P-YMRS (Young Mania Rating Scale) helps parents assess whether their child might have the symptoms of bipolar disorder.

The P-YMRS consists of eleven questions that parents are asked about their child's present state. The original rating scale (Young Mania Rating Scale), was developed to assess severity of symptoms in adults hospitalized for mania. It has been revised in an effort to help clinicians such as pediatricians determine when children should be referred for further evaluation by a mental health professional (such as a child psychiatrist), and also to help assess whether a child's bipolar symptoms are responding to treatment. The scale is NOT intended to diagnose bipolar disorder in children (that requires a thorough evaluation by an experienced mental health professional, preferably a board-certified child psychiatrist). This version has been tested in a pediatric research clinic with a high number of children with bipolar disorder. The child's total score is determined by adding up the highest number circled on each question. Scores range from 0-60. Extremely high scores on the P-YMRS increase the risk of having bipolar disorder by a factor of 9, roughly the same increase as having a biological parent with bipolar disorder. Low scores decrease the odds by a factor of ten. Scores in the middle don't change the odds much.

The average scores in children studied were approximately 25 for mania (a syndrome found in patients with Bipolar-I), and 20 for hypomania (a syndrome found in patients with BP-2, BP-NOS, and Cyclothymia). Anything above 13 indicated a potential case of mania or hypomania for the group that was studied, while anything above 21 was a probable case. In situations where the odds of bipolar diagnosis are high to begin with (a child with mood symptoms with 2 parents having bipolar disorder), the P-YMRS can be extremely helpful. But for most groups of people, the base rate of bipolar disorder is unknown but low. Then, the most that a high score can do is raise a red flag (similar to having a family history of bipolar disorder).

Even a high score is unlikely to indicate a bipolar diagnosis. The P-YMRS is performing similar to the screening test for prostate cancer, where it will identify most cases of bipolar, but with an extremely high false positive rate. The P-YMRS is presently being studied in a community pediatrics practice to determine its validity in that setting. The P-YMRS is provided here for educational purposes only, and should not be used as a substitute for evaluation by mental health professionals.

Reference: The P-YMRS was revised from the Y-MRS originally developed by Young et al and was presented at the First Annual International Conference on Bipolar Disorders, Pittsburgh, June, 1996 (Gracious BL et al). Exploration of its statistical properties are outlined in: Discriminative Validity of a Parent Version of the Young Mania Rating Scale. Gracious, Barbara L., Youngstrom Eric A, Findling, Robert L, and Calabrese Joseph R et al. Journal of the American Academy of Child and Adolescent Psychiatry (2002) 41(11): 1350-1359.

next: Bipolar Disorder Diagnosis and Medical Tests
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If you have a mental illness, what can you do to better cope with war, terrorism and other types of traumatic events?

With ongoing war in Iraq and the continuing terrorist threat here at home, Americans are experiencing many powerful emotions. For most people, feelings of anxiety, sadness, grief and anger are healthy and appropriate. But some people may have more profound and debilitating reactions to the war. This could be especially true for those who live with serious mental illnesses, such as schizophrenia, bipolar disorder, depression, substance abuse problems, anxiety or post-traumatic stress disorder.

It is important to remember that everyone reacts differently to trauma and each person has his or her own tolerance level for difficult feelings. When confronted with a crisis, a person with a mental illness may experience the symptoms of his or her disorder or see new ones emerge.

Some consumers who have experienced this say that there are warning signs. Here are some common warning signs of an oncoming relapse:

• Stopping your usual routines, such as attending school or joining family activities
• Changing your sleeping pattern or eating habits, not caring about your appearance, difficulties with your coordination, lapses in short-term memory
• Experiencing mood swings, feeling out of control or very agitated, thinking about suicide or violence
• Doing things that make others think you're out of touch with reality
• Hearing or seeing things that other do not
• Being unable to let go of an idea, thought or phrase
• Having trouble thinking or speaking clearly
• Deciding not to take your medications or to follow through with your treatment plan (missing appointments, etc.)
• Feeling unable to enjoy things that are usually pleasurable
• Being unable to make even routine decisions

Different people can have different warning signs, so be aware of anything that seems out of the ordinary for you. If people around you notice changes, listen to what they say. You could be totally unaware of changes in your behavior. Be sure to report any changes, especially any talk or thoughts of suicide or self-inflicted injury, to your doctor or treatment team.

Even in uncertain times such as these, you must take an active role in managing your illness. Continue to follow the treatment plan you've developed with your doctor or treatment team:

• Take your medications just as your doctor prescribed
• Keep your therapy appointments
• Avoid alcohol use
• Do not use illicit drugs or any that are not prescribed specifically for you
• Keep a journal or diary
• Have prescribed laboratory and psychological tests
• Stay connected with or get involved in a support group
• Report any signs of a relapse to your treatment team

To get through the current crisis, take advantage of the people and tools that are available to you:

• Involve family and friends. Don't be afraid to ask for help.
• Keep your doctor and treatment team informed about how the war is affecting you.
• Make contact with self-help groups and support organizations that help people with serious mental illnesses and related problems.
• Access peer support and other programs, ranging from drop-in centers to housing, employment and recreational opportunities, that can help you better manage your illness.
• Learn all you can about your illness and what you have to do to move to recovery.
• Use the computer to get information about your illness, and to contact and exchange views and experiences with others who share your experiences.
• Stay in touch with your spirituality, if you find that comforting. Be optimistic about the challenges that lie ahead.

Find what works for you. The process of moving toward recovery, especially in times or war or crisis, is not a simple one. Stay fully involved in the process by following your treatment plan and seeking the support you need, when you need it.

For More Information:

For more information, contact your local Mental Health America affiliate or the national Mental Health America office.

Source: Mental Health America

next: Alternative Treatments for Autism

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A short essay about investing yourself in a relationship, then the person leaves and you have to let go.

Life Letters

To a friend who is hurting,

You are saddened, hurt and angry that you have put so much energy into yet another relationship, given unselfishly of yourself to one more wounded soul. And now that she is nourished, comforted, and healed, she's walked out of your life, abandoned you. I watch this strong woman whom I have come to care deeply about weep bitter tears. As is so often the case when I am with you, I am once again at a loss. Words of comfort seem inadequate just now. I have only my compassion and understanding to offer. I sit quietly for a time, holding you in my heart.

Then I remember the squirrel. And you, the weaver of words and worlds, quietly listen while I tell you a story...

I had been working on a case summary when I heard just out my window, a soft and pathetic wailing. When I looked outside, I discovered, to my distress, a tiny animal struggling in what looked very much to me like death throws. Its tiny body was writhing and quivering in apparent and absolute agony. I turned away from the window in horror, but I couldn't block out the creature's cries. My first impulse was to turn the music on loudly and return to my work, allowing nature to take its course. Within minutes though, I was reluctantly stepping outside.

It was a squirrel. Its little body was gyrating so rapidly that I couldn't even begin to assess the damage. Satisfied that I was helpless, I ran off down the road to my neighbor's house where I began pounding on the door. Basil appeared in the doorway looking anxious, understanding instantly that I was distressed. I blurted out my story and then took off towards my cottage, trusting Basil to follow. Bless him, he did. As we stood beside the squirrel, I asked him what we should do. "Jeez, Tammie, I don't know." He sounded irritated. "I could chop off its head," he offered unenthusiastically. "Oh, No!" I exclaimed, horrified. "Can you help me get it into a container so I can take it to the vet?" I whined. He clearly didn't want to, but he said he would. I ran into our storage shed and brought out a lobster pot with a lid. Basil, grim faced, proceeded to prod the squirrel into the pot with a stick. I placed the pot on the passenger seat and sped out of the driveway. I had just gone a short distance when the squirrel began his dramatic attempts to escape. The lid began clattering, the pot began bouncing, and I was struck by two thoughts. One, I didn't know where the nearest vet was, as we used one in another town; and two, what if the squirrel had rabies, managed to escape and bit me! I could see the headlines now, "Local woman attacked by rabid squirrel while driving!"

I was a nervous wreck, attempting to drive with one hand and keep the lid on (literally and figuratively) with the other. I pulled into a gas station, saw a young man, blew my horn and motioned him over. "Where's the nearest vet?" I practically yelled to the poor kid. He looked leery as he peered into the blazer window at a wild-haired, wild-eyed woman, desperately struggling to hold a cover on a pot which contained a screaming, unidentified object. He told me how to get to the vet, glancing uneasily over at my captive pot as he recited the directions. I thanked him and was off again. The squirrel seemed to be unbelievably strong, and I was terrified that I was going to lose the battle. I fought with the lid, drove, and devised a plan of retreat should the squirrel win.

Finally, I made it to the animal hospital. I was not well received. The receptionist informed me coldly that they did not treat wild animals. I begged her. I promised I would pay whatever the fee was. The vet, a young and kind looking woman, agreed to take a look at the squirrel as soon as she could, and suggested I come back just before closing time.

When I returned, I was handed a cat carrying box which contained a pretty eyed, anesthetized squirrel, resting peacefully. I was informed that he had sustained what looked to be a pretty serious head injury, and had been infested with fleas. He had been treated for both conditions. I was told to keep him safely in the box for 24 hours, and that if he survived the night, he would probably recover, and it would then be safe to release him. I was presented with a ninety-dollar bill, which I gratefully paid, and off we went home.

I watched the squirrel until late into the night. He cried pitifully and I vacillated between fearing he would die one moment, and wishing for us both to be put out of our misery the next. I barely slept all night and was thrilled to find him wide-eyed and alive the next morning. After seeing Kristen off to school, I reluctantly went to work, hating to leave him alone. On the way to my office, I began to consider keeping the squirrel for a pet. I thought about him off and on all day - about my investment in his rescue, and my growing attachment to and sense of ownership of him. I vacillated back and forth and by the end of the day, I reluctantly accepted what I had to do.

That night, I watched with sadness and with pride, as Kevin set my squirrel free. As my little friend scampered away, I watched him disappear with both a sense of longing as well as satisfaction.

My story was over. We sat again in silence for a time. Then I added, "When you invest a huge part of yourself into something or someone, it almost begins to seem as though some part of them belongs to you, even though you know realistically that we belong only to ourselves. Sometimes, all we get to do is care for something or someone and then have to let go." I paused for a moment, searching for what I would say next and then continued. "We usually feel a significant loss in the letting go, we can even feel abandoned. We might even begin to wonder why we bothered in the first place. What we don't always recognize is that we're never left empty handed. We can hold on to the satisfaction and pride that comes from knowing that we've participated in someone's growth or healing, that our lives have made a difference. "

You smiled at me, and I knew immediately that you understood. It seems my friend that you always do.

Yours Always, A Fellow Traveler

next: Life Letters: Pass It On

Proper breathing can reduce stress and anxiety levels. Learn about breathing and stress and breathing techniques to help you relax.

The primary role of breathing is gas exchange: our cells need oxygen and their waste product, carbon dioxide, needs to be expelled. Breathing is an automatic body function, controlled by the respiratory center of the brain. However, we can also deliberately change our rate of breathing.

Different healing systems, from different cultures, have long realized the healing benefits of the breath, including Yoga, Tai Chi, and some forms of meditation. Many holistic practitioners believe that the breath is the link between the physical body and the ethereal mind, and that spiritual insight is possible through conscious breathing.

Regardless of the philosophy, scientific studies have shown that correct breathing can help manage stress and stress-related conditions by soothing the autonomic nervous system.

A range of disorders
The use of controlled breathing as a means of promoting relaxation can help manage a range of disorders, including:

• Anxiety
• Asthma
• Chronic fatigue syndrome
• Chronic pain
• High blood pressure
• Insomnia
• Panic attacks
• Some skin conditions, such as eczema
• Stress.

How we breathe
To stay inflated, the lungs rely on a vacuum inside the chest. The diaphragm is a sheet of muscle slung underneath the lungs. When we breathe, the diaphragm contracts and relaxes. This change in pressure means that air is 'sucked' into the lungs on inhalation and 'pushed' out of the lungs on exhalation.

The intercostal muscles between the ribs help to change the internal pressure by lifting and relaxing the ribcage in rhythm with the diaphragm. Flexing the diaphragm requires the use of the lower abdominals. If your abdomen gently moves in and out while you breathe, then you are breathing correctly.

Breathing and stress
The brain sets the breathing rate according to carbon dioxide levels, rather than oxygen levels. When a person is under stress, their breathing pattern changes. Typically, an anxious person takes small, shallow breaths, using their shoulders rather than their diaphragm to move air in and out of their lungs. This style of breathing empties too much carbon dioxide out of the blood and upsets the body's balance of gases. Shallow over-breathing - or hyperventilation - can prolong feelings of anxiety by exacerbating physical symptoms of stress, including:

• Chest tightness
• Constant fatigue
• Faintness and lightheadedness
• Feelings of panic
• Headaches
• Heart palpitations
• Insomnia
• Muscular aches, twitches or stiffness
• Tingling, numb and cold hands and face.

The relaxation response
When a person is relaxed, their breathing is nasal, slow, even, and gentle. Deliberately mimicking a relaxed breathing pattern seems to calm the autonomic nervous system, which governs involuntary bodily functions. Physiological changes can include:

• Lowered blood pressure and heart rate
• Reduced amounts of stress hormones
• Reduced lactic acid build-up in muscle tissue
• Balanced levels of oxygen and carbon dioxide in the blood
• Improved immune system functioning
• Increased physical energy
• Feelings of calm and wellbeing.

Abdominal breathing

There are different breathing techniques to bring about relaxation. In essence, the general aim is to shift from upper chest breathing to abdominal breathing. You will need a quiet, relaxed environment where you won't be disturbed for 10 to 20 minutes. Set an alarm if you don't want to lose track of time.

Sit comfortably and raise your ribcage to expand your chest. Place one hand on your chest and the other on your abdomen. Take notice of how your upper chest and abdomen are moving while you breathe. Concentrate on your breath and try to breathe in and out gently through the nose. Your upper chest and stomach should be still, allowing the diaphragm to work more efficiently with your abdomen and less with your chest.

With each breath, allow any tension in your body to slip away. Once you are breathing slowly and with your abdominals, sit quietly and enjoy the sensation of physical relaxation.

Special considerations
Some people find that concentrating on their breath actually provokes panic and hyperventilation. If this is the case, look for another way to relax.

Where to get help

• Your doctor
• Stress management specialist, such as a psychologist

Things to remember

• Shallow, upper chest breathing is part of the typical stress response.
• The stress response can be switched off by consciously breathing with the diaphragm.
• Abdominal breathing plugs into the autonomic nervous system and encourages it to relax, bringing about a range of health benefits.

Self-Therapy For People Who ENJOY Learning About Themselves

Since you are competent enough to read and understand this, the question isn't whether you need therapy but whether you want it. And whether you want it enough.

You can decide if you want therapy enough by weighing the expected costs against the expected rewards.

You can evaluate the costs by thinking about money, time, and energy.

FINANCIAL COSTS

Your out of pocket costs can range from nothing (for those with great insurance) to much more than $150 per hour (for those who need a psychiatrist and must pay on their own).

You need a psychiatrist if you have medical complications related to therapy. Most therapists are "clinical social workers" and some are "clinical psychologists."

If you need medication you might see a psychiatrist just once or occasionally and sometimes for less than an hour but you'd see the social worker or psychologist for your regular meetings.

Fees vary greatly. Competence is not directly related to fees! Fees are mostly related to the therapist's circumstances:
overhead, agency policies, lifestyle, etc. [My monthly rate is low because of low expenses. Ask for info if you want telephone counseling or could see me in person in Milwaukee.]

Finances should not keep you out of therapy. If you can't afford the fees and have no insurance, call a Family Service agency or call the local Mental Health Association. They can find help based on your ability to pay. (If you have enough income but prefer to spend it on other things, you don't want therapy enough...)

One of the best ways to evaluate whether you want therapy enough is simply to ask yourself:
"Would it be worth an hour of my time and energy each week to talk to a therapist about the things I want to improve about my life?"

If the answer to this question is "Yes," then you probably want therapy enough.

If the answer is "No," you probably don't want it enough. (Unless deciding to value yourself is one of the problems you should work on.)

It is reasonable to assume that you will at least learn to understand yourself and your situation very well through therapy.

Since nothing is perfect, it is not reasonable to assume that you will solve all of the problems in your life.

When I end therapy with someone, I ask them to rate everything they wanted to change during therapy.
They then put a percentage on each item to indicate the degree to which we were successful or unsuccessful.

Most people report improvement in all areas, and enough improvement to be quite happy about it on 90% of the things they wanted to change.

The Best Ways To Find A Good Therapist:

• Go back to any therapist you had in the past if you were happy with their work.

• Ask your friends what they like about their therapists, and notice if these same factors are important to you.

Don't rely on your insurance company. Their primary interest is in keeping costs down. They usually refer to therapists who agree to follow the insurance company's very restrictive guidelines for short-term therapy.

Remember: You Are Hiring The Therapist. You decide if they are right for you, and you have every right to shop around if you want. A therapist should feel like a good match for you, regardless of their credentials.

One of the most important factors in finding a good therapist is whether the therapist truly believes he or she can help you. Notice their level of personal confidence.

Something is very wrong if your therapist believes they know you better than you know yourself or if the therapist acts "superior" in any way.

Therapists are the experts on the therapy process. You are the expert on yourself!

Enjoy Your Changes!

Everything here is designed to help you do just that!

next: Depression In The Culture

Self-Therapy For People Who ENJOY Learning About Themselves

On September 11, 2001 the World Trade Center in New York was completely destroyed, and the Pentagon, the center of American military power, was greatly damaged as well.

About three thousand people died. All U.S. citizens, and citizens of all other countries, were in shock.

I was scheduled to attend a professional workshop six days after this attack.

Since a friend of mine traveled quite a distance to attend the workshop with me, I decided to go even though my mind wasn't at all on the subject.

The workshop itself was not good, but, because of the attack, the instructor handed us the following quote which she said was written by "Mother Theresa" (a famous religious figure from Belgium).

As soon as I read it I knew I wanted to share it with you, even though I've only wanted to put my own writing at this site, and even though my own definition of "God" might differ from hers.

Here it is. I hope it holds as much meaning for you as it does for me.

People are often unreasonable, illogical, and self-centered.
Forgive them anyway.
If you are kind, people may accuse you of selfish, ulterior motives.
Be kind anyway.
If you are successful, you will win some false friends and some true enemies.
Succeed anyway.
If you are honest and frank, people may cheat you.
Be honest and frank anyway.
What you spend years building someone could destroy overnight.
Build anyway.
If you find serenity and happiness, they may be jealous.
Be happy anyway.
The good you do today, people will forget tomorrow.
Do good anyway.
Give the world the best you have, and it may never be enough.
Give the world the best you have anyway.
You see, in the final analysis, it is between you and God.
It was never between you and them anyway.

next: Are You Expecting Too Much?

Articles to help you improve in your relationships, family, at work, with any addictions you may have. Learn how to feel better and improve yourself.

Click on a link to see the menu of articles on that specific topic

• I'm curious about myself.
• I'm curious about my mental health knowledge.
• I'm a therapist or other helping professional.
• I want to improve and I am willing to work on myself for a while.
• I may be depressed.
• I am often scared or anxious.
• I often feel ashamed.
• I often feel futile or hopeless.
• I want to learn about child abuse.
• I want to learn about addictions.
• I want help with my love relationship.
• I want help socially, with all kinds of relationships.
• I want help with children or with family problems.
• I want help about employment problems.
• Topics everyone should eventually read

back to: Inter Dependence Homepage

Chapter 78 of the book Self-Help Stuff That Works

by Adam Khan

YEARS AGO I READ the book Shogun, by James Clavell, about the Japanese samurai (professional warriors). A samurai gave total allegiance to his liege lord and would die for him without question. The whole system was filled with honor and loyalty and was very beautiful in that respect.

While reading the book, I started treating my boss like my liege lord. What a difference it made! My attitude toward my boss changed and my boss's attitude toward me changed dramatically. The working relationship became smoother, more friendly and more efficient. I did everything my boss asked me to do, to the best of my ability and without question. Of course, if my boss asked me to jump off a bridge, I wouldn't have, but usually bosses don't ask employees to do anything but their jobs.

I've often seen a different kind of attitude in the workplace, however, and I'm sure you've seen it too. It can be stated as "I'm not going to kiss anyone's ass!" This attitude is characterized by arguing with the boss when asked to do something or trying to get away with not doing it very well. These people, even more than the rest of us, don't like being told what to do, and actively resist it, which forces the boss to bear down to maintain control, turning the working relationship into an unnecessarily antagonistic contest of wills.

I've worked with people who got along great with everyone except the boss. And I've worked in places where I had a great boss, but my coworkers had a supreme jerk for a boss - and it was the same person. My "samurai" attitude had changed my boss for me.

In a way, your attitude toward a person creates that person. Interact with someone with a chip on your shoulder and the person will usually respond defensively. Approach someone with friendliness and cooperation and the person is likely to respond in kind. We play a part in creating the way someone treats us.

Do you want to stand out? Treat your boss like a liege lord and do what she or he asks you to do cheerfully, without question, and to the best of your ability and you will stand out. In your boss's mind, you will contrast sharply with the people who don't want to be told what to do. And it'll be more enjoyable for you to be at work.

Create a boss you enjoy working with. In actual behavior, the difference isn't much. You won't be any more tired or worn out by it. But you and your organization will be better off when you adopt a samurai attitude.

Treat your boss like a liege lord.

Here's a way to make your work more enjoyable.
Play the Game

One way to be promoted at work and succeed on the job may seem entirely unrelated to your actual tasks or purpose at work.
Vocabulary Raises

This is a simple technique to allow you to get more done without relying on time-management or willpower.
Forbidden Fruits

Here is a way to turn your daily life into a fulfilling, peace-inducing meditation.
Life is a Meditation

A good principle of human relations is don't brag, but if you internalize this too thoroughly, it can make you feel that your efforts are futile.
Taking Credit

next: Unnatural Acts

Magnetic Therapy, Electroconvulsive Therapy and Acupuncture are reviewed here as experimental procedures for bipolar disorder.

Magnetic Therapy. Repeated transcranial magnetic stimulation (rTMS) is also being studied for depression and bipolar disorder. Unlike ECT, this procedure appears not to cause seizures, memory lapses, or impaired thinking. The only side effect reported is a mild headache. One study in patients with unipolar depression found that after one year relapse rates were significantly lower after rTMS than after ECT, although only a few small studies have been conducted using this procedure and it still needs refinement.

Acupuncture. The first study on acupuncture as an add-on therapy for bipolar disorder is currently underway in the US. Some studies have suggested that acupuncture may affect part of the nervous system that regulates the stress response, which might aid patients with bipolar disorder.

next: The Impact of Antidepressant Discontinuation on Relapse, Remission, and Mood Episode Cycling in Bipolar Disorder
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