How might you help a bipolar I patient explain how they are feeling?

I think there’s a couple of things to think about. The first is to build up a routine set of questions that you ask patients regularly, so that when they start to look like they might be becoming hypomanic or manic, they’re not shocked when you ask them these particular questions on that occasion. It’s especially good to start to build in those questions when you meet people for their first assessment, particularly if they’re euthymic so you can help them start to learn how to talk about feelings, and so they trust that when you ask about their feelings; it’s not just because they’re starting to become high. The reason for this is because as people become hypomanic or manic, they tend to regard other people around them as trying to thwart them, to stop them doing things they really want to do and their misinterpretations might be that you’re just jealous because of their energy, or you want to be like them.

When talking about emotions it’s important to talk to people about the idea that emotions are like the colours of a rainbow, you can be somewhere on the spectrum - where do they see themselves as fitting in at that moment? If you feel that their description isn’t really what you’re observing, I often ask them who they most trust in the world? Whose opinion do they regard in a positive way? I then ask them if that person has commented, or has made any observations about their behaviour.

The crucial things from a therapy and bipolar point of view is the idea that when people are becoming manic or hypomanic they become incredibly self-focussed; they only look at things from their own perspective. The critical thing is to shift that focus to be able to get them to see other people’s perspectives and to acknowledge that it may be about illness, rather than about being this fantastic person who has boundless energy.

How is the list of symptoms that you might make together with the patient important and how does it help with their treatment?

In the first or second interview I usually get patients to help me construct a list based on what they know are the things that happen to them as they start to become high and also as they start to become depressed. The sequenced list of symptoms that they get as they start to become hypomanic or manic is really important, because if somebody is becoming hypomanic or manic, I can get out their own list and show it to them so it avoids getting into a battle with somebody about an opinion, where they might see me as just taking the opposite view; instead it’s me feeding back to them about what they have already told me about not sleeping very well or spending more money. We can then try to look at the situation and see if we can contain it a bit.