4. Bipolar Disorder

According to WHO, what does the term bipolar mean?

refers to difficulties that affect a person's mood, energy, activity and thought and is characterised by manic (or hypomanic) and depressive episodes

How many people are living with bipolar?

40 million people worldwide

What occurs to the life expectancy in those with bipolar disorder?

reduced by approximately 12 to 14 years

Do those with bipolar disorder find diagnosis helpful?

a recent report by Bipolar UK, indicated that 84% of 2458 ppts with a diagnosis of bipolar disorder had found the diagnosis helpful, around a quarter of the respondents would want to keep their bipolar disorder even if it were possible to remove it forever, and their reasons for keeping it related particularly to the sense of identity that the diagnosis gave them

What is bipolar associated with?

higher scores on measures of childhood trauma, also associated with extreme appraisals of internal states and sleep disruption

What are hypomania & mania?

periods of overactive and high energy behaviour that can have a significant impact on day-to-day life

What is mania specifically?

a more severe form, it typically lasts for a week or longer, unless it is cut short by treatment, mania can have a significant impact on ability to do usual day-to-day activities

What is hypomania specifically?

a milder version of mania that typically lasts for a shorter period, hypomania typically lasts for a few days, it can feel more manageable than mania

What are the possible feelings of mania/hypomania?

happy, joyful or a sense of wellbeing, very excited or uncontrollably excited, like you can't get words out fast enough, irritable or agitated

What are the possible behaviours of mania/hypomania?

being more active than usual, talking a lot, speaking very quickly and not making sense to people, being friendly to others, saying or doing things that are inappropriate or out of character, sleeping very little or not at all

What are the possible feelings for depression?

down, upset or tearful, tired of sluggish, uninterested in things you usually enjoy, low self esteem and lack of confidence, guilty, worthlessness or hopeless

What are the possible behaviours for depression?

not doing things you normally enjoy, having trouble sleeping or sleeping too much, eating too little or too much, withdrawing or avoiding social situations

What criteria needs to be met for the diagnosis of Bipolar I?

it is necessary to meet the criteria for a manic episode

What criteria needs to be met for the diagnosis of Bipolar II?

it is necessary to meet the criteria for a hypomanic episode and the criteria for a major depressive episode

What criteria needs to be met for the diagnosis of cyclothymia?

for at least 2 years (1 for children) there have been numerous periods with hypomanic symptoms that do not meet criteria for hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for major depressive episode

What is the primary care offered for people with bipolar depression inline with NICE guidelines?

a psychological intervention developed specifically for bipolar disorder with evidence based manual describing how it should be delivered OR a choice of psychological intervention (CBT, interpersonal or behavioural couples therapy) in line with advice on treatment options for more severe depression

What is the secondary care offered for people with bipolar depression inline with NICE guidelines?

for mania/hypomania - pharmacological interventions are recommended, for depression the recommendation is the same as primary care

What is the longer term care offered for people with bipolar depression inline with NICE guidelines?

offer family intervention for those who are living with or in close contact with family, offer structured psychological intervention (individual, group or family), which has been designed for bipolar disorder and has published evidence based manual describing how it should be delivered to prevent relapse or for people with persisting symptoms

What are the five psychological interventions offered for bipolar disorder?

enhances relapse prevention/individual psychoeducation, CBT, interpersonal and social rhythm therapy, group psychoeducation, family-focused therapy

What is enhanced relapse prevention / individual psychoeducation?

a relatively brief intervention in which the individual is trained in strategies to identify and cope effectively with early warning signs of mania and depression

What is cognitive behavioural therapy (CBT)?

a form of talking therapy focusing on the role our thinking and behaviour has on our emotions, and how they reciprocally influence each other

What is interpersonal and social rhythm therapy?

focuses on interpersonal factors and factors such as sleep-wake cycle, work-life balance and daily routines for the course of bipolar disorder

What is group psychoeducation?

a structured intervention of high frequency and intensity (up to 21 sessions, each of 2 hours' duration) to help individuals experiencing bipolar disorders to become experts in their own condition to improve medication adherence, mood stability and self-management

What is family focused therapy?

a psychoeducational programme for individual families in which one member experiences bipolar disorder. It incorporates a strong behavioural component by focusing on understanding disorder specific risks, communication and problem-solving skills in the family. Each of these approaches is primarily focused on reduction of relapse and recurrence of mania or depression

What are some of the common features of psychological interventions?

providing essential information about bipolar, identifying early warning signs and signs of relapse, helping develop coping strategies to deal with early warning signs, mood instability or triggering situations, developing a crisis plan and a post-treatment 'staying well' plan

What are mood swings consequences of?

conflicting appraisals of changes in internal states such as mood, thoughts, images and physical sensations

What do appraisals lead to?

to a struggle to try and control internal states and stay within a range considered acceptable by the individual e.g feelings of high energy = imminent success vs feelings of high energy = mental breakdown

What is the integrative cognitive model of bipolar disorder from top down (Mansell et al., 2007)?

a triggering event leads to a change in internal state which is then appraised as having extreme personal meaning (affecting descent and ascent behaviours)

What is the integrative cognitive model of bipolar disorder from bottom up (Mansell et al., 2007)?

life experiences & beliefs about the self can influence how someone appraises those changes in internal states

What is an integrative cognitive model of bipolar disorder used for?

to help someone make sense of their mood related difficulties

What does TEAMS stand for?

thinking effectively about mood swings

What is TEAMS therapy?

a new cognitive behavioural therapy that is designed specifically for working with people experiencing difficulties related to bipolar

What are active ingredients to TEAMS therapy?

exposure to previously avoided internal states, disconfirmation of extreme appraisals of internal states, reorganising and reprioritising life goals & values

What are example techniques of TEAMS therapy?

behavioural experiments, imagery restructuring, using metaphors

What is the Icarus Metaphor of conflicting appraisals?

can't fly to close to sun as wings melt, but not too close to water as will get wet - bandwidth after teams: tolerate and accept wider range of moods to pursue life goals

What does the recovery POETIC include?

purpose/meaning, optimism/hope, empowerment, tensions, identity, connectedness

What is purpose/meaning in terms of recovery?

having or finding meaningful activities in the present and making sense of extreme mood experiences from the past

What is optimism/hope in terms of recovery?

Hope-inspiring relationships often helped to foster a 'Belief in the possibility of recovery'

What is empowerment in terms of recovery?

meant that participants felt they had 'Control over life' by understanding and being able to manage their moods and accessing professional support if needed

What is tensions in terms of recovery?

characterises personal recovery in bipolar disorder as a complex process with possible conflicts between the different recovery domains

What is identity in terms of recovery?

rebuilding a positive sense of self

What is connectedness in terms of recovery?

the importance of feeling connected with different groups of people, including family, friends, peers with lived experience of bipolar disorder, and professionals, particularly psychotherapists