Pine Rest Mission Statement
Pine Rest Christian Mental Health Services is called to express the healing ministry of Jesus Christ by providing behavioral health services with professional excellence, Christian integrity and compassion.

Bipolar Disorder

Bipolar disorder, also known as manic-depressive illness, is a serious brain disease that causes extreme shifts in mood, energy, and functioning. It affects approximately 2.3 million adult Americans—about 1.2 percent of the population. Men and women are equally likely to develop this disabling illness. The disorder typically emerges in adolescence or early adulthood, but in some cases appears in childhood. Cycles, or episodes, of depression, mania, or "mixed" manic and depressive symptoms typically recur and may become more frequent, often disrupting work, school, family, and social life.

Depression: Symptoms include a persistent sad mood; loss of interest or pleasure in activities that were once enjoyed; significant change in appetite or body weight; difficulty sleeping or oversleeping; physical slowing or agitation; loss of energy; feelings of worthlessness or inappropriate guilt; difficulty thinking or concentrating; and recurrent thoughts of death or suicide.

Mania: Abnormally and persistently elevated (high) mood or irritability accompanied by at least three of the following symptoms: overly-inflated self-esteem; decreased need for sleep; increased talkativeness; racing thoughts; distractibility; increased goal-directed activity such as shopping; physical agitation; and excessive involvement in risky behaviors or activities.

"Mixed" state: Symptoms of mania and depression are present at the same time. The symptom picture frequently includes agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. Depressed mood accompanies manic activation.

Especially early in the course of illness, the episodes may be separated by periods of wellness during which a person suffers few to no symptoms. When four or more episodes of illness occur within a 12-month period, the person is said to have bipolar disorder with rapid cycling. Bipolar disorder is often complicated by co-occurring alcohol or substance abuse.

Severe depression or mania may be accompanied by symptoms of psychosis. These symptoms include: hallucinations (hearing, seeing, or otherwise sensing the presence of stimuli that are not there) and delusions (false personal beliefs that are not subject to reason or contradictory evidence and are not explained by a person's cultural concepts). Psychotic symptoms associated with bipolar typically reflect the extreme mood state at the time.

Treatments
A variety of medications are used to treat bipolar disorder. But even with optimal medication treatment, many people with the illness have some residual symptoms. Certain types of psychotherapy or psychosocial interventions, in combination with medication, often can provide additional benefits. These include cognitive-behavioral therapy, interpersonal and social rhythm therapy, family therapy, and psychoeducation.

Lithium has long been used as a first-line treatment for bipolar disorder. Approved for the treatment of acute mania in 1970 by the U.S. Food and Drug Administration (FDA), lithium has been an effective mood-stabilizing medication for many people with bipolar disorder.

Anticonvulsant medications, particularly valproate and carbamazepine, have been used as alternatives to lithium in many cases. Valproate was FDA approved for the treatment of acute mania in 1995. Newer anticonvulsant medications, including lamotrigine, gabapentin, and topiramate, are being studied to determine their efficacy as mood stabilizers in bipolar disorder. Some research suggests that different combinations of lithium and anticonvulsants may be helpful.

According to studies conducted in Finland in patients with epilepsy, valproate may increase testosterone levels in teenage girls and produce polycystic ovary syndrome in women who began taking the medication before age 20. Increased testosterone can lead to polycystic ovary syndrome with irregular or absent menses, obesity, and abnormal growth of hair. Therefore, young female patients taking valproate should be monitored carefully by a physician.

During a depressive episode, people with bipolar disorder commonly require additional treatment with antidepressant medication. Typically, lithium or anticonvulsant mood stabilizers are prescribed along with an antidepressant to protect against a switch into mania or rapid cycling. The comparative efficacy of various antidepressants in bipolar disorder is currently being studied.

In some cases, the newer, atypical antipsychotic drugs such as clozapine or olanzapine may help relieve severe or refractory symptoms of bipolar disorder and prevent recurrences of mania. More research is needed to establish the safety and efficacy of atypical antipsychotics as long-term treatments for this disorder.

Research Findings
More than two-thirds of people with bipolar disorder have at least one close relative with the disorder or with unipolar major depression, indicating that the disease has a heritable component. Studies seeking to identify the genetic basis of bipolar disorder indicate that susceptibility stems from multiple genes. Scientists are continuing their search for these genes using advanced genetic analytic methods and large samples of families affected by the illness. The researchers are hopeful that identification of susceptibility genes for bipolar disorder, and the brain proteins they code for, will make it possible to develop better treatments and preventive interventions targeted at the underlying illness process.

Researchers are using advanced imaging techniques to examine brain function and structure in people with bipolar disorder. An important area of imaging research focuses on identifying and characterizing networks of interconnected nerve cells in the brain, interactions among which form the basis for normal and abnormal behaviors. Researchers hypothesize that abnormalities in the structure and/or function of certain brain circuits could underlie bipolar and other mood disorders. Better understanding of the neural circuits involved in regulating mood states will influence the development of new and better treatments, and will ultimately aid in diagnosis.

This article was excerpted from the NIMH article located at http://www.nimh.nih.gov/publicat/manic.cfm Additional information and references may be obtained there.

Integrating Mental Health and Addiction Services in Pine Rest/Saint Mary's Hospital-Based Services

By Jim Bottenhorn, MA, LLP
Director of the Contact Center and Utilization Management

Since 1910, Pine Rest hospital has been a premier provider of Christian mental health services. Over the course of the past three years a culture shift has taken root, instilling addiction and recovery services into our mental health treatment milieus.

Based on discharge diagnoses, up to 50% of patients on some of our adult units suffer from both a mental illness and a substance use disorder. Given this prevalence, a broader skill mix is critical if we are to treat the whole patient and ensure that discharge plans are aligned with patient needs.

At the invitation of Network 180, previously known as Kent County Community Mental Health, Pine Rest has adopted a charter which espouses an integrated treatment philosophy by incorporating the perspectives of both mental health and substance disorders, and has set a goal of dual diagnosis competency for all clinicians.

As a partner in this initiative, Pine Rest has sponsored a number of training opportunities, for staff and the community at large, in order that staff acquire the attitudes, values, knowledge, and skills needed to treat patients who come to us with co-occurring disorders. The Pine Rest Professional Lecture Series, coordinated by the Pine Rest marketing department and underwritten by the Pine Rest Foundation, has attracted nationally-recognized leaders in the addictions field, which has furthered this initiative.

The cultural shift that is underway in the hospital is mirrored throughout the organization with the acquisition of Pathfinder Resources in July of 2005 and the development of both ambulatory and residential detoxification services, soon to be introduced in the Spring of 2006. To meet the needs of our expanded addiction services three addictionologists have been credentialed by the medical staff.

Broadening our range of clinical skills, integrating both mental health and addiction services, is a challenging yet rewarding venture which will serve to further augment the clinical excellence that Pine Rest is known for.

Integrating Substance Abuse and Mental Health Treatment

by Tom Graham, MA, LLP, CSW, Pine Rest Campus Clinic
Traditionally, substance abuse and mental health difficulties have been viewed as separate problems. Services to treat these conditions have been isolated from each other and often, as in John's case, in conflict with each other. People seeking help have found that substance abuse programs often screen out individuals with significant mental health concerns and conversely, individuals seeking help for mental health problems are often screened out because of an existing substance abuse problem. As John found out, some health insurance companies have policies and practices that effectively discourage people from getting the help they need when they need it.

Unfortunately, in the world of behavioral health care services, it has been rare to have mental health and substance abuse problems treated in a coordinated manner. John had been candid with the therapist he saw for depression about his increased use of alcohol but his increased drinking pattern was not identified as a problem in his treatment plan. Conversely, many individuals in treatment for substance abuse are shocked to learn their counselor does not want to talk about their difficulties with mood. Often they feel the substance abuse counselor is unconcerned about their mood difficulties, viewing these complaints as signs of avoidance or denial of their substance abuse problem.

Reasons for the separate and often antagonistic approaches in the treatment of these problems are varied. For years, clinicians have been trained to be an expert in one field or the other. Each field has had proponents that have justified their view, often at the expense of the other. This has resulted in barriers for people in getting the help they need when they need it.

Goals of treatment have traditionally been different for these disorders as well. Mental health treatment has focused on the reduction of symptoms. These treatment environments have concentrated on providing support, most often typified by a therapeutic relationship with a psychologist or social worker. A psychiatrist (medical doctor with advanced psychiatric training) will often prescribe medication for the resolution of a disorder. The individual receiving medication may or may not be involved in other psychotherapy or counseling for the difficulty.

Goals of substance abuse treatment programs are typically abstinence from alcohol and/or other drugs. Treatment models have been more confrontational and group-based in an effort to break through what is viewed as the individual's denial process. Separate philosophies and training of professionals in the fields of mental health and substance abuse have also influenced the development of today's behavioral health care insurance policies and practices. It is encouraging however that this has begun to change and there is now more of an emphasis on providing care in an integrated manner. Clearly this is a benefit to the person who is struggling to cope with both a substance abuse and mental health problem.

For some time now our culture has had clear evidence that untreated problems, whether they are of a substance abuse or mental health nature, only get worse. When mental health and substance abuse difficulties are present in the same person at the same time they are said to be coexisting or co-occurring. Persons with coexisting disorders are often referred to as dual diagnosis patients.

(Excerpted from the Today magazine article "Integrating Mental Health and Substance Abuse Treatment". The complete article can be found here: http://www.pinerest.org/education/today/substanceabuse/integration.asp)

Tom Graham, MA, LLP, CSW, has over 27 years' experience in traditional mental health, substance abuse, and dual diagnosis (coexisting mental health and substance abuse concerns) treatment. Graham received a Master's degree in Counseling Psychology from Western Michigan University and a master's degree in clinical psychology from Vermont College of Norwich University.

Upcoming Events

Classes and Workshops
February 18
2006 Grand Rapids Christian Parenting Conference
Clinicians from eight area agencies share helpful information with parents on bullying, self-esteem, spirituality, autistic spectrum disorders, diversity, blended families, strong-willed children, and more. 8:30 a.m. to 12:15 p.m. at Grand Rapids Christian High School, 2300 Plymouth SE. Cost: Free. For more information, call Pine Rest Marketing Department at 616/455-6500 or for more information click here.

March 7, 14, 21, 28
Anger Management Classes
Classes will be led by Jim Bottenhorn, M.A., L.L.P., director of Pine Rest ’s Contact Center.
Classes are geared toward adults and older teens (aged 16 and older), and are open to both men and women.
Participants may attend alone, bring their spouse, or another family member. The cost is $65 for individuals; $95 for two family members. Persons interested in these classes do not have to be patients of Pine Rest. Space may be limited and early registration is recommended. For more information and to register, call 616/493-6033 or for more information click here.

General Events
February 14
Lunch in the Gardens: A Valentine’s Date for Pastors, Church Leaders and Their Wives
As part of the Marriage and Family Building Series and in conjunction with Celebrate Marriage Month, Pine Rest Family Institute will host a luncheon on February 14, 2006 from noon to 1:30 p.m. at Frederick Meijer Gardens, featuring a presentation by Dan Seaborn, MA. The luncheon is entitled "Lunch in the Gardens: A Valentine’s Date for Pastors, Church Leaders and Their Wives." It is free of charge and pre-registration is required. For more information or to register, interested persons should call 616/455-5279 or for more information, click here.

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Disclaimer

Copyright © 2006, Pine Rest Christian Mental Health Services. All rights reserved. The contents of Mental Health News & Information are for informational purposes only. The content is not intended to be a substitute for professional medical or mental health advice, diagnosis, or treatment. It cannot and should not be used as a basis for diagnosis or choice of treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical or mental health condition.