Part 1 -- Basics

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  • 1. Part I -- Bipolar Basics Kurt Weber, PhD [email_address] Mental Health America Brown County Bemis International Center St Norbert College May 13, 2008

2.

  • Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide.

3.

  • I am fortunate that I have not died from my illness, fortunate in having received the best medical care available, and fortunate in having the friends, colleagues, and family that I do.
  • Kay Redfield Jamison, PhD,An Unquiet Mind , 1995, p 6

4. Purpose of today

  • Some foundation information that mental health professionals and consumers should know

5. Bipolar disorder

  • formerly known as manic-depressive disorder
  • brain disorder
    • causes unusual shifts in a persons mood, energy, and ability to function
  • Some people alternate mania and depression, others have episodes of mostly one kind
  • Episodes vary in duration from days to years
  • the symptoms of bipolar disorder are severe
    • damaged relationships
    • poor job or school performance
    • suicide

6. good news

  • treatable
    • bipolar disorder can be treated, and people with this illness can lead full and productive lives

7. Types of Bipolar Disorders

  • The classic form of the illness, which involves recurrent episodes of mania and depression, is calledbipolar I disorder
  • Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is calledbipolar II disorder
  • When 4 or more episodes of illness occur within a 12-month period, a person is said to haverapid-cyclingbipolar disorder
  • Some people experience multiple episodes within a single week, or evenwithin a single day
  • Rapid cycling tends to develop later in the course of illness and is more common among women than among men

8. demographics

  • Approximately 23 million Americans suffer from bipolar disorder
  • National Comorbidity Study-Replicated (NCS-R)
    • the lifetime prevalence of bipolar disorder is 51%
  • National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)
    • lifetime prevalence of bipolar I disorder of 33%
    • Native Americans have the highest incidence
    • Asians and Hispanics have the lowest
  • World Health Organization (1990)
    • bipolar disorder is the sixth leading cause of disability worldwide among people 15-44 years old

9.

  • Studies suggest that bipolar disorder clients will be fully symptomatic 8% of the time, and symptomatic 59% of the time
  • 30% of bipolar clients have both manic and depressive episodes
  • 32% have mixed manic and depression
  • 22% have only manic episodes
  • 10% have only mixed episodes

10. Depressive episodes in BD

  • Depression
    • most frequent episode
    • episodes last longer (254 weeks) than manic episodes (55 weeks)

11. comorbidity

  • 485% of bipolar clients will have an anxiety disorder
  • 708% will have a personality disorder
  • Suicidal ideation is also highly associated with comorbid substance abuse
  • There is a strong association of suicide attempts and comorbid anxiety disorders

12. suicide

  • NIMH (2000)
    • Suicide is a significant risk in bipolar disorder, the highest of any psychiatric disorder at 20%
  • As many as 25-50% of clients will make a suicide attempt
  • Most suicidal ideation occurs during depressed or mixed episodes

13. features and subtypes (Mays)

  • Bipolar IBipolar II
  • Psychomotorretardedagitated or retarded
  • Sleephypersomniainsomnia/hypersomnia
  • Suicide+++++++
  • Switching tomaniahypomania
  • Genderm = ff > m
  • Prevalence1%1-2%

14. mixed episodes

  • 50% of clients have mixed mania
  • state of mind characterized by symptoms of both mania and depression
  • more common in bipolar children and women
  • may feel agitated, angry, irritable, and depressed all at once
  • combines a high activity level with depression
    • particular danger of suicide or self- injury

15. Rapid cycling

  • frequently recurring (4+ episodes/yr) treatment resistant depression alternating with hypomanic/manic episodes
  • most commonly seen in female clients and with bipolar II disorder
  • 15-25% of clients
  • early onset common
  • not known whether antidepressants can initiate rapid cycling
  • Variations include
    • ultra-rapid (1 day to 1 week)
    • ultradian (