caught my interest um because I know most of the people listening and watching this would want to understand to have a 10-year-old who has extremes of mood, you know, that's very irritable, or they start crying over things that I ideally wouldn't or shouldn't be crying for a 10-year-old. And so there's that mood dysregulation. And then, of course, there's the adolescent period that sets in. And adolescence in itself has its own biological changes and also its own disruption in terms of mood regulation and all that. So, how do we differentiate between what is normal for a child and what is actually now um bordering on the clinical symptoms of bipolar?

SPEAKER_00 19:31

Um it would be important to look at the duration of the symptoms and in addition to that, look at the level of dysfunction, social and occupational dysfunction would warrant a clinical evaluation. But for the listeners, it's important that should you recognize that your child is suffering from irritability, some um intense oscillations between extreme happiness, extreme sadness, and is inconsolable, it would be important that we have the patient evaluated as soon as possible.

unknown 20:12

Okay.

SPEAKER_01 20:13

Yes, I think that gives a very good um understanding. So the patient is brought for, or rather the child or even an adult is brought for clinical evaluation. You've already rightfully described the symptoms and all that. But are there any tests that you you we do at the clinical setting that actually help us now with diagnosing this condition?

SPEAKER_00 20:31

Yes, indeed. Um there are various tests. And first and foremost is to make sure that we do not have uh structural problems in the brain because bipolar has been shown to have specific um changes as regards probably the size and the neuronal activity, the activity within um certain areas of the brain. Uh, allow me to show them, like for example, the front of the brain, so that you have the prefrontal cortex. You also have an area of the brain called the amygdala, what we call the reptile brain. It's in charge of things like fear and aggression. So some of those areas may have, I mean, any pathology in that area can also cause symptoms like those. In addition to probably somebody who's had an injury in the frontal part of the head, it can also make them start having mood dysregulation and even uh problems when it comes to things like planning and, for example, concentration, all those may be affected. So, one would be imaging techniques. It's important to have a child, an adult. A young adult, an elderly person, go for imaging, either CT scan or computerized tomography, which is CT scan of the brain, or MRI, which is magnetic resonance imaging. They would also need to have thyroid function tests done. They would need to have a blood count to look at how the liver is functioning, the kidneys, because we would also want to rule out any causes of uh any medical causes of their symptoms. In addition to that, it's uh important that we also do uh evaluation for other conditions that may coexist, like diabetes. These are called uh comorbidities. Patients with bipolar would also be predisposed to diabetes, hypertension, they may present with chronic migraines, hypothyroidism, that is low thyroid levels. So we would also want to evaluate the heart, find out, do an electrocardiogram, find out how the heart of this patient is. So some of those tests are done depending on a case-to-case basis, because then the patient needs to see the psychiatrist, needs to have a history taken, physical examination done, mental state examination done, and therefore, depending on what are the findings, then appropriate tests would be prescribed or would be requested. In addition to that, we have uh psychometric tests. We have various questionnaires that we can ask. For example, uh the client, if they are a student, probably the teacher, may help differentiate between certain uh conditions like attention deficit, hyperactivity disorder. So that you may have questionnaires both for the parent, uh for the for the teacher, you may also have questionnaires like mood disorder questionnaire for the adult, you may also have uh ADHD questionnaire for adults to complete themselves and give us a subjective report. Let them report to us what symptoms they're experiencing so that that also strengthens the clinical evaluation. So all this, uh the clinical evaluation, the lab tests, the imaging, the various questionnaires, they help us piece together these pieces of a puzzle and come up with a diagnosis, which we then discuss with the client and their significant other with their consent. And therefore, then we're able to dialogue on management.

SPEAKER_02 25:04

Okay.

SPEAKER_00 25:05

So that the patient doesn't leave the clinic not knowing for many years why they swallow some pills or why they have an injection administered every month.

SPEAKER_02 25:17

Okay.

SPEAKER_00 25:18

Yet it is not quite clear what is happening. Then they also have a stake.

SPEAKER_02 25:23

Yeah.

SPEAKER_00 25:24

Because compliance is also uh pegged on the fact that the patient has insight, knows that they have a problem, they know that they need help, and they are willing to get help. The help, I must say, must not just be medication. It could be talk therapy.

SPEAKER_02 25:46

Yeah, yeah.

SPEAKER_00 25:48

So cognitive behavioral therapy, for example, is very useful when it comes to reshaping our thought patterns because we think, therefore we feel, and that influences our behavior. So, an example, supposing a client is depressed and they now think that they're useless or they are a total failure, they will start feeling useless. Well, how do they behave? They withdraw socially. So when we say hi to them, we try to engage them.

SPEAKER_01 26:27

They're not responding.

SPEAKER_00 26:28

The person doesn't respond. The person spends the entire day, the entire month in their room and only comes out when people have gone to sleep. So it's important that we look at all those aspects of treatment. So by treatment, we are not just talking about a peel that you swallow or an injection that is administered. We are also talking about involving you in other activities. For example, um in occupational therapy, there will be activities of daily living, like for example, cooking, they will also be taught things like shaving, they will be taught crocheting, they will engage in uh activities, sporting activities, table tennis, they will do volleyball, they will do football, they will do all those activities. So when it comes to management, we want a holistic approach so that we don't leave any stone and tanned, no area of the person's life unaddressed. Because remember, we said this person may have occupational dysfunction. So they may actually need a vocation to do some carpentry, some tailoring, they may do some pottery. The I mean, depending on the severity of the illness. Yeah.

SPEAKER_01 28:05

So basically, you've rightfully put it that the treatment is comprehensive and looks at very as many aspects of life of this patient and even the caregivers, because then it means it's a chronic condition. I think a common thing of the clinical setting is you've done the assessment, you've evaluated, and finally you've reached a conclusion that actually this patient is suffering from bipolar disorder. And then you have, as you rightfully said, have to discuss it with them and the significant person they've come with. So, what exactly does it mean for someone to have this diagnosis of bipolar for them? Because I'm looking at it from a perspective where you've told a client or a patient, you know, you have bipolar from these symptoms, and now they their reaction definitely to one, the illness. Unlike cancer, which someone would think of death, because they know cancer is equal to death, but now mental illness is a bit different for the patient, you have a diagnosis of bipolar. What does it mean for their lives now moving forward from that from that point?

SPEAKER_00 29:10

For most clients, one, um it's a heavy diagnosis. Because how do you tell me that I'm suffering from a serious mental illness, that I need treatment for the rest of my life? Those treatments are described. And now that bipolar is a psychotic illness, it's characterized by not just episodes, but chronic instability, especially when you have a relapse of the symptoms. Relapse means the symptoms have come back. Yes. Now, the next thing would be: what does it mean? These medications I'm using, I am female, I would like to go the family way. I want to begin my obstetric career. This medication you're giving me, sometimes the periods may disappear, especially when it comes to antipsychotics. Bipolar is a psychotic illness. So especially the newer antipsychotics, the second generation, they're very useful. But the periods may disappear because of the way they work. They may increase a hormone called prolactin. Yes, yes. So then your periods disappear. So what do you make of me? I am female, I am young, I have no periods, I need to go into the family way. There are some medications that we want to discuss with you because then we don't want to give them to you if you're in the reproductive age unless you have folic acid on board. Otherwise, there might be some malformation. So you see, there I'm just looking at, I'm being selfish. I've started with the females.

SPEAKER_01 31:14

Yes, yes.

SPEAKER_00 31:15

So I'm trying to look at it how it looks like for me as a female, I might add some, I might put put on some kilos.

SPEAKER_02 31:24

Yeah, sure.

SPEAKER_00 31:25

So who wants that? It's a bit of a weighty thing. The gentleman is uh a CEO, he's a he's providing for his family. He might start wondering what happens to my C-suite job. But I must say he's going to keep it. Yeah. If he's on treatment, he's going to keep it. If he's not on treatment, likely that he'll lose the job. He might lose the job. We are not prophets of doom.

SPEAKER_01 31:57

Yes, yes.

SPEAKER_00 31:57

But it's not worth the risk. There are many people who love taking the risk, but this one is not worth taking. Okay. So then you're the provider of the family. I mean, what happens to me? I'm a police officer, I'm an army officer. My bread and butter is from that firearm. Now I suddenly have this diagnosis that once in a while may prove tricky with my use of the firearm. This is my child. They are going to a school, a boarding school, and they might need to be swallowing tablets and be seen hanging around the dispensary looking for the nurse every day. Then what has it that oh this person has a mental illness? Has a mental illness, the stigma, yeah, yeah. Isn't it?

SPEAKER_01 32:56

Yeah.

SPEAKER_00 32:57

So some of those things, what about the teacher who knows that that student had a psychotic episode? What about that prefect who probably had a manic episode at the assembly?

SPEAKER_02 33:14

Yeah.

SPEAKER_00 33:16

What about probably the things that or the symptoms that maybe you don't want to talk about that happened during those manic episodes? And they happened at your church, and now you're the pastor.

SPEAKER_01 33:31

So it's quite heavy.

SPEAKER_00 33:33

Or you're the leader. You know, the diagnosis tends to be a bit heavy, but we deliver the diagnosis in a sensitive manner.

SPEAKER_02 33:43

Okay.

SPEAKER_00 33:44

So that it's not a situation where you feel like you have been dropped from the hundredth floor, from the top floor of a building, and you're wondering what next. So I would say it is something we do, it is something we ought to do as practitioners, but depending on how the message is delivered, then it can make you or break you. But delivered in the right way, and you being given time to process and also to be part of the treatment that can help us manage the patients. But it's not doom and gloom. People with bipolar do live normal lives, especially if other conditions that coexist, like substance use, are treated. Because again, if you're taking the bipolar medication, you're also using substances, you're multiplying the symptoms.

SPEAKER_02 34:55

Yeah, for sure.

SPEAKER_00 34:56

Because, as I said, there are some substances that will actually lead to either a manic episode or a depressed episode. If you have some anxiety that you're dealing with, it also needs to be brought on board. That is why we need that you're evaluated by a psychiatrist so that all those conditions that you may have are considered. If you have migraine, then we may need a neurologist. If you need to go the family way, like I said, we will bring in an obstetrician. So this is, I would say, a multidisciplinary condition that we all need to, we we need to involve all the stakeholders. Stakeholders meaning the client, their significant others, uh probably their employer. Because you may need flexi hours. Sometimes your medication makes you a bit sleepy.

SPEAKER_02 36:03

Yeah.

SPEAKER_00 36:04

You may need to report to work later.

SPEAKER_01 36:07

Than the usual time.

SPEAKER_00 36:09

But that doesn't mean you don't perform. We also don't want the patient now to say, um, if they trip, they say I'm bipolar. If uh they do something antisocial, they steal something from somebody, they also say I'm stealing because I'm bipolar. No. But there is also the aspect of in this country, bipolar, among other conditions, are also recognized as disability.

SPEAKER_02 36:38

Yeah.

SPEAKER_00 36:39

So if indeed you have a diagnosis like that, it is high time you registered with the National Council of People Living with Disabilities. And your provisions, or rather, your your benefits would include exemption. Yeah, exemption of payers you earn. Then you work for longer. Meaning we are accommodating you even at the workplace. Instead of you working until 60, the age of 60 years, you can work until 65.

SPEAKER_02 37:12

Okay.

SPEAKER_00 37:13

Which gives you more time so that the lost time you may have had during your relapses, you're able to still fend for your family. And you're still able to plan for your retirement. Planning retirement is mandatory.

SPEAKER_01 37:28

Yeah.

unknown 37:29

Yeah.

SPEAKER_01 37:29

So there's something you said that once you've diagnosed, you explained all this and all these questions that come to the patient, their caregivers, and whoever they're with. And so one thing that that is very common in the clinic setting is that they'll listen, they'll process, they'll go take medication, and then stop taking medication. And then so there is that initial struggle of accepting the condition, of taking the medication. What would be your advice, especially on this aspect of the start-stop? I start taking medication, I am functional, and then because there are so many people also around me who are telling me, you know, these medications are not very good for you in the long term. So it creates that environment where someone feels like, I can try and see if I'll be okay without medication, and then they try and then they relapse. Yeah, what would you be your advice on that for such okay?

SPEAKER_00 38:31

I I want to say that this is really commonplace. Yes. There are patients whose motivation is usually for the appointment is when am I stopping medication? Yes. Or when are you reducing my medication? Now, it's important that I put a disclaimer.

SPEAKER_02 38:52

Yes.

SPEAKER_00 38:53

Bipolar is a chronic relapsing condition, chronic instability. So you do not want to try because then you're likely to relapse. And relapsing means several steps backwards. But the start stop usually happens because usually the patient will be like, uh, maybe the doctor may have made a mistake. So why don't I try on my own without telling them? Yes. Then what happens? The symptoms come back. So that start stop uh is not advisable. In fact, you would rather follow up and so that with time when newer treatments come, you're able to benefit from the newer treatments. Maybe what I should encourage people is the fact that it's not just about medication, not just about talk therapy. There are also newer therapies. Things like transcranial magnetic stimulation, which is useful especially for depressed patients. But on the other hand, it can trigger mania. So it has to be treatment that is done but is monitored. We have ketamine, for example, for depression, and you don't need the drip all the time. There is even the intranasal, there's a spray. It's not available in our market, but it's coming. So some of those things, deep brain stimulation, there are other modes of therapy. So if you really feel medication is bogging you down, come to us. Discuss. Ask the doctor. That's why they are trained.

unknown 40:48

Yeah.

SPEAKER_00 40:49

That is why they should keep reading about the newer treatments. And now the world is a global village. So you have all the information. But remember, there is an infodemic. So let's try also to get advice from the experts so that yes, you can quickly do mood disorder questionnaire on your own, you make a diagnosis. You do ADHD questionnaire, you also make a diagnosis. Then as word would have it, you consult AI and it gives you the number of drugs you can take plus the dosages. But are you getting expert opinion?

SPEAKER_01 41:32

Yeah, so that brings me to a very interesting um in the era in which we're living in today. There's a lot of information out there. And now we have um certain AI-enabled um functionalities like ChatGPT, you know, that people go in, type in their symptoms, and they get like a rundown of the symptoms and a diagnosis and treatment, you know. And so they you we common also to come have someone come and tell you, I've come here because I think I have bipolar. You know, they've already self-diagnosed themselves, and so you have to deal with that, you know. I think for me, what would be the point is that they could have diagnosed themselves with bipolar, but it's not really bipolar. And there's something you said that I found quite interesting about ADHD, that is adults, adulthood, I mean attention deficit hyperactivity disorder. What are the similarities between the two? Bipolar and ADHD, especially in the adults. Yeah. Yeah.

SPEAKER_00 42:34

Um, one is to let me go to the last part of the question, the similarities. They're called look-alikes, they're differential diagnosis. Yes, yes. Now, the irritability, the impulsivity, and most of like, for example, the overtalkativeness. Those are three symptoms that are very similar. So if you're completing the questionnaire, you will actually find that you're actually ticking the three for both. So you might actually be having ADHD symptoms, which usually do not wax and win. These ones are consistent. If it's about your impulsivity, it's not a certain time during which you're also presenting with your mood symptoms and the other symptoms I talked about. It's consistent. So if it's high risk behavior, it is across the board. If it's the the over talkativeness, it's not at a certain time. Like we said, when you're even a rapid cycler, there are times when you're having high the highs or the high mood, and there's a time when you're having the low mood. So this one is constant. So it would be important that you have or one goes for an evaluation. To tell the difference between the bipolar and the ADHD. Or are they coexisting? Because they can also coexist in the same client. Then, in addition to that, talking about technology, we have wearable devices.

SPEAKER_02 44:17

Yes.

SPEAKER_00 44:17

Wearable devices can be useful and they should be useful because they can help us catch symptoms long before you have a wearable device. You will tap on it, it will tell you your heart rate, your oxygen saturation, it will also tell you about the number of steps you have done, if you have activated, and it will also check your emotional well-being. So in the evening, it will tell you today you are satisfied or you are content, depending on what, just by wearing it. It will also tell you about your sleep pattern. So we're also encouraging the use of digital tools. We don't want you to be obsessed that now you're making graphs about your sleep pattern. The device will do it for you. But for someone who has a diagnosis of bipolar, for example, they had difficulty sleeping. It is very easy now for us to tell has the sleep pattern normalized or not. Because initially we would rely on the patient to report. But now the device, so long as it's worn, then it will tell you this was your sleep pattern. Yes, it was deep sleep. Even when you go to your doctor, discuss about the sleep pattern. Discuss about your appetite. Make sure that you're able to, you're moving most of the time so that you don't add weight, so that you're also, I mean, you're active.

SPEAKER_01 46:08

I think we've had a very good, elaborate um discussion of what bipolar is, how much it impacts functionality, treatment, and all that. Any successful stories of patients you've treated?

SPEAKER_00 46:22

Many.

SPEAKER_01 46:23

I know you know. You definitely have many, yeah?

SPEAKER_00 46:25

I am not allowed because of doctors. Yeah, I do understand that. Yeah. Patient confidentiality to delve into examples. Yeah. But I must say people who are treated, people who keep up with follow-up, whether the treatment is um it has to do with medication, psychotherapy, and any other treatments that are useful, including the electroconvulsive therapy, the RTMS, all those. If patients are consistent, then I would say there are many success stories. Then there is also I would like to encourage people to report because you already know the red flags. You already know if I'm not sleeping enough, if I'm feeling wired, excessive, I have excessive energy. If I'm talking too much, you can actually tell if you're talking too much, or if somebody has mentioned that you're talking too much, then it's time to get an early appointment with your psychiatrist before things go south.

unknown 47:40

True.

SPEAKER_00 47:41

Then, in addition to that, when it comes to um people seeking help, I've also found uh clients who have self-stigma, they've accepted their condition. Two, the people who are around them, please stop telling patients immediately they I mean they hurt their foot because they've uh I mean they they they've kicked on a seat or something by mistake. You ask them whether they've taken their medication. Please, you see, even when it's uncalled for, you're asking the person, did you take your medication? Then also referring to them as the illness. Stop calling them so-and-so is bipolar. True, true, true. So why are we calling them bipolar? Why do you don't you call others this one is hypertension? Okay, if you have children, you say this one is bipolar, this one is hypertension, this one is diabetes. Neilitas.

SPEAKER_01 48:40

I get what you're trying to say.

SPEAKER_00 48:42

So we need first person lingua where we are saying this is a person living with bipolar. Then I would want to encourage those with lived experience to come out and talk to people and demystify, debunk these myths, show them that you're a person just like any other, and that you're able to function. Because sometimes the, I mean, people will say, okay, fine, you're telling us about bipolar. You have not experienced bipolar yourself. So what are you talking about? True. Yeah, so it would be good to also have people with lived experience come out and actually tell them. Come out and do the advocacy as we also advocate for our patients. Let them advocate for themselves.

SPEAKER_01 49:36

Okay. Yeah, so I I like I like how you you say that also those who live with lived experience should also actually come out and tell their stories. And the whole point of success stories was that the take-home message is that if someone actually is diagnosed with bipolar illness, they take medication consistently, they keep on their follow-ups, then the success comes with that they are not disrupted in their social life, in their occupational life. So they can live their normal lives and just continue with their normal lives and uninterrupted. Yeah. I think that's the most important point because we do get patients who feel like, so now my life is doomed because um, I mean, I have a diagnosis of diapola, and especially in the Kenyan society, mental illness is mainly more people look at people who are out there in the streets walking naked or causing chaos and talking to themselves and don't realize that actually it can happen very subtly within ourselves and in the working spaces and the social spaces that we actually sit in and actually engage in every day. Um thank you very much, Doc. It's been quite a very, very, very lively discussion, very informative. Um, and of course, now the years of experience have actually brought it out there and for people to actually understand what bipolar is. Um before I think wind up and like you to just give us your closing remarks.

SPEAKER_00 51:01

I would want to encourage that we have we educate and we create awareness about the various conditions. Today we are discussing bipolar mood disorder. And we would want as much as possible people to know from early age that it's important to name your emotions, whether they are pleasant or unpleasant. So your child, if they are sad, encourage them to talk about sadness. Let them not be guilt-tripped and be told, oh, how many uh teddy bears they have, or how they should be thankful for having a roof over their head. Let them be able to name emotions. Then that way, when things are deteriorating or when we need help, it will be easy for themselves and even those around them to seek help.

unknown 52:03

Okay.

SPEAKER_01 52:04

Thank you very much, Doc. I we really appreciate your presence and um for you sharing your knowledge, expertise with us, and for the audience, of course, um, who are basically the main target audience of these sessions that we normally have in this podcast. So this has been another episode of the mental wellness podcast. If you've ever had misconceptions about what bipolar illness is or bipolar disorder, and you've had misconceptions about um someone who has probably mood swings, and you think it's bipolar noise more than mood swings, it's actually a chronic illness and quite debilitating and disabling and actually impairs social and occupational functioning. I hope and I believe that you've had a lot of information and knowledge from our expert today, Dr. Musher Wangombe, a consultant psychiatrist. 20 years of experience in psychiatry and quite a lot of knowledge. This episode basically, just like many other episodes of the mental wellness podcast, are geared towards educating and creating awareness about mental illnesses in the co in the community, in the society, another way in a global village across the globe. You watching this from whichever part of the globe you're watching, and we hope that it has actually been insightful to you. You can like, subscribe, and share on the links are on our bio. And I am Dr. Chibanzi Machon.

SPEAKER_02 53:30

Thank you.