The issue does not seem to be tackled with the urgency it deserves, and this is even more accentuated in Malta where even the most basic research on mental health among the Maltese population is lacking, Ms Gauci explained.

TMID interviewed Ms Gauci in view of a chain of educational activities that the Richmond Foundation will be organising, starting Thursday 23 September with a seminar on bipolar disorder.

“We do not have any local statistics of people who suffer from bipolar disorder. But research in a number of countries suggests that there is a stable two per cent in every country who suffer from this condition. Therefore we assume that Malta stands somewhere along these lines.”

Given certain characteristics of this disease that make it particularly hard to diagnose, the percentage could rise in the near future as better diagnosis methods are found.

Bipolar disorder is commonly known as manic depression. People who suffer from it go through mood swings that alternate between depressive periods to manic, over excited, episodes.

The problem with this mood alternation is that the condition is often misdiagnosed as depression, and therefore inappropriately treated. Research shows that, on average, it takes 10 years to accurately diagnose bipolar disorder from the patient’s first mood episode.

There is no specific age at which a person can start suffering from this disorder. Research shows that it is distributed equally between men and women and that it also transcends social class, therefore making it probable that it the disease has a strong physical basis.

Ms Gauci said that when patients go through manic periods they feel very energetic, able to do anything they choose and generally in a very good mood. They may have racing thoughts and speech, poor

judgement, elation and euphoria,

inappropriate optimism, excessive spending and inflated sense of self-importance. They may even experience hallucinations.

When they go through these phases they will feel good so

usually it is their relatives or friends that detect that something is wrong.

Patients going through manic phases may take more risks, possibly become more promiscuous and generally engage in behaviour that is not in line with their character.

Conversely, during depressive episodes, patients often feel mental and physical slowing, loss of interest and energy, persistent lethargy, loss of concentration, irritability, anger, agitation, anxiety and a general self-doubtful pessimistic outlook.

When they are going through depressive periods, the patient will feel down and usually seek help during these phases.

“This is the thrust behind the educational campaign that we will be organising,” Ms Gauci said. Misdiagnosis of this condition is the result of lack of information. Unfortunately the condition is often diagnosed as depression because manic phases are often not seen in doctors’ clinics. As a consequence when general practitioners are approached for help, they are faced with depressive symptoms and are not given information about symptoms of manic periods.

Psychiatrists have learnt to differentiate some episodes within the condition from other, relatively routine, episodes. Mixed episodes, for example, present symptoms of manic and major depressive episodes at the same day for at least a week. On the other hand, hypomanic episodes are similar to manic episodes except that delusions and hallucinations are not present.

The patterns of illness vary considerably from person to person, and mood swings can be very rapid, making the illness hard to control and predict. Some patients have episodes of depression followed by mania while others may have periods of depression with occasional episodes of mania. Both phases may have the characteristic psychotic feature of hallucinations and delusions. With each additional mood episode, the risk of future episodes increases and the functioning between episodes progressively worsens, as do the probabilities of a good prognosis.

The condition is a serious life-long disorder that can have fatal or debilitating consequences. It is estimated that an average of 25-50 per cent of people who suffer from bipolar disorder will commit suicide. Ten to 15 per cent of these are successful. Suicide is usually contemplated during the depressive periods or mixed phases.

Misdiagnosis of the disorder leads to inappropriate treatment and further progression of the illness. There is no definitive cure for this disorder but there is therapy and medicine that can help manage the illness effectively by decreasing the associated symptoms. Bipolar patients are usually prescribed mood stabilisers. Antipsychotics – to treat mania – and antidepressants are also used when either phase is prolonged or particularly intense.

However it is a manageable condition and with the appropriate treatment people suffering from it can live a full and active life, Ms Gauci explained. “There are a number of well known personalities that suffered from bipolar disorder and still achieved great successes in life – people such as Abraham Lincoln, Winston Churchill, Isaac Newton, Leo Tolstoy and many others.

“I find the lack of research on local mental illnesses very frustrating, especially given the importance of the subject,” Ms Gauci said. “Unfortunately mental illness is still a taboo subject and is often treated lightly by people. People will go to their doctor when they experience symptoms of physical illness but somehow act differently when it comes to mental illness. There are a lot of cases when people suffering from depression are simply told to get a hang of themselves and cheer up, when in fact they are suffering from a mental condition that often has a physical basis.”

Asked whether the foundation would engage in research itself, Ms Gauci said at the moment the organisation was focusing its limited resources on consolidating its community projects. “In the future we would certainly like to explore the possibility of having our own research done but we have to be cautious and take one step at a time.

“EU funding is another option but, there again, accessing funds requires an investment in legal research, which at the moment the foundation does not have at its disposal. Hopefully with the educational campaigns planned we will be able to attract interest not only from the public but also from prospective researchers and not only from psychiatry but also psychology.”

Richmond Foundation is a non-profit organisation, affiliated to Richmond Fellowship. The organisation has been working for the past eleven years in promoting mental health issues and providing people suffering from mental disorders with community services.

Over the years the foundation has lunched a number of projects aimed at de-institutionalising mental health patients, whenever possible, through their half-way-house, Villa Chelsea, housing opportunities throughout Malta and community services.

Anyone interested in the seminar, Bipolar disorder: a call to action can phone the foundation’s headquarters for more information or book a seat on telephone numbers 2148-2366, 2144-0324 or email address [email protected]