Bipolar Disorder: Bipolar Disorder: Essentials & Essentials & ExamplesExamples

Presented by: Presented by:

Jackie MorrisonJackie Morrison

Fall 2007Fall 2007

St. John Fisher College StudentSt. John Fisher College Student

Bipolar Disorder (BD)Bipolar Disorder (BD)

When you hear those two words, When you hear those two words, what is the immediate thought that what is the immediate thought that runs through your head, if any?runs through your head, if any?– Be completely honest!Be completely honest!

Famous PeopleFamous People

Abraham Lincoln/Teddy RooseveltAbraham Lincoln/Teddy Roosevelt Winston Churchill/Edgar Allan PoeWinston Churchill/Edgar Allan Poe Charles Dickens/Ernest HemmingwayCharles Dickens/Ernest Hemmingway Beethoven/Van GoghBeethoven/Van Gogh Sir Isaac NewtonSir Isaac Newton Jim Carrey/Tim Burton/Ben Jim Carrey/Tim Burton/Ben

Stiller/Robin Williams/Patty DukeStiller/Robin Williams/Patty Duke Kurt Cobain/Courtney LoveKurt Cobain/Courtney Love What about Britney Spears???What about Britney Spears???

In a nutshell:In a nutshell:

It is also known as manic depressionIt is also known as manic depression Bipolar disorder is a treatable mood Bipolar disorder is a treatable mood

disorder marked by extreme changes in disorder marked by extreme changes in mood, thought, energy, and behavior. A mood, thought, energy, and behavior. A persons mood can alter between mania persons mood can alter between mania and depression, or the two poles of the and depression, or the two poles of the mood. Mood swings can last for hours, mood. Mood swings can last for hours, days, weeks, or months. days, weeks, or months.

2 million people are said to have some 2 million people are said to have some diagnosis of within the bipolar spectrum, diagnosis of within the bipolar spectrum, 1% of the adult population.1% of the adult population.

41275

170240

380280

8under

1020-29 40-49 60-69

The onset of Biolar patients

number of patients

Data about onsetData about onset

60-90% have symptoms before the age 60-90% have symptoms before the age of 20, but don’t get diagnosed until of 20, but don’t get diagnosed until much after that.much after that.– An average of 7 years for a correct An average of 7 years for a correct

diagnosisdiagnosis– Many parents can trace it back to infancyMany parents can trace it back to infancy

Early onset, before age 10, is Early onset, before age 10, is becoming increasingly popular.becoming increasingly popular.

One of the most denied illnesses on One of the most denied illnesses on the part of the patient.the part of the patient.

So a little bit about me…So a little bit about me… I graduated from C-NS in 2004. Those were I graduated from C-NS in 2004. Those were

good times. I spent most of my time in the good times. I spent most of my time in the social studies wing and in the training social studies wing and in the training room.room.

I am 21 years old now and am graduating I am 21 years old now and am graduating from college this academic year. I am from college this academic year. I am studying education and psychology. I work studying education and psychology. I work for the 2006 D3 Football Team of the Year. I for the 2006 D3 Football Team of the Year. I volunteer in a psychiatric hospital. I have a volunteer in a psychiatric hospital. I have a great family, great friends, and am well great family, great friends, and am well respected on my campus as the Student respected on my campus as the Student Government President.Government President.

So why am I presenting BD to So why am I presenting BD to you?you?

As much as I am the ideal family member, friend, As much as I am the ideal family member, friend, student, and leader I have had my fair share of student, and leader I have had my fair share of difficulties in all these roles. difficulties in all these roles.

In 8In 8thth grade, I had 64 referrals by the time I was done. I grade, I had 64 referrals by the time I was done. I was a successful athlete but way too much energy to was a successful athlete but way too much energy to know what to do with.know what to do with.

In 9In 9thth grade I was suicidal, increasingly agitated and grade I was suicidal, increasingly agitated and depressed. Doctors diagnosed me with depression. I depressed. Doctors diagnosed me with depression. I started taking medication and seeing someone…it started taking medication and seeing someone…it didn’t work. I had seizures to the medication; I stopped didn’t work. I had seizures to the medication; I stopped medication and seeing the therapist.medication and seeing the therapist.

In 11In 11thth grade, I was cycling between feelings of total grade, I was cycling between feelings of total elation and total withdrawal. I told my parents I needed elation and total withdrawal. I told my parents I needed help. I was diagnosed with Bipolar disorder II. help. I was diagnosed with Bipolar disorder II.

For a period of over a year…I was on trying all sorts of For a period of over a year…I was on trying all sorts of medications and seeing a therapist. Side effects took a medications and seeing a therapist. Side effects took a significant toll on my educational performance, and I significant toll on my educational performance, and I considered ditching the diagnosis all together. considered ditching the diagnosis all together.

But I didn’t…But I didn’t… because life with medication and therapy was a lot better because life with medication and therapy was a lot better

than without (but that doesn’t mean I don’t test that theory than without (but that doesn’t mean I don’t test that theory from time to time).from time to time).

In 12In 12thth grade, I was happy and healthy (after the initial grade, I was happy and healthy (after the initial month and a half of medication changes), but I still had the month and a half of medication changes), but I still had the attention span of a flea. That’s when I was diagnosed with attention span of a flea. That’s when I was diagnosed with ADHD.ADHD.

ADHD medication significantly alleviated some of my ADHD medication significantly alleviated some of my attention problems and I was on track for college. attention problems and I was on track for college.

College brought more issues however. The lack of sleep College brought more issues however. The lack of sleep and stress can have a significant impact on the disorder, and stress can have a significant impact on the disorder, especially when I didn’t take my medications.especially when I didn’t take my medications.

I cycled all throughout my sophomore year of college I cycled all throughout my sophomore year of college without medication, and as I was attempting to get back on without medication, and as I was attempting to get back on it last year during a depression, I spiraled out of control. it last year during a depression, I spiraled out of control.

Last winter, I was hospitalized for 2 weeks due to bipolar Last winter, I was hospitalized for 2 weeks due to bipolar disorder II, triggered by a shoulder surgery.disorder II, triggered by a shoulder surgery.

Since spring semester, I have been stable, on good Since spring semester, I have been stable, on good medication combination and loving my life. I am trying not medication combination and loving my life. I am trying not to return to a hospital and not to get off my medication. It to return to a hospital and not to get off my medication. It is not easy though is not easy though

HypomaniaHypomania Increased energyIncreased energy Increased activityIncreased activity Decreased need for sleepDecreased need for sleep Increased confidenceIncreased confidence Impulsive behaviorImpulsive behavior Euphoria or irritabilityEuphoria or irritability CreativityCreativity These symptoms are much milder than regular These symptoms are much milder than regular

mania and contribute less severe impairments. mania and contribute less severe impairments. Mood has to be different than non depressed Mood has to be different than non depressed

moodmood

ManiaMania A sense of heightened energyA sense of heightened energy CreativityCreativity Social easeSocial ease decreased need for sleepdecreased need for sleep Excessive Irritability or aggressive behaviorExcessive Irritability or aggressive behavior Increased physical and mental activityIncreased physical and mental activity Rapid Speech and flight of ideas (racing Rapid Speech and flight of ideas (racing

thoughts)thoughts) DistractibilityDistractibility Poor Judgment/ impulsivenessPoor Judgment/ impulsiveness Others appear “slow”Others appear “slow” Excessive planningExcessive planning

Extreme ManiaExtreme Mania Reckless behavior( spending sprees, rash Reckless behavior( spending sprees, rash

decisions relating to business, and erratic decisions relating to business, and erratic driving.driving.

Paranoia = thinking people or things are out Paranoia = thinking people or things are out to get you (e.g. John Nash or friends)to get you (e.g. John Nash or friends)

Delusional psychosis = Hearing or seeing Delusional psychosis = Hearing or seeing things that do not exists (voices and such)things that do not exists (voices and such)

Grandiosity = You think you are someone Grandiosity = You think you are someone you are not, or a lot better than you are you are not, or a lot better than you are (e.g. you are not Lebron James or Jesus)(e.g. you are not Lebron James or Jesus)

IMPORTANT: IS NOT CAUSED BY DRUGS OR IMPORTANT: IS NOT CAUSED BY DRUGS OR ALCOHOLALCOHOL

DepressionDepression Diminished interest or pleasure in all or most Diminished interest or pleasure in all or most

activities Significant changes in sleep or appetiteactivities Significant changes in sleep or appetite Loss of enjoymentLoss of enjoyment Loss of motivationLoss of motivation Loss of energy, very lethargicLoss of energy, very lethargic Feelings of guilt and/or worthlessnessFeelings of guilt and/or worthlessness Inability to concentrate, indecisivenessInability to concentrate, indecisiveness Physical agitation, restlessnessPhysical agitation, restlessness Reoccurring thoughts of death or suicideReoccurring thoughts of death or suicide Slowing speech, thought, and body movementSlowing speech, thought, and body movement Indifference or pessimism Indifference or pessimism Unexplained sadness and cryingUnexplained sadness and crying

Bipolar Disorder, Severe Bipolar Disorder, Severe Depression, & SuicideDepression, & Suicide

Nearly 20% commit suicide. Nearly 20% commit suicide. Mortality rate is 2 to 3 times higher Mortality rate is 2 to 3 times higher

than general populationthan general population At least 25% to 50% of patients with At least 25% to 50% of patients with

bipolar disorder also attempt suicide bipolar disorder also attempt suicide at least once at least once

Frequent drug or alcohol users Frequent drug or alcohol users correlates with higher suicide correlates with higher suicide attemptsattempts

Carrie FisherCarrie Fisher

"Roy decorated my house and Pam has to live "Roy decorated my house and Pam has to live in it," – Carrie Fisherin it," – Carrie Fisher– ROY = MANIC EXTROVERSIONROY = MANIC EXTROVERSION– PAM = DEPPRESSED INTROVERSIONPAM = DEPPRESSED INTROVERSION

I'm fine, but I'm bipolar. I'm on seven I'm fine, but I'm bipolar. I'm on seven medications, and I take medication three medications, and I take medication three times a day. This constantly puts me in touch times a day. This constantly puts me in touch with the illness I have. I'm never quite with the illness I have. I'm never quite allowed to be free of that for a day. It's like allowed to be free of that for a day. It's like being a diabetic. being a diabetic.

What it can be What it can be misdiagnosed as or misdiagnosed as or

combined with…combined with… ADHD/ADDADHD/ADD SchizophreniaSchizophrenia Dissocative Identity DisorderDissocative Identity Disorder Major depression or unipolar Major depression or unipolar

depressiondepression Anxiety DisordersAnxiety Disorders Conduct/Antisocial Personality Conduct/Antisocial Personality

DisordersDisorders

Types of Bipolar DiagnosisTypes of Bipolar Diagnosis Bipolar 1Bipolar 1 Schizoaffective disorder—Bipolar typeSchizoaffective disorder—Bipolar type Bipolar 2Bipolar 2 Bipolar NOS (not otherwise specified)Bipolar NOS (not otherwise specified) CyclothymiaCyclothymia SubtypesSubtypes

Rapid CyclingRapid Cycling Mixed or Dysphoric ManiaMixed or Dysphoric Mania Bipolar Spectrum disorderBipolar Spectrum disorder Covert CyclingCovert Cycling Depressive disorderDepressive disorder

Bipolar 1 (most severe)Bipolar 1 (most severe)

Characterized by one or more manic Characterized by one or more manic episodes or mixed episode (depression episodes or mixed episode (depression and mania occur almost every day for at and mania occur almost every day for at least one week.) and one or more major least one week.) and one or more major depressive episodes. depressive episodes.

Marked by EXTREME manic episodesMarked by EXTREME manic episodes Require medicine and often hospitalizationRequire medicine and often hospitalization 50% manifest a psychosis ( inability to 50% manifest a psychosis ( inability to

deal with reality)deal with reality)

Schizoaffective –Bi polar Schizoaffective –Bi polar typetype

Diagnostic challengeDiagnostic challenge Manifest depression, mania, and Manifest depression, mania, and

persistent psychotic symptoms.persistent psychotic symptoms. Hallucinations and delusions common Hallucinations and delusions common

and often overlap with severe mood and often overlap with severe mood swingsswings

Mood Stabilizers will help unlike in the Mood Stabilizers will help unlike in the cases of Schizophreniacases of Schizophrenia

Also very seriousAlso very serious

Bipolar 2 Bipolar 2 Characterized by one or more depressed Characterized by one or more depressed

episodes (usually long) accompanied by at episodes (usually long) accompanied by at least one or more hypo-manic episodes.least one or more hypo-manic episodes.

Hypo-manic episode should be elevated Hypo-manic episode should be elevated and clearly different that a person’s non-and clearly different that a person’s non-depressed mood. depressed mood.

These hypo-manic episodes may or may These hypo-manic episodes may or may not cause notable problems at work.not cause notable problems at work.

Generally not sever enough for Generally not sever enough for hospitalizationhospitalization

No psychosis involvedNo psychosis involved

Bipolar 2 con’tBipolar 2 con’t

Often resist treatment for disorder often Often resist treatment for disorder often only remember depressive episodes. only remember depressive episodes.

Many go undiagnosed….because they Many go undiagnosed….because they are treated for depression with anti-are treated for depression with anti-depressant medications.depressant medications.

These medications can increase mood These medications can increase mood cycles, and lead to reoccurrences of cycles, and lead to reoccurrences of depression, rapid cycling, or mixed depression, rapid cycling, or mixed state. state.

Cyclothymia (mildest form)Cyclothymia (mildest form)

Characterized by chronic fluctuating moods Characterized by chronic fluctuating moods involving period of hypo-mania and involving period of hypo-mania and depression. depression.

Shorter, less severe, and not as regular as Shorter, less severe, and not as regular as Bipolar 1 or 2Bipolar 1 or 2

Function well, with some interruptions Function well, with some interruptions during periods of mild or moderate during periods of mild or moderate depression alternating with mild hypo-depression alternating with mild hypo-mania and increased social activity.mania and increased social activity.

In the future may develop Bipolar 1 or 2In the future may develop Bipolar 1 or 2

Rapid Cycling Rapid Cycling Bipolar patients that have four or more Bipolar patients that have four or more

episodes of mania or depression in one episodes of mania or depression in one year in any combination. year in any combination.

Shorter times of normal mood and Shorter times of normal mood and increased episodes of changing moodsincreased episodes of changing moods

Between 5 and 15 % of the patients get it Between 5 and 15 % of the patients get it at some point in their life.at some point in their life.

Can change within the same day or even Can change within the same day or even hour.hour.

Women are prone to itWomen are prone to it NO preventable treatmentsNO preventable treatments

Mixed or Dysphoric ManiaMixed or Dysphoric Mania

Most disabling form, depression and Most disabling form, depression and mania occur simultaneouslymania occur simultaneously

Can be found in Bipolar 1 or 2Can be found in Bipolar 1 or 2 Occurs in 40-45% of Bipolar patientsOccurs in 40-45% of Bipolar patients Can often be misdiagnosed as other Can often be misdiagnosed as other

disordersdisorders

Bipolar Spectrum /Covert Bipolar Spectrum /Covert Cycling DisorderCycling Disorder

A class of disorders that have Bipolar features

Overlaps Bipolar NOS…. Reoccurring mood changes with

Agitation, increased activity, impulsive behavior, and alternating with a depression or mixed state

Causes of Bipolar DisorderCauses of Bipolar Disorder

Genetic vulnerability in familiesGenetic vulnerability in families Brain Chemistry Brain Chemistry

– NeurotransmittersNeurotransmitters Actual Brain structureActual Brain structure Environmental FactorsEnvironmental Factors

Genetic Vulnerability Genetic Vulnerability

If one parent has symptoms of If one parent has symptoms of Bipolar than the offspring has a 7.8% Bipolar than the offspring has a 7.8% chance to also have it and 11.2 % chance to also have it and 11.2 % chance of uni-polar depression. It chance of uni-polar depression. It increases when both parents are increases when both parents are bipolar with a 50-75% chance of the bipolar with a 50-75% chance of the offspring receiving it. offspring receiving it.

NeurotransmittersNeurotransmitters

chemicals produced by the nerve chemicals produced by the nerve cells in the brain that send messages cells in the brain that send messages back and forth across the space back and forth across the space between the cells (synapse) between the cells (synapse) – Zoloft CommercialZoloft Commercial

serotonin, norepinephrine, dopamine, serotonin, norepinephrine, dopamine, and gamma-aminobutyric acid and gamma-aminobutyric acid (GABA) are key in mostly depression (GABA) are key in mostly depression and some mania. and some mania.

Early “Treatment”Early “Treatment” Physicians in the 18th and Physicians in the 18th and

19th centuries used crude 19th centuries used crude devices to treat mental devices to treat mental illness, none of which offered illness, none of which offered any real relief. The any real relief. The circulating swing, circulating swing, top left,top left, was used to spin depressed was used to spin depressed patients at high speed. patients at high speed. American physician Benjamin American physician Benjamin Rush devised the Rush devised the tranquilizing chair, tranquilizing chair, top right,top right, to calm people with mania. to calm people with mania. The crib, The crib, bottom,bottom, was widely was widely used to restrain violent used to restrain violent patients. (MSN Encarta)patients. (MSN Encarta)

Treatment…not so crude.Treatment…not so crude.

Early 1950s and prior: Early 1950s and prior: CHLOROPROMAZINE CHLOROPROMAZINE – medicine with popular usage for medicine with popular usage for

schizophrenia and Bipolar disorder.schizophrenia and Bipolar disorder.– most treatment was with ECT.most treatment was with ECT.

The population and mental hospitals The population and mental hospitals was increasing 10 % per year. With was increasing 10 % per year. With the addition of anti-psychotic the addition of anti-psychotic medicine it started to decrease at medicine it started to decrease at 10% per year.10% per year.

Treatment…now a daysTreatment…now a days Medication (almost always necessary)Medication (almost always necessary)

– AntipsychoticAntipsychotic– Anticonvulsants Anticonvulsants

TherapyTherapy– Cognitive-BehavioralCognitive-Behavioral– FamilyFamily– Interpersonal/Social Rhythm Interpersonal/Social Rhythm – Family Family – PsychoeducationPsychoeducation

Herbal Supplements (not highly recommended)Herbal Supplements (not highly recommended) Electroconvulsive Therapy (ECT)Electroconvulsive Therapy (ECT) Hospitalization (if all else fails)Hospitalization (if all else fails)

What increases your chance What increases your chance of a relapse?of a relapse?

Alcohol or drug useAlcohol or drug use stressful life event stressful life event relapse may occur even in the absence of a relapse may occur even in the absence of a

stressful event. stressful event. Discontinuing medications Discontinuing medications changes in daily routines can increase your changes in daily routines can increase your

risk for a manic episode. (sleep especially)risk for a manic episode. (sleep especially) Treatment with antidepressants or Treatment with antidepressants or

stimulants by themselves with no mood stimulants by themselves with no mood stabilizerstabilizer

Self – help (things you Self – help (things you shouldshould do if you have Bipolar disorder)do if you have Bipolar disorder)

Back-up PlansBack-up Plans Maintain a healthy sleep patternMaintain a healthy sleep pattern Self-monitoringSelf-monitoring Strong support System Strong support System Stress management Stress management Keep a diary/mood chartKeep a diary/mood chart Maintain hope and a positive attitudeMaintain hope and a positive attitude Do what the doctor says = Prognosis Do what the doctor says = Prognosis

depends on effectiveness and follow depends on effectiveness and follow through on treatment plan!through on treatment plan!

The things most people with The things most people with BD will always have trouble BD will always have trouble

with:with: Sticking to a treatment planSticking to a treatment plan Believing in their diagnosisBelieving in their diagnosis Continuing their medicationsContinuing their medications Getting the right diagnosis to begin withGetting the right diagnosis to begin with Establishing trust with their doctorsEstablishing trust with their doctors Trying to explain the disorder to family and Trying to explain the disorder to family and

friendsfriends Staying on a routine.Staying on a routine. Dealing with society’s stigmaDealing with society’s stigma Finding appropriate mental health coverage Finding appropriate mental health coverage

and servicesand services

The most difficult thing…The most difficult thing…

"I would try and tell them that their "I would try and tell them that their personality is almost completely personality is almost completely independent of the disease. The independent of the disease. The disease is not who you are; it's what disease is not who you are; it's what you have to deal with. You can't you have to deal with. You can't really be who you are until you've really be who you are until you've dealt with it." dealt with it."

Support for people with BDSupport for people with BD Strong support and encouragement to seek help Strong support and encouragement to seek help

from family and friendsfrom family and friends Help the person follow their treatment planHelp the person follow their treatment plan Assist them in finding a support group or Assist them in finding a support group or

supportive friendssupportive friends Find out accurate information about the disorderFind out accurate information about the disorder Find out what the triggers or symptoms of mania Find out what the triggers or symptoms of mania

and depression are for that personand depression are for that person Get immediate assistance, such as hospitalization Get immediate assistance, such as hospitalization

or a doctor on call, if a person threatens suicide or or a doctor on call, if a person threatens suicide or appears to be in an extreme manic episode.appears to be in an extreme manic episode.

BibliographyBibliography

Cohen, David. “Bipolar Disorder.” Encarta. CD-Cohen, David. “Bipolar Disorder.” Encarta. CD-ROM. Redmond: Microsoft, 2002.ROM. Redmond: Microsoft, 2002.

““Young and Bipolar.” Time Magazine. 19 august Young and Bipolar.” Time Magazine. 19 august 2002.38-47 and 51. 2002.38-47 and 51.

Fawcett, Jan, Bernard Golden, Nancy Rosenfeld. Fawcett, Jan, Bernard Golden, Nancy Rosenfeld. New Hope for people with Bipolar disorder. New Hope for people with Bipolar disorder. Roseville, California: Prima Publishing, 2000. Roseville, California: Prima Publishing, 2000.

““Bipolar Disorder.” DBSA. 6 Jan 2004. Depression Bipolar Disorder.” DBSA. 6 Jan 2004. Depression and Bipolar Support Alliance. 7 Jan 2004. and Bipolar Support Alliance. 7 Jan 2004. <http://www.dbsalliance.org/info/bipolar.html><http://www.dbsalliance.org/info/bipolar.html>