Psychology
Bipolar Disorder
Bipolar disorder is a mental health condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). These mood shifts can be disruptive to daily life and can affect energy levels, judgment, behavior, and the ability to think clearly. Treatment typically involves a combination of medication and psychotherapy to manage symptoms and improve quality of life.
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11 Key excerpts on "Bipolar Disorder"
eBook - PDFWhat Works for Whom?, Second Edition
A Critical Review of Psychotherapy Research
- Anthony Roth, Peter Fonagy(Authors)
- 2013(Publication Date)
- The Guilford Press(Publisher)
C H A P T E R 5 Bipolar Disorder DEFINITIONS Bipolar Disorder—sometimes referred to as manic–depression—is character- ized by one or more manic episodes, usually alternating with one or more major depressive episodes. Depressive episodes have been defined in Chapter 4, which discusses treatments for depression. DSM-IV-TR defines the essential diagnostic features of a manic episode as a period lasting at least 1 week (or any period, if hospitalization is required or psychotic symptoms are present), during which the predominant mood is either elevated, expansive, or irritable, and there are associated features of the manic syndrome. The disturbance is sufficiently severe to cause marked impairment in social and occupational functioning or to require hospitaliza- tion to prevent harm to self or others. At least three of the following charac- teristic symptoms should be present: inflated self-esteem or grandiosity (which may be delusional), decreased need for sleep, pressure of speech, flight of ideas, distractibility, increased involvement in goal directed activity, psy- chomotor agitation, and excessive involvement in pleasurable activities that may have a painful outcome that the person does not recognize. Only when the severity of symptoms is such that there is a marked impact on functioning can a diagnosis of manic episode be made. Individuals without delusions and with milder symptoms, who are able to function socially and occupationally without a need for hospitalization, would receive a diagnosis of hypomanic episode. DSM-IV-TR distinguishes bipolar I disorders and bipolar II disorders, as follows: 135 Bipolar I Disorders There are four variants of bipolar I disorder, each of which relates to the his- tory of previously diagnosed manic or depressive episodes: (1) most recent episode hypomanic (but where there has been at least one previous manic episode), (2) most recent episode manic, (3) most recent episode mixed, and (4) most recent episode depressed.
eBook - PDF- Paul Fallon(Author)
- 2019(Publication Date)
- Bloomsbury Academic(Publisher)
People with Bipolar Disorder also often have comorbid conditions such as anxiety disorders, attention deficit hyperactivity disorder (ADHD), alcohol and drug dependence (Miklowitz & Johnson, 2006). The social costs of Bipolar Disorder are significant as many people experience periodic reoccurrences of symptoms which affect their ability to sustain careers and relationships. MADNESS: A BIOGRAPHY 124 Given that one pole of Bipolar Disorder is depression it is not uncommon for people who initially present with a depressive epi-sode to be diagnosed as depressed and only be reclassified as bipo-lar when they subsequently present with a hypomanic or manic episode. Therefore, it has been argued that there can be delays of between 5 and 10 years between the first episode of illness and receiving treatment (Bauer & Pfennig, 2005) and that bipolar dis-order is a considerably underdiagnosed condition (Angst et al., 2010). Bipolar Disorder is a disorder where the individual has two or more episodes of significantly disturbed mood (WHO, 2018c). Some of these episodes will be of an elevated mood (mania or hypomania, which is milder in character) including symptoms such as increased energy, overactive behaviour, talking rapidly (pressure of speech), decreased need for sleep and distractibility. They also often exhibit grandiose ideas such as a belief that they possess vast sums of money and this can lead to significant problems if they spend money they don’t actually possess. Sometimes when people experience an elevated mood, what is commonly described as a ‘manic’ phase they may also experience psychotic symptoms. This demonstrates both how mental health conditions can overlap and how difficult it can be to accurately diagnose the person presenting in front of you. Other episodes of illness may be a feeling of low mood which itself can be of varying severity from mild depression to being severely depressed.
eBook - PDF- Edward Bittar(Author)
- 1999(Publication Date)
- Elsevier Science(Publisher)
Chapter 11 Bipolar Disorder JAMES C.-Y. CHOU and ROBERTCANCRO Introduction Diagnosis Epidemiology Pathogenesis Genetics Environmental Factors Biological Factors Psychological Factors Neurochemical Studies CT/MRI Studies Functional Studies Somatic Treatments Treatment of Mania Treatment of Mixed Episode Treatment of Bipolar Depression Maintenance Treatment Summary 218 218 220 221 221 221 222 223 223 226 227 228 228 229 229 230 231 Biological Psychiatry, pages 217-232. Copyright 9 2000by JAI Press Inc. All rights of reproduction in any form reserved. ISBN: 1-55938-819-6 217 218 JAMES C.-Y. CHOU and ROBERT CANCRO INTRODUCTION Bipolar Disorder, also known as manic-depressive illness, is a severe mental dis-order characterized by episodes of abnormal mood and related cognitive and behavioral changes which lead to various degrees of functional impairment. While the characteristic syndromes of mania and hypomania are hallmarks of Bipolar Disorder, bipolar depressed patients may be, in a cross-sectional evaluation, clinically indistinguishable from patients with unipolar depression. The lifetime prevalence of Bipolar Disorder is about 1% throughout the world. Patients who suffer a manic episode have a 90% chance of having another episode within 5 years. One fourth of all bipolar patients attempt suicide, and one tenth complete suicide. If unidentified or untreated, a patient who has a first episode of Bipolar Disorder with an onset at age 25 will suffer, on average, an estimated loss of 9 years of life, 14 years of productivity, and 12 years of good health. This same patient, with optimal diagnosis and treatment, will recover on average 6.5 years of life, 10 years of productivity, and 8.5 years of good health. Clearly, this is an illness which is managed rather than cured. While a wide range of neurobiological and psychological abnormalities have been found in bipolar patients, a specific etiology and pathogenesis remain elu-sive.
- Michael B. First, Allan Tasman(Authors)
- 2013(Publication Date)
- Wiley(Publisher)
CHAPTER 28 Mood Disorders: Bipolar Disorder Diagnosis Mood episodes are discrete periods of altered feeling, thought, and behavior. Typically they have a distinct onset and offset, beginning over days or weeks and eventually ending gradually after several weeks or months. The definition of Bipolar Disorder is built on the identification of individual mood episodes (Table 28.1). Bipolar Disorder is defined by the occur- rence of depressive plus manic, hypomanic, or mixed episodes, or the occurrence of only manic or mixed episodes. Most individuals with a Bipolar Disorder have major depressive as well as mania or hypomanic episodes. Those who experience manic episodes are diagnosed with Bipolar I Disorder, and those with major depressive and hypomanic (milder manic) episodes are diagnosed with Bipolar II Disorder. This separation of Bipolar II Disorder from both Bipolar I Disorder and Major De- pressive Disorder is supported by several types of evi- dence. For instance, Bipolar II Disorder occurs more frequently in families of persons with Bipolar II Disor- der in comparison to families of persons with Bipolar I Disorder or Major Depressive Disorder. Study of the course over time of Bipolar II Disorder indicated that persons with hypomania tended to have recurrent hypo- manic episodes and did not convert into Bipolar I Disorder by developing mania. In addition, persons with Bipolar II Disorder may have more episodes over time than persons with Bipolar I Disorder. However, biologi- cal differences between these bipolar types have not been reliably demonstrated. Nonetheless, it should not be construed that Bipolar II Disorder is in all respects milder than Bipolar I Disorder, although hypomania is by definition less severe than mania. Specifically, the social and occupational function and quality of life for persons with Bipolar II Disorder are similar to those for persons with Bipolar I Disorder.
- Michel Hersen, Jay C. Thomas(Authors)
- 2007(Publication Date)
- SAGE Publications, Inc(Publisher)
Sadly, treatment of depression without accurate diagnosis of a history of mania can create substantial difficulties because antide-pressant medications in the absence of mood-stabilizing medications have been found to trigger episodes of mania (Ghaemi, Lenox, & Baldessarini, 2001). Therefore, one vital public health goal is to increase recognition of this disorder by mental health practitioners. The Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV-TR; APA, 2000) rec-ognizes several forms of Bipolar Disorder, each defined on the basis of manic symptoms of vary-ing duration and severity: bipolar I disorder, bipolar II disorder, cyclothymia, and bipolar dis-order not otherwise specified (NOS). Bipolar I disorder is defined by one or more lifetime episodes of mania. According to DSM-IV-TR, a manic episode is defined by intense euphoric or irritable mood, accompanied by three associated symptoms (four if mood is irritable only). Associated symptoms can include decreased need for sleep, elevated self-esteem, distractibility, increased talkativeness, increased goal-directed activity, and excessive involvement in high-risk pleasurable activities (Table 11.1). To meet diag-nostic criteria for mania, these symptoms must either create severe impairment for at least 1 week or be severe enough to necessitate hospitalization. The episode of mania can be accompanied by simultaneous symptoms of depression, in which case it is called a mixed episode. Despite the name bipolar, depression is not required for a diagnosis 153 154 SPECIFIC DISORDERS of bipolar I disorder. Nonetheless, episodes of major depression are common for people with this disorder (see Table 11.1 for diagnostic criteria of depression). Bipolar I disorder is the most severe form of the disorder, but a variety of milder forms of dis-order have been defined, including bipolar II dis-order, cyclothymia, and Bipolar Disorder NOS.
eBook - PDFClinical Handbook of Psychological Disorders
A Step-by-Step Treatment Manual
- David H. Barlow(Author)
- 2021(Publication Date)
- The Guilford Press(Publisher)
The majority of the chapter describes a focused, time-limit- ed, outpatient psychosocial treatment—family-focused treatment (FFT)—that comprises three interrelated modules: psychoeducation, communication enhance- ment training (CET), and problem-solving skills train- ing (Miklowitz, 2010). It is designed for adult or ado- lescent patients who have had a recent episode of mania or depression. DIAGNOSIS DSM‑5 Criteria The core characteristic of Bipolar Disorder is extreme affective dysregulation, or mood states that swing from extremely low (depression) to extremely high (mania). Patients in a manic episode have euphoric, elevated mood or irritable mood and behavioral activation, usually indicated by an increase in energy and activ- ity, talking very fast, and sleeping very little or not at all. They may engage in risky sex, drive recklessly, or impulsively spend excessive amounts of money. Mania also affects thinking, as evidenced by “grandiose” or psychotic ideas (e.g., beliefs about one’s special powers, superior intelligence, or artistic ability), extreme dis- tractibility, and the tendency to jump from one idea to another when speaking. The reaction of listeners is one of confusion, disbelief, and often, intimidation. Manic symptoms typically go on for one or more weeks. For C H A P T E R 12 Bipolar Disorder David J. Miklowitz Bipolar Disorder 481 the diagnosis of bipolar I, most diagnostic systems also require that the person show disrupted functioning (e.g., marital problems, arrests, loss of job) or require emergency treatments such as hospitalization. In this chapter, the term Bipolar Disorder refers either to bipolar I or bipolar II disorder (see below) as defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Asso- ciation, 2013). A patient in a hypomanic episode shows many of the same symptoms, but the duration is typically shorter (i.e., 4 days or more).
eBook - PDFAbnormal Psychology
The Science and Treatment of Psychological Disorders
- Ann M. Kring, Sheri L. Johnson(Authors)
- 2021(Publication Date)
- Wiley(Publisher)
Manic symptoms are the defining feature of each of these disorders. The Bipolar Disorders are differentiated by how severe and long-lasting the manic symptoms are. These disorders are labeled “bipolar” because most people who experience mania will also experience depression during their lifetime (mania and depression are considered oppo- site poles). Contrary to what people may believe, an episode of depression is not required for a diagnosis of bipolar I disorder (although most people with an episode of mania will experience an episode of depression; see Cuellar, Johnson, & Winters, 2005). Depression is required for a diagnosis of bipolar II disorder. Bipolar I Disorder The criteria for diagnosis of bipolar I disorder (formerly known as manic-depressive disorder) include at least one episode of mania during a person’s life. Note, then, that a person who is diagnosed with bipolar I disorder may or may not be experiencing current symptoms of mania. In fact, even someone who experienced only 1 week of manic symptoms years ago is still diag- nosed with bipolar I disorder. Mania is a state of intense elation or irritability, along with abnormally increased activity and other symptoms shown in the diagnostic criteria. During manic episodes, people will act and think in ways that are highly unusual compared to their typical selves. They may become louder and make an incessant stream of remarks, sometimes full of puns, jokes, rhymes, and interjections about nearby stimuli that attract their attention. They may be difficult to interrupt and may shift rapidly from topic to topic, reflecting an underlying flight of ideas. During mania, people may become sociable to the point of intrusiveness. They can also become excessively self-confident. They may stop sleeping even as they become incredibly energetic. Attempts by others to curb such excesses can quickly bring anger and even rage. Mania often comes on suddenly over a period of a day or two.
eBook - PDF- Preston, John D., Fast, Julie A.(Authors)
- 2012(Publication Date)
- New Harbinger Publications(Publisher)
CHAP TER THREE Multipolar Disorder Bipolar Disorder is not characterized just by mania and depression. In fact, BI-polar disorder is a bit of a misnomer. Yes, people with the illness do go up and down, but doesn’t it seem as if they also go sideways or do little corkscrews as well? Maybe if it were called MULTI-polar disorder, people would understand the illness a bit more. Most people assume that Bipolar Disorder is only about mania and depres- sion. And to a large extent that’s true, but a holistic view understands that the disorder also includes a variety of symptoms in addition to mania and depression that also affect your partner’s thinking and behavior. One key to treating the disorder successfully is knowing what you, as the partner of someone with Bipolar Disorder, are up against. It’s very important for you to get a solid handle on the multifaceted nature of this disorder so as not to be surprised by the various and sometimes confusing symptoms of the illness. Bipolar Disorder is complex. These days in the psychiatric literature it’s popular to refer to “bipolar spectrum disorders,” as there appear to be a number of related conditions that share some common features. All variants of Bipolar Disorder include the following features: Multipolar Disorder 19 • Obvious changes in mood. • These mood changes are episodic, meaning that they are gener- ally not continuous but come in fairly separate bouts with mea- surable time in between. (Rapid cycling is the exception to this and will be defined later in this chapter.) • Bipolar Disorder is due primarily to a biological abnormality involving changes in brain chemistry. The illness is typically lifelong and doesn’t simply disappear one day. Without appro- priate treatment it can become progressively more severe. It may be stressful for you to read that the illness is lifelong. Luckily, treatment is possible. This illness is predictable.
eBook - PDFBipolar II Disorder
Modelling, Measuring and Managing
- Gordon Parker(Author)
- 2009(Publication Date)
- Cambridge University Press(Publisher)
4 Bipolar II Disorder in context: epidemiology, disability and economic burden George Hadjipavlou and Lakshmi N. Yatham The beginning of wisdom is calling things by their right names. Confucius Introduction Writing in the late nineteenth century, the Prussian psychiatrist Ewald Hecker provided a clinical picture of a form of ‘cyclothymic’ illness manifesting in periods of depression and hypomania that bears a striking resemblance to the contempor- ary diagnostic category of Bipolar II Disorder (BP II) (Koukopoulos, 2003). Hecker and his senior colleague, Ludwig Kaulbaum, likely influenced Emile Kraepelin’s seminal work on ‘manic-depressive insanity’ (Baethge et al., 2003). Kraepelin used the term ‘hypomania’ to refer to non-psychotic, milder forms of mania, which were expressed along a single continuum ranging from purely manic to recurring depressive states (Akiskal and Pinto, 1999; Koukopoulos, 2003). It is not difficult to imagine how a disorder similar to BP II would have fitted within this scheme (Akiskal and Pinto, 1999). Preceding such views by almost 2000 years, Aretaeus of Cappadocia is also known to have described a spectrum of bipolar illness with varying intensities of mania and depression in the first century AD (Goodwin and Jamison, 1990). Despite these early, and perhaps even seemingly prescient advances, the modern concept of BP II was only first defined in the 1970s by Dunner and colleagues (Dunner et al., 1976). But it was not until the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM–IV) in 1994 that BP II became officially recognised as a discrete, diagnostic entity (American Psychiatric Association, 1994). The current diagnosis of BP II is based on the presence or history of hypomania – a distinct period of persistently elevated, expansive or irritable mood lasting a minimum of 4 days – in conjunction with at least one major depressive episode.
eBook - PDF- McBride, Linda, Ludman, Evette, Greenwald, Devra, Kilbourne, Amy, Bauer, Mark(Authors)
- 1(Publication Date)
- New Harbinger Publications(Publisher)
For instance, you were introduced to a snippet of 1940s psychoanalytic thinking from Dr. Fenichel about the condition. More recent psychological research has focused less on causes of the disorder and more on factors that affect its course. In addition to psychoanalytic theories, several other approaches to understanding Bipolar Disorder have been advanced. Most of this theorizing is based on research in depression that has been extended to Bipolar Disorder. This is because the depressive symptoms in Bipolar Disorder and unipolar depression are the same. Unfortunately, no clear psychological theory of mania has yet emerged. Nonetheless, each of these theories has contributed a psychological method to the treatment of Bipolar Disorder. So, not surprisingly, elements of each of these therapies have found their way into this workbook: 8 Cognitive theory suggests that people have unrealistically negative beliefs about them- selves and their world. These beliefs or thoughts in turn leave them prone to depression (Basco and Rush 2007). Overcoming Bipolar Disorder 24 8 Behavior theory views depression as a mental giving up when goals cannot be reached (Lewinsohn 1974). 8 Interpersonal theory proposes that depression develops most often in the context of adverse events, particularly loss or conflict related to important relationships (Frank 2007). As you can probably imagine, no single psychological theory has a lock on Bipolar Disorder. But if you look at all the medications that work in managing Bipolar Disorder, you’ll find that the same is true for biology as well! HOW DO SOCIAL FACTORS LIKE STRESS HELP US TO UNDERSTAND Bipolar Disorder? The research on social factors in Bipolar Disorder relates mainly to how stresses affect the course of the illness—specifically, the number and severity of episodes (Johnson 2005). It appears that stresses are of two types. 8 Physical stress for some people can trigger or worsen episodes.
eBook - PDF- Fox, Daniel J.(Authors)
- 2021(Publication Date)
- New Harbinger Publications(Publisher)
During the depressive phase of Bipolar Disorder, the individual experiences a decline in energy, prolonged sadness, a decrease in activity, poor concen- tration and decision-making, excessive worry and anxiety, feelings of guilt, and possible suicidal ideation, intent, or gestures. These are common symp- toms seen in those with BPD as well. The average age of the initial manic or hypomanic episode is approximately eighteen, and the first BPD symp- toms are likely to occur in early adulthood, which begins at age eighteen (APA 2013). Noting the similarity in symptoms and age of onset, it’s no wonder there’s so much confusion that impacts the interventions. Complex Borderline Personality Disorder 58 If you’ve been diagnosed with Bipolar Disorder when it’s actually BPD, the approach to treatment and therapeutic expectations are going to be vastly different and likely miss the mark of an effective intervention. In this case, it can mean that you’re given a medication that has limited impact on symptoms or causes side effects, and therapy may not be the central focus, like in Wendy’s case. If therapy is pursued, the treatment trajectory and goals will be different and are unlikely to include therapeutic strategies from effective treatments for BPD, such as dialectical behavior therapy (DBT) or transference-focused psychotherapy. In the opposite case, if you’ve been diagnosed with BPD, but it’s actually Bipolar Disorder, you may not receive mood-stabilizing medication or inter- ventions that pinpoint specific areas of concern, such as impairment in cog- nitive functioning (Porter, Inder, et al. 2020). Also, your mental health provider may be ill prepared to manage and confront your mood fluctua- tions and subsequent behavioral changes often seen in those with a Bipolar Disorder diagnosis. You may be misperceived as “treatment resistant,” meaning that you’ve not been complying with treatment goals purposefully.
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