Transcript Bipolar Disorder

Bipolar Disorder
BrainU 2012
Human Neurological
Disorders
Tehmeena Qamar
and
Sandra Muellner
Measurable brain changes
•
•
•
•
Amygdala
Hippocampus
Prefrontal Cortex
Cerebellum
Causes???
**Complex interaction of genetics and environment.
Characteristics of bipolar
disorder
Each of you will receive a card with a
characteristic that you can act out and/or
describe.
Work together to discuss and categorize your
characteristic according to manic or
depressive symptoms.
Move to the group that best fits your symptom.
Was this easy or difficult? Why?
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/
http://faculty.washington.edu/chudler/bipolar.html
Mania (the "high"): In this phase, the person experiences an abnormally elevated mood (lasting for a
week or more), but they also experience at least three of the following symptoms:
1.Inflated self-esteem
2.Reduced need for sleep
3.Excessive talkativeness
4.Racing thoughts
5.Distractability
6.Activities done to excess (for example, spending money)
7.Pursuit of risky behaviors or activities
Depression (the "low"): Mania can quickly and without warning change to a depressive episode. In
addition to a general sad mood, a person in the depressive stage may experience:
1.Loss of interest in activities they previously enjoyed
2.Changes in appetite resulting in weight gain or loss
3.Changes in sleep patterns resulting in difficulty sleeping or oversleeping
4.Agitation
5.Loss of energy
6.Trouble concentrating or thinking
7.Repeated thoughts of suicide or death
These episodes of mood changes can also be accompanied by:1.psychosis: an altered mental state that
is characterized by hallucinations (hearing or seeing something which is not really there). An example
of a hallucination is seeing a large purple floating rat and believing it is real.2.delusions: believing
something about yourself that is not true. An example of a delusion is believing that you have the
ability to fly.
Signs and Tests
•
•
•
•
•
•
Personal Medical History/Medications
Family Medical History
Family’s Behavior Views
History of Mood Swings
Thorough Examination for Check of Illnesses
Lab Tests for Thyroid Problems and Drug Levels
– Drug Use/Abuse Maybe Symptom
• Observation of Moods and Behaviors/Mood Charting
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/
Goals of Treatment
• Periods of Mania & Depression return in most patients
even with Treatment
• Remission, normal function, reduction of medications
or therapy
• Goals:
–
–
–
–
–
Prevention of movement between phases
Avoiding Hospital Stay
Help patient function as well as possible between episodes
Prevent Self Injury and Suicide
Make episodes less frequent and severe
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/
Treatment and Options
• Mood Stabilizer are generally used first
– Carbamazepine, Lamotrigine, Valproate, Lithium
•
•
•
•
Atypical Anti-pscyhotics: Zyprexa, Risperdal, Abilify (Weight Gain)
Anti-depressant to treat depression
Anti-seizure medication
Anti-psychotic & Anti-anxiety drugs to manage mood problems
– Benzodiazepine
•
•
•
•
Electro-Convulsive Therapy (ECT)
Trans-cranial Magnetic Stimulation (TMS)
Hospitalization for Mood Stabilization & Behavior Control
Psychotherapy
• Treatment in children & adolescents – undecided
• Family/Caregiver Education and Support
Ethical Questions
• Conversation about Treatment of Children with Bipolar
Disorder
• Agreement?
• Research on children: brain scans, medication
• Confidentiality issues: when to report threats
• Untreated: Legal, Financial, Relationship, Work
Performance Problems – Societal Issues and
Implications
• Stigma
http://www.mayoclinic.com/health/bipolar-disorder/DS00356/DSECTION=complications
Current Controversies
• Increased diagnosis and treatment in
children
• Major diagnostic tool leads to
misdiagnosis with major depressive
disorder
http://ps.psychiatryonline.org/article.aspx?volume=52&page=51
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2504732/?tool=pmcentrez
Use of Different Diagnostic Tools used for Patients with
Major Depressive Episodes
80%
Percent diagnosed with disorder
70%
60%
50%
Major Depressive Disorder
Bipolar Disorder
40%
30%
20%
10%
0%
DSM-IV
Systematic Structured Interviews
Type of Tool
Impact on Learning
• Both mania and the resulting grandiosity
makes learning seem irrelevant
• Depression isolates individual possibly
resulting in increased absences
• Inability to pay attention affect group and
individual work
• Hospitalizations, self-injury and suicidal
thoughts/attempts result in extended
absences
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/
In Conclusion
For further understanding:
You Tube
Bipolar Disorder: My Story
http://www.youtube.com/watch?v=Q_XWa0BVc
uw
Our thanks to Dr. Gail Bernstein at the University of Minnesota
Dept. of Child and Adolescent Psychology