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Understanding People Who Have Bipolar Disorders Mary Bittle, PhD, RN, LMFTA Objectives Recognize characteristics of bipolar disorders. Differentiate DSM-IV-TR and DSM-V characteristics, effective 1/1/14. Differentiate between mania and hypomania Recognize contributing factors of genetics and brain chemistry. Recognize common treatments Recognize challenges of managing Recognize famous people who have/had Acknowledge people with successful management can lead successful lives What are Bipolar Disorders? Disturbances of mood that significantly interfere with the daily functioning of an individual. DSM IV-TR mood DO. DSM V places in separate category Two types: Bipolar I and Bipolar II 19th century called manic-depressive, no longer a correct term. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed. ). Washington D.C.: American Psychiatric Publishing. Bipolar Disorders U.S. Prevalence: 2.6% Classified Severe: 82.9% (2.6%) = 2.2% National Institute for Mental Health. National Institutes for Health. (2005). Bipolar disorder among adults. Retrieved 11/13/13 from /statistics/1bipolar_adult.shtml Some 10 million people National Alliance on Mental Illnesses. Bipolar Disorder FACT SHEET. Retrieved 11/13/13 from /factsheets/bipolardisorder_factsheet.pdf Bipolar I A. Must have at least one manic episode lasting at least 1 week B. During manic episode must have 3 or more out of 7 behavioral manifestations of mania(next slide) C. Major impairment in life functioning D. Cannot be explained by medications or drugs for another medical condition May also be followed or preceded by hypomania and/or major depression. Hypomania/MD not necessary for BPI DO. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed. ). Washington D.C.: American Psychiatric Publishing. Behaviors of Mania 1. Grandiosity, increased self esteem 2. Insomnia 3. Pressured or continuous talking 4. Expresses that thoughts are racing or expressed thoughts jump rapidly from one topic to another, called flight of ideas 5. Distractibility 6. Increase in goal-directed or non-goal-directed activity, called psychomotor activity 7. Activities are of increased risk: pain, excessive spending, hypersexuality May include psychotic behavior American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed. ). Washington D.C.: American Psychiatric Publishing. Behaviors of Hypomania Same as for mania except: A. Lasts at least 4 days B. Uncharacteristic for usual behaviors of the person C. Others notice the increased/expansive behaviors D. Not severe enough for major impairment in life functioning American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed. ). Washington D.C.: American Psychiatric Publishing. Bipolar I Typical age of onset 18 years old Prevalence: US 0.6% 11 other countries 0.0% - 0.6% Male to female occurrence 1.1:1 More common in countries with higher incomes Higher rates in separated, widowed Suicide risk 15 X that of general population 36.3% Lifetime risk American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed. ). Washington D.C.: American Psychiatric Publishing. Bipolar II Same as Bipolar I EXCEPT: A. Elevated mood of at least 4 days. B. Not characteristic of person C. Observable by others D. Does not significantly interfere with functioning nor require hospitalization Must include at least one major depressive episode, present or past American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed. ). Washington D.C.: American Psychiatric Publishing. Other Characteristics of Bipolar II Common impulsive behaviors troublesome. Suicide ideation and risk increased 1/3 have suicide attempt in lifetime, 32.4 % Use more lethal means , so success greater Substance abuse Value of increased creativity leads to denial and aversion to treatment American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed. ). Washington D.C.: American Psychiatric Publishing. Bipolar II Prevalence 0.8% US 0.3% Internationally Typical age for development mid 20s Usually begins with a depressive episode Once there is ever a hypomanic episode, DX = BP II and not MDD More lifetime episodes than BP I May be rapid cycling, females more likely, poorer prognosis Once there is a manic episode, DX changes to BP I American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed. ). Washington D.C.: American Psychiatric Publishing. Mania_ Hypomania_ Normal Mood - Eupnea _ Dysthymic Cyclothymic _ Depressed_ Bipolar Moods Time - Comparison Bipolar I 1 week elevated mood 3/7 characteristics (4 if mood irritable) Marked impairment ADLs Psychosis when present defines BP I May have major depression American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed. ). Washington D.C.: American Psychiatric Publishing. Bipolar II 4 days elevated mood 3/7 Characteristics (4 if mood irritable) ADLs NOT markedly affected. Hospitalization not necessary. Behaviors noted by others Must include Major Depression DSM V Coding 296. for Bipolar I Codes following decimal: Mild, Moderate, Severe Most current episode Mania, Hypomania, Depressed Psychotic feature present Partial or Full Remission 296.89 for Bipolar II Further modifiers are written in words American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed. ). Washington D.C.: American Psychiatric Publishing. Major Depression A. For at least a period of 2 weeks, 5 of 9 symptoms (next slide) have occurred. Depressed mood or anhedonia (loss of pleasure) Represents change from usual. The symptoms are not due to another medical condition. B. Major impairment in life functioning/distress C. Not due to another medical condition or effects of a substance American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed. ). Washington D.C.: American Psychiatric Publishing. Behaviors of Depression 1. Depressed mood (sadness, emptiness, hopelessness, crying) most all day, most every day. 2. No or nearly no interest in pleasure or activities, most all day, most every day. (Anhedonia) 3. Significant loss of appetite with unplanned weight loss (=/5%) 4. Too much or too little sleep, insomnia or hypersomnia 5. Significant activity slowing or irritability American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed. ). Washington D.C.: American Psychiatric Publishing. Behaviors of Depression 6. Continuous low energy and/or fatigue 7. Feeling of excessive guilt (may be delusional) or worthlessness. 8. Less ability to concentrate or make decisions most all day, most every day. 9. Thoughts of death: suicidal ideation with or without a plan The above may be subjective or observed by others. The above may not be normal reactions to significant loss American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed. ). Washington D.C.: American Psychiatric Publishing. Depression Major depressive SX are the most common first presentation for which people with BP II disorder seek medical attention, particularly hospitalization. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed. ). Washington D.C.: American Psychiatric Publishing. Suicide Ideation Thoughts of Death Wanting relief The world will be better off w/o me Significant others will be better off w/o me Contemplation Plan Means and lethality Energy with which to carry out Clues to Suicide and Interventions Verbalizing the future w/o oneself Giving things away Threats ALWAYS take any clue to suicide seriously. ADDRESS person openly Do want to harm yourself? Do you have a plan? What is you plan? Notify significant others and /or authorities Offer HOPE. Things NOT to say: guilt, shame, false reassurance, can “snap out of it.” Suicide Prevention? Research does not support effectiveness of “Suicide Contracts.” American Psychiatric Association. (2003). Practice guidelines for the assessment and treatment of patients with suicidal behaviors. American Journal of Psychiatry, 160(11Suppl.), 1-60. Use written “Plan for Life” (positive approach) When I feel_ (describe) I will _ (activities) I will call _ (support persons) I will call _ (Suicide Contact ph. #s, 911) Psychosis BPI may have psychotic features Psychoses of BPD are usually of the type of Delusions strongly held/fixed beliefs that defy evidence or reality Examples: grandiosity, persecutory, referential, erotomanic, somatic, nihilistic. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed. ). Washington D.C.: American Psychiatric Publishing. Bipolar Typical Characteristics People who have mania or hypomania frequently do not recognize/deny that their behaviors are abnormal. They may enjoy their elevated moods. They may value ability to accomplish goals. If behaviors are serious enough, persons may have to be hospitalized. Usually they are resistant to hospitalization resulting in involuntary admission. Behaviors, particularly delusional, may result in illegal transgressions. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed. ). Washington D.C.: American Psychiatric Publishing. Co Morbidity Drug and Substance use, abuse, and addictions are common Alcohol Marijuana Persons desperately want to relieve symptoms Etiology Multiple - Complex Familial Relatives of those with Bipolar Disorders are more likely to have. 10X the risk. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed. ). Washington D.C.: American Psychiatric Publishing. -Both par