Download Bipolar Disorder I

Bipolar Disorder I
Kate Ueland
“Depression is a painfully slow, crashing death. Mania is the other extreme, a wild roller coaster run off its
tracks, an eight ball of coke cut with speed. It's fun and it's frightening as hell. Some patients - bipolar type I experience both extremes; other - bipolar type II - suffer depression almost exclusively. But the "mixed state,"
the mercurial churning of both high and low, is the most dangerous, the most deadly. Suicide too often results
from the impulsive nature and physical speed of psychotic mania coupled with depression's paranoid selfloathing.”
- David Lovelace, Scattershot: My Bipolar Family
DSM Criteria
O The essential feature of a Bipolar I Disorder is the
presence of at least
O one episode of mania; the patient may have
experienced mixed, hypomanic, and depressive
episodes as well.
O The criteria for pediatric Bipolar Disorder are not
defined, and adult criteria are typically used.
Children and adolescents often present with a
pattern of illness of very rapid, brief, recurring
episodes and/or rapid fluctuations in mood and
behavior, however pediatric diagnosis should be
made with caution.
Statistics
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Seven out of 10 people with bipolar disorder
receive one misdiagnosis.
30 %of people with untreated bipolar
disorder commit suicide.
Delayed diagnosis or misdiagnosis
contributes to 50 % of bipolar consumers
abusing alcohol or drugs.
An equal number of men and women
develop this illness and it is found among all
ages,
races, ethnic groups and social classes.
Average length of time from onset of
symptoms to diagnosis is 10 years.
Bipolar disorder accounts for approximately
$7.6 billion in direct healthcare costs in the
U.S.
Lifetime costs per consumer range from
$12,000 for a person with a single manic
episode to more than $600,000 for those
with multiple episodes.
The manifestation of
Bipolar disorder
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The biopsychosocial model is the leading theory regarding the cause of Bipolar
Disorder.
O biological vulnerabilities, such as carrying genes that make one more
susceptible, it is known that depressed individuals are often significantly
disturbed with regard to endocrine, immune, and neurotransmitter system
functioning.
O psychological factors, such as a bias toward pessimistic thinking, which make
one more vulnerable, deficits in coping skills, judgment problems, and
impaired emotional intelligence
O social factors, such as trauma,, early separation, lack of social support, or
harassment (bullying) can all contribute to vulnerability (Nemade, Reiss and
Dombeck 2007)
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The stress-diathesis model is the leading theory about how Bipolar Disorder is
triggered.
O Diathesis means vulnerability, and refers to things like genetic vulnerability.
O Stress means social and psychological stress which exceed our ability to
cope and increase our chances of illness onset and subsequent mood
episodes. (Nemade, Reiss and Dombeck 2007)
“It's difficult. I take a low dose of lithium nightly. I take an antidepressant for my darkness because
prayer isn't enough. My therapist hears confession twice a month, my shrink delivers the host, and I can
stand in the woods and see the world spark.”
- David Lovelace, Scattershot: My Bipolar Family
Signs and Symptoms
Mania or a manic episode include:
Mood Changes
O A long period of feeling "high," or an overly
happy or outgoing mood
O Extremely irritable mood, agitation, feeling
"jumpy" or "wired.“
Behavioral Changes
O Talking very fast, jumping from one idea to
another, having racing thoughts
O Being easily distracted
O Increasing goal-directed activities, such as
taking on new projects
O Being restless
O Sleeping little
O Having an unrealistic belief in one's abilities
O Behaving impulsively and taking part in a lot
of pleasurable, high-risk behaviors, such as
spending sprees, impulsive sex, and
impulsive business investments.
Depression or a depressive episode include:
Mood Changes
~ Along period of feeling worried or empty
~ Loss of interest in activities once
enjoyed, including sex.
Behavioral Changes
~ Feeling tired or "slowed down“
~ Having problems concentrating,
remembering, and making decisions
~ Being restless or irritable
~ Changing eating, sleeping, or other
habits
~ Thinking of death or suicide, or
attempting suicide.
Treatment Goals:
Pharmacotherapy
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Bipolar is a lifelong disease that swings from manic to depressive episodes that vary in
length and severity. Currently there is no cure for the disease and so treatment goals
focus on managing the episodes with pharmaceutical drugs. Psychotherapy has shown
to be very effective as an adjunct to pharmacotherapy.
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Three Phases of Drug Treatment:
Acute Phase - goal is to control the most severe symptoms of the manic, mixed or
depressive disorder (antipsychotic + mood stabilizer)
Stabilization Phase - goal is to help the patient fully recover from the acute phase
(antipsychotic + mood stabilizer)
Maintenance Phase – goal is to prevent recurrences and continue to treat residual
symptoms (antidepressant) (Barlow,2008).
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Medications: Mood Stabilizers: - Lithium carbonate, Anticonvulsants - Epakote,
Lamictal, Antipsychotics - Seroquel and Risperdal Antidepressants - Selective
serotonin reuptake inhibitors (SSRIs), Monoamine oxidase inhibitors (MAOIs) –
although antidepressants are used they haven’t been found to be as effective as mood
stabilizers.
Treatment Goals:
Psychotherapy
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Patients who are treated for Bipolar Disorder exclusively with pharmacotherapy tend
to have “breakout episodes”. Research has shown psychotherapy to help reduce the
frequency of breakout episodes. It also helps patients with symptom management by
providing a skill set to cope with stress triggers (e.g., life events and family tensions),
augment social and occupational role functioning, and to keep patients on their
medications (Barlow,2008).
O Psychotherapy Treatments:
~ Cognitive behavioral therapy (CBT) helps people with bipolar disorder learn to
change harmful or negative thought patterns and behaviors. The use of CBT group
therapy as part of the pharmacological treatment have demonstrated that after
treatment, participants presented fewer manic, depressive and anxiety symptoms and a
reduction in the frequency and duration of mood change episodes (Thomaz da
Costa,2010).
~ Family-focused therapy includes family members. It helps enhance family coping
strategies, such as recognizing new episodes early and helping their loved one
(Miklowitz, Simoneau, George, et. al. 2000). This therapy also improves
communication, problem-solving, enhanced lithium compliance, fewer relapses and a
reduced rehospitalization rate (Huxley, Parikh, & Baldessarini, 2000).
Treatment Goals:
Psychotherapy
~ Interpersonal and social rhythm therapy along with
medications, combines the basic principles of interpersonal
psychotherapy with behavioral techniques to help patients
regularize their daily routines, improve their relationships with
others and adhere to medication regimens. It modulates both
biological and psychosocial factors to mitigate patients’ circadian
and sleep–wake cycle vulnerabilities (Frank, 2000).
~ Psychoeducation teaches people with bipolar disorder about the
illness and its treatment and is usually done from a CBT approach
(Otto, Reilly-Harrington, Sachs 2003). This treatment helps people
recognize signs of relapse so they can seek treatment early, before a
full-blown episode occurs. Usually done in a group,
psychoeducation may also be helpful for family members and
caregivers. (Miklowitz, Simoneau, George, et. al. 2000).
“I know the empathy borne of despair; I know the fluidity of thought, the
expansive, even beautiful, mind that hypomania brings, and I know this is
quicksilver and precious and often it's poison. There has always existed a sort
of psychic butcher who works the scales of transcendence, who weighs out the
bloody cost of true art..”
- David Lovelace, Scattershot: My Bipolar Family
Challenges
~ Diagnosis can be tricky or go undiagnosed and is
often misdiagnosed as unipolar depression.
~ People not adhering to their medications and having
relapses in either manic or depressive episodes.
~ The distinction between bipolar disorder and Axis
II disorders is especially difficult
~ Reconciling with the idea that they have an illness.
This can be hard on both the patients and the family
members.
(Barlow, 2008)
Discussion
O From the presentation what other
challenges can you foresee as a health
counselor either from a personal or a
professional standpoint
O Which therapy focus resonates most with
each of you?
References
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Barlow, D.H. (2008). Clinical Handbook of Psychological Disorders – A Step-By-Step Treatment
Manual. New York: The Guilford Press. 421-462.
Frank, E. (2000) Interpersonal and Social Rhythm Therapy: Managing the Chaos of Bipolar Disorder.
Society of Biological Psychiatry,48,593–604.
Huxley, N.A., Parikh, S.V., & Baldessarini, R.J. (2000). Effectiveness of Psychosocial Treatments in
Bipolar Disorder: State of the Evidence. Harvard Rev Psychiatry, 8, 126–140.
Miklowitz, D.J., Simoneau, T.L., George, E.L. et. al. (2000). Family-Focused Treatment of Bipolar
Disorder: 1-Year Effects of a Psychoeducational Program in Conjunction with Pharmacotherapy.
Society of Biological Psychiatry, 48, 582–592.
National Institute of Health (2012). Bipolar Disorder.
http://www.nimh.nih.gov/health/publications/bipolar-disorder/index.shtml
Nemade R. Reiss S. Dombeck M. (2007) Current Understandings of Major Depression Biopsychosocial Model. http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=12997&cn=5
Otto, M.W., Reilly-Harrington, N. & Sachs, G.S. (2003). Psychoeducational and cognitive-behavioral
strategies in the
management of bipolar disorder. Journal of Affective Disorders, 73, 171–181.
Thomaz da Costa, R. et. al. (2010) The effectiveness of cognitive behavioral group therapy in treating
bipolar disorder: a randomized controlled study International Journal of Nursing Studies, 47, 896–908