_disorder journey through mania and depression双相情感障碍的躁狂和抑郁的旅程课件

Bipolar Disorder: Journey Through Mania and Depression H.E. Logue, M.D. Bias Disclaimer nThere is no pharmaceutical support for this program. nI am active in the research field and involved in clinical trials for most of the major pharmaceutical companies. Goals and Objectives nPromote better understanding of the following aspects of Bipolar Disorder: nPrevalence nRecognition and Diagnosis nUnderstanding Risk Factors nGenetic Predisposition nTreatment Considerations nCo-morbid Conditions nReferral Consideration nRichard Dreyfuss nKitty Dukakis nLiza Minnelli nCarman Miranda nMarilyn Monroe nJ.P. Morgan nRalph Nader nSir Isaac Newton nFlorence Nightingale nOzzy Osbourne nDolly Parton nBoris Pasternak nGeorge Patton nJane Pauley nPablo Picasso nCole Porter nAbraham Lincoln nJoshua Logan nJack London nGreg Louganis nMartin Luther nImelda Marcos nAnn Margaret nHerman Melville nBurgess Meredith nKurt Vonnegut nVivian Vance nVictor Hugo nEdgar Allen Poe nLeo Tolstoy nMichelangelo nEzra Pound nCharlie Pride nSergey Rachmaninoff nPatty Duke nThomas Eagleton nThomas Edison nT.S. Eliot nRalph Waldo Emerson nWilliam Faulkner nEddie Fisher nF. Scott Fitzgerald nBetty Ford nHarrison Ford nStephen Foster nSigmund Freud nKing George III nTipper Gore nRobert E. Lee nVivian Leigh nJohn Lennon nAlexander Hamilton nJoan Rivers nNorman Rockwell nCharles Schultz nKing Saul nWilliam Tecumseh Sherman nNeil Simon nRod Steiger nWilliam Styron nAlfred, Lord Tennyson nKing Herod nNathaniel Hawthorne nErnest Hemingway nAudrey Hepburn nHoward Hughes nThomas Jefferson nJoan of Arc nLyndon Baines Johnson nDanny Kaye nTed Turner nMozart nLarry King nJessica Lange nMark Twain nMike Tyson nJean Claude Van Damme nQueen Victoria nMike Wallace nGeorge Washington nRobin Williams nTennessee Williams nThomas Wolfe nVirginia Woolf nLord Tennyson nVincent van Gogh nPeter Tchaikovsky nF. Scott Fitzgerald nCharles Dickens nRobert Louis Stevenson nWalt Whitman nSylvia Plath nMarlon Brando nArt Buckwald nJohn Bunyan nRodney Dangerfield nCharles Darwin nKing David nJohn Denver nPrincess Diana of Wales nCharles Dickens nEmily Dickenson nTheodore Dostoevski nJack Dreyfus nDrew Carey nDick Cavett nRay Charles nFrederick Chopin nWinston Churchill nDick Clark nRosemary Clooney nKurt Cobain nNatalie Cole nSamuel Coleridge nSheryl Crow nIrving Berlin nSteven Foster nLord Byron (George Gordon) nNoel Coward nAlexander the Great nEdwin “Buzz” Aldrin nHans Christian Anderson nRoseanne Barr nLudwig Von Beethoven nWilliam Blake nNapoleon Bonaparte Prevalence nBipolar Disorder affects approximately 5.7 million adult Americans nThe median age of onset for Bipolar Disorder is 25 years. nAn equal number of men and women develop Bipolar Disorder and it is found in all ages, races, ethnic groups and social classes. nBipolar Disorder is the sixth leading cause of disability in the world. nBipolar Disorder results in 9.2 years reduction in expected life span, and as many as one in five patients with bipolar disorder completes suicide. Bipolar Disorder Subtypes nClassic Bipolar Disorder nBipolar I nBipolar II nSubtypes nCyclothymia nMajor Depression Unipolar/Recurrent nDysthymic Disorder nBipolar NOS (Not Otherwise Specified) nOther Considerations nRapid Cycling (part of Bipolar I) nPost-partum Onset nSeasonal Pattern Mood Disorders Five or more of the following: nDepressed mood nDiminished interest or pleasure in activities nSignificant weight loss/gain or decrease/increase in appetite nInsomnia or hypersomnia nPsychomotor agitation or retardation nFatigue or loss of energy nFeelings of worthlessness or excessive or inappropriate guilt nDiminished ability to think or concentrate, or indecisiveness nRecurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. DSM-IV Criteria - Depression Diagnostic Dilemmas nSecondary Depression Depression with nOther psychiatric illnesses nSchizophrenia nAnxiety nPanic disorder nObsessive-compulsive disorder nPersonality Disorders nBorderline nCompulsive nPost-traumatic stress disorder nPost-partum depression nGrief/depression nPractically any psychiatric disorder Depression with nOrganic/Medical Illnesses nHypothyroidism nB-12 deficiency nFolate deficiency nTuberculosis nMyasthenia gravis nDiabetes mellitus nHepatitis C nCushings disease nMononucleosis nParkinsons disease nCHRONIC FATIGUE SYNDROME DSM-IV Criteria - Mania Three or more of the following: nInflated self-esteem or grandiosity nDecreased need for sleep nMore talkative than usual or pressure to keep talking nFlight of ideas or subjective experience that thoughts are racing nDistractibility nIncrease in goal-directed activity or psychomotor agitation nExcessive involvement in pleasurable activities that have a high potential for painful consequences Mood Symptoms nEuphoria/Mania nDepression (in mixed state) nAnxiety nAnger nHostility nIrritability Behavioral Symptoms nEnergized Activity nDiminished Need to/for Sleep nImpulsivity nAnger with Violence nElevated Libido nDiminished Inhibitions nReckless Behavior Cognitive Symptoms nRacing Rapid Thoughts nDiminished Insight/Invincibility nSensory Hyperacuity nHallucinations nDelusions nPerceptual Distortions nDistractible Disorganized Thoughts S-H-O-T nS: Symptomatology nDo the symptoms appear to be manic or depressed or repeated episodes of depression or mania or continuing mood swings? nH: History nWhat is the history of the person? The history of the family? Is there a family history of mood swings, mood disorders, substance abuse in persons with mood disorders or Bipolar diagnosis? nO: Ongoing illness nWhat is the progression of the illness? What is the course of the disease? Does it continue to go on in a progression appearing as a Bipolar disease course? nT: Treatment response nIf one looks at the response of the treatment one should get a good deduction as to the nature of the illness. Understanding Risk Factors nStress (major or prolonged) nSleep Deprivation/Disruption nAlcohol (major problem) n“Recreational” Drug Use nDiscontinuation of Medications nLoss or Perceived Loss (job, family, friends, finances, health, etc.) nInterpersonal Conflict nTravel Across Time Zones nMood-Altering Medications (benzodiazepines, antidepressants, antipsychotics) nDeath of Loved One or Friend nInadequate Coping Skills nEarly Dementia or Minimal Brain Damage Treatment nDepression: Pre-Modern Era nTincture of Time nPrescribed trip to Europe nActivity nPhysical nSocial nMental nSomatic nInsulin shock nElectric shock nSpiritual nDepression: Modern Era nEducation and Psychotherapy nPharmacotherapy n1950s Tricyclics n1960s Tetracyclics, etc. n1990s SSRIs (Prozac, Paxil, Zoloft) nSNRI (Wellbutrin) nSSNRIs (Effexor, Remeron, Cymbalta) nSpiritual nDepression vs. Bipolar Depression Treatment Statistics nPatients with Bipolar Disorder face up to ten years of coping with symptoms before receiving an accurate diagnosis. nNearly 9 out of 10 patients with bipolar disorder are satisfied with their current medication(s), although side effects remain a problem. nParticipation in a Depression and Bipolar Support Alliance patient-to-patient support group improved treatment compliance by almost 86% and reduced in-patient hospitalization. nConsumers who report high levels of satisfaction with their treatment and treatment provider have a much more positive outlook about their illness and their ability to cope with it. Bipolar Disorder Type II (Depressed Type) nIncorporate all of the previous slide nRecent studies suggest antidepressants cause a sooner relapse or conversion to mania nTreating the Bipolar component is equivalent to casting both broken legs. nMood stabilizers nLithium only drug proven to reduce suicide rate nAntidepressants n1950s Richard Dreyfuss n1990s Depakote, Tegratol, Trileptal, Lamictal nAtypicals? Bipolar Disorder Type I (Manic and Depressive) nMania nAntipsychotics n1953