Bipolar Disorder: A Biopsychosocial Overview
Jan 15, 2016
Bipolar Disorder: A Biopsychosocial Overview
mdl.psych.northwestern.edu
Source: Touched by Fire, Jamison, 1996
Bipolar Disorder: Epidemiology
• Elevated suicide, divorce, work impairment, substance use
• 6th leading cause of disability worldwide (Murray & Lopez, 1996).
• Accounts for nearly half the inpatient mental health care costs in the US (Kent et al., 1995).
Roadmap: A series of Questions
Four Questions about Bipolar Disorder
1. What is it?
2. What is its stigma?
3. Is there a blood test?
4. What are its treatments?
Roadmap: A series of Questions
Four Questions about Bipolar Disorder
1. What is it?
2. What is its stigma?
3. Is there a blood test?
4. What are its treatments?
Depression Mania
Mood disorder involving severe mood swings
Severity
Cyclothymia Bipolar II Disorder Bipolar I Disorder
Erratic depressive and hypomanic symptoms
MDE and Hypomanic Episodes
Manic Episode
No MDE
No Manic Episode MDE not necessary for diagnosis
~ 2-4 percent of population has bipolar spectrum diagnosis
0
10
20
30
40
50
60
Unipolar Depression
Anxiety Disorder
Schiz Personality Disorder
Subst. Abuse
Schizo-Affective
% o
f P
atie
nts
Mis
diag
nose
d Misdiagnosis of Bipolar Disorder
60
26
1817
1411
Hirschfeld, et al. J Clin Psychiatry 64: 161-174, 2003
Age-of-Onset of Bipolar Disorder
Pediatric Bipolar Disorder
- 10-20% onset < 10 yo - Controversial (40-fold increase)
- Difficult to differentiate from ADHD
Roadmap: A series of Questions
Four Questions about Bipolar Disorder
1. What is it?
2. What is its stigma?
3. Is there a blood test?
4. What are its treatments?
- Predicts worse course and social isolation
- Limit social interactions
- Social isolation in caregivers
Grief for the Loss of the Healthy Self
Roadmap: A series of Questions
Four Questions about Bipolar Disorder
1. What is it?
2. What is its stigma?
3. Is there a blood test?
4. What are its treatments?
PFC PFC
Limbic Limbic
- Common to many psychiatric disorders
- Biology of positive emotion may yield cues more specific to bipolar
Ventral Striatum
‘Wanting’ Circuit in the Brain
Bipolar disorder characterized by a hypersensitivity in the wanting circuit
Reward-Processing in Bipolar Disorder
Reward-Related Brain Activity: MDD < Comparison
Forbes et al., 2009, Am J Psychiatry
Comparison MDD
-Bipolar disorder and unipolar depression characterized by distinct profiles in the wanting or reward circuit
-Biomarkers and treatment
Roadmap: A series of Questions
Four Questions about Bipolar Disorder
1. What is it?
2. What is its stigma?
3. Is there a blood test?
4. What are its treatments?
Bipolar disorder may not be curable but it is livable
Psychosocial Treatments for Bipolar Disorder
Cognitive Behavioral Therapy
Family-Focused Therapy
IPSRT
mdl.psych.northwestern.edu