Bipolar Disorder Ashleigh Pigusch
What do these people have in common? Vivien Leigh Carrie Fisher Jean-Claude Van Damme Linda Hamilton Sinéad O'Connor Virginia Woolf Jane Pauley Mariette Hartley Catherine Zeta-Jones Vincent van Gogh
What is Bipolar I Disorder? First references go back to as early as the second century BC Mania Emil Kraepelin- Manic- Depressive Insanity and Paranoia Laid groundwork for future Formally known as Manic- Depressive Disorder Characterized as a mood disorder Severe mood swings- high highs (mania) and low lows (depression) Associated with high creativity Colom, F. et. al, 2006, DSM-IV-TR, 2000; Newman, C.F. et. al, 2002
Defining Features of Bipolar I Disorder Axis I diagnosis One or more manic or mixed episode Asymptomatic between episodes With age episodes become more frequent and longer Can include euphoria, anger, and irritability Cyclic patterns of mood, behavior, and thoughts Suicidal ideation Anxiety Loss of energy and sleep problems Dehabilitating 6 subclasses DSM-IV-TR, 2000; Johnson, S.L. et. al (Eds), 2004; Preston, J.D. et. al, 2010
Epidemiology of Bipolar I Disorder Lifetime Prevalence- 0.4%- 1.6% Suicidal rate- 15-20% Ratio of Men to women- very evenly distributed 1:1 Age of onset- between 20-40 years of age 10-15% of adolescents with recurrent Major Depressive Episodes eventually develop Bipolar I 60-65% have positive family history Psychotic features- 47-75% Average episodes in lifetime- 7-9 Recovery time from depressed, manic or mixed state- 5-14 weeks DSM-IV-TR, 2000; Miklowitz, D.J. et. al, 1997; Newman, C.F. et. al, 2002;Preston, J.D. et. al, 2010
Etiology of Bipolar I Disorder Genetic Factors High rate family history Neurotransmission Theories Signaling pathways Low serotonin Circadain Dysregulation Instability in the body Psychological Theories Psychoeducation DSM-IV-TR, 2000; Frank, E., 2005; Newman, C.F. et. al, 2002; Preston, J.D. et. al, 2010
Diagnostic Criteria Bipolar I Disorder, Single Manic Episode Presence of only one Manic Episode and no past Major Depressive Episodes Manic Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified Specify its current clinical status/features Mild, Moderate, Severe without Psychotic Features or Severe with Psychotic Features Catatonic Features Postpartum Onset In Partial Remission/In Full Remission DSM-IV-TR, 2000
Diagnostic Criteria Bipolar I Disorder, Most Recent Episode Manic Currently (or most recently) Manic Episode There has previously been at least one Major Depressive Episode, Manic Episode, or Mixed Episode Mood Episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified Specify its current clinical status/features Mild, Moderate, Severe without Psychotic Features or Severe with Psychotic Features Catatonic Features Postpartum Onset In Partial Remission/In Full Remission DSM-IV-TR, 2000
Diagnostic Criteria Bipolar I Disorder, Most Recent Episode Mixed Currently (or most recently) in a Mixed Episode There has previously been at least one Major Depressive Episode, Manic Episode, or Mixed Episode Mood Episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified Specify its current clinical status/features Mild, Moderate, Severe without Psychotic Features or Severe with Psychotic Features Catatonic Features Postpartum Onset In Partial Remission/In Full Remission DSM-IV-TR, 2000
Assessment Structured Clinical Interview Self-Report Measures General Behavior Inventory (GBI) Parent General Behavior Inventory (P-GBI) Assessment in Children Kiddie Schedule for Affective Disorder and Schizophrenia (K-SADS) Baroni, A. et. al, 2008; Hunsley, J., Johnson, S.L. et. a (Eds), 2004; Mash, E.J., 2008
Treatment Medication Mood Stabilizer- Lithium Antidepressants Antipsychotics Benzodiazepines Cognitive Behavioral Treatment (CBT) Focuses on experiences during the depressed and manic phases Family Focused Therapy (FFT) Family understanding Goals- 6 of them Benefits Alloy, L.A. et. al, 2006; Miklowitz, D.J. et. al, 1997; Ngazimbi, E.E. et. al, 2008; & Patelis-Siotis et. al, 2001
Research and Controversies Controversy over use of antidepressants- increase rapid cycling Recommendations for length of antidepressants College population suffering from Bipolar I Disorder Alda, M. et. al, 2003; & Federman, R., 2011
Case Study What sticks out to you about this client? What possible diagnoses are there? What treatment plan would you use? Would family therapy be a part of the treatment plan? Would you use medication in the treatment plan? If so, what would you prescribe?
Thank you! Questions?