1. BIPOLAR DISORDER A QUILT OF, IPSRT, ASSESSMENT, AND TOOLS Marilee Boe, M.A., L.P.C marileeboe.com Psychotherapy to Promote Balance

2. IPSRT CREATE BALANCE Sleep Play Food Work

4. IPSRT Developed by Ellen Frank Ph.D. and colleagues MERIT award by NIMH Western Psychiatric Institute and Clinic at The University of Pittsburg https://www.ipsrt.org/contributors/7616

5. WHAT IS IPSRT Interpersonal Social Rhythm Therapy Primary goal: prevention of mood episodes Circadian rhythms out of balance Interpersonal problems Prevention tools

6. 4 PHASES OF TREATMENT Initial: history, interpersonal, symptoms, initiate social rhythm metric, education Intermediate: social skills, symptom management, triggers, schedule balance Later: client driven, reinforce balanced rhythms, interpersonal tools, Termination

7. INITIAL PHASE

9. CLIENT HISTORY Presenting problem(s) Goals…. (why now) Family history of mood, anxiety, substance/Rx, behavior, suicide Health/meds Trauma

10. CLIENT HISTORY CONT. Religion Adoption Quality of sleep/Hx Relationship with food Financial issues Legal issues

11. INTERPERSONAL HISTORY Prenatal Parents/siblings School years Friends Spouse(s)/children Work environments

15. SELF MOOD RANKING -10 ……-5………..0……….+5………+1 0 -10 = most depressed/suicidal -5 = moderate depression 0 = normal mood +5 hypo manic +10 extremely manic may be psychotic, happy, agitated, or extremely irritable Marilee Boe, M.A., L.P.C.

18. - Anxiety Substances OCD TRAU MA DNA Sleep Hyper….. Depression Marilee Boe, MA, LPC C OPYRIGHT ©

19. Owwwww That hurts!

21. INTERMEDIATE STAGE

22. IDENTIFY PROBLEM AREAS Establish goals Symptom management Medication Skills lacking Relationship deficits

24. SOCIAL CONSEQUENCES Sixth leading cause of disability worldwide Lost work productivity Increase use of health services Divorce/family dysfunction Legal system

25. http://www.youtube.com/watch?v=Iz2dPiEgigY Illustration of Mania

26. BREAK

27. IS IT IN THE DSM? PRETENDING Internal/External locus of control Sugar consumption/carbs Risk taking Attire, make-up, appearance

29. HOLMES-RAHE LIFE STRESS INVENTORY https://www.ohrd.wisc.edu/home/portals/0/opc/2009/letting%20go%20of %20stress.pdf

30. Social Rhythm Metric Sleep Cycle Social Cycle Life Events Stress Change/loss

31. SOCIAL RYTHEM METRIC CONT. Work cycles Moves Travel Appetite/food Tools

32. MAINTAIN BALANCE What to do every day When you feel well Red flags What others see

34. TOOLS

36. WISE MIND MARSHA LINEHAN Ph.D

37. DIALECTICAL BEHAVIORAL THERAPY Mindfulness Observe Describe Participate Interpersonal Effectiveness

38. THOUGHT DISTORTIONS NEGATIVE THINKING Catastrophyzing Polarization Global labeling Blaming Emotional reasoning Filtering Mary Ellen Copeland

39. (IPSRT) "P L E A S E M A S T E R." Treat Physical illness Balance Eating Avoid mood-Altering drugs Balance Sleep Get Exercise Build M A S T E R y PLEASE MASTER

41. ProsCons ProsCons

42. Lori Gordon Ph.D

43. 7 CHAIN ANALYSIS

44. 3rd PHASE OF TREATMENT Client driven Successful use of skills More observant Accepting Repair work

45. 4th PHASE OF TREATMENT Termination of treatment Review successes Maintain daily schedule May return later

48. SOURCES 1 Mcgregor, S. (2007) Substance Abuse and Bipolar Disorder. The Bipolar Child Parent Questionnaire http://bpchildresearch.org/cbq/cbq_survey.cfm http://bpchildresearch.org/cbq/cbq_survey.cfm Beck Depression Inventory.http://drjeremybarowsky.com/site/wp- content/uploads/2013/07/JB_Assessment-Tools_Depression_07_17_13.pdfhttp://drjeremybarowsky.com/site/wp- content/uploads/2013/07/JB_Assessment-Tools_Depression_07_17_13.pdf 2 15 Moreno C, Laje G, Blanco C, et al. National trends in the outpatient diagnosis and treatment of bi- polar disorder in youth. Arch Gen Psychiatry. 2007; 64(9): 1032-1039. Title: 3) S uicide in bipolar disorder in a national English sample, 1996–2009: frequency, trends and characteristics. Authors: Clements, C. 1 Morriss, R. 2 Jones, S. 3 Peters, S. 4 Roberts, C. 5 Kapur, N. 1 J Clin Psychiatry. 2000;61 Suppl 9:47-51. Suicide and bipolar disorder.

49. 5 15 Moreno C, Laje G, Blanco C, et al. National trends in the outpatient diagnosis and treatment of bi- polar disorder in youth. Arch Gen Psychiatry. 2007; 64(9): 1032-1039. 6 - See more at: http://www.psychiatrictimes.com/articles/suicide-attempts-and- completions-patients-bipolar-disorder#sthash.5lpMRp5H.dpufhttp://www.psychiatrictimes.com/articles/suicide-attempts-and- completions-patients-bipolar-disorder#sthash.5lpMRp5H.dpuf 7 http://blogs.uw.edu/brtc/files/2013/03/Behavioral-Analysis.pdf May 01, 2007 | Bipolar Disorder, Cultural Psychiatry, Mood Disorders, Panic Attacks, Bipolar II Disorder, Mania, Major Depressive Disorder, Addiction, Alcohol Abuse, Suicide By Steven C. Dilsaver, MD - See more at: http://www.psychiatrictimes.com/articles/suicide-attempts-and- completions-patients-bipolar-disorder#sthash.D4ijrsB6.dpufhttp://www.psychiatrictimes.com/articles/suicide-attempts-and- completions-patients-bipolar-disorder#sthash.D4ijrsB6.dpuf

50. Resources Food and Mood by Elizabeth Somer, M.A., R.D. Cognitive Distortions http://www.apsu.edu/sites/apsu.edu/files/counseling/COGNITIVE_0.pdf http://www.bridgingthechasm.com/resources/bipd/JBRF-ChildhoodBipolarQuestionaire.pdf Childhood Onset Bipolar Disorder http://informahealthcare.com/doi/abs/10.3109/1067322950901 7185

51. Resources dbsaalliance.org Child Mania Rating Scale http://www.dbsalliance.org/pdfs/ChildManiaSurvey.pdf Connors Abbreviated Teachers Rating Scale http://robb.ucisd.net/ourpages/auto/2010/4/5/48121608/Connor_s%20Abbreviated%20 Rating%20Scale.pdf