Bipolar Disorder Past Paper PDF

8/25/2024 Copyright Notice Do not remove this notice. 1 CHAPTER 6 BIPOLAR DISORDER Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Ri...

8/25/2024 Copyright Notice Do not remove this notice. 1 CHAPTER 6 BIPOLAR DISORDER Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-2 2 1  8/25/2024 LEARNING OBJECTIVES 6.1 Differentiate bipolar I disorder, bipolar II disorder and cyclothymic disorder 6.2 Understand the epidemiological aspects of bipolar disorder 6.3 Describe the possible causes of bipolar disorder 6.4 Describe the medical and psychological interventions used to treat and prevent bipolar disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-3 3 2008 Getty Images Andrew Johns, previously a professional rugby league player, has spoken publicly about his bipolar disorder to raise awareness of mood disorders. This will contribute to the de-stigmatisation and acceptance of these conditions in the community. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-4 4 2  8/25/2024 The History of Bipolar Disorders For much of history, mania and depression (melancholia) were viewed as separate disorders During the late nineteenth century, mania and depression began to be considered as a single entity In 1957, Karl Leonhard argued that the term ‘manic depressive insanity’ was too inclusive, and coined the term ‘bipolar disorder’ An Australian psychiatrist, John Cade, “discovered” lithium as an effective treatment for mania—which revolutionised the treatment of bipolar disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-5 5 DSM-5-TR Bipolar and Related Disorders Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder Substance/Medication Induced Bipolar and Related Disorder Bipolar and Related Disorder Due to Another Medical Condition Other Specified Bipolar and Related Disorder Unspecified Bipolar and Related Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-6 6 3  8/25/2024 DSM-5-TR Bipolar and Related Disorders Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder Substance/Medication Induced Bipolar and Related Disorder Bipolar and Related Disorder Due to Another Medical Condition Other Specified Bipolar and Related Disorder Unspecified Bipolar and Related Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-7 7 The Bipolar Disorders With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-8 8 4  8/25/2024 The Bipolar Disorders Bipolar disorders embrace a spectrum of disorders including bipolar I, bipolar II and cyclothymic disorder These three disorders all share symptoms of pathologically elevated, expansive, or irritable mood These mood states are referred to as manic and hypomanic episodes Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-9 9 The Bipolar Disorders Bipolar I disorder: – Presence of one or more manic episodes – Major depression may be present but not required for the diagnosis Bipolar II disorder: – At least one episode of major depression – At least one episode of hypomania – Must not have had a manic episode Cyclothymic disorder: – Symptoms are less extreme but more chronic than bipolar I or II – Numerous periods of elevated and depressed mood, but not severe enough to meet criteria for hypomanic, manic or major depressive episode Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-10 10 5  8/25/2024 DSM Defined [Mood] Episodes Primary depressive (and bipolar) disorders are based on the presence or absence of various types of Episodes: – Major Depressive (learned about last week) – Manic – Hypomanic Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-11 11 DSM-5 Diagnostic Criteria for a Manic Episode A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary). B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behaviour. 1) Inflated self-esteem or grandiosity. 2) Decreased need for sleep (e.g., feels rested after only 3 hours of sleep). 3) More talkative than usual or pressure to keep talking. 4) Flight of ideas of subjective experience that thoughts are racing. 5) Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. 6) Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed-activity). 7) Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-12 12 6  8/25/2024 DSM-5 Diagnostic Criteria for a Manic Episode C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another medical condition. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-13 13 Manic Episode Manic At least one week Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-14 14 7  8/25/2024 DSM Defined [Mood] Episodes Hypomanic episode shares the same symptom profile as mania. In hypomania the symptoms are not severe enough to interfere with daily functioning. A hypomanic episodes is usually of a shorter duration. In hypomania the symptoms do not include hallucinations or delusions and do not necessitate hospitalisation. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-15 15 DSM-5 Diagnostic Criteria for a Hypomanic Episode A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day. B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree. 1) Inflated self-esteem or grandiosity. 2) Decreased need for sleep (e.g., feels rested after only 3 hours of sleep). 3) More talkative than usual or pressure to keep talking. 4) Flight of ideas of subjective experience that thoughts are racing. 5) Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. 6) Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed-activity). 7) Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-16 16 8  8/25/2024 DSM-5 Diagnostic Criteria for a Hypomanic Episode C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic. D. The disturbance in mood and the change in functioning are observable to others. E. The episode is NOT severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic. F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment). Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-17 17 Manic and Hypomanic Episodes Manic Hypomanic Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-18 18 9  8/25/2024 Now, from Episodes to Disorders Last week - Depressive Disorders Today - Bipolar Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-19 19 Now, from Episodes to Disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-20 20 10  8/25/2024 DSM-5 Diagnostic Criteria for Bipolar I Disorder A. Criteria have been met for at least one manic episode. B. The occurrence of the manic and major depressive episode(s) [if they are present] is not better explained by another mental disorder… Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-21 21 Bipolar Disorders: Bipolar I Manic At least one week Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-22 22 11  8/25/2024 Bipolar Disorders: Bipolar I Manic Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-23 23 Bipolar Disorders: Bipolar I Manic Major Depressive Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-24 24 12  8/25/2024 Bipolar Disorders: Bipolar I Manic Major Depressive Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-25 25 Bipolar Disorders: Bipolar I Manic Hypomanic Major Depressive Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-26 26 13  8/25/2024 DSM-5 Diagnostic Criteria for Bipolar II Disorder A. Criteria have been met for at least one hypomanic episode AND at least one major depressive episode. B. There has NEVER been a manic episode. C. The occurrence of the manic and major depressive episode(s) [if they are present] is not better explained by another mental disorder… D. The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment… Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-27 27 Bipolar Disorders: Bipolar II Hypomanic Major Depressive Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-28 28 14  8/25/2024 Bipolar Disorders: Bipolar II Hypomanic Major Depressive Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-29 29 Although Depressive episodes are typically more frequent (or of longer duration) than are hypomanic episodes (like 30/1 or 50/1) (50% versus 1% of the time). They are also more common or of longer duration in Bipolar I although the ratio is more like 3/1 (30% compared to 10% of the time) for depressive to manic episodes. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-30 30 15  8/25/2024 DSM-5 Diagnostic Criteria for Cyclothymic Disorder A. For at least 2 years (or 1 for children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode. B. During the above period, the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time. C. Criteria for a major depressive, manic, or hypomanic episode have never been met. D. The symptoms of criterion A are not better explained by another mental disorder… E. The symptoms are not attributable to the physiological effect of a substance, or a medical condition. F. The symptoms cause distress or impairment. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-31 31 Cyclothymic Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-32 32 16  8/25/2024 Subtypes of Bipolar Disorders With…. Anxious distress Seasonal – Episodes happen regularly at a particular time of year Rapid cycling – At least 4 episodes within past year Peripartum onset – Within 4 weeks of giving birth Catatonia – Extreme physical immobility or excessive peculiar physical movement Psychotic features – Delusions or hallucinations Melancholic features – Inability to experience pleasure (anhedonia) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-33 33 Rapid Cycling Subtype of Bipolar Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-34 34 17  8/25/2024 The Bipolar Disorders With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-35 35 Prevalence Data - Australia Data from: Teesson, Mitchell, Deady, Memedovic, Slade, & Baillie. (2011). Affective and anxiety disorders and their relationship with chronic physical conditions in Australia: findings of the 2007 National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 45, 939-946 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-36 36 18  8/25/2024 Prevalence Data – USA (lifetime) GENDER Bipolar I Bipolar II Major Dep Dysthymia MEN 0.7 % 0.4 % 2.6 % 2.2 % WOMEN 0.9 % 0.5 % 7.0 % 4.1 % Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-37 37 The Epidemiology of Bipolar Disorders Lifetime prevalence of 1.3 per cent, and 12-month prevalence of 0.9 per cent (from a different Australian study) Men and women are generally equally likely to meet criteria for bipolar I disorder; women may be slightly more likely than men to meet criteria for bipolar II disorder Median age of onset is around 25 years; between 50% and 67% of BD-I and BD-II have onset before age 18 Most time is spent in depressive episodes, compared to manic or hypomanic episodes In community studies, 25% to 33% of bipolar I patients report unipolar mania. High rates of relapse are made worse by poor medication compliance Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-38 38 19  8/25/2024 Problems with Underdiagnosis and Overdiagnosis of Bipolar Disorder Patients with bipolar disorder may be misdiagnosed as having schizophrenia (men) or major depressive disorder (women) – Misdiagnosis as schizophrenia may be because of similarities between psychotic features of acute mania and schizophrenia (e.g., delusions and hallucinations) – Misdiagnosis as major depressive disorder may be because past episodes of hypomania or mania are not adequately explored by the clinician Brief periods of elevated mood may be wrongly diagnosed as hypomania – Common for those with borderline personality disorder – Could mean inappropriate use of mood-stabilising medications Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-39 39 Additional Problems Associated with Bipolar Disorder Anxiety disorders – Nearly one in two individuals with bipolar disorder have a diagnosis of at least one anxiety disorder Substance misuse – Reported in 39 per cent of people with bipolar disorder Social and economic costs – Those with bipolar disorder are almost five times more likely to have disrupted relationships Suicide – Suicide rate is nearly 15 times that of the general population Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-40 40 20  8/25/2024 Impairment in Psychosocial Functioning
The majority of patients with BD experience significant impairment in work, social, and family functioning after illness episodes.
In a large study of 253 adult patients with bipolar disorder, only about one in three worked full-time outside of the home.
More than half (57%) were unable to work or worked only in sheltered settings.
A remarkable feature of bipolar spectrum disorders is the wide range of functioning, with some individuals doing quite well and others struggling with core domains of life such as employment and relationships. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-41 41 Bipolar Disorder and Creativity Potential association between bipolar disorder and creativity Research findings are inconsistent but many people with bipolar disorder identify as creative. Many historical figures in the arts, literature, and politics are believed to have possibly had bipolar disorder—Vincent Van Gogh, Ernest Hemingway, and Winston Churchill are examples. Subjective value of creativity has implications for treatment of bipolar disorder, e.g., addressing concerns that bipolar medication might blunt creativity. Shared vulnerability model – Vulnerability to pathology and creativity share factors such as cognitive disinhibition, an attentional bias towards novel stimuli, and neural hyperconnectivity Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-42 42 21  8/25/2024 The Bipolar Disorders With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-43 43 The Aetiology of Bipolar Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-44 44 22  8/25/2024 The Aetiology of Bipolar Disorder Significant genetic component – As noted, twin studies suggest a heritability rate of about 85% or as high as 93%. Neurotransmitters Stressful life events and sleep disruption – Diathesis-Stress Model: there is an interaction between underlying vulnerability and stressful life events, particularly when they affect circadian rhythms. Goal Dysregulation Model – Mania is the result of excessive goal engagement. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-45 45 Aetiology: Genetic Factors
As noted, bipolar disorder is among the most heritable of disorders, with heritability estimates from twin studies ranging as high as.85 to.93.
Among first-degree relatives of those with bipolar disorder, estimates have ranged from 5% to 12%, and between 20% and 25% when all forms of mood disorder in first-degree relatives are considered.
Overall evidence suggests an aggregated small effect of a large number of genes (risk variants), with weak differences among diagnoses. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-46 46 23  8/25/2024 Aetiology: Genetic Factors
Among the first-degree relatives of people with BD, there is an increased risk of major depressive disorders as well as schizophrenia.
Monozygotic twins of individuals with schizophrenic disorder are at an increased risk for BD (8.2%) as well as schizophrenia (40.8%).
Likewise, the monozygotic twins of BD patients are at an increased risk for schizophrenia (13.6%) and BD (36.4%).
Of the genetic regions hypothesized to be involved in BD, several appear to overlap with those proposed to increase risk for schizophrenia. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-47 47 Aetiology: Neurotransmitters
Dopamine, serotonin, and glutamate have been studied
Theoretically, dopamine function is enhanced during mania and diminished during depression.
Among people without BD, dopaminergic agonists have been found to trigger manic symptoms such as increased mood, energy, and talkativeness.
Manic symptoms in response to amphetamine are more pronounced among people with BD than among those without BD.
As serotonin constrains other neurotransmitter systems, deficits in the function of the serotonin system are believed to allow greater variability in the function of dopamine. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-48 48 24  8/25/2024 Stressful Life Events and Sleep Disruption
Sleep deprivation has been found to: i. Interfere with recalibrating the sensitivity of dopamine receptors. ii. Diminish functional activation of the prefrontal cortex to emotionally relevant cues iii. Heighten reactivity to negative stimuli and reward stimuli.
Sleep deprivation might mediate the effects of life events on episodes of BD, noting that life events often interfere with the ability to sleep (e.g., transmeridian flights, childbirth, etc.).
In one study, people with BD reported more life events that disrupted social rhythms in the 8 weeks before mania recurrences than in the 8 weeks before depressive recurrences.
Such findings provide one more potential mechanism for understanding how life events affect the onset of mania. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-49 49 Stressful Life Events and Sleep Disruption
Patients with BD show greater variability in their circadian patterns of activity, as measured using actigraphy, than controls, even during interepisode periods.
Self-ratings of instability in social rhythms also were found to predict the onset of mood episodes among undergraduates with high scores on measures of subsyndromal depressive and manic symptoms.
Once manic states are present, many people with BD show diminished sleep at night, as assessed using actigraphy.
BD may be characterised by a vulnerability of the sleep and circadian rhythm system, such that even at baseline, people show less distinct and regular routines.
As people become manic, profound reductions in sleep and circadian rhythms may occur.
Bidirectional effects appear likely, in that: a. Sleep deprivation can trigger manic symptoms. b. Life events involving schedule disruption are common before manic episodes. c. Manic symptoms can foster a more chaotic lifestyle and sleep-wake pattern. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-50 50 25  8/25/2024 Aetiology: Goal Dysregulation
Goal dysregulation (emphasising reward sensitivity)
It has long been hypothesized that BD relates to dysregulation in reward pathways.
People diagnosed with BD have been shown to have greater activation of the nucleus accumbens (thought to play a role in reward and pleasure) during reward anticipation than in those with no mood disorder.
Thus, people with BD may be more reactive to rewards and successes in their environment.
Elevated reward sensitivity has been found to predict a more severe course of mania among those diagnosed with bipolar I disorder.
In a longitudinal study of bipolar I patients, goal- attainment life events predicted increases in manic but not depressive symptoms, even after controlling for baseline manic symptoms and excluding life events that could have been caused by these symptoms. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-51 51 Aetiology: Goal Dysregulation
Those with BD endorse highly ambitious life goals, and ambitious goal setting is associated with a more severe course of mania.
Highly ambitious goal setting also predicts the onset of BD in vulnerable adolescents.
There are distinct behavioural shifts after success that are more pronounced for those with BD than for those without the disorder; for example, more active goal pursuit after making initial progress toward a goal.
In sum, goal attainments and successes appear to inspire bursts of confidence, which then fuel increased goal engagement in BD.
Excessive goal engagement may accelerate the development of manic symptoms. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-52 52 26  8/25/2024 The Bipolar Disorders With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-53 53 Treatment of Bipolar Disorder Hospitalisation—when patients are suicidal or psychotic Mood stabilising medication Psychological approaches: – Psychoeducation—identify signs of relapse, medication adherence, minimise risk – Cognitive behaviour therapy—foster self-efficacy – Interpersonal and social rhythm therapy(IPSRT)—reduce disruption in daily routines and sleep/wake cycles – Family interventions—improve family knowledge, communication and problem-solving skills – Relapse prevention—the instability model of bipolar disorder relapse – New developments—mindfulness-based cognitive therapy, internet-based treatments, focus on quality of life, self-management for bipolar disorder focusing on wellness and personal recovery Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-54 54 27  8/25/2024 John Cade, the Australian psychiatrist who discovered the beneficial effects of lithium, which was to transform the treatment of individuals with bipolar disorder. Courtesy the family of Professor John Cade See also: http://science.jrank.org/pages/3953/Lithium-John-Cade.html Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-55 55 Medications for Bipolar Disorder Lithium – Up to 80% receive at least some relief with this mood stabilizer – Potentially serious side effect  Lithium toxicity Newer mood stablizers – Anticonvulsants  Depakote – Antipsychotics  Zyprexa – Both also have potentially serious side effects Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-56 56 28  8/25/2024 Psychological Treatment of Bipolar Disorder Psychoeducational approaches – Provide information about symptoms, course, triggers, and treatments Interpersonal and social rhythm therapy – includes techniques to stabilize social rhythms and resolve interpersonal problems that preceded the episode Family-focused treatment (FFT) – Educate family about disorder, enhance family communication, improve problem solving. CBT – Similar to with depressive disorders, with a few modifications. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-57 57 CBT for Bipolar Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-58 58 29  8/25/2024 Any Questions? If so, post them online Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-59 59 30