Bipolar disorder jacqueline corcoran 2014
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Transcript of Bipolar disorder jacqueline corcoran 2014
From: Mental Health in Social Work (Pearson, 2014)
http://www.jacquelinecorcoran.com
Jacqueline Corcoran, Ph.D.
Bipolar Disorder
2.1% (National Comorbidity Study)
Prevalence
Bipolar I At least one manic episode, usually accompanied by a major depressive episode.
Bipolar II Characterized by one or more major depressive episodes accompanied by at least one hypomanic episode.
MDD • Just depressive episodes• If there is a hx of at least one manic or
hypomanic episode = BP
Cyclothymic Disorder• experience of numerous episodes of hypomanic
and depressive symptoms that don’t meet criteria for MDD
• possibility of developing bipolar disorder
Differential Diagnoses
Differential Diagnoses
Non-episodic, chronic, rapid-cycling mixed state featuring agitation, excitability, labile affect, aggression, and irritability with child’s age-appropriate functioning significantly impaired
Frequent comorbidity with ADHD & CD Disruptive mood dysregulation disorder
(DSM V)
Bipolar in Children
Suicide: 10-15% School truancy, school failure,
occupational failure, divorce Other diagnoses
• Eating Disorders• ADHD• Anxiety Disorders• Substance-Related Disorders (60%
risk) Borderline Personality Disorder
Medical disorders
Comorbidity
First-degree relatives elevated rates of Bipolar I Disorder (4-24%), Bipolar II Disorder (1-5%), and MDD (4-24%) Twin and adoption studies - evidence of genetic influence Polygenic models promising but core of BPD remains elusive Limbic system Amount of norepinephrine, serotonin, gamma-aminobutyric acid neurotransmitters are abnormal Actions of thyroid and other endocrine glands also account for nervous system changes Biorythms (body’s natural sleep and wake cycles) are erratic - may cause or result from chemical imbalances Damage to areas in brain responsible for emotional activity
Etiology: biological factors predominate
Stressful life events (onset and course)
Early onset 10% rapid cycling Families with high EE Lack of social support Number of previous episodes History of anxiety Persistence of affective
symptoms even when mood is relatively stable
Poor occupational functioning
Other Risk FactorsCourse
Mood-stabilizing meds sometimes prescribed with antipsychotic meds to treat BP I
Antidepressants - BP II
Medication
Improvements in 70% of clients Relatively short half life - must be taken
more than once per day Takes 2-3 weeks to establish effect Doesn’t preclude possibility of recurrence
• 36% recurrence rate in 5 yrs. • Combinations (with antidepressant, antipsychotic,
& anticonvulsant drugs) may help
Lithium prescribed for 1 year after first or second episode, permanent after third episode
Lithium Carbonate
Difference between therapeutic and toxic levels is not so great
Monitoring monthly for 1st 4-6 months, every 6 mos. after that
Symptoms: thirst, weight gain, fatigue, hand tremor, muscle weakness, confusion, diarrhea, dizziness, nausea, slurred speech, spastic muscle movements
Importance of Monitoring Blood
Levels
Blocks norepinephrine reuptake, may also break down GABA
Advantages over lithium• stabilize mood in 2-5 days• as effective for stabilizing • more effective for maintenance• has a greater antidepressant effect
Side effects problematic - 50% not taking a year later
Anticonvulsants: Carbamazephine
Comparable to lithium May be better than carbamazepine for
rapid cycling Trend toward prescribing
anticonvulsants as initial tx strategy
Anticonvulsants, cont.: Valproate
Lithium, carbamazepine, and valproate all used with children
Prospects of chronic weight problems and long-term effects on kidney function need to be considered
Medication Used with Children
Coming to terms• Reduce medication non-
adherence• Enhance social and
occupational functioning• Enhance family and
social support• Identify stresses that
may trigger mood episodes
Psychoeducation
Interpersonal therapy• interpersonal conflicts major
source of depression• also assumes sleep/wake cycle
and social rhythms influence course
CBT• challenge cognitions that may
activate episodes and be related to medication compliance
Individual Psychotherapy