Dr.

Anila Sadaf

BIPOLAR DISORDERS

1
Two broad types: Quick Guide to the
Mood Disorders
 Involves only depressive symptoms
 Involves manic symptoms (bipolar disorders)
DSM-5 Depressive Disorders:
 Major depressive disorder
 Persistent depressive disorder
 Premenstrual dysphoric disorder
 Disruptive mood dysregulation disorder
DSM-5 Bipolar Disorders:
 Bipolar I disorder
 Bipolar II disorder
 Cyclothymia
Quick Guide to the Bipolar Disorders
 Mood Episode

 A mood episode refers to any period of time when a patient feels abnormally happy or sad.

 Mood episodes are the building blocks from which many of the codable mood disorders are
constructed.
 Most patients with mood disorders (though not the majority of mood disorder types) will
have one or more of three different episodes.
 Without additional information, none of these mood episodes is a codable diagnosis.
Mood Episode
 Mood Episode

Major depressive episode

 It is characterized by extremely low moods, period of sadness and hopelessness

for at least 2 weeks.

 The patient feels depressed (or cannot enjoy life) and has problems with eating

and sleeping, guilt feelings, low energy, trouble concentrating, and thoughts

about death (suicide).

 Major Depressive
Episode

Diagnostic Criteria for Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same
2 week period and represent a change from previous functioning; at least one of
the symptoms is either
 depressed mood
 loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical
condition.
1. Depressed mood most of the day, nearly every day, as indicated by either
subjective report (e.g., feels sad,
empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In
 Major Depressive
Episode

2.Markedly diminished interest or pleasure in all, or almost all, activities most of

the day, nearly every day (as indicated by either subjective account or
observation).
3.Significant weight loss when not dieting or weight gain (e.g., a change of more
than 5% of body weight in a month), or decrease or increase in appetite nearly every
day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5.Psychomotor agitation or retardation nearly every day (observable by others, not
merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
 Major Depressive
Episode

7.Feelings of worthlessness or excessive or inappropriate guilt delusional) nearly

every day (not merely self- reproach or guilt about being sick).
8.Diminished ability to think or concentrate, or indecisiveness, nearly every day
(either by subjective account or as observed by others).
9.Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific plan for committing
suicide.
B. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or to
another medical condition.
 Major Depressive
Episode

D. The occurrence of the major depressive episode is not better explained by schizoaffective
disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified
and unspecified schizophrenia spectrum and other psychotic disorders.
E. There has never been a manic episode or a hypomanic episode.
 Mood Episode

Manic episode
 It is characterized by full blown high mood for at least 1 week.
 The patient feels elated (or sometimes only irritable) and may be grandiose,
talkative, hyperactive, and distractible.
 Bad judgment leads to marked social or work impairment; often patients must
be hospitalized.
 Manic Episode

Diagnostic Criteria for Manic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or
irritable mood and abnormally
and persistently increased activity or energy, lasting at least 1 week and present
most of the day, nearly every
day (or any duration if hospitalization is necessary).
B.During the period of mood disturbance and increased energy or activity, three
(or more) of the following symptoms (four if the mood is only irritable) are
present to a significant degree and represent a noticeable change from usual
behavior:
1. Inflated self-esteem or grandiosity.
 Manic Episode

4.Flight of ideas or subjective experience that

thoughts are racing.
5.Distractibility (i.e., attention too easily drawn
to unimportant or irrelevant external stimuli),
as reported or
observed.

6.Increase in goal-directed activity (either socially,

at work or school, or sexually) or psychomotor
 Manic Episode

C. The mood disturbance is sufficiently severe to cause marked impairment in

social or occupational functioning or to necessitate hospitalization to prevent
harm to self or others, or there are psychotic features.
D. The episode is not attributable to the physiological effects of a substance (e.g.,
a drug of abuse, a medication, other treatment) or to another medical condition.
Note: Criteria A–D constitute a manic episode. At least one lifetime manic
episode is required for the
diagnosis of bipolar I disorder.
Manic Episode
Depressive Vs. Manic
Episode
 Mood Episode

Hypomanic episode
 It is characterized by less severe than full blown episode but
differ from normal state.
 This is much like a manic episode, but it is briefer and less
severe.
 Hospitalization is not required.
 Hypomanic Episode

Diagnostic Criteria for Hypomanic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or
irritable mood and abnormally and
persistently increased activity or energy, lasting at least 4 consecutive days and
present most of the day, nearly
every day.
All other symptoms are same as maniac episode.
Mood Episode
Comparing Manic And
Hypomanic Episode
 Mood Disorder

 A mood disorder is a pattern of illness due to an abnormal mood.

 Nearly every patient who has a mood disorder experiences depression at
some time, but some also have highs of mood.
 Many, but not all, mood disorders are diagnosed on the basis of a mood
episode.

Bipolar And Related Disorders

 Approximately 25% of patients with mood disorders experience manic or
hypomanic episodes.
 Nearly all of these patients will also have episodes of depression.
 The severity and duration of the highs and lows determine the specific
bipolar disorder.
 Bipolar I Disorder

Diagnostic Criteria of Bipolar I Disorder

A. Criteria have been met for at least one manic episode.

B.The occurrence of the manic and major depressive episode(s) is not better
explained by schizoaffective disorder, schizophrenia, schizophreniform
disorder, delusional disorder, or other specified or unspecified
schizophrenia spectrum and other psychotic disorder. Approximately 25% of
patients with mood disorders experience manic or hypomanic episodes.
Bipolar I Disorder

 One or more Manic Episode or Mixed Manic Episode

 Minor or Major Depressive Episodes often present
 May have psychotic symptoms
 Specifiers:
 anxious distress,
 mixed features, rapid cycling,
 melancholic features, atypical features,
 mood-congruent psychotic features,
 mood incongruent psychotic features, catatonia,
 peripartium onset,
 seasonal pattern
 Severity Ratings: Mild, Moderate, Severe (DSM-5, p. 154)

APA (2013) 23
 Bipolar II Disorder

Diagnostic Criteria of Bipolar II Disorder

For a diagnosis of bipolar II disorder, it is necessary to meet the criteria for a current or
past hypomanic episode and the following criteria for a current or past major
depressive episode.
A. Criteria have been met for at least one hypomanic episode and at least one major
depressive episode
B. There has never been a manic episode.
C.The occurrence of the hypomanic episode(s) and major depressive episode(s) is not
better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder,
delusional disorder, or other specified or unspecified schizophrenia
spectrum and other psychotic disorder.
D.The symptoms of depression or the unpredictability caused by frequent alternation between
Bipolar II
 One or more Major Depressive Episode
 One or more Hypomanic Episode
 No full Manic or Mixed Manic Episodes
 Specifiers: anxious distress, mixed features,
rapid cycling, melancholic features, atypical
features, mood-congruent psychotic features,
mood incongruent psychotic features,
catatonia, peripartium onset, seasonal patter
 Severity Ratings: Mild, Moderate, Severe
(DSM-5, p. 154)
APA (2013) 25
 Cyclothymic Disorder

Diagnostic Criteria of Cyclothymic Disorder

A.For at least 2 years (at least 1 year in children and adolescents) there have been
numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic
episode and numerous periods with depressive symptoms that do not meet criteria for a
major depressive episode.
B.During the above 2-year period (1 year in children and adolescents), the hypomanic
and depressive periods have been present for at least half the time and the individual has
not been without the symptoms for more than 2 months at a time.
C. Criteria for a major depressive, manic, or hypomanic episode have never been met.
 Cyclothymic Disorder

D.The symptoms in Criterion A are not better explained by schizoaffective disorder,

schizophrenia, schizophreniform disorder, delusional disorder, or other specified or
unspecified schizophrenia spectrum and other psychotic disorder.
E. The symptoms are not attributable to the physiological effects of a substance (e.g., a
drug of abuse, a medication) or
another medical condition (e.g., hyperthyroidism).
F.The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
Cyclothymia

 For at least 2 years (1 in children and adolescents),

numerous periods with hypomanic symptoms that
do not meet the criteria for hypomanic

 Present at least ½ the time and not without for

longer than 2 months

 Criteria for major depressive, manic, or

hypomanic episode have never been met
APA (2013) 28
 Substance/Medication-Induced
Bipolar and Related Disorder

Diagnostic Criteria
A.A prominent and persistent disturbance in mood that predominates in the clinical
picture and is characterized by elevated, expansive, or irritable mood, with or without
depressed mood, or markedly diminished interest or pleasure in all, or almost all,
activities.
B. There is evidence from the history, physical examination, or laboratory findings of
both:
1.The symptoms in Criterion A developed during or soon after substance intoxication or
withdrawal or after exposure to a medication.
2. The involved substance/medication is capable of producing the symptoms in
Criterion A.
 Substance/Medication-Induced
Bipolar and Related Disorder

C.The disturbance is not better explained by a bipolar or related disorder that is not
substance/medication-induced. Such evidence of an independent bipolar or related
disorder could include the following:
D. The disturbance does not occur exclusively during the course of a delirium.
E.The disturbance causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
 Bipolar and Related Disorder Due to
Another Medical Condition

Diagnostic Criteria
A.A prominent and persistent period of abnormally elevated, expansive, or irritable
mood and abnormally increased activity or energy that predominates in the clinical
picture.
B. There is evidence from the history, physical examination, or laboratory findings
that the disturbance is the direct
pathophysiological consequence of another medical condition.
C. The disturbance is not better explained by another mental disorder.
D. The disturbance does not occur exclusively during the course of a delirium.
E.The disturbance causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning, or necessitates hospitalization to
 Specifiers Of Bipolar and
Related Disorder

Specifiers
Two special sets of descriptions can be applied to a number of the mood
episodes and mood disorders.

1. Specifiers describing current or most recent episode

These descriptors help characterize the most recent major depressive episode;
all but the
first two can also apply to a manic episode. (Note that the specifiers for
severity and remission).

2. Specifiers describing course of recurring episodes

These specifiers describe the overall course of a mood disorder, not just the
 Specifiers Of Bipolar and
Related Disorder

Specifiers Describing Current Or Most Recent Episode

1. With atypical features.
These depressed patients eat a lot and gain weight, sleep excessively, and have
a feeling of being sluggish or paralyzed. They are often excessively sensitive
to rejection.

2. With melancholic features.

This term applies to major depressive episodes characterized by some of the “classic”
symptoms of severe depression. These patients awaken early, feeling worse than they
do later in the day. They lose appetite and weight, feel guilty, are either slowed down
or agitated, and do not feel better when something happens that they would normally
 Specifiers Of Bipolar and
Related Disorder

Specifiers Describing Current Or Most Recent Episode

3. With anxious distress.

A patient has symptoms of anxiety, tension, restlessness, worry, or fear that
accompanies a mood episode.

4. With catatonic features.

There are features of either motor hyperactivity or inactivity. Catatonic features
can apply to major depressive episodes and to manic episodes.
 Specifiers Of Bipolar and
Related Disorder

5. With mixed features.

Manic, hypomanic, and major depressive episodes may have mixtures of manic
and depressive symptoms.

6. With peripartum onset.

A manic, hypomanic, or major depressive episode (or a brief psychotic disorder)
can occur in a woman during pregnancy or within a month of having a baby.

7. With psychotic features.

Manic and major depressive episodes can be accompanied by delusions,
which can be mood-congruent or incongruent.
 Specifiers Of Bipolar and
Related Disorder

Specifiers Describing Course Of Recurring Episodes

1. With rapid cycling.

Within 1 year, the patient has had at least four episodes (in any combination) fulfilling
criteria for major depressive,
manic, or hypomanic episodes.

2. With seasonal pattern.

These patients regularly become ill at a certain time of the year, such as fall or winter.
 Specify
If

 Remission
 2 to 7 weeks without meeting DSM criteria
 Recovery
 8 weeks without meeting DSM criteria
 40% to 100% will recover in a period of 1 to 2 years
 Relapse
 2 weeks meeting DSM criteria
 60% to 70% of those that recover relapse on average
between 10 to 12 months
 Chronic
 Failure to recover for a period of at least 2 years
Unspecified Bipolar and Related Disorder

 Bipolar features that do not meet criteria for any

specific bipolar disorder.

APA (2013) 38
 Manic Episode Criteria

◦ A distinct period of abnormally and persistently elevated, expansive, or irritable mood.

◦ Lasting at least 1 week.

◦ Three or more (four if the mood is only irritable) of the following symptoms:

1. Inflated self-esteem or grandiosity

2. Decreased need for sleep
3. Pressured speech or more talkative than usual
4. Flight of ideas or racing thoughts
5. Distractibility
6. Psychomotor agitation or increase in goal-directed activity
7. Hedonistic interests

APA (2013 39
Manic Episode Criteria
(cont.)
◦ Causes marked impairment in occupational functioning in
usual social activities or relationships, or

◦ Necessitates hospitalization to prevent harm to self or

others, or

◦ Has psychotic features

◦ Not due to substance use or abuse (e.g., drug abuse,

medication, other treatment), or a general medial
condition (e.g., hyperthyroidism).
◦ A full manic episode emerging during antidepressant
treatment

APA (2013) 40
DSM-5 Diagnosis

 Hypomanic Criteria
 Similarities with Manic Episode
 Same symptoms

 Differences from Manic Episode

 Length of time
 Impairment not as severe
 May not be viewed by the individual as pathological
 However, others may be troubled by erratic behavior

APA (2013) 41
DSM-5 Diagnosis

 Major Depressive Episode Criteria

 A period of depressed mood or loss of interest or
pleasure in nearly all activities
 In children and adolescents, the mood may be
irritable rather than sad.
 Lasting consistently for at least 2 weeks.
 Represents a significant change from previous
functioning.

APA (2013) 42
DSM-5 Diagnosis

 Major Depressive Episode Criteria (cont.)

 Five or more of the following symptoms (at least one of which is
either (1) or (2):
1) Depressed mood
2) Diminished interest in activities
3) Significant weight loss or gain
4) Insomnia or hypersomnia
5) Psychomotor agitation or retardation
6) Fatigue/loss of energy
7) Feelings of worthlessness/inappropriate guilt
8) Diminished ability to think or concentrate/indecisiveness
9) Suicidal ideation or suicide attempt

APA (2013) 43
DSM-5 Diagnosis
 Major Depressive Episode Criteria (cont.)
◦ Causes marked impairment in occupational
functioning or in usual social activities or relationships
◦ Not due to substance use or abuse, or a .general
medial condition
◦ Not better accounted for by Bereavement
 After the loss of a loved one, the symptoms persist for
longer than 2 months or are characterized by marked
functional impairment, morbid preoccupation with
worthlessness, suicidal ideation, psychotic symptoms, or
psychomotor retardation

APA (2013) 44
DSM-5 Diagnosis
 Rapid-Cycling Specifier
◦ Can be applied to Bipolar I or II
◦ Four or more mood episodes (i.e., Major Depressive,
Manic, Mixed, or Hypomanic) per 12 months
◦ May occur in any order or combination
◦ Must be demarcated by …
 a period of full remission, or
 a switch to an episode of the opposite polarity
 Manic, Hypomanic, and Mixed are on the same pole

◦ NOTE: This definition is different from that used in some

literature, where in cycling refers to mood changes within
an episode (Geller et al., 2004).

APA (2013) 45
 Bipolar I
Alternative Diagnosis Differential Consideration
Major Depressive Person with depressive Sx never had Manic/Hypomanic
Disorder episodes
Bipolar II Hypomanic episodes, w/o a full Manic episode
Cyclothymic Disorder Lesser mood swings of alternating depression -
hypomania (never meeting depressive or manic criteria)
cause clinically significant distress/impairment

Normal Mood Swings Alternating periods of sadness and elevated mood,

without clinically significant distress/impairment

Schizoaffective Disorder Sx resemble Bipolar I, severe with psychotic features but

psychotic Sx occur absent mood Sx
Schizophrenia or Psychotic symptoms dominate. Occur without
Delusional Disorder prominent mood episodes
Substance Induced Stimulant drugs can produce bipolar Sx
Bipolar Disorder
Source: Francis (2013) 46
 Bipolar II
Alternative Diagnosis Differential Consideration

Major Depressive No Hx of hypomanic (or manic) episodes

Disorder
Bipolar I At least 1 manic episode
Cyclothymic Disorder Mood swings (hypomania to mild depression) cause
clinically significant distress/impairment; no history of
any Major Depressive Episode

Normal Mood Swings Alternately feels a bit high and a bit low, but with no
clinically significant distress/impairment

Substance Induced Hypomanic episode caused by antidepressant

Bipolar Disorder medication or cocaine

ADHD Common Sx presentation, but ADHD onset is in early

childhood. Course chronic rather than episodic. Does
not include features of elevated mood.
47
Source: Francis (2013)
 Cyclothymic Disorder
Alternative Diagnosis Differential Consideration
Normal Mood Swings Ups &downs without clinically significant
distress/impairment
Major Depressive Had a major depressive episode
Disorder
Bipolar I At least one Manic episode
Bipolar II At least one clear Major Depressive episode
Substance Induced Mood swings caused by antidepressant medication or
Bipolar Disorder cocaine. Stimulant drugs can produce bipolar
symptoms

48
Source: Francis (2013)
Co-existing Disabilities
AD/HD Criteria Comparison
Bipolar Disorder (mania) AD/HD

1. More talkative than usual, or 1. Often talks excessively

pressure to keep talking

2. Distractibility 2. Is often easily distracted by

extraneous stimuli

3. Increase in goal directed

activity or psychomotor 3. Is often “on the go” or often
agitation acts as if “driven by a
motor”

Differentiation = irritable and/or elated mood, grandiosity, decreased

need for sleep, hypersexuality, and age of symptom onset (Geller et al., 1998). 49
Co-existing Disabilities
 Developmental Differences
 Children have higher rates of ADHD than do adolescents
 Adolescents have higher rates of substance abuse
 Risk of substance abuse 8.8 times higher in adolescent-onset bipolar
disorder than childhood-onset bipolar disorder
 Children have higher rates of pervasive developmental disorder
(particularly Asperger’s Disorder, 11%)
 Similar but not comorbid
 Unipolar Depression
 Schizophrenia

Pavuluri et al. (2005) 50

Prevalence & Epidemiology

 No data on the prevalence of preadolescent bipolar disorder

 Lifetime prevalence among 14 to 18 year olds, 1%
 Subsyndromal symptoms, 5.7%
 Mean age of onset, 10 to 12 years
 First episode usually depression

Pavuluri et al. (2005) 51

 Epidemiol
ogy

Prevalence in Adults
 BD spectrum disorders: 5%
 Overall % of BD: 2.8% (Males:2.9%,
Females: 2.8%)
 Majority with onset before age 20 (NIMH)

Meta-analysis of BD in youth around the world

 Overall rate of BD 1.8%
 BD prevalence in youth ~ BD prevalence in
adults
 BD prevalence in youth not different in US
vs other countries
Etiology Of
Bipolar Disorder
Neurobiological Etiology Of
Bipolar Disorder
Neurobiological Etiology Of
Bipolar Disorder
Neurobiological Etiology Of
Bipolar Disorder
Neurobiological Etiology Of
Bipolar Disorder
Psychosocial Etiology Of
Bipolar Disorder
Etiology
 Although the etiology of [early onset bipolar spectrum
disorder] is not known, substantial evidence in the adult
literature and more recent research with children and
adolescents suggest a biological basis involving genetics,
various neurochemicals, and certain affected brain
regions.

 It is distinctly possible that the differing clinical

presentations of pediatric BD are not unitary entities but
diverse in etiology and pathophysiology.

Lofthouse & Fristad (2006, p. 212); Pavuluri et al. (2005, p. 853)

59
Etiology
 Genetics
1. Family Studies
2. Twin Studies
MZ = .67; DZ = .20 concordance
3. Adoption Studies
4. Genetic Epidemiology
Early onset BD = confers greater risk to relatives
5. Molecular genetic
 Aggregates among family members
 Appears highly heritable
 Environment = a minority of disease risk

Baum et al. (2007); Faraone et al. (2003); Pavuluri et al. (2005) 60

Etiology
 Neuroanatomical differences
◦ White matter hyperintensities.
 Small abnormal areas in the white
matter of the brain (especially in the
frontal lobe).

◦ Smaller amygdala

◦ Decreased hipocampal volume

Hajek et al. (2005); Pavuluri et al. (2005) 61

1. White matter hyperintensities: small abnormal areas in the white matter of
the brain (especially in the frontal lobe) as seen using magnetic resonance
imaging. These abnormalities may be caused by the loss of myelin or axons.

2. The evidence for involvement of the amygdala early in the course of the
disease is fairly strong. Involvement of the amygdala in BD is consistent
with its central role in emotional and social behavior (assigning emotional
valence to stimuli and memories, facilitating encoding). The amygdala plays
a key role in emotions and forming emotional memories. This almond-
shaped structure integrates your senses and links them with your emotions.
It also affects basic behaviors such as feeding, sexual arousal, and the
“fight-or-flight” reaction to stress.

3. The hippocampus is a horseshoe-shaped brain structure involved in

memory, learning, and emotion. It forms new memories and organizes them
with related memories and emotions.

62
Etiology
 Neuroanatomical differences
 Reduced gray matter volume in
the dorsolateral prefrontal cortex
(DLPFC)
 Bilaterally larger basal ganglia
 Specifically larger putamen
DLPFC

Basal Ganglia

Hajek et al. (2005); Pavuluri et al. (2005) 63

 The evidence for involvement of the striatum early in the course of
illness is strong.
 These brain areas have been implicated in the modulation of socially
appropriate emotional behavior.
 Increased striatal volume may be compensatory to a deficit in the
fermentation from the frontal lobes or to deficits downstream within
the circuitry involving the pallidum and thalamus.

64
Assessment tool for Bipolar
Disorder
Suicide Risk With Bipolar
Disorder
Suicide Risk With Bipolar
Disorder
Preventing Suicide With
Bipolar Disorder
Intervention For Bipolar
Disorder
Prognosis
 With respect to prognosis …, [early onset bipolar
spectrum disorder] may include a prolonged and
highly relapsing course; significant impairments in
home, school, and peer functioning; legal difficulties;
multiple hospitalizations and increased rates of
substance abuse and suicide

 In short, children with [early onset bipolar spectrum

disorder] have a chronic brain disorder that is
biopsychosocial in nature and, at this current time,
cannot be cured or grown out of

Lofthouse & Fristad (2006, p. 213-214)

70
Prognosis
Outcome by subtype (research with adults)
 Bipolar Disorder I
 More severe; tend to experience more cycling & mixed
episodes; experience more substance abuse; tend to recover
to premorbid level of functioning between episodes.
 Bipolar Disorder II
 More chronic; more episodes with shorter inter-episode
intervals; more major depressive episodes; typically present
with less intense and often unrecognized manic phases; tend
to experience more anxiety.
 Cyclothymia
 Can be impairing; often unrecognized; many develop more
severe form of Bipolar illness.
 Bipolar Disorder Not Otherwise Specified (NOS)
 Largest group of individuals

71
Treatment
Psychopharmacological
DEPRESSION MANIA
 Mood Stabilizers  Mood Stabillizers
 Lamictal  Lithium, Depakote, Depacon,
 Anti-Obsessional Tegretol
 Paxil  Atypical Antipsychotics
 Anti-Depressant  Zyprexa, Seroquel, Risperdal,
 Wellbutrin Geodon, Abilify
 Anti-Anxiety
 Atypical Antipsychotics
 Benzodiazepines
 Zyprexa
 Klonopin, Ativan

72
Biological Treatment Of
Bipolar Disorder
Pharmacological Treatment Of
Bipolar Disorder
Pharmacological Treatment Of
Bipolar Disorder
Side-Effects For Pharmacological
Treatment Of
Bipolar Disorder
Psychological Treatment Of
Bipolar Disorder
Psychological Treatment Of
Bipolar Disorder
Treatment
Psychopharmacology Cont.
 Lithium:
 History
 Side effects/drawbacks
 Blood levels drawn frequently
 Weight gain
 Increased thirst, increased urination, water retention
 Nausea, diarrhea
 Tremor
 Cognitive dulling (mental sluggishness)
 Dermatologic conditions
 Hypothyroidism
 Birth defects
 Benefits & protective qualities
 Brain-Derived Neurotropic Factor (BDNF) & Apoptosis
 Suicide

79
Treatment

 Therapy
 Psycho-Education
 Behavior therapy, CBT, REBT, Alderian psychotherapy
 Family Interventions
 Multifamily Psycho-education Groups (MFPG)
 Cognitive-Behavioral Therapy (CBT)
 RAINBOW Program
 Interpersonal and Social Rhythm Therapy (IPSRT)
 Schema-focused Therapy

80
 Much of the research base for psychotherapy for BPD focuses on relapse
and medication compliance.
 Many of the treatments for bpd are psychoeducational in nature, & tend to
include 2-9 sessions that are mainly informative about the disease and its
pharmacological treatment.

 Its goal is to define BPD illness as a biological disturbance and to focus

treatment on pharmacological measures.


81
Family-focused interventions

 addresses enhancing communication and coping

skills,

 as well as the role of expressed emotion amongst

families.

 Studies seem to indicate some decreases in relapse

rates.


82
Multi Family Psycho education groups MFPE

 Empirically supported, not empirically validated.

 Initial findings indicate increase in parental
knowledge regarding disorder,
 improvement in parent-child relationship.

 Children showed increase in perceived parental

support & increase in perceived social peer support.

83
CBT
 A short-term psychotherapeutic individual intervention designed for
treating depression.

 cognitive restructuring and is aimed at decreasing depressive symptoms

and improving self-esteem.

 self-monitoring and self-regulation, by means of managing and dealing

with automatic, dysfunctional thoughts,

behavioral techniques for decreasing environmental stress & promote

social adaptation .

 There is substantial evidence for the effectiveness of CBT for depression.

 There is evidence that improvements in mood and social functioning have

been made with individual CBT.

 There have been no studies on group CBT.

84
RAINBOW program

It’s a combination of CBT & Family Intervention.

Focuses on Routine
 Affect regulation
 positive “I” statements
 eliminating Negative thoughts
 developing social and problem-solving skills;
 and learning where and how to get support.
 A recent study has indicated a decrease in symptom severity.
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IPSRT
 addresses the impact of biological and social rhythms on life
events.
 Treatment focuses on eliciting and defining the salient
problem area, followed by supported processing of
emotion,
 and problem-solving around practical consequences.
 With unipolar depression, there is much evidence to support
this intervention. T
 here is limited research with bpd, with some evidence to
support an impact on subsyndromal symptoms, with impact
on the stability of social routine and can lead to longer periods
of euthymia .

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Schema-focused therapy

 is an integration of cognitive therapy with experiential

techniques,
 and was originally developed for personality disorders.
 Schemas are core beliefs/pervasive themes regarding oneself and
others.
 They are self-perpetuating, with an individual tending to distort
information to maintain its validity.
 The modified schema-focused cognitive therapy incorporates
schemas associated with adaptability to illness and adaptability
styles.
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MORE THERAPIES

 ALDERIAN PSYHOTHERAPY
 MBCBT
 DBT
 ACT
 REIKI
 EFT

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Summary Of Treatment for
Bipolar Disorder
Intervention For
Bipolar Disorder
 Case
Evaluation

X.Y.Z ran a catering service with her second husband, Donald, who was the main
informant. At age 38, she already had two grown children, so her husband could
understand why this pregnancy might have upset her. Even so, she had seemed
unnaturally sad. From about her fourth month, she spent much of each day in bed, not
arising until afternoon, when she began to feel a little less tired. Her appetite, voracious
during her first trimester, fell off, so that by the time of delivery she was several pounds
lighter than usual for a full-term pregnancy. She had to give up keeping the household
and business accounts, because she couldn’t focus her attention long enough to add a
column of figures. Still, the only time her husband became really alarmed was one
evening at the beginning of her ninth month, when she told him that she had been
 Case
Evaluation

After their son was born, her mood brightened almost at once. The crying spells and the
hours of rumination disappeared; briefly, she seemed almost her normal self. Late one
Friday night, however, when the baby was 3 weeks old, her husband returned from
catering a banquet and find she is wearing awkward clothes and icing a cake. Two
other just-iced cakes were lined up on the counter, and the kitchen was littered with
dirty pots and pans. The baby is crying in his cradle but she is not getting bothered by
his extreme crying and neither she wants her husband to immediately take care of their
child. All the next day, she was out with friends, leaving her husband home with
the baby. On Sunday she spent nearly $300 for Christmas presents at an April garage
sale. She seemed to have boundless energy, sleeping only 2 or 3 hours a night before
arising, rested and ready to go. On Monday she decided to open a bakery; by
 Case
Evaluation

Her behavior became so inconsistent that for the next two evenings that her husband
stayed off work to care for the baby, but his presence only seemed to provoke her
sexual demands. Then there was the marijuana. Before she became pregnant, she
would have an occasional toke (she called it her “herbs”). Yesterday she had shaken him
awake at 5 a.m. and announced, “I am becoming God.” That was when he had made
the appointment to bring her for an evaluation.
She herself could hardly sit still during the interview. In a burst of speech, she described
her renewed energy and plans for the bakery. She volunteered that she had never felt
better in her life. In rapid succession she then described her mood (ecstatic), how it
made her feel when she put on her best silk dress, where she had purchased the dress,
how old she had been when she bought it, and to whom she was married at the time.
 Case
Evaluation

1. Identify the main symptoms of the

client X.Y.Z?
2. Give a suitable diagnosis?
3. Explain differential Diagnosis, if
any possible?
4. Develop goals and intervention
plan as well?
 https://youtu.be/gR4-ittuZi8

 https://youtu.be/lrQl9Ge5gIE

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