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Bipolar Disorder What Is It? Bipolar Disorder What is it? Risk & Safety If you are having a medical or psychiatric emergency, please log off and call 911 immediately. If you have an urgent psychiatric concerns, please call Adult Psychiatry at (408)366-4400 Mood Log Mood Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Manic 5 4 3 Time to Intervene 2 Monitor closely 1 0 -1 -2 Monitor closely -3 Time to Intervene -4 -5 Depression Mood Scale Description (“+” numbers) 5+ Auditory Hallucination, Visual Hallucinations Intervene 4+ Grandiose Thoughts, Aggressive behavior Intervene Rapid Thoughts Getting increasingly angry at people’s observation of me 3+ Not sleeping, Impatient, Spending excessively/debt, Excessive substance abuse Intervene Don’t accept other people’s observation of my own behavior, Dramatic behavior 2+ More talkative/quick speech, Increase spending, Scattered thoughts, Scattered Monitor closely energy, Increase substance abuse, Scattered energy, Start projects-don’t complete, Medication non compliance 1+ Talkative, Feeling of extreme happiness, Increase in sex drive, Extreme optimism, No task is too difficult, Life of the party, Increased spending, Starting to drink/drugs 0 Able to make decision, Happy/even keel, Can show emotions, Enjoy Normal hobbies/outdoors, Laugh a lot/sense of humor, Can entertain self, Good relationship with family Slow to anger/easy going, Sleep well, Enjoys friends/socializing, Can focus and concentrate, Good Self-care, Energetic, Feel creative/do creative things Mood Scale Description (“-” numbers) -1 Difficult making decisions, Sadness, No interest in hobbies Decrease of sense of humor, Low self-esteem, Increase negative thinking, Increase nervousness, Increase fatigue/tiredness -2 Increase in poor sleep, Too much television, Don’t want to wear make-up, Decrease Monitor closely sex drive, Less interest in activities, Feeling thoughts of suicide, Beginning to reject other’s observations of me, Decrease organizational skills, Substance use, Considering medication non-compliance -3 Poor hygiene, Medication non-compliance, Obsess on small details, If left alone, Intervene feel increasingly anxious, Decreased sex drive, Too much television/decrease activity, Apathetic, Flat feeling, extreme worrying, Rejecting other people’s observations of me, Increased sense of hopelessness, Thoughts of suicide, Increased confusion/cloudy thinking -4 Not speaking as much, Poor hygiene, Not eating or over eating, Weight gain, Sleep a Intervene lot, No Sex -5 Suicide/Homicide plan Intervene Check In Name: First Name and First Letter of Last Initial Mood Safety Concerns One challenge this past week One goal of self care this coming week What is Bipolar Disorder? Chronic or Episodic Mental Disorder Unusual, often Extreme and Fluctuating Changes in Mood, Energy, Activity, Concentration or Focus Types of episodes seen in Bipolar disorder Depression Hypomania Mania and Mixed Episodes Develops or starts during late adolescence or early adulthood Usually requires lifetime treatment and is treatable Symptoms of Bipolar Disorder? Symptoms of a Manic Episode Symptoms of Depressive Episode Feeling very up, high, elated or extremely Feeling very down or sad or anxious irritable or touchy Feeling jumpy or wired, more active than usual Feeling slowed down or restless Racing thoughts Trouble concentrating or making decisions Decreased need for sleep Trouble falling asleep, waking up too early or sleeping too much Talking fast about a lot of different things Talking very slowly, feeling like you have (“flight of ideas”) nothing to say or forgetting a lot Excessive appetite for food, drinking, sex or Lack of interest in almost all activities other pleasurable activities Feeling like you are unusually important, Unable to do even simple things talented or powerful Thinking you can do a lot of things at once Feeling hopeless or worthless, or thinking about without getting tired death or suicide Mood Episodes Episode Type Predominant Mood State Duration Associated Features MANIA High, Happy, Euphoric, At least 1 week Increased self Expansive, Irritable esteem/grandiosity Decreased need for sleep More talkative Racing Thoughts Distractible Increased goal directed activities/Psychomotor agitation Risk Taking HYPOMANIA High, Happy, Euphoric, At least 4 days Increased self Expansive, Irritable esteem/grandiosity Decreased need for sleep More talkative Racing thoughts Distractible Increased goal directed activities/Psychomotor agitation Risk Taking Mood Episodes Episode Type Predominant Mood State Duration Associated Features DEPRESSION Low, Sad, Disinterested At least 2 week Sleep disturbance (increase or decreased) Diminished interest Decreased energy Guilt/Low self-esteem Inability to concentrate/make simple decisions Appetite disturbance Psychomotor retardation/agitation Suicidal agitation/morbid preoccupation MIXED STATE Both High and Low Mood at At least 1 week Symptoms of both depression the same time (Often and mania are present at the irritable and sad) same time Types of Bipolar Disorder Bipolar I Disorder: Manic episodes that last at least seven days or when manic symptoms are so severe that hospital care is needed. Usually, separate depressive episodes occur as well, typically lasting at least two weeks. Episodes of mood disturbance with mixed features are also possible Bipolar II Disorder: Pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above Cyclothymic Disorder: persistent hypomanic and depressive symptoms that are not intense enough or do not last long enough to quality as hypomanic or depressive episodes. The symptoms usually occur for at least two years in adults Other Specified and Unspecified Bipolar and Related Disorders: Category that refers to bipolar disorder symptoms that do not match any of the recognized categories Conditions That Can Co-Occur with Bipolar Disorder Psychosis: Severe episodes of mania or depression may be accompanied with hallucinations or delusions. Psychotic symptoms tend to match the person’s extreme mood. Manic – Falsely believe that they are famous, have a lot of money or special powers Depressive –Inaccurately believe they are financially ruined or have committed a crime Anxiety Disorders and ADHD Mood Altering Substance Misuse or Abuse Eating Disorder Causes of Bipolar Disorder The EXACT cause of bipolar disorder is UNKNOWN. There is NO single cause. Instead a COMBINATION of factors may contribute Genes Bipolar disorder often runs in families. MANY genes are involved and NO ONE gene can cause the disorder. People with a parent or a sibling with bipolar disorder are more likely to develop the disorder, MOST people with a family history will NOT develop the illness. 8% of the person’s first degree relatives have bipolar The rate of mood disorder among first degree averages about 20% 12% have Major Depressive Episodes without mania or hypomania Brain Structure and Function: Research is ongoing Biological Vulnerability Causes of Bipolar Disorder (Contd.) Vulnerability and Stress Vulnerability Causes of Bipolar Disorder (Contd.) Stress and bipolar episodes Major Life Changes Stressful Life Changes: Examining your history Role of Sleep-Wake cycle Conflict with Significant Others At this time, diagnosis is based on symptoms rather than brain imaging or other diagnostic tests Role of Stress in Your Life Approximate Age/Date Type of Episode Stressful Event of Episode (manic/hypomanic, (describe) depressed, mixed) Grief Anger, Sadness about loss of dreams or hopes Loss or interruption of an anticipated vocational, relational, educational trajectory Implications of having chronic illness Stigma Navigating bureaucracy Other How is Bipolar Disorder Diagnosed Diagnosis is based on Complete full Physical Exam and Medical Testing to rule out other illnesses. Symptoms, Lifetime course and Experiences of the Individual are considered Initial misdiagnosis is a Possibility Bipolar disorder has symptoms common with several other mental health disorder Family and friends may notice the symptoms but not realize that the symptoms are part of a more significant problem There may be other health conditions which make it hard to diagnose How is Bipolar Disorder Treated Medication May Need to Try Several Different Medications Most Common types of medication include Mood Stabilizers and Atypical antipsychotics Additional medications that target sleep and anxiety are added Understand the risks/benefits and Report concerns and side effects to MD Avoid Stopping medication How is Bipolar Disorder Treated (Contd.) Psychotherapy Cognitive Behavior Therapy Dialectical Behavior Therapy Interpersonal Social Rhythm Therapy Other Treatments Electroconvulsive therapy Transcranial magnetic stimulation Regular Exercise Life Chart References National Institute of Health The Bipolar Disorder Survival Guide by David Miklowitz Interpersonal and Social Rhythm Therapy by Ellen Frank Psychoeudcation Manual for Bipolar Disorder by Colom, Francesc Take Charge of Bipolar Disorder by Julie Fast Loving Someone with Bipolar Disorder by Julie Fast PsychEducation.org by Dr. James Phelps QUESTIONS?.
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