(gentle music) - Welcome back to "Family Health Matters."

I'm Shelley Irwin.

With me today, Dr. Charletta Dennis, medical director at Priority Health.

Good that you are here.

Dr. Gregory Mallis, psychologist at Pine Rest Christian Mental Health Services.

Hello to you as well.

All right, thank you for what you do in this, I would think, challenging, perhaps a popular field in these times.

How do you spend your day in this niche, Dr. Dennis?

- Well, as a medical director at Priority Health, I am responsible for ensuring that patients receive the right care at the right time, so ensuring that patients, if they need outpatient treatment, if they need inpatient treatment, that they get the level of care that they need.

- Right, Dr. Dennis, or Dr... - Mallis.

- Hopefully we can edit this, three, two, one, Dr. Mallis?

- Yeah, so I'm an outpatient psychologist with Pine Rest, so I spend my day seeing individual clients.

I work with individuals, I work with couples, I work with families, helping them manage issues related to mental health.

- Right, are you both busy in this field?

- Yes, I think my schedule has been a lot busier over the past several years, and in particular over the last three to six months, been fairly busy.

- [Shelley] And new clients?

- Absolutely, I believe since the previous pandemic was the rise of mental health concerns has greatly increased, and the amount of patients that people are seeing is definitely on the rise.

- Let's begin with the basic definitions of review, bipolar disorder, or how do you describe it?

- Bipolar disorder is a mental health issue.

It's a medical condition actually, and people who have it, they suffer from symptoms that can disrupt their personal, private, educational, employment lives.

So they have symptoms like distractibility, irritability, they can have rapid or pressured speech, and all of these cause impairment in their daily functioning.

- Add to that and then Dr. Mallis, the use of the term disorders, is that okay?

- Yeah, I mean, I think it is a disorder.

And it describes something that is not working right in our lives, as was mentioned, that impairs our ability to function.

I mean, I think I would add to what was just said that for bipolar disorder in particular, it is having symptoms related to depression at times, but also symptoms related to mania or hypomania.

And that's really the big piece with bipolar disorder is looking at those manic or hypomanic experiences, and figuring out how to treat that.

- How would you make the diagnosis with you?

- Yeah, so if somebody comes into my office, and they're describing me a history of very significant mood swings, and what I mean by mood swings is the low mood swing would be something like clinical depression, where they are low energy, depressed mood for several months, possibly suicidal ideation, difficulty functioning.

Along with that, there has to be an experience, a time period in their lives where they had sort of that up mood swing, where they had the pressured speech, where they had the lack of need for sleep, more energy, impulsivity, irritability and anger, and all of that starts to impair their functioning or their relationships as well.

So you really need both of those components.

- Add to that, Dr. Dennis, and would these early signs be indicative with those from kids to adults, or do those vary?

- Absolutely, it varies, but the majority of the patients that live with symptoms, they would spend their lives in a depressed phase.

Most of the times you really don't get an understanding of whether or not it's actually bipolar disorder, until they've had that manic phase, until they've either needed to have hospitalization, or the symptoms are impairing them so much that it's causing issues that others will notice as well.

- What causes bipolar disorder?

- It's multifactorial, but we do know that people have a genetic predisposition for it.

So if they have family members who have had, if they had parents or grandparents who have had symptoms of depression, may have gone undiagnosed, but we do know there is a genetic predisposition for bipolar disorder.

- Is early intervention key, Dr. Mallis?

- Absolutely, I think early intervention is key in helping people to learn how to understand what their experience is, and also how to regulate and manage it.

We really, if you don't know what's going on, you're much less likely to be able to deal with it in an effective way, and it's gonna start kind of railroading your life in a negative fashion.

- Let's stay with the niche of the adolescent, a parent sees some of these symptoms, what's the action item?

- Well, the action item is to go and talk to a specialist.

There are lots of things that kids can experience, mood swings that are pretty normative, especially thinking about teenagers.

Those mood swings are pretty big swings, but they're also pretty normal in that stage.

And so a specialist is gonna be able to help understand, are these more normal kinds of things, or are they indicative of kind of a bipolar that is starting to present?

- Add to that?

- Absolutely, you have to take a look at how a person is functioning, what's happening in their life at that moment?

People experience symptoms in the way they relate to others.

You can see with children, they can be passive or they can be quiet, or they can be very irritable, and won't want to do the things that they normally need to do.

As you get older, you may see different symptoms.

You may see somebody who's withdrawn, someone who's not doing the things that they used to do, or not functioning at the level that they used to function.

So you have to look at, we look at it on a continuum, and the way someone may present early in life may be different after they've received treatment, or if they have not received any treatment at all.

- Well, obviously intervention, early intervention key, but let's talk in general, early treatment.

What do you have to offer, Dr. Dennis?

- It depends on what phase of the illness that a person is in, and how severe their symptoms are.

If they present with depressed, in a depressed phase, you wanna make sure that there's an antidepressant on board.

You wanna make sure that they're seeing a therapist.

But you also have to be cautious about antidepressants with bipolar disorder because some of them can actually bring out the manic phase of bipolar disorder, and then you would have to treat with a mood stabilizer.

If their symptoms progress to psychotic symptoms, you may have to add an anti-psychotic as well.

- And you would trust your provider knows that each individual's is different, yes?

- Absolutely.

- You are a therapist, you sit down and begin talk therapy?

- Yeah, so I think that with bipolar disorder, it is important to be utilizing both the talk therapy side and the medication side.

The medication is really gonna help to kind of balance things a little bit, to lower that ceiling for the manic phase and the manic symptoms.

But what therapy is going to do is it's gonna provide that opportunity to be learning coping skills.

Because this is a lifelong illness that people are going to be dealing with for the rest of their lives, they need to know how to manage it.

So the biggest things that in treatment we're working on are first identifying the symptoms that lets you know you're sliding into a depressive phase, or into a manic or hypomanic phase, because it's very hard to manage them if you don't recognize that they're happening.

Once we've identified them, then we start working on skills to help bring stability back into our lives, coping skills, resources, people in our lives, therapists, medication, all of that comes together to really help the individual with bipolar disorder to be able to function effectively through these periods.

- And obviously it depends upon the severity and the patient, but much of this can be done outpatient versus inpatient?

- Yeah, depending on the severity of the particular episode that they're experiencing, and their particular symptoms, we can do a lot in outpatient.

But when that severity reaches over that level, inpatient is definitely the best place to get rapid resources and medication changes that are gonna help stabilize someone.

- And at what point do you bring the family in?

- I think you bring the family in as soon as you can.

Because this is lifelong, they're gonna need supportive resources around them throughout their lives.

So helping the families to understand kinda what bipolar disorder is, and what their family member, their loved one needs from them, depending on whether they're in a depressive episode or a manic episode, or they're somewhere in between.

- And then treatment continues as needed, as it's a lifelong journey, so as much education as possible, but expand here?

- Absolutely, there are different levels of care, and it definitely depends on their symptoms, how severe it is.

Outpatient treatment is great for someone who's in stable condition, and you wanna monitor the symptoms, and make sure that they don't reach a point where they need a higher level of care, such as inpatient.

Someone who needs to go inpatient, they're having thoughts of suicide, or they're unable to control what they're doing, so they're irritable, and they are not sleeping at all, and they're multitasking.

They really can't gather their thoughts, pretty much to be able to calm down.

You can also have a patient that needs maybe partial hospitalization, where they are having some symptoms, and they need a little bit extra, a little bit more than what outpatient can provide.

So it really depends on what the symptoms are, and how severely they're impacting their lives.

- And if we're talking a young adult, or an adolescent, obviously keeping the norm of life as possible, like continuing with school, or homeschool, or how does that- - I mean, it depends on the situation, but if possible, keeping as much normalcy and stability as you can.

If they're gonna be hospitalized, they're gonna have to take that time out of school.

Partial hospitalization still is gonna take most of the day, and not gonna allow them to be in school.

But we have to balance that with, if these symptoms, if this disorder is not treated, it's gonna cause more significant problems than missing some amount of school.

- Starting with you, Dr. Mallis, when do you know it's time for discharge?

- I think you know it's time for discharge when if they were experiencing a manic or hypomanic episode, those symptoms have come down, and they're starting to think more rationally, they're starting to be able to kind of have insight into what's going on.

If it was a depressive episode, the suicidal ideation, any thoughts around self-harm have really gone away, or are well managed, and there's a reasonable ability to believe that this person is not a danger to themselves.

- Again, every case is different, but Dr. Dennis, can one stay on these medications for a lifetime?

- Absolutely.

What you wanna make sure is that a patient is on what they need to be on, so the right medication at the right dose.

Sometimes people don't continue with medications, because they may have side effects to them, or they may not like the way they actually make them feel, but you wanna make sure that you're preventing the symptoms from returning, and you also wanna make sure that you're keeping a patient as stable as you can.

- One of the things to also watch out with for bipolar disorder, and the manic episodes in particular, is that some patients will stop taking meds in a manic episode, because they actually like the feeling of the manic episode.

It's euphoric, you have a lot more energy, you don't need to sleep, you get a lot of things done.

So it's really important for an individual with bipolar disorder, and their families and support networks, to recognize they need to continue these medications, even if they're feeling good and energized, that it could actually be a bad sign.

- Let me talk a little bit about other lifestyle changes once perhaps one is discharged, but continues with this journey.

What about the role of sleep?

- Oh, the role of sleep is so important.

When you don't get the right amount of sleep, you actually can cause yourself to think a little bit more than you normally would.

If you're not doing things consistently, you can throw yourself off kilter, throw yourself off balance.

So you wanna make sure that you're having a consistent schedule.

And it doesn't necessarily mean that you need eight hours of sleep every night, but you wanna make sure that you're getting consistent and restful sleep.

- Hmm, and nutrition?

- Oh, absolutely, because there is a genetic component to bipolar disorder, we wanna make sure that our bodies are running efficiently and effectively.

We wanna make sure that we've got the nutrients and the resources in our body to help manage all of the things that are going on.

So a healthy diet is a big part of that, making sure that you're drinking enough water, staying hydrated, make sure that you're getting all the vitamins and minerals and nutrients that are necessary.

- Let's talk in another subset of this conversation about suicide.

- Absolutely, what we do know is most people who are having suicidal thoughts are typically in a depressed phase of bipolar disorder.

However, there are more actions when someone is in a manic phase, because they're not really at a phase where they can really think about what they're doing.

They're quite impulsive, and they do things that they want to make themselves feel good in the moment.

But suicide rates are very high, and you have to think about how can you equip someone with thoughts and behaviors that's gonna be more adaptive than thinking about suicide.

And that's where therapy comes into play.

So people who have bipolar disorder, it's very important for them not to only be on medication, but to also be connected with a therapist.

- Mhm, add to that, and let's move on to substance abuse.

- Yeah, so I think in terms of suicide, when someone's depressed is usually when those thoughts are gonna be there.

But as they start to get more energy, as they swing into that manic phase, that's the real dangerous part, because now they've got the thoughts plus energy, and a willingness to act on some of them.

And as was mentioned, a lack of thought about the consequences, or a lack of care about the consequences.

So therapy is great for helping to come up with safety plans, and giving people different thoughts, different behaviors.

We also have to make sure that the environment is safe, and that's something that an individual who's not in a manic phase is gonna be more likely to do.

But also, this is where the family and the social supports come in, is they can help make sure that the environment is safer for this individual.

You mentioned substance use, and what we see with particularly the population of individuals with bipolar disorder is a higher rate of substance use, because they're trying to manage their symptoms.

They're trying to use that really a maladaptive coping skill to reduce the negative impact of their symptoms, they're gonna go to a substance.

So we really wanna try and work on identifying more adaptive coping skills, healthier ways to deal with the things that we're feeling.

- Your thoughts on substance use?

- Substance use is definitely a high comorbid issue with people with bipolar disorder.

You see that patients who experience symptoms, they want to try to mask what's going on with them.

They want to try to cover up those, that sadness.

So they may turn to things like cocaine or amphetamines, they wanna mask what's really going on with them.

And we also find that people who have bipolar I disorder, in particular with psychotic features, if they're hearing voices, or they're having these thoughts that are very intrusive, they want to try to dull those out.

So they may turn to things like opiates, and even alcohol to really try to dull those symptoms out.

- Where does the diagnosis of a ADHD come in?

Is this another comorbid factor here?

- Yes, it can be definitely comorbid with bipolar disorder.

And some of the symptoms can even overlap.

So you would see someone who's very fidgety, or very irritable and they have intrusive-type behaviors.

It's a very fine line, but finding out what symptoms started first, and how these symptoms are impacting their lives, it's very, very important to really coming up with an accurate diagnosis.

- Are the comorbid factors here?

- I mean, I think with any kind of mood disorder like this, there's also comorbidity for anxiety and stress.

So we really wanna look at their whole history and their presentation.

I think as was mentioned, it's really hard to tease apart some of these disorders, because the symptoms overlap.

So you do wanna look at history.

For ADHD, there's gonna be a history of these kind of distractible behaviors, the impulsive behaviors from a very young age, and you see it more impacting school, and some social things, than other areas.

If there isn't that school history, and it just starts sort of in early adulthood, or in adulthood, maybe that's a sign that this is more towards the bipolar.

But you often see a lot of anxiety comorbid, as we mentioned, the substance issues are comorbid as well, so there's a lot to tease out.

- Does telehealth work with this diagnosis?

- Yeah, telehealth, it will work with almost any diagnosis, to some degree.

I think it really depends on the individual.

I do a fair amount of telehealth work in my practice, and what I find is that telehealth can be very effective for some individuals, but other individuals really prefer that in-person face-to-face kind of contact.

I think the higher the risk of the individual, the more I would encourage face-to-face, because it's just harder to manage some of the risk issues in a tele situation.

- Dr. Dennis, lots of talk of loneliness with all ages, is that another comorbid factor, or cause and effect, or makes it worse, or?

- It actually can be a symptom of someone being in a depressed phase.

Loneliness, not having family members or friends that you can talk to, that you can be around, it definitely can impact your behavior.

That feeling of isolation definitely can lead to those thoughts of suicide.

That is a very, very high risk factor for someone who's having suicidal thoughts.

It's feeling isolated and lonely.

- This conversation of bipolar disorder, equal men and women diagnosed?

- Yes, it is, it's very equal with men and women across the board.

You can see symptoms present as early as age 20 to 22 years old in men, and usually about 23 to 25 in women.

But the prevalence is typically equal.

- And as you mentioned, popular and busy here in West Michigan.

- Yes.

- What are some resources Priority Health shares?

- Priority Health has behavioral health available 24 hours a day, seven days a week.

If you're a Priority Health member, the number's on the back of all Priority Health cards, 24 hours a day, seven days a week.

- Yes, peer support, back with your therapy hat on, if an adolescent has perhaps gone through treatment, and is now ready to return to school, perhaps in the fall, how does he or she meander the stereotypes, the myths and more?

- Yeah, I mean, I think that that's a really good question, and a really difficult question.

My experience has been that our society is moving to be a little bit more open about mental health issues in general.

And so there's more kinda space to talk about that, there's more acceptance of the reality that all of us are dealing with, or many of us are dealing with some aspect of difficulties in mental health, or stress and anxiety or depression.

I think once you've left that higher level of care treatment, so the inpatient or the partial hospitalization, continuing to have regular contact with an outpatient therapist, continuing to meet with a psychiatrist to manage medications, it's really just kind of continuing to have those touch points, to make sure that we're practicing those coping skills, learning new ones when we need them.

Peer support is very helpful, especially for teenagers, but for adults as well.

And there are many support groups.

Pine Rest has several support groups that can be found on our website.

I'm sure there are other ones in the area as well, but that's a great place to be able to connect with others who have struggled in the same way.

As humans, we are social creatures by nature, and there is a real value to connecting with others and feeling not alone in our experience.

- And that would be a 16 year old talking to another 16 year old, and hopefully with mom and dad not in the room?

- Yeah, so most of those teen groups will have at least periods of time where it's just the teenagers or the adolescents in the group.

In my experience, sometimes they have parents and the adolescents in there together, to do some psychoeducation, to help kind of understand what's going on, but then they break apart so that the teenagers kind of get that opportunity to connect with each other.

- Hmm, Dr. Dennis, are there triggers, as this is a lifelong journey?

Could one go three or four years, back to the new normal lifestyle, and then perhaps a trigger?

- Absolutely, there can be things that can predispose someone to having an episode, anything that can upset your normal life.

So if it's a big event like a death, you know, a loss of a loved one, a loss of a job, things that impact the way you normally function can definitely bring on a depressive episode.

Usually manic episodes tend to come about once there's some, a huge upset as well, but you can never tell if someone is going to have a manic episode or a depressive episode with an upset in their life.

So things like death definitely can bring about an episode.

- Yes, and obviously that might be discussed in therapy, that things may challenge you at times?

- Yeah, so I think those big stressors in life, some of them we can kinda see them coming.

You know, that might be a job change, moving, something big that you can kind of see a transition.

But in therapy, you can talk about what are the things that we might not expect, we might not be able to predict.

And so when they come, like a sudden death, or something else in life that you just weren't expecting, that really knocks your center off, that's when we really need to rely on those coping skills.

And we need to say like, "This is a time where some of these symptoms are gonna come."

If they come, that's okay.

We expect that it will happen.

Here's what we can do in response to them.

We can't stop them from happening, but we can't choose how we can respond, so that we can manage those symptoms in the best way.

- Do you use exercise as a form of therapy?

- I mean, absolutely, I think, as we talked about, having good nutritional health is important, just as having good physical health is important.

If we can keep our bodies running well, and being maintained, then it gives us more internal resources to manage what's going on.

- Dr. Dennis, extensive resume, certified in correctional healthcare by the National Commission of Correctional Healthcare.

Where does this come into play with this topic?

- Absolutely, we see a lot of people with bipolar disorders, schizoaffective disorders, substance use disorder in the correctional setting.

And oftentimes they're in a manic phase, and they're doing things that are not in the confines of the law, so they get arrested.

And oftentimes you see that comorbid substance use with people who have criminal histories.

- Hmm, yes, have to ask, is there a way to prevent this?

- I don't think there's a way to prevent this, just as there's no way to prevent cancer at the moment.

It's a thing that happens for some individuals.

And so I'm not sure prevention is the best thing, but I think trying to identify early, trying to recognize the symptoms, trying to reduce stigma on this, and figure out how do we help people to manage when there are things happening in their body that they cannot directly control.

- And what is still the stigma that needs to be broken?

- That this means that you are broken, or that you have done something wrong in your life, that you're not doing well enough, that you're not enough.

This is just a thing that happens to some people, like diabetes is a thing that happens for some individuals.

Now there are things you can do to contribute to that, to make it more likely that this will happen.

And sometimes substance use can trigger manic episodes, or can kinda trigger a bipolar experience, but even when you're not doing those things, it can still happen.

So helping our culture to really look at this and say, "This isn't the person's fault.

This is something they experience."

So how can we come along and support that individual to help them function the best that they can?

- This is something that you wanted to do, or this is something that you chose to do, absolutely not.

Bipolar disorder, just like schizophrenia, it's a medical condition, not unlike diabetes, not unlike hypertension.

If you don't receive the right treatment, it's gonna lead to devastation, it's gonna lead to things that can go awry.

So you wanna make sure that you're treating your body as a whole.

Yes, lifestyle modification is great.

You wanna make sure you're eating right, you wanna make sure you're sleeping right, but you also wanna make sure that you're taking care of your mind.

- Yes, what keeps you strong in this business, as we look to close?

- What keeps us strong in this business, I think is trying to recognize that everyone who's coming in, everyone who's struggling with something is a person, right?

They've got a life, they've got things that contribute to what they're experiencing, that when you put it to together make sense for where they're at right now.

And we really try to help individuals understand all of those pieces, and then figure out where they wanna go.

I think one of the big myths of mental health is that I'm here to tell people what to do, and I'm really not.

Like, it's their lives, I want them to feel empowered to figure out what they wanna do, and make choices that lead them in that direction.

- Right, take home message would be, starting with you?

- Take home message is try to be aware of what your experience is, and if you're feeling like something is off, something's not right, something's not how you want it to be, seek help.

- Right, how do we find out more information about Pine Rest?

- Yeah, you can go to Pine Rest's website at pinerest.org.

There are tons of information about resources that are available, all the way from outpatient to inpatient services.

We have many clinics around West Michigan, as well as a telehealth clinic.

So it doesn't matter where you are in Michigan, you can be connected with a Pine Rest therapist.

- Thank you for you.

Dr. Dennis, what do you leave us with?

What's your take home, take charge message?

- My take home message is seek help.

It's not you, it's the illness within you.

You have to make sure that you're taking care of you, and it's okay to seek help.

These are medical conditions, so make sure that you go see a provider, or talk to family and friends.

If you don't want to reach out to someone you don't know, reach out to someone you do know.

- And it's important that we keep talking about it more and more.

- Priorityhealth.com, you can reach, you can go to the website.

You can also look on the back of Priority Health cards, 24 hours a day, seven days a week, our behavioral health team is available.

- Which is important to say, because sometimes at two in the morning, that's when we need to make the call.

And what keeps you strong in this business?

- Knowing that I can help someone, no matter what level of care they need, I can direct people into a place that they need for them, the right care, the right place, the right time.

- Great, all right, we'll end it on top.

Thank you very much, Dr. Charletta Dennis, Dr. Gregory Mallis.

On behalf of this conversation, bipolar disorder's real, and you share good thoughts.

Thank you for you.

Thank you for listening and watching, take care.

(gentle music)