DUYGU SAVCI- 454358 Psychotheraphy Spring 2016 C:\Users\DUYGU\Desktop\6358855668965132282014366179_bipoalr-2.jpg BIPOLAR ? —Bipolar disorder (manic-depressive illness) is referred as an episodic and lifelong and clinically severe mood disorder —Mania/ manic episode: an elevated, euphoric, and expansive mood,often interfered by outbursts of strong irritability or violence—particularly when others do not go with the manic person’s wishes and thoughts —Depressive episode: markedly depressed mood or loss of interest in pleasurable activities —Manic and hypomanic periods are tend to be shorter than depressive periods —Hard to distinguish from unipolar major depression —Tends to have psychotic features too —Impairment of occupational and social functioning, hospitalization might be necessary in manic episodes Cyclothymic Disorder Bipolar I Bipolar II cyclothmc.png Cyclothymic Disorder: persists for at least 2 years, lacks certain extreme symptoms and psychotic features —Bipolar I: at least one manic episode or mixed episode —Bipolar II: the person does not experience full-blown manic (or mixed) episodes — Experience of clear-cut hypomanic episodes as well as major depressive episodes as in bipolar I disorder bipolar1-2.png Bipolar tablosu.png —Has its roots in the work of the Greek physicians of the classical period —Mania and melancholia are two of the earliest described human diseases —Classical Era and Hippocrates: mania, melancholia, paranoia, deliria, hysteria —Aretaeus: eclecticism, biological causes and melancholia —Jean-Pierre Falret: “‘a circle of both types one single disease.” —The modern concept: in France, 19th century, hospital La Salpetriere, Jean-Pierre Falret. —Emil Kraepelin “the father of modern psychiatry” —Counter arguments to bipolar disorder —Re-birth of bipolar disorder: Jules Angst 1966, Switzerland — —Bipolar disorder is seen equally in both men and women but the depressive episodes are more common in women —Average age of onset is 18-22 —Bipolar II occurs around 5 years later than Bipolar I —Both recurrent — —United States —The life time prevalence of Bipolar I: around 0.6% —The life time prevalence of Bipolar II: around 0.8% — (Merikangas, 2007) —Europe —The life time and 12 months prevalence of Bipolar disorder in general: around 0.9% —Bipolar II > Bipolar I — — (Pini, Stefano, 2005) Wittchen, Hans-Ulrich, Stephan Mühlig, and Lukas Pezawas. "Natural Course and Burden of Bipolar Disorders." The International Journal of Neuropsychopharmacology Int. J. Neuropsychopharm. 6.2 (2003): 145-54. Web. —Causal Factors in Bipolar Disorder —Biological causal factors -Genetic factors: 8-10% first degree relatives, twin studies and high concordance (60% in monozygotic, 12% in dizygotic) -Neurochemical factors: norepinephrine, serotonin, dopamine and high dopamanergic activity - Hormonal abnormalities: elevated cortisol, thyroid hormones - - - - -Neurological factors: “blood flow to the left prefrontal cortex is reduced during depression, during mania it is increased in certain other parts of the prefrontal cortex (Goodwin & Jamison, 2007)” (Butcher, 246). -Enlarged basal ganglia and amygdala, reduced volume in hippocampal area -Biological rhythms: sleep and circadian rhythms — C:\Users\DUYGU\Desktop\most-stressed-out-cities-slideshow-1.jpg Psychological Causal Factors -Stressful life events -Social and environmental factors: low social support, neuroticism, cognitive styles and cognitive vulnerability —Interview with the patient —Interview with the family or relatives —Observation —DSM-V Criteria C:\Users\DUYGU\Desktop\What-Does-Psychology-of-Marketing-Mean.jpg —The important problem ! —People usually tend not to seek help —Relapses —Public awareness —People who can get a treatment and people who cannot get a treatment —1950: monoamine oxidase inhibitors (MAOIs) —Treating depression but dangerous / sometimes fatal —1960-1990: tricyclic antidepressants —Side effects —Selective Serotonin Reuptake Inhibitor (SSRI) —Side effects such as sexual dysfunction — —Lithium —Mood stabilizer —Especially for manic episodes —Better for preventing cycling —Still some side effects: cognitive slowing, weight gain etc. —Electroconvulsive Theraphy —Severe depression, suicidal risks, for people who deny to take medicine etc. —Transcranial Magnetic Stimulation (TMS) —A magnetic coil is placed near the head of the person and it produces small electric signals to the brain region. —Less side effects to the cognitive functioning —Deep Brain Stimulation —A neurostimulator is placed in the specific brain region which sends electrical signals —Bright Light Theraphy — Exposure to daylight or to specific wavelengths of light — —“The belief that people with psychological problems can change—can learn more adaptive ways of perceiving, evaluating, and behaving—is the conviction underlying all psychotherapy” (Butcher, 2007). — —Cognitive-Behavioral Theraphy —Combination with medication — —Behavioral Activation Theraphy —Interpersonal therapy — —Family Theraphy —Criticism reduce and its effect on relapses — —“A key component addressed in CBT for bipolar depression is the way that the patients deal with the serious losses that experience as a consequence of their bipolar disorder” (Mansell, W., Colom, F., & Scott, J. 2005). —Changing the negative cognitions —Activity schedules which encourages the abilities and activities of the patients that they think they are gone —“In particular, the patient is encouraged to see the benefits of pleasurable behaviour that do not involve large increases in activity and are not directed at achieving highly challenging goals. Having a bath or listening to relaxing music are examples” (Mansell, W., Colom, F., & Scott, J. 2005). —Brief form of treatment (usually 10 to 20 sessions) which focuses on here and present problems —Focus on the results of the disorder on the patient’s life and well being —Focus on suicidal risks —Focus on negative appraisals —Uses pleasurable relaxing activities —Relapse prevention —Focuses on helping patients to become more active and become more in interaction with their environment —Scheduling activities —Exploring new behavior to reach goals —Role playing to find out the deficits —Focuses more on changing the behavior than CBT —Positive reinforcement and reduced avoidance — —Interpersonal Theraphy: —Focuses on present relationship problems —Focuses on changing the maladaptive relation and interaction patterns —Focuses on stabilizing the daily rhythm and social patterns —Relapses can be triggered by the negative elements in the patient’s family life —Criticism as an element for depression relapse —Expressed emotions and hostility in the family as a trigger to bipolar relapses —Family interventions —Providing information for the family about how to deal with the disorder —Marital interventions which focus on marital problems in the patient’s life and to increase marital satisfaction — (Johnson, 2005) —“My temperament, moods, and illness clearly, and deeply, affected the relationships I had with others and the fabric of my work. But my moods were themselves powerfully shaped by the same relationships and work. The challenge was in learning to understand the complexity of this mutual beholdenness...” (Alloy, 2005). —Alloy, L. B., Abramson, L. Y., Urosevic, S., Walshaw, P. D., Nusslock, R., & Neeren, A. M. (2005). The psychosocial context of bipolar disorder: Environmental, cognitive, and developmental risk factors. Clinical Psychology Review, 25(8), 1043-1075. —Butcher, J. N., Mineka, S., & Hooley, J. M. (2007). Abnormal psychology. Boston: Pearson/Allyn and Bacon. —Johnson, S. L. (2005). Life events in bipolar disorder: Towards more specific models. Clinical Psychology Review, 25(8), 1008-1027. —Mansell, W., Colom, F., & Scott, J. (2005). The nature and treatment of depression in bipolar disorder: A review and implications for future psychological investigation. Clinical Psychology Review, 25(8), 1076-1100. —Mendlewicz, J., Souery, D., & Rivelli, S. K. (1999). Short-term and long-term treatment for bipolar patients: Beyond the guidelines. Journal of Affective Disorders, 55(1), 79-85. —Merikangas, K. R., Akiskal, H. S., Angst, J., Greenberg, P. E., Hirschfeld, R. M., Petukhova, M., & Kessler, R. C. (2007). Lifetime and 12-Month Prevalence of Bipolar Spectrum Disorder in the National Comorbidity Survey Replication. Arch Gen Psychiatry Archives of General Psychiatry, 64(5), 543. —Müller-Oerlinghausen, B., Berghöfer, A., & Bauer, M. (2002). Bipolar disorder.The Lancet, 359(9302), 241-247. —Pini, S., Queiroz, V. D., Pagnin, D., Pezawas, L., Angst, J., Cassano, G. B., & Wittchen, H. (2005). Prevalence and burden of bipolar disorders in European countries. European Neuropsychopharmacology, 15(4), 425-434. —Wittchen, H., Mühlig, S., & Pezawas, L. (2003). Natural course and burden of bipolar disorders. The International Journal of Neuropsychopharmacology Int. J. Neuropsychopharm., 6(2), 145-154. —https://www.youtube.com/watch?v=IJtXLXQ326A — Thank you for listening !