Bipolar Disorder: Essentials & Examples

1. Bipolar Disorder: Essentials & Examples Presented by: Jackie Morrison Fall 2007 St. John Fisher College Student

2. Bipolar Disorder (BD) • When you hear those two words, what is the immediate thought that runs through your head, if any? • Be completely honest!

3. Famous People • Abraham Lincoln/Teddy Roosevelt • Winston Churchill/Edgar Allan Poe • Charles Dickens/Ernest Hemmingway • Beethoven/Van Gogh • Sir Isaac Newton • Jim Carrey/Tim Burton/Ben Stiller/Robin Williams/Patty Duke • Kurt Cobain/Courtney Love • What about Britney Spears???

4. In a nutshell: • It is also known as manic depression • Bipolar disorder is a treatable mood disorder marked by extreme changes in mood, thought, energy, and behavior. A persons mood can alter between mania and depression, or the two poles of the mood. Mood swings can last for hours, days, weeks, or months. • 2 million people are said to have some diagnosis of within the bipolar spectrum, 1% of the adult population.

6. Data about onset • 60-90% have symptoms before the age of 20, but don’t get diagnosed until much after that. • An average of 7 years for a correct diagnosis • Many parents can trace it back to infancy • Early onset, before age 10, is becoming increasingly popular. • One of the most denied illnesses on the part of the patient.

7. So a little bit about me… • I graduated from C-NS in 2004. Those were good times. I spent most of my time in the social studies wing and in the training room. • I am 21 years old now and am graduating from college this academic year. I am studying education and psychology. I work for the 2006 D3 Football Team of the Year. I volunteer in a psychiatric hospital. I have a great family, great friends, and am well respected on my campus as the Student Government President.

8. So why am I presenting BD to you? • As much as I am the ideal family member, friend, student, and leader I have had my fair share of difficulties in all these roles. • In 8th grade, I had 64 referrals by the time I was done. I was a successful athlete but way too much energy to know what to do with. • In 9th grade I was suicidal, increasingly agitated and depressed. Doctors diagnosed me with depression. I started taking medication and seeing someone…it didn’t work. I had seizures to the medication; I stopped medication and seeing the therapist. • In 11th grade, I was cycling between feelings of total elation and total withdrawal. I told my parents I needed help. I was diagnosed with Bipolar disorder II. • For a period of over a year…I was on trying all sorts of medications and seeing a therapist. Side effects took a significant toll on my educational performance, and I considered ditching the diagnosis all together.

9. But I didn’t… • because life with medication and therapy was a lot better than without (but that doesn’t mean I don’t test that theory from time to time). • In 12th grade, I was happy and healthy (after the initial month and a half of medication changes), but I still had the attention span of a flea. That’s when I was diagnosed with ADHD. • ADHD medication significantly alleviated some of my attention problems and I was on track for college. • College brought more issues however. The lack of sleep and stress can have a significant impact on the disorder, especially when I didn’t take my medications. • I cycled all throughout my sophomore year of college without medication, and as I was attempting to get back on it last year during a depression, I spiraled out of control. • Last winter, I was hospitalized for 2 weeks due to bipolar disorder II, triggered by a shoulder surgery. • Since spring semester, I have been stable, on good medication combination and loving my life. I am trying not to return to a hospital and not to get off my medication. It is not easy though

11. Hypomania • Increased energy • Increased activity • Decreased need for sleep • Increased confidence • Impulsive behavior • Euphoria or irritability • Creativity • These symptoms are much milder than regular mania and contribute less severe impairments. • Mood has to be different than non depressed mood

12. Mania • A sense of heightened energy • Creativity • Social ease • decreased need for sleep • Excessive Irritability or aggressive behavior • Increased physical and mental activity • Rapid Speech and flight of ideas (racing thoughts) • Distractibility • Poor Judgment/ impulsiveness • Others appear “slow” • Excessive planning

13. Extreme Mania • Reckless behavior( spending sprees, rash decisions relating to business, and erratic driving. • Paranoia = thinking people or things are out to get you (e.g. John Nash or friends) • Delusional psychosis = Hearing or seeing things that do not exists (voices and such) • Grandiosity = You think you are someone you are not, or a lot better than you are (e.g. you are not Lebron James or Jesus) • IMPORTANT: IS NOT CAUSED BY DRUGS OR ALCOHOL

15. Depression • Diminished interest or pleasure in all or most activities Significant changes in sleep or appetite • Loss of enjoyment • Loss of motivation • Loss of energy, very lethargic • Feelings of guilt and/or worthlessness • Inability to concentrate, indecisiveness • Physical agitation, restlessness • Reoccurring thoughts of death or suicide • Slowing speech, thought, and body movement • Indifference or pessimism • Unexplained sadness and crying

16. Bipolar Disorder, Severe Depression, & Suicide • Nearly 20% commit suicide. • Mortality rate is 2 to 3 times higher than general population • At least 25% to 50% of patients with bipolar disorder also attempt suicide at least once • Frequent drug or alcohol users correlates with higher suicide attempts

17. Carrie Fisher • "Roy decorated my house and Pam has to live in it," – Carrie Fisher • ROY = MANIC EXTROVERSION • PAM = DEPPRESSED INTROVERSION • I'm fine, but I'm bipolar. I'm on seven medications, and I take medication three times a day. This constantly puts me in touch with the illness I have. I'm never quite allowed to be free of that for a day. It's like being a diabetic.

18. What it can be misdiagnosed as or combined with… • ADHD/ADD • Schizophrenia • Dissocative Identity Disorder • Major depression or unipolar depression • Anxiety Disorders • Conduct/Antisocial Personality Disorders

19. Types of Bipolar Diagnosis • Bipolar 1 • Schizoaffective disorder—Bipolar type • Bipolar 2 • Bipolar NOS (not otherwise specified) • Cyclothymia • Subtypes • Rapid Cycling • Mixed or Dysphoric Mania • Bipolar Spectrum disorder • Covert Cycling • Depressive disorder

20. Bipolar 1 (most severe) • Characterized by one or more manic episodes or mixed episode (depression and mania occur almost every day for at least one week.) and one or more major depressive episodes. • Marked by EXTREME manic episodes • Require medicine and often hospitalization • 50% manifest a psychosis ( inability to deal with reality)

21. Schizoaffective –Bi polar type • Diagnostic challenge • Manifest depression, mania, and persistent psychotic symptoms. • Hallucinations and delusions common and often overlap with severe mood swings • Mood Stabilizers will help unlike in the cases of Schizophrenia • Also very serious

22. Bipolar 2 • Characterized by one or more depressed episodes (usually long) accompanied by at least one or more hypo-manic episodes. • Hypo-manic episode should be elevated and clearly different that a person’s non-depressed mood. • These hypo-manic episodes may or may not cause notable problems at work. • Generally not sever enough for hospitalization • No psychosis involved

23. Bipolar 2 con’t • Often resist treatment for disorder often only remember depressive episodes. • Many go undiagnosed….because they are treated for depression with anti-depressant medications. • These medications can increase mood cycles, and lead to reoccurrences of depression, rapid cycling, or mixed state.

24. Cyclothymia (mildest form) • Characterized by chronic fluctuating moods involving period of hypo-mania and depression. • Shorter, less severe, and not as regular as Bipolar 1 or 2 • Function well, with some interruptions during periods of mild or moderate depression alternating with mild hypo-mania and increased social activity. • In the future may develop Bipolar 1 or 2

25. Rapid Cycling • Bipolar patients that have four or more episodes of mania or depression in one year in any combination. • Shorter times of normal mood and increased episodes of changing moods • Between 5 and 15 % of the patients get it at some point in their life. • Can change within the same day or even hour. • Women are prone to it • NO preventable treatments

26. Mixed or Dysphoric Mania • Most disabling form, depression and mania occur simultaneously • Can be found in Bipolar 1 or 2 • Occurs in 40-45% of Bipolar patients • Can often be misdiagnosed as other disorders

27. Bipolar Spectrum /Covert Cycling 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

28. Causes of Bipolar Disorder • Genetic vulnerability in families • Brain Chemistry • Neurotransmitters • Actual Brain structure • Environmental Factors

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

30. Neurotransmitters • chemicals produced by the nerve cells in the brain that send messages back and forth across the space between the cells (synapse) • Zoloft Commercial • serotonin, norepinephrine, dopamine, and gamma-aminobutyric acid (GABA) are key in mostly depression and some mania.

31. Early “Treatment” • Physicians in the 18th and 19th centuries used crude devices to treat mental illness, none of which offered any real relief. The circulating swing, top left, was used to spin depressed patients at high speed. American physician Benjamin Rush devised the tranquilizing chair, top right, to calm people with mania. The crib, bottom, was widely used to restrain violent patients. (MSN Encarta)

32. Treatment…not so crude. • Early 1950s and prior: CHLOROPROMAZINE • medicine with popular usage for schizophrenia and Bipolar disorder. • most treatment was with ECT. • The population and mental hospitals was increasing 10 % per year. With the addition of anti-psychotic medicine it started to decrease at 10% per year.

33. Treatment…now a days • Medication (almost always necessary) • Antipsychotic • Anticonvulsants • Therapy • Cognitive-Behavioral • Family • Interpersonal/Social Rhythm • Family • Psychoeducation • Herbal Supplements (not highly recommended) • Electroconvulsive Therapy (ECT) • Hospitalization (if all else fails)

35. What increases your chance of a relapse? • Alcohol or drug use • stressful life event • relapse may occur even in the absence of a stressful event. • Discontinuing medications • changes in daily routines can increase your risk for a manic episode. (sleep especially) • Treatment with antidepressants or stimulants by themselves with no mood stabilizer

36. Self – help (things you should do if you have Bipolar disorder) • Back-up Plans • Maintain a healthy sleep pattern • Self-monitoring • Strong support System • Stress management • Keep a diary/mood chart • Maintain hope and a positive attitude • Do what the doctor says = Prognosis depends on effectiveness and follow through on treatment plan!

37. The things most people with BD will always have trouble with: • Sticking to a treatment plan • Believing in their diagnosis • Continuing their medications • Getting the right diagnosis to begin with • Establishing trust with their doctors • Trying to explain the disorder to family and friends • Staying on a routine. • Dealing with society’s stigma • Finding appropriate mental health coverage and services

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

39. Support for people with BD • Strong support and encouragement to seek help from family and friends • Help the person follow their treatment plan • Assist them in finding a support group or supportive friends • Find out accurate information about the disorder • Find out what the triggers or symptoms of mania and depression are for that person • Get immediate assistance, such as hospitalization or a doctor on call, if a person threatens suicide or appears to be in an extreme manic episode.

40. Bibliography • Cohen, David. “Bipolar Disorder.” Encarta. CD-ROM. Redmond: Microsoft, 2002. • “Young and Bipolar.” Time Magazine. 19 august 2002.38-47 and 51. • Fawcett, Jan, Bernard Golden, Nancy Rosenfeld. New Hope for people with Bipolar disorder. Roseville, California: Prima Publishing, 2000. • “Bipolar Disorder.” DBSA. 6 Jan 2004. Depression and Bipolar Support Alliance. 7 Jan 2004. <http://www.dbsalliance.org/info/bipolar.html>

41. THE END