Bipolar Disorder
(previously known as Manic Depressive Reaction (DSM-I) and Manic Depressive
Illness (DSM-II)) is a mood disorder characterized by a long-term episodic
cyclical course of extreme fluctuations in mood resulting in significant impairment
in social, interpersonal and occupational functioning. The results of repeated
extreme unstable fluctuations in mood can be devastating to the individual
and family members over time. Bipolar Disorder is a serious illness that requires
psychiatric and psychological treatment. Untreated individuals with bipolar
disorder have a significantly higher lifetime rate of attempted and completed
suicide.
The most severe form of the disorder, Bipolar I Disorder, is characterized
by one or more Manic or Mixed episodes of sufficient severity to cause
marked impairment in social and occupational functioning most often resulting
in
a psychiatric hospitalization.
Typically, individuals with Bipolar I disorder experience extreme fluctuations
in mood ranging from Severe Depression to Mania. During Manic Episodes
individuals experience very elevated or irritable moods in which
they may become highly
energized, have an inflated sense of self-esteem, experience a markedly
reduced need for sleep, become very talkative, have racing thoughts,
may take on multiple
projects at once and become easily distracted.
Individuals in a more severe state of mania may lose their normal
sense of judgment and may undertake risky behaviors with the potential
for
painful negative consequences. In the most severe stages of Mania
individuals will
become disorganized in their behavior and thought processes. These
may appear bizarre to others and they may experience strange or
unusual ideas. The disorganized
and sometimes frightening behavior can lead to a psychiatric hospitalization.
Bipolar II Disorder is characterized by one
or more Major Depressive Episodes with at least one Hypomanic Episode in
which the patient’s
functioning is not compromised severely enough to cause marked
impairment in social or
occupational functioning. Bipolar II Disorder, while by definition
not involving an episode of severe mania, has a high risk of suicide and
is
often associated
with a severe depressive course just as devastating as that experienced
in Bipolar I disorder.
Individuals with both types of Bipolar Disorder also experience
significant periods of severe Depression in which they may
experience depressed
mood and loss of interest or pleasure as well as the following
symptoms: significant
weight loss or decrease or increase in appetite, sleeping too
much or too little, being agitated or slowed down or feeling
fatigued. During depressed
periods individuals often report feelings of worthlessness,
excessive or inappropriate guilt, diminished ability to think or concentrate,
indecisiveness, or suicidal
thoughts or plans. These problems or symptoms cause significant
distress or impairment in social, occupational, or other important
areas of
functioning.
Careful assessment before prescribing medication is important
because individuals with Bipolar Disorder experience significant
periods
of depression as well
as distinct periods of high moods. About 60% of individuals
who present initially with mainly Depressive symptoms may go on to
experience a Manic or Hypomanic
Episode. Individuals who receive an anti-depressant may experience
a medication induced Manic or Hypomanic Episode.
Cognitive
Behavioral Therapy (CBT) is a form of psychotherapy that teaches people
specific cognitive and behavioral skills
to help
them control and even prevent
serious mood swings. Typically, CBT involves a very structured
systematic approach in which clients are taught specific techniques
to address overly positive or
negative moods that may escalate into new episodes of depression
or mania. The therapist also helps individuals recognize
and address
environmental
stressors
(major life changes, relationship problems, over-stimulating
conflictual situations, etc) that may exacerbate their mood swings.
Such
changes may require a great
deal of practice, individualized attention and encouragement.
However, once individuals learn that they can manage mood swings
more effectively, their
sense of self-efficacy
and self-esteem typically improves, and they are much more likely
to
apply their newly learned skills in the future.
A number of new approaches to the treatment of bipolar
disorder have been developed in the past few years that
are designed
to supplement standard
pharmacotherapy
or medication management. The good news is that several of
these approaches appear to be quite promising in terms of their
ability to reduce the
risk
of future
relapses (new episodes of illness) as well as offering an exciting
potential for prevention and early intervention. The
National Institute of Mental
Health (NIMH) has recently published a strategic plan
for mood disorders research
which emphasizes the promise of new psychosocial and behavioral
therapies.
“For people suffering from a mood disorder, the outlook has never
been better.
Effective therapies, both pharmacological and behavioral, can
help them recover from
potentially devastating episodes of depression or mania and
prevent possible relapses.”
(NIMH Strategic Plan Report, Page 75)
Not every individual with bipolar disorder will require psychotherapy
(otherwise known as behavioral or psychosocial treatment).
Adding psychotherapy to
your medication regimen should be considered if you are
having difficulty remaining
stable and experience significant breakthroughs of hypomania
or depression even while on medication. In an excellent self-help
book,
The Bipolar
Disorder Survival
Guide: What You and Your Family Need to Know, Dr. David
Miklowitz has summarized the potential goals for psychotherapy as follows:
Improves medication compliance and treatment adherence
(or “treatment
concordance”)
Assists clients in identifying stress-related triggers
Develops self-management skills and coping strategies
Helps clients maintain stable “social rhythms” and
lifestyle
Addresses the long-term impact of the illness on family
members, spouses and friends
Helps you make sense of your illness
Discusses planning and strategies to keep you stable,
given your vulnerability to future episodes
Helps you accept a long-term medication regimen
(Adapted in part from Miklowitz (2002) table on page
122) with respect to stress in their life situation
Some individuals are able to remain relatively stable
on a long term medication regimen. However, if
you are continuing
to have
episodes
or significant
periods of depression or hypomania, despite being
on medication you should consider
professional help, especially if you are having
suicidal ideation,
severe hopelessness and
depression or hypomanic episodes that have caused
significant problems for you. It appears that only certain specific
structured and directive
psychotherapies,
including cognitive behavioral therapy, are particularly
helpful in terms of
being effective in reducing the severity of mood
swings and future episodes.
Several excellent self-help publications are now
available that illustrate how and when to use
techniques to manage
mood swings.
We think that “The Bipolar
Disorder Survival Guide- What You and Your Family need to Know” by
David J. Miklowitz is particularly useful and well
grounded in science and research.
Adapted from article prepared for The Academy
of Cognitive Therapy Website- Consumer Information
by Robert Reiser,
Ph.D. and Larry
W. Thompson, Ph.D
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