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Residential Treatment of Bipolar Disorder at CooperRiis

Residential treatment of bipolar disorder at CooperRiis starts when residents take part in a full psychiatric evaluation in which they give a history of their lives, symptoms, and illness. We pay special attention to the resident’s treatment experiences, both negative and positive. It is important that we know what treatments and medications have been helpful, or not, as symptoms of bipolar are so varied that we must be sure that they do not originate in or are exacerbated by an organic source. For instance, a common symptom of bipolar disorder is insomnia. If a resident has undiagnosed asthma or allergies, both common causes of insomnia, these issues must be treated along with other symptoms.

At CooperRiis, we want to know people as whole people, not only for how they experience difficulties.

Our Integrative Psychiatry Director and the resident discuss and set goals for medication treatment. This shared decision-making model has been very successful for our residents as we believe in empowering our residents to guide their own recovery.

Medication and Supplements

Every person is a unique individual so we work to find the best dosage of medication that will result in reduced symptoms without such side effects as over sedation, sexual side effects, and mental fogginess. We want to minimize symptoms, but never at the expense of the resident’s well-being.

We believe the only sustainable solution is one where quality of life goes together with symptom reduction. Residents are fully involved by keeping us apprised of their symptoms and how they are feeling.

Supplements, such as vitamins, minerals and plant extracts, are also used in healing. In some instances, the dosage of a prescription medication can be reduced because the supplements have such a positive effect on symptoms.

Medications generally used to treat bipolar disorder include:

  • Mood stabilizers
  • Atypical antipsychotics
  • Antidepressants

The Recovery Model

At CooperRiis we strongly believe that recovery is possible, which means that rather than focusing on an illness or a diagnosis, we shift the resident’s focus to wellness and possibility. The Dream Statement helps residents embrace the concept that recovery and a fulfilling life are possible

The Dream Statement

All residents who join us at CooperRiis describe the larger hopes and dreams for their lives in a Dream Statement.

Bipolar disorder is a disruptive illness that often wreaks havoc on a person’s life. The Dream Statement can help refocus the resident on more positive aspects of life. Rather than thinking about the negative impact their symptoms have had, residents are encouraged to think about what they want to achieve in the future. The Dream Statement becomes a road map to their recovery.

Residents set core goals that are achievable over several months and goals which are achievable within a week or two; it is very individualized. These weekly and monthly goals are always aimed toward the larger dream.

For example, if a resident wants to work in a job that helps people (Dream Statement), then a short-term goal may be to eat three nutritious meals a day. If healthy eating promotes the strength and energy that are necessary to help others, this weekly goal will help ensure that the resident is always working toward her or his dream.

The Healing Community Way: Treat the Whole Person

CooperRiis offers an array of mental health services such as individual psychotherapy, group therapy, structured work and learning opportunities, and structured social experiences in addition to medication. Every facet of the resident’s life is addressed.

Seven Domains of a Whole, Healthy Person

  1. Physical wellness
  2. Emotional and psychological health
  3. Spirituality
  4. Intellectual creativity and learning
  5. Social and community connectedness
  6. Purpose, productivity, and fulfillment
  7. Empowerment and independence

Our residents work with an interdisciplinary recovery team which is comprised of professionals with expertise in the above domains. Because every person is different, some domains will receive more emphasis than others, but all will be attended to.

Seven Domains Enhanced Recovery Model
The Seven Domains Enhanced Recovery Model by Sharon Young, Ph.D.

What are bipolar disorders?

Bipolar disorders, also known as manic-depressive illness, are disorders that cause changes in a person’s mood, energy, activity levels, and ability to function.
People with bipolar disorders have periods of normal moods that are interrupted by episodes of extreme emotional states. These intense mood episodes are categorized as manic, hypomanic, and depressive.

Signs and Symptoms

Symptoms and their severity vary from person to person. When making a diagnosis, we look for symptoms that indicate the person has experienced dramatic changes in mood, energy, sleep, and behavior. People who have bipolar disorder will have episodes in which they feel overly happy and energized and episodes of feeling very sad and sluggish. In between these episodes they usually feel normal.

Manic Episode:

To be diagnosed with bipolar disorder, a person must have experienced at least one manic or hypomanic episode. The first manic episode can start anytime from early childhood to later adulthood, but most often happens around the age of eighteen. People experiencing a manic episode will have more energy than usual and be very high spirited or extremely irritable for a period of at least one week. They will also demonstrate a minimum of three of the following, showing a change in behavior:

  • Trouble sleeping, less need for sleep
  • Feeling wired or restless
  • Feeling elated
  • Being agitated and/or irritable
  • Talking more than usual
  • Talking loudly and/or rapidly
  • Distracted easily
  • Increased activity levels, doing many activities at once, overscheduling
  • Increased risky behavior (e.g., reckless sex, reckless driving, spending lots of money)
  • Unusually high sex drive
  • Uncontrollable racing thoughts
  • Quickly changing ideas or topics
  • Exaggerated self-esteem or grandiosity
  • Being more impulsive than usual
  • Drug and/or alcohol abuse

Everyone experiences mood swings and changes in behavior. In a manic episode, the symptoms are so severe that they cause issues at work or with family and friends. The symptoms are obvious and often worry friends, family, and coworkers.

Hypomanic Episode:

A hypomanic episode is a less severe manic episode with similar, but more moderate symptoms, that lasts four days in a row. People with hypomania can often function well in social situations and at work.

Depressive Episode:

A major depressive episode is a period of at least two weeks in which a person has at least five of the following symptoms, including one of the first two in the list:

  • Intense sadness or despair; feeling helpless, hopeless or worthless
  • Loss of interest in activities once enjoyed
  • Feeling guilty
  • Feeling worried
  • Feeling empty
  • Becoming forgetful
  • Changes in sleep patterns such as sleeping too little or too much
  • Feeling restless or agitated
  • Slowed speech or movements
  • Eating too much or too little
  • Energy loss, fatigue
  • Difficulty making decisions
  • Frequent thoughts of death or suicide
  • Decreased activity levels
  • Difficulty concentrating

The Four Basic Types of Bipolar Disorder:

  • Bipolar I disorder
  • Bipolar II disorder
  • Cyclothymic disorder
  • Unspecified bipolar and related disorders

All four types of bipolar disorder involve changes in mood, energy, and activity levels at varying degrees.

Bipolar I Disorder

To be diagnosed with bipolar I disorder, someone must have a manic episode that lasts at least seven days, or have manic symptoms so severe that a person requires immediate hospitalization. Usually depressive episodes occur as well but they are not necessary for diagnosis.

Bipolar II Disorder

With bipolar II disorder, people experience depressive episodes interspersed with hypomanic episodes.

Cyclothymic Disorder

Cyclothymic disorder is a milder form of bipolar disorder. People diagnosed with cyclothymia experience a chronically unstable mood state with alternating hypomania and depression symptoms for at least two years but they are less severe than in bipolar I or bipolar II.

Other Specified and Unspecified

Those who do not meet the diagnosis criteria for bipolar I, bipolar II, or cyclothymic disorder but still experience significant mood swings and mood elevation will be diagnosed with Bipolar disorder “other specified” or “unspecified”.

Family Members: Support and Education

The resident’s family is an essential part of their treatment team at CooperRiis. Family support of someone with mental illness can reduce the rate of re-hospitalization by up to 75 percent over a three-year period (SAMHSA). Our families are also in need of recovery, support, and the tools to care for their loved one. Strong families help support strong recoveries.

Although we strongly encourage family participation, the resident guides and informs our communications with family members. We encourage our residents to reach out to their families in healthy and beneficial ways.

Each resident has a family liaison, a Recovery Coordinator, who communicates with family members every other week. Since bipolar disorder can cause disruptions and stress for the family, family members may also benefit from professional resources.

Some of the ways we support families are:

  • Educating families about how they can best support their loved one
  • Regular family meetings
  • Family education weekends twice a year on our campus
  • An online course called Families Healing Together

Michael Groat

About the Author

Michael Groat, PhD, MS is President and CEO of CooperRiis residential treatment program located in Asheville and Mill Spring, North Carolina. Michael earned his Ph.D. in Counseling Psychology from SUNY-Albany. Prior to joining CooperRiis, he was associate professor of psychiatry and behavioral sciences at the Baylor College of Medicine, Houston, TX, where he also served as director of the division of adult services at the Menninger Clinic.

Michael is also a former candidate in adult psychoanalysis at the Center for Psychoanalytic Studies, Houston, and completed a 4-year fellowship in psychodynamic psychotherapy at the Austen Riggs Center. He has published on suicide prevention, applications of attachment research, and uses of clinical outcomes, and has lectured nationally and internationally on the same. Michael has long-standing interest in suicide prevention, therapeutic communities, organizational and systemic interventions, personality assessment, and intensive psychotherapy.

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