Bipolar Disorder: A Biopsychosocial Overview. mdl.psych.northwestern.edu.

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Presentation transcript:

Bipolar Disorder: A Biopsychosocial Overview

mdl.psych.northwestern.edu

Source: Touched by Fire, Jamison, 1996

Bipolar Disorder: Epidemiology Elevated suicide, divorce, work impairment, substance use 6 th leading cause of disability worldwide (Murray & Lopez, 1996). Accounts for nearly half the inpatient mental health care costs in the US (Kent et al., 1995).

Roadmap: A series of Questions Four Questions about Bipolar Disorder 1.What is it? 2. What is its stigma? 3. Is there a blood test? 4. What are its treatments?

Roadmap: A series of Questions Four Questions about Bipolar Disorder 1.What is it? 2. What is its stigma? 3. Is there a blood test? 4. What are its treatments?

Depression Mania Mood disorder involving severe mood swings

Severity CyclothymiaBipolar II DisorderBipolar I Disorder Erratic depressive and hypomanic symptoms MDE and Hypomanic Episodes Manic Episode No MDE No Manic EpisodeMDE not necessary for diagnosis ~ 2-4 percent of population has bipolar spectrum diagnosis

Unipolar Depression Anxiety Disorder Schiz Personality Disorder Subst. Abuse Schizo- Affective % of Patients Misdiagnosed Misdiagnosis of Bipolar Disorder Hirschfeld, et al. J Clin Psychiatry 64: , 2003

Age-of-Onset of Bipolar Disorder Pediatric Bipolar Disorder % onset < 10 yo - Controversial (40-fold increase) - Difficult to differentiate from ADHD

Roadmap: A series of Questions Four Questions about Bipolar Disorder 1.What is it? 2. What is its stigma? 3. Is there a blood test? 4. What are its treatments?

- Predicts worse course and social isolation - Limit social interactions - Social isolation in caregivers Grief for the Loss of the Healthy Self

Roadmap: A series of Questions Four Questions about Bipolar Disorder 1.What is it? 2. What is its stigma? 3. Is there a blood test? 4. What are its treatments?

PFC Limbic - Common to many psychiatric disorders - Biology of positive emotion may yield cues more specific to bipolar

Ventral Striatum ‘Wanting’ Circuit in the Brain Bipolar disorder characterized by a hypersensitivity in the wanting circuit

Reward-Processing in Bipolar Disorder

Reward-Related Brain Activity: MDD < Comparison Forbes et al., 2009, Am J Psychiatry ComparisonMDD -Bipolar disorder and unipolar depression characterized by distinct profiles in the wanting or reward circuit -Biomarkers and treatment

Roadmap: A series of Questions Four Questions about Bipolar Disorder 1.What is it? 2. What is its stigma? 3. Is there a blood test? 4. What are its treatments?

Bipolar disorder may not be curable but it is livable

Psychosocial Treatments for Bipolar Disorder Cognitive Behavioral Therapy Family-Focused Therapy IPSRT

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