Bipolar Disorder

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					        Bipolar Disorder

             Presented by:
            APS Healthcare
Southwestern PA Health Care Quality Unit
                (HCQU)
                          Disclaimer
Information or education provided by the HCQU
is not intended to replace medical advice from
the consumer’s personal care physician, existing
facility policy or federal, state and local
regulations/codes within the agency jurisdiction.
The information provided is not all inclusive of
the topic presented.
Certificates for training hours will only be awarded to those who attend a
training in its entirety. Attendees are responsible for submitting paperwork
to their respective agencies.



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         Note of Clarification

While mental retardation (MR) is still
recognized as a clinical diagnosis, in an
effort to support the work of self-advocates,
the APS SW PA HCQU will be using the
terms intellectual and/or developmental
disability (I/DD) to replace mental
retardation (MR) when feasible.




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                   Objectives
Upon completion of the session the participant will:
1. Define Bipolar Disorder
2. Distinguish between Bipolar I and Bipolar II
   Disorders
3. Identify successful treatment options for
   Bipolar Disorder




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      What is Bipolar Disorder?

 A mental illness
 A psychiatric disorder characterized by
  wide swings in mood, energy level and
  need for sleep
 A mood disorder




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 Why is it Important to Think about Mood
               Disorders?
 Pennsylvania found that a vast majority
  of mental illness in people with I/DD is
  mood disorders
 8-13% of the general population is
  affected by a mood disorder
 30% of people with I/DD are affected by
  a mood disorder


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               Prevalence of the Various
                      Syndromes
        Others
        (4%)                               Schizophrenia
                                               (1%)



 Anxiety
 Disorders
   (20%)




Mood Disorders
     (75%)
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Causes/Triggers of Bipolar Disorder

 No one cause
 Thought to be genetic in origin
     Researchers attempting to identify
      susceptible genes
     Illness is familial (60% of cases)
 Biological
 Stress of an early environment
 Stress triggers
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             Presentation
 Mood swings vary from person to
  person
 Presentation will be depressive, manic,
  or mixed
 Mood changes may be related to
  situational or seasonal changes
 Mood episodes may last weeks, months
  or years


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          Bipolar Disorder Facts

   Symptoms can be managed
   No cure
   May be triggered by stress
   If untreated, may get worse
   Difficult to diagnose
   Difficult to identify mood episodes or
    “flare-ups” in people with I/DD

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    What You May See as a Diagnosis
   Atypical Psychosis or Schizophrenia
   Psychosis or Schizophrenia NOS
   Organic Disorder (Atypical or NOS)
   Intermittent Explosive Disorder (IED)
   Borderline Personality Disorder
   Impulse Control Disorder
   Adjustment or Oppositional Defiant Disorder
   Conduct Disorder
   ADD or ADHD


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              Bipolardy

                    Bipolar Disorder
Definitions         and I/DD


100 POINTS          100 POINTS
200 POINTS          200 POINTS
300 POINTS          300 POINTS



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           Bipolar Disorders

 Bipolar I Disorder
  • Manic Episode
 Bipolar II Disorder
  • Major Depressive Episode
  • Hypomania
 Cyclothymic Disorder
 Bipolar Disorder NOS


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    Bipolar I Disorder: What is it?

 One or more manic or mixed episodes
 Often will have one or more major
  depressive episodes
 Recurrence indicated by either shift in
  polarity of episode or interval between
  episodes of at least 2 months without
  manic symptoms


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 DSM-IV Criteria for Manic Episode
A. Distinct period of abnormally and
   persistently elevated, expansive, or irritable
   mood, lasting at least one week
B. During the mood disturbance, three or more
   of the following need to be present:
  1. Inflated self-esteem or grandiosity
  2. Decreased need for sleep
  3. More talkative than usual or pressure to keep
     talking
  4. Flight of ideas or feels like thoughts are racing

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   Criteria for Manic Episode, con’t.
  5. Distractibility
  6. Increase in goal-directed activity or psychomotor
     agitation
  7. Excessive involvement in pleasurable activities
     that have a high potential for negative
     consequences
C. Symptoms do not meet other criteria
D. The mood disturbance causes marked
   impairment in all areas of functioning
E. Symptoms are not due to a medical
   condition or substance abuse

                                                         16
       Bipolar II – What is it?
 Occurrence of one or more Major
  Depressive Episodes accompanied by
  at least one Hypomanic Episode
 Frequent mixed states, more rapid
  cycling than Bipolar I Disorder




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     Criteria for Major Depressive
                Disorder
A. Five or more of the following must be
   present during the same two week period:
  1. Depressed mood most of the day, nearly every
     day
  2. Diminished interest or pleasure in all or almost
     all activities previously enjoyed
  3. Significant weight loss or weight gain
  4. Insomnia or hypersomnia
  5. Psychomotor agitation
  6. Fatigue or loss of energy

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     Criteria for Major Depressive
             Disorder, con’t.
  7. Feelings of worthlessness or excessive or
     inappropriate guilt
  8. Diminished ability to think or concentrate or
     indecisiveness
  9. Recurrent thoughts of death, suicidal ideation
B. Symptoms do not meet other criteria
C. Symptoms cause clinical distress in
   functioning levels
D. Not due to medical or substance abuse


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          Criteria for Hypomania
 Period of elevated or irritable mood lasting for
  at least four days
 Must exhibit at least three symptoms, shown
  in Manic episode
 The change in mood is “out of the norm” for
  the person
 The mood disturbance is observable by
  others
 Episode is not severe enough to impair
  functioning


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               Bipolardy

Bipolar I Disorder   Bipolar II Disorder


100 POINTS           100 POINTS
200 POINTS           200 POINTS
300 POINTS           300 POINTS



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         Cyclothymia: What is it?

 Chronic milder spectrum of bipolar
  disorders
 Consists of :
     Short periods of mild depression
      Short periods of hypomania
     Lasts a few days to a few weeks
      separated by short periods of normal mood



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        Cyclothymia - Symptoms
 Restlessness, thrill seeking
 Unstable school and work histories
 Multiple placements or history of stormy
  relationships, repeated interpersonal crises
 Energetic, upbeat and friendly but easily
  irritated, critical, hostile when frustrated or
  crossed
 Obtrusiveness
 Talkativeness and difficulty getting to the
  point
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     Cyclothymia – Symptoms, con’t.

   Hopelessness or pessimism
   Guilt, worthlessness, or helplessness
   Fatigue
   Insomnia or hypersomnia
   Decreased ability to concentrate or make
    decisions
   Restlessness or irritability, agitation
   Loss of appetite, weight loss or gain
   Chronic pain not caused by physical disease
   Recurrent thoughts of death or suicide; suicide
    attempts

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Bipolar Disorder NOS: What is it?
 Person experiences some of the
  symptoms of bipolar disorder
 Does not fit into standard bipolar
  classifications
 Does not fit into any other category of
  mood disorder



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             Episode Specifiers
 Mixed episodes
    Meet criteria for both manic and depressive
 Rapid cycling
    4 or more mood episodes within 1 year
 Ultra rapid cycling
    May be daily or weekly
 With seasonal patterns
    Onset and remission occur at certain times of the
     year
 With psychotic features
    Indicates psychotic features are present


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    Supporting Someone with Bipolar
               Disorder…
 Learn about the person’s history
 Know the person’s stressors/triggers
 Don’t be judgmental
 Know the medications and possible side
  effects
 A change in behavior may be the onset
  of an episode


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     Basic Positive Approaches
            Philosophies
 All behavior is meaningful
 People have good reasons for doing
  what they do
 People do the best they can with what
  they know in that context and at that
  point in time



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                  Treatment

 Medications
  •   Mood stabilizing medication
  •   Antidepressant medication
  •   Atypical antipsychotic medication
  •   Anti-anxiety medication



*Medication alone is never the answer

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               Treatment con’t.

   Medication compliance
   Address safety concerns
   Thyroid Function
   Therapy
   Electro Convulsive Therapy (ECT)
    • When medication has been ineffective
    • Used for episodes of severe depression, mania, or
      mixed
    • Be aware of possible long term effects



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             Bipolardy

Treatment          Bonus Round


100 POINTS         100 POINTS
200 POINTS         200 POINTS
300 POINTS         300 POINTS



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              In Conclusion…
 Bipolar disorder is a long-term condition
 It’s difficult to diagnose
  • may require caregivers to report behavioral
    manifestations descriptively and objectively
 It can be treated
 People with bipolar disorder can and do lead
  full and productive lives




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                   References
 www.mayoclinic.com
 www.pendulum.org
 www.mentalhealth.net
 National Institute of Mental Health. Bipolar Disorder.
  www.nimh.nih.gov/publicat/bipolar.cfm
 R.Sovner and MA Lowry 1990, Habilitative Mental
  Health Newsletter 9:55-56, 1990
 Dr. Lauren Charlot, PhD, Assistant Professor of
  Psychology, University of Massachusetts Medical
  School
 DSM-IV TR


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              References

 Unmasking Mood Disorders, Guy
  Legare, M.Ps., Clinical Training
  Consultant, Temple University, Institute
  on Disabilities, University affiliated
  Program and OMR Statewide Training
  Initiative




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     To register for future trainings,
                    or
 for more information on this or any other
physical or behavioral health topic, please
            visit our website at

      www.hcqu.apshealthcare.com


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         Evaluation

  Please take a few moments to
  complete the evaluation form
found in the back of your packets.


          Thank You!


               4-24-2008/es          37