Bipolar & Related Disorders for NCMHCE Study

Review of DSM5 Mental Disorders for NCMHCE Study

1. Bipolar I Disorders2. Bipolar II Disorder3. Cyclothymic Disorder4. Substance/ Medication Induced Biolar and

Related Disorder

Diagnosis ITypically repetitive cycle of depression and mania, possibly between depressive episodesEither phase can lead to delusions and hallucinationsChronic but can have years between episodesOften begins in early 20s

1. Manic periods Abnormal high or irritable

mood Increased energy and goal-

directed activity Lasts 1 week or more (less if

hospitalized) Includes 3-4 of:

Grandiosity Racing thoughts Little sleep Distractibility High risk activities Pressured speech and

activity2. Sufficient intensity of

episode

Diagnosis IISpecifiers include kinds and how current the episodes:

Major depression Hypomania Mania Mixed Rapid cycling (four mood episodes without

break during the last 12 month period) Mood is most of the time, nearly every dayImpairs function

Diagnosis IIICo-occurring:AnxietySubstance abuseEating DisordersADHDImpulse Control DisordersConduct DisordersAutism Tourette’s DisorderDiabetesMigraines

Rule Out:Schizophrenia & Psychotic Disorders: No psychosis except when depressed Depressive Disorders: Anti-depressants will not trigger anxiety or mania

Find OutFamily history

Clearest connection of all mental disorders

Symptomology development Affective functioningCognitive functioningSubstance historyTrauma and loss historyChart moods

Treatments 1. MedicationMood-stabilizing like Lithium (useless against mania, and toxic side effects) Anti-psychotic, like Lamotrogine, or anti-convulsants, like OlanzapineCan reduce manic phase from months to daysAvoid antidepressants, which trigger anxiety and mania

2. TherapiesCBT Cognitive

Behavioral TherapyBehavioral family

therapy IPSRT

Interpersonal Social Rhythm Therapy

Reducing expression of intense feelings

FFT Family Focused Therapy

CyclothymiaAlternating between hypomanic symptoms, and mild or moderate depressive moods, like Bipolar II Less severe, higher functioning

Bipolar II1 or more hypomanic episodes (4 days or more), and no mania1 or more major depressive episodes (2 weeks or more)

Bipolar IMore severe1 or more manic or mixed episodesLeading to:Serious problems, orHospitalization, orPsychotic features

Diagnosis More severe1 or more distinct manic episodes, or mixedOften with aggression or lack of sexual inhibitionsOften with little sleep or appetiteLeading to:Serious legal or work problems, orHospitalization to avoid harm orPsychotic features

S1. Find OutAffective functioningCognitive functioningSymptom developmentFamily historyTrauma historySubstance use

S2. Assess & ReferRefer for psychological testing

S4.Treatments 1. MedicationMood-stabilizing like Lithium (useless against mania, and toxic side effects) Anti-psychotic, like Lamotrogine, or anti-convulsants, like OlanzapineCan reduce manic phase from months to daysAvoid antidepressants, which trigger anxiety and mania

2. TherapiesPsychoeducationCBT Cognitive

Behavioral TherapyBehavioral family

therapy Interpersonal Social

Rhythm TherapyReducing

expression of intense feelings

S5. Monitoring 1. Mood charting2. Monitoring problematic behavior3. Affective functioning4. Medication compliance

S6. TerminationMedication monitoring for compliance and side effectsPsychotherapiesSupport group

Diagnosis 1 or more hypomanic episodes (4 days or more),

and no mania1 or more major depressive episodes (2 weeks or more)

DiagnosisSymptomsAlternating between elevated mood (hypomanic symptoms), and mild or moderate depressive moods, like Bipolar II Less severe symptoms and higher functioning than Bipolar Disorder I or II

S1. AssessmentFamily history

Rule OutSleep problem

S5. TreatmentTherapyInterpersonal and Social Rhythm Therapy (IPSRT)Family Focused Therapy (FFT)Cognitive Behavioral TherapyGroup TherapyAlso Career counseling Interpersonal skill Group counseling

MedicationsMood stabilizers, like Lithium Anti-seizure or anticonvulsants, like DepakoteAntipsychotics, Seroquel or RisperdalAnti-anxiety, like benzodiazepinesAvoid Antidepressants, which trigger mania

S4. Goals of Treatment1.Decrease risk of developing into bipolar disorder 2.Reduce the frequency and severity of symptoms3.Prevent a relapse of symptoms, through maintenance treatment4.Treat alcohol or other substance abuse problems, since they can worsen cyclothymia symptoms