Copyright 2017 by Lorelei Woerner, OTR/L, C-IAYT

Transcription

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2 All rights reserved. This presentation, or any portion thereof, may not be reproduced or used in any manner whatsoever without the express written permission of the publisher/producer. Thank you

3 Bipolar disorder is a neurobiological disorder that occurs in a specific area of the brain and is due to the dysfunction of neurotransmitters (chemical messengers) in the brain. These chemicals may involve norepinephrine, serotonin and probably many others.

4 No one cause Genetic component/ family history Bipolar disorder is not directly passed from one generation to another genetically. It is the result of a complex group of genetic, psychological, and environmental factors. Neurochemical High amounts of stress over long period (social stressors) Multiple stressors linked to societal reactions/ not accepted

5 The current thinking is that this is a predominantly neurobiological disorder that occurs in a specific part of the brain and is due to a malfunction of certain brain chemicals (that occur both in the brain and the body). Three specific brain chemicals have been implicated serotonin, dopamine and noradrenaline. As a neurobiological disorder, it may lie dormant and be activated spontaneously or it may be triggered by stressors in life. Serotonin -- controls sleep, aggression, eating, sexual behavior, mood Norepinephrine -- helps our bodies recognize and respond to stressful situations Dopamine -- plays a role in controlling our drive to seek out rewards, as well as our ability to obtain a sense of pleasure Neurobiological Disorder an illness of the nervous system caused by: genetic, metabolic or other biological factors (also autism, ADHD, OCD, schizophrenia, tourettes)

6 Bipolar disorder, also called manic depressive disorder, is characterized by severe mood swings, at least one episode of mania and may include repeated episodes of depression. Too much activity in the limbic system and too little in the frontal lobes (which inhibit action). Significantly, these are present even when no symptoms are present

7 The PFC Dorsolateratal attention and decisions Orbitofrontal emotional responses Ventrolateral Behavior and judgment

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9 Mania (elevated, expansive) Racing thoughts one cannot control Rapid, frenzied speech Decreased need for sleep Grandiose beliefs about superiority Repeatedly changing topics in the middle of a conversation without notice Impulsivity Lack of good decision making and judgements Anger, rage, aggression, irritability Depressed feelings, lack or worth Mood swings Loss of interest in normal daily activities/ people Increased or decreased weight loss Low energy and fatigue Suicidal thoughts and self-harm

10 Unipolar Depressed, sad (dysphoric) Loss of interest and pleasure Extreme fatigue Decreased sexual drive Decreased motivation Withdrawal and isolation No desire to talk, interact, socialize Lack of attention to hygiene Accusatory, self-blaming Dwelling on guilt, personal failures Difficulty concentrating, remembering Heightened sensory sensitivities Bipolar Expansive,high (euphoric) Irritable, critical, argumentative Decreased need for sleep Hypersexuality Impulsive Intrusive and uninhibited Anger and rage Disroganized and easily distracted Recklessness, spending money Inflated self concept, lack of insight Difficulty concentrating, remembering Racing thoughts, pressured speech Decreased sensitivity, seeks excess stimulation

11 1. Acting without appropriate amount of deliberation, planning, foresight, consideration of consequences. Rapid, unplanned reactions to internal or external stimuli, which are poorly planned, prematurely expressed, risky, or inappropriate. May result in negative consequences and impede long-term goals or strategies for success. 2. Choosing short-term gains over long-term ones (delayed gratification) Delayed Gratification is the ability to resist the temptation for an immediate reward (typically smaller) and wait for a later reward (typically a larger one) It includes Self-Regulation concepts such as: patience, impulse control, self-control, willpower Growing research demonstrates that the ability to delay gratification is linked to academic success, physical health and social competence

12 Research is beginning to note dopamine s effect on impulsive decision making. In a study, participants who received L-DOPA (precursor to Dopamine) were more likely to make shortersooner choices with impulsive tendencies rather than delaying gratification for greater goals ADHD is associated with higher dopamine levels

13 Bipolar I -- has at least one manic episode, and usually one severe depressive episode. Bipolar 1, Mixed more common, attacks of pure mania distinct from depressive episode. Can display symptoms of mania and depression simultaneously. Risk of suicide due to energized state of despair. Bipolar II recurrent, severe depressive episodes with swing into hypomanic episodes. They do not become psychotic and often overlook periods of hypomania or interpret them as feeling great! They seek treatment only for depression. Problem: if only get anti-depressant, it may trigger Rapid cycling -- four or more mood disordered episodes per year. Can be triggered by antidepressants. Ultradian cycling -- a rare, more chronic form where fluctuations occur many times a day.

14 Feel very happy or act silly in a way that s unusual. Have a very short temper. Talk really fast about a lot of different things. Have trouble sleeping but not feeling tired. Have trouble staying focused.

15 Have an increase in agitation Trouble sleeping Have major changes in appetite Suicidal thoughts Feeling very sad Feeling hopeless Feeling extremely energized

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18 No definitive test to diagnose it Medication Diet changes Exercise daily in morning Reduce stress Support system Psychotherapy & talk therapy

19 Motivation necessary to persist with determination when things become challenging Concentration/Reflection In order for our brain to absorb information, we must focus on the task and think deeply about it. Environment distractions can interfere with concentration Attainable Tasks in order to learn larger concepts and tasks, they must be broken down into small achievable steps Feeling Success without which it becomes too difficult to keep up motivation

20 Strategies To Decrease Arousal Level Reduce novelty Reduce complexity/grade task Reduce verbal instructions, tone and volume of voice, speed of speaking, flatter tone Reduce directions to your primary goal Decrease sensory stimuli Provide proprioceptive input Facilitate soft, low tone sounds

21 Strategies To Increase Arousal Level Use novel activities Use intrinsically motivating activities Increase stimuli and sensory input (high intensity and irregular rhythm) Increase tone and volume of voice, speed of speaking, more dynamic Facilitate strong low tone sounds

22 The ability to use both sides of the brain and body simultaneously and in a coordinated manner. The Corpus Callosum is involved in communication between the hemispheres, eye movement and vision, balancing arousal and attention, sensory registration, cognition and processing speed. Typical neurological development occurs between the ages of 3 and 10 years and is the indicator that the two sides of the brain are communicating effectively.

23 1. Symmetrical both sides doing the same thing (clapping, hopping) 2. Reciprocal one side doing the exact opposite movement of the other side and alternating (climbing stairs, skipping, riding a bicycle) 3. Cross Lateral movement involving diagonal extremities (crawling or cross crawl, where right arm and left leg are moving simultaneously) 4. Assymmetrical separate actions for same goal, both sides working on the same task, each performing a different action. Dominant hand does the main task and non-dominant hand is the helper (holding paper and cutting, throwing up a ball and hit with the other hand). 5. Crossing Midline -- spontaneously crossing midline of the body to complete a motor task on the opposite side (using one arm to pull a sleeve over the opposite arm).

24 Avoiding crossing midline Right-left confusion Lack of age-appropriate development of a skilled/preferred hand use Inefficient sequencing or projected movements Often seen with postural-ocular movement disorders Theorized to be related to vestibular-proprioceptive processing deficits. It is a disorder of motor planning characterized by problems with planning and producing bilateral and projected action sequences. (Fisher, Murray, Bundy, 1991)

25 Praxis is a uniquely human skill requiring conscious thought and enabling the brain to conceptualize, organize, and direct purposeful interaction with the physical world. It is a very complex activity involving many parts of the brain -- frontal lobe, parietal lobe, thalamus and cerebellum. (Ayres, Mailloux and Wendler, 1987) Praxis is a form of critical thinking that combines reflection and action

26 3 Components of Praxis: 1. Ideation is the ability to come up with a novel motor action, generate an idea of what to do. This is a cognitive process that relates to EF functions. 2. Motor Planning is the ability to organize a novel action in space and time, knowing how to do it. This is a blend of cognitive and motor processes. 3. Execution involves the neuromuscular ability to perform the task, and is therefore sometimes considered separate from praxis.

27 Resolving Conflict Stick to specifics Avoid extreme statements Take responsibility for your position Keep your tone even Take the person out of emotionally manipulative mode ( Tell me what you want, and let s discuss it. ) Stay away from expressing strong feelings yourself Listen/be empathetic without judgment. Methods: change your approach, concede, chance (such as flip a coin), compromise, creative alternative.

28 Dealing with Anger Notice warning signs and set limits before behavior escalates Give a 5-point anger scale Ask them to describe feelings rather than acting on them Reinforce a choice in terms of how they communicate their anger. Stand when they stand, and ask them to sit back down to talk. Lots and lots of positive regard when you can

29 Dealing with Anger (cont) Teach your student to stop and think before reacting. Encourage them to take a moment to stop, breathe, reflect, and choose a positive and productive course of action instead of an impulsive angry one. Teach Assertiveness in place of aggression -- make needs or distress known directly (avoid you always and you never ). Good templates to use are: I feel when you and I would really appreciate it if you could. You may not always get your way, but you may have your say

30 Bṛmhana practice when in depression May need to activate the person to reduce anxiety, especially in the morning when depressed Recommend a daily walk first thing in the morning ( 1/2 hour) Good to have them do the practice with a family member if they are depressed- to motivate them and increase compliance. Active standing postures, with chanting in postures Vinyāsa such as sūrya namaskār Use bṛmhana sounds such as ha, ra, hṛām, the bīja mantra series for the sun Consider sun visualization with postures and in meditation Langhana when in mania Apāna region focus to promote the relaxation response Sounds such as namo namaha a Chant santi and om to reduce anxiety. Finger nyasam and mantra.

31 Encourage exercise every morning when cortisol is highest Diet is fresh foods, no processed foods if possible (tamas) Consider what the symptoms are ( type of bipolar)