Managing symptoms of bipolar

In general, if the client presents during a depressive episode, management of symptoms should follow the guidelines for the management of depressive symptoms (see Table 43). As previously mentioned, low mood is often a trigger for relapse to AOD use and addressing depressive symptoms is an important component of relapse prevention [1019]. If, however, the client is experiencing a manic episode or symptoms of psychosis, consultation with a medical practitioner is recommended for the prescription of appropriate pharmacological interventions.

The techniques outlined in Table 44 may assist in the management of a person experiencing symptoms of mania or hypomania. Some clients may be aware that they are unwell and will voluntarily seek help; others may lack insight into their symptoms and refuse, or not perceive the need for, help. In some instances, a person’s manic symptoms can put both the client and others at risk of harm. In such circumstances mental health services should be contacted, whether the client wants such a referral to be made or not.

Table 43: Dos and don’ts of managing a client with depressive symptoms of bipolar

Do:
	Encourage and emphasise successes and positive steps (even just coming in for treatment).
	Take everything they say seriously.
	Maintain eye contact and sit in a relaxed position – positive body language will help you and the client feel more comfortable.
	Use open-ended questions such as ‘So tell me about...?’ which require more than a ‘yes’ or ‘no’ answer. This is often a good way to start a conversation.
	Constantly monitor suicidal thoughts and talk about these thoughts openly and calmly.
	Encourage the client to express their feelings.
	Be available, supportive, and empathetic.
	Offer realistic hope (i.e., that treatment is available and effective).
	Encourage regular sleep, exercise and eating patterns.
	Keep language clear, specific, and simple.
	Assist the client to identify early warning signs that they may become unwell.
	Provide contact details of counselling services and offer to make referrals if required (many depressed people struggle to do this alone).
	Encourage participation in healthy, pleasurable, and achievement-based activities (e.g., exercise, hobbies, work).
Don't:
	Make unrealistic statements or give unrealistic hope, like ‘everything will be fine’.
	Invalidate the client’s feelings.
	Be harsh, angry, or judgemental. Remain calm and patient.
	Lose hope or become frustrated.
	Act shocked by what the client may reveal.

Adapted from Scott et al. [1020], Clancy and Terry [448] and Headspace [1021].

Table 44: Dos and don’ts of managing a client experiencing mania/hypomania

Do:
	Ensure the safety of the client, yourself, and others.
	Assist the client identify early warning signs that they may become unwell.
	Help to reduce triggers that aggravate the person’s symptoms (e.g., reduce stimulation such as noise, clutter, caffeine, social gatherings).
	Speak clearly and calmly, asking only one question or giving only one direction at a time.
	Answer questions briefly, quietly, calmly, and honestly.
	Use a consistently even tone of voice, even if the person becomes aggressive.
	Encourage regular sleep, exercise and eating patterns.
	Be cautious about becoming swept up by the person’s elevated mood.
	Point out the consequences of the client’s behaviour. Be specific.
	If the person is well enough, discuss precautions they can take to prevent risky activities and negative consequences (e.g., give their credit cards and/or car keys temporarily to a trusted family member or friend to prevent reckless spending and driving).
	If promiscuity or socially inappropriate behaviour is a problem, encourage the person to avoid situations in which their behaviour may lead to negative consequences.
	Encourage the person to postpone acting on a risky idea until their mood is stable.
	Ensure both you and the client can access exits – if there is only one exit, ensure that you are closest to the exit.
	Have emergency alarms/mobile phones and have crisis teams/police on speed dial.
	If the person is placing themselves at risk, or they are experiencing severe symptoms of psychosis, arrange transfer to an emergency department for assessment and treatment by calling an ambulance on 000.
Don't:
	Argue, criticise, or behave in a threatening way towards them. Consider postponing or avoiding discussion of issues that aggravate the client for the time being. Try to talk about more neutral topics.
	Get visibly upset or angry with the client. Remain calm and patient.
	Confuse and increase the client’s level of stress by having too many workers attempting to communicate with them.
	Get drawn into long conversations or arguments with the person as these can be overstimulating and upsetting. People with elevated moods are vulnerable despite their apparent confidence, and they tend to take offence easily.
	Leave dangerous items around that could be used as a weapon or thrown.
	Laugh (or let others laugh) at the person.
	Act horrified, worried, or panic.