Bipolar Disorder An overview of Bipolar Disorder, Cyclothymia, common symptoms, and treatment considerations such as psychotherapy, psychopharmacological interventions and psychosocial rehabilitation are included. The neurochemical (neurotransmitters), environmental and brain structure and functioning thought to be involved in causation will be reviewed. Elijah Levy, Ph.D. www.thelevylaunch.com email: thelevylaunch@yahoo.com (562) 230-3334

Dr. Elijah Levy Director of Founders Outreach: A nonprofit center providing psychosocial rehabilitation to 90 mentally ill residents at Founders House of Hope (18 years) Ph.D . in Clinical Psychology, 25 years experience treating the mentally ill in inpatient and residential care settings implementing psychiatric/psychosocial rehabilitation programs. Adjunct Faculty at University of Redlands teaching in the undergraduate and graduate school (23 years) and adjunct at Southern California University of Health Sciences teaching psychology (2 years). Director of The Levy Launch: A Consulting & Resource Center www.thelevylaunch.com providing corporate education and training, management development, coaching, strategy consultation, coaching and forensic psychology. The center provides material for lifelong learning in areas of creative aging, cultural pluralism, comparative religion, career development, health and wellness and psychiatric rehabilitation. Academic resources such as curriculum for college courses and how to become an outstanding instructor is available at the center. Author of two books, editor of anthology of poetry written by the mentally ill, producer of documentary on mental illness. Awarded excellence in teaching award several times and honors/recognition for volunteering. Good bio on Elie to establish credibility as an expert in this field

Bipolar Disorder A brain disorder that causes unusual shifts in mood, energy and the ability to perform one’s daily demands. Sometimes referred to as Manic Depressive Illness Symptoms are severe and can damage relationships, disrupt job or school performance and some consider suicide. Causes: There is no single cause but includes many factors such as: Genetic Neurochemical Environmental Brain Structure About 3% of Americans suffer from Bipolar Disorder (10 million) Affects men and women equally.

Neurochemical Factors in Bipolar Disorder The cause of bipolar disorder is not entirely known. Genetic, neurochemical and environmental factors probably interact at many levels to play a role in the onset and progression of bipolar disorder. Neurochemical Factors in Bipolar Disorder Bipolar disorder is primarily a biological disorder that occurs in a specific area of the brain due to the dysfunction of certain neurotransmitters, or chemical messengers, in the brain. These chemicals may involve neurotransmitters like norepinephrine, serotonin and probably many others. As a biological disorder, it may lie dormant and be activated on its own or it may be triggered by external factors such as psychological stress and social circumstances.   A person who has one parent with bipolar disorder has a 15 to 25 percent chance of having the condition. The current thinking is that this is a predominantly biological disorder that occurs in a specific part of the brain and is due to a malfunction of the neurotransmitters (chemical messengers in the brain).

Genetic Factors It tends to run in families, many different genes are involved in combination with environmental factors. This question has been researched through multiple family, adoption and twin studies. In families of persons with bipolar disorder, first-degree relatives (parents, children, siblings) are more likely to have a mood disorder than the relatives of those who do not have bipolar disorder. Studies of twins indicate that if one twin has a mood disorder, an identical twin is about three times more likely than a fraternal twin to have the mood disorder. In bipolar disorder specifically, some studies have put the concordance rate (when both twins have the disorder) at 80 percent for identical twins, as compared to only 16 percent for fraternal twins. There is overwhelming evidence that bipolar disorder can be inherited and that there is a genetic vulnerability to developing the illness.

Neurotransmitters Some studies suggest an imbalance of neurotransmitters is the cause; that a low or high level of a specific neurotransmitter such as serotonin, norepinephrine or dopamine. Experts believe bipolar disorder is partly caused by an underlying problem with specific brain circuits and the balance of brain chemicals called neurotransmitters. In short, researchers are quite certain that the neurotransmitter system is at least part of the cause of bipolar disorder, but further research is still needed to define its exact role. The brain chemical serotonin is connected to many body functions such as sleep, wakefulness, eating, sexual activity, impulsivity, learning, and memory. Researchers believe that abnormal functioning of brain circuits that involve serotonin as a chemical messenger contribute to mood disorders (depression and bipolar disorder).

Stress Triggers For mental, emotional and environmental issues, stressful life events are thought to contribute to the development of bipolar disorder. These can range from a death in the family to the loss of a job, from the birth of a child to a move. With that in mind, research has found that stressful life events can lead to the onset of symptoms in bipolar disorder. However, once the disorder is triggered and progresses, "it seems to develop a life of its own." Once the cycle begins, psychological and/or biological processes take over and keep the illness active. When we look for the cause of bipolar disorder, the best explanation according to the research available at this time is what is termed the "Diathesis-Stress Model." The word diathesis means, in simplified terms, a physical condition that make a person more than usually susceptible to certain diseases. Thus the Diathesis-Stress Model says that each person inherits certain physical vulnerabilities to problems that may or may not appear depending on what stresses occur in his or her life. Durand and Barlow define this model as a theory "that both an inherited tendency and specific stressful conditions are required to produce a disorder."

Brain Structure and Functioning MRI’s of individuals with Bipolar Disorder reveal that the brain’s prefrontal cortex tends to be smaller and function less well than individuals without Bipolar Disorder. The prefrontal cortex is involved in executive functions such as solving problems, decision making, emotion and impulsivity. The prefrontal cortex and it’s relationship to other parts of the brain mature during adolescence suggesting that abnormal development of this brain circuit may account for why the disorder tends to emerge during the teen years.

Bipolar Disorder Bipolar I Disorder—defined by manic or mixed episodes that last at least seven days, or by acute manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. You typically see psychosis in Bipolar I such as hallucinations and delusions during mania. Estimates are that 70% of people having acute mania experience psychosis Bipolar II Disorder—defined by a pattern of severe depressive episodes and hypomanic episodes (less intense mania) but no full-blown mania. There are typically no psychotic symptoms during a hypomanic episode. Bipolar Disorder Not Otherwise Specified (BP-NOS)—diagnosed when symptoms of the illness exist but do not meet diagnostic criteria for either Bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior. Cyclothymic Disorder, or Cyclothymia—a mild form of Bipolar Disorder. These individuals have episodes of hypomania and mild depression for at least 2 years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder. A severe form of the disorder is called Rapid-Cycling Bipolar Disorder. Rapid cycling occurs when a person has four or more episodes of major depression, mania, hypomania, or mixed states, all within a year.

Manic Symptoms Depressive Symptoms An inflated feeling of power, greatness, or importance, extreme irritability Needing little sleep Talking more than usual; pressured speech Racing thoughts Being easily distracted (attention shifts between many topics in just a few minutes) Intense focus on goal-directed activity or restlessness Risky or impulsive behavior (like excessive spending sprees; indiscriminate sex) Depressive Symptoms Depressed mood most of the day; feeling sad or empty, tearful; hopeless Significant loss of interest or pleasure in activities that used to be enjoyable Significant weight loss (when not dieting) or weight gain; decrease or increase in appetite Insomnia or Hypersomnia (sleeping too much) Agitation; or slowing down of thoughts and reduction of physical movements Fatigue or loss of energy; no motivation Feelings of worthlessness or inappropriate guilt Poor concentration or having difficulty making decisions Thinking about death or suicidal ideation

Antipsychotics Side Effects: Dry mouth, blurred vision, loss of muscle control, sun sensitivity, nausea, sedation, diarrhea, muscle spasms, tremors, weight gain. Drowsiness, skin rashes, menstrual problems for women. Side effects also include weight gain and changes in metabolism; increased risk of diabetes and high cholesterol. Introduced in 1950’s One of the first – Thorazine, Haldol Newer generation of atypical antispychotics introduced in 1990’s called Serotonin Dopamine Antagonsists Clozaril Abilify Geodon Seroquel Risperdal Zyprexa

Antidepressants Medications: Used for depressive disorders, such as anxiety and bulimia; in addition to treating symptoms of depression in Bipolar Disorder. Medications: Lexapro, Prozac, Paxil, Zoloft, Imipramine, Wellbutrin Changes the concentration of specific neurotransmitters in the brain Can provide lasting long-term recovery from depression Side Effects: Headache, Nausea, Agitation

Mood Regulators for Bipolar Disorder Mood stabilizers balance certain brain chemicals that control emotional states and behavior. Mood stabilizers can help to treat mania and to prevent the return of both manic and depressive episodes in bipolar disorder. They may also help treat the mood disorder problems associated with Schizophrenia such as depression Medications: Depakote, Lithium and Tegretol Side effects of these medications: Nausea Vomiting Diarrhea Increased thirst and need to urinate Weight gain Drowsiness

Psychotherapy and Support Group for Bipolar Disorder The modalities include: Behavioral Therapy focuses on the behavioral changes the individual initiates to decrease stress in their life. Cognitive Therapy involves learning to identify and modify patterns of behavior and thinking associated with mood shift; identifying irrational thoughts the individual has about their illness. Interpersonal Therapy focuses on one’s social relationships and how strains in these interpersonal relations interfere with the individual’s ability to function adaptively. Support Group allows individuals to receive encouragement and learn more effective coping skills while feeling less isolated. The individual gains insight and strength from the power in the group.

Anti-Anxiety Medications High-potency benzodiazepines combat anxiety and have few side effects other than drowsiness. Because people can get used to them and may need higher and higher doses to get the same effect, benzodiazepines are generally prescribed for short periods of time, Klonopin is used for social phobia and GAD Ativan is helpful for panic disorder Xanax is useful for both panic disorder and GAD. Some people experience withdrawal symptoms if they stop taking benzodiazepines abruptly instead of tapering off, and anxiety can return once the medication is stopped.

Treatment In general, anxiety disorders are treated with medication, specific types of psychotherapy, or both. Treatment choices depend on the problem and the person’s preference. Antidepressants SSRIs: Some of the newest antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. SSRIs alter the levels of the neurotransmitter serotonin in the brain, which, like other neurotransmitters, helps brain cells communicate with one another. Prozac, Zoloft, Lexapro, Paxil, Celexa are some of the SSRIs commonly prescribed for panic disorder, OCD, PTSD, and social phobia.

Cognitive-Behavioral Therapy Psychotherapy Psychotherapy involves talking with a trained mental health professional, such as a psychiatrist, psychologist, social worker, or counselor, to discover what caused an anxiety disorder and how to deal with its symptoms. Cognitive-Behavioral Therapy Cognitive-behavioral therapy (CBT) is very useful in treating anxiety disorders. The cognitive part helps people change the thinking patterns that support their fears, and the behavioral part helps people change the way they react to anxiety-provoking situations.