ELearning Presentation

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E-Learning Presentation

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CPDUs

• Watch the PowerPoint Presentation
• Complete the corresponding Quiz
• Complete one activity of your choice from the
  list at the end.
• Complete a brief (1 page) reflection
• Complete the evaluation form
• Submit all of the above with the CPDU checklist
• Up to two extra CPDUs can be earned

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Bipolar Disorder

• Illinois Service Resource Center
• 3444 W. Dundee Rd.
• Northbrook, Illinois 60062
• 847-559-8195
• www.isrc.us
• isrc_at_irsc.us

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Dr. Daniel Friedman Psychologist D/HH Behavior
Specialist friedman.daniel_at_yahoo.com
Raven Stromek Teacher of the Deaf HoH D/HH
Behavior Specialist DeafEduc8or_at_comcast.net
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What is Bipolar Disorder?

• Also known as
• Manic-depressive illness
• Brain disorder
• unusual shifts in a persons
• Mood
• Energy
• Ability to function
• More severe than everyday ups downs

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Facts

• Affects approximately 5.7 million adult
  Americans, age 18 and older every year. (National
  Institute of Mental Health)
• Some 20 of adolescents with major depression
  develop bipolar disorder within five years of the
  onset of depression. (Birmaher, B., "Childhood
  and Adolescent Depression A Review of the Past
  10 Years." Part I, 1995)

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Facts

• Bipolar disorder results in 9.2 years reduction
  in expected life span
• one in five patients completes suicide. (National
  Institute of Mental Health)
• Bipolar disorder is the sixth leading cause of
  chronic disability in the world. (World Health
  Organization)

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Facts-Manic Episode

• Typically begins in the early 20s
• The 1st manic episode tends to begin suddenly,
  following an acute psychosocial stressor
  (eg.death, transition to adulthood, etc.).
• In adults, manic phase must last at least one
  week and typically during the manic phase the
  person does not recognize there is a problem.
• Manic phase can last up to several months.
• In adults, a person is likely to experience
  several manic episodes per year.

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Facts- Manic episode

• Following a manic phase, periods of depression
  usually occur lasting hours to several days.
• Major Depression (at least 2 weeks of depressed
  mood) does not always occur.
• In the depressed state, the person often
  experiences guilt and remorse for their behavior
  during the manic phase.
• This is followed by a period of normal
  functioning until the next manic episode occurs.

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Diagnosis- Manic Episode

• A manic episode is diagnosed if elevated mood
  lasts at least one week and occurs with
• three or more of the other symptoms most of the
  day,
• nearly every day,
• If the mood is irritable, four additional
  symptoms must be present.

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Additional Symptoms of Mania

• Inflated self-esteem or grandiosity (may appear
  delusional).
• Racing thoughts, jumping from one idea to another
  
• Distractibility- attention drawn too easily to
  irrelevant external stimuli
• Decreased need for sleep
• Talkative, pressured speech.

• Increase in goal directed activities (socially,
  academically, work, or sexually).
• Excessive involvement in pleasurable activities
  that have a high potential for dangerous
  consequences.

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Additional Criteria for Diagnosis (one of the
following)

• Symptoms must cause significant impairment to
  social, occupational, and/or relational
  functioning.
• Person has been hospitalized due to danger to
  self or others.
• Psychotic symptoms are present.
• Usually involves delusions of grandeur (eg. I am
  King Bob) or delusions of persecution (eg. the
  mafia is after me.)

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Symptoms of Depression

• sad, anxious, or empty mood
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
  
• Loss of interest or pleasure in activities once
  enjoyed, including sex
• Decreased energy, a feeling of fatigue or of
  being slowed down
• Restlessness or irritability

• Difficulty concentrating, remembering, making
  decisions
• Sleeping too much, or cant sleep
• Change in appetite and/or unintended weight loss
  or gain
• Chronic pain or other persistent bodily symptoms
  that are not caused by physical illness or injury
  
• Thoughts of death or suicide, or suicide attempts
  

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Degrees of episode
                                                  
             
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Methods used to Diagnosis Bipolar

• Clinical Interview and observation
• Medical/Psychiatric History
• Child Mania Survey
• Bipolar Checklist

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Diagnosis

• Bipolar I - Diagnosed when a person has a history
  of at least one manic episode, with or without an
  episode of Major Depression.
• Bipolar II- Diagnosed when a person has a history
  of Major Depression with at least one episode of
  Hypomania.

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Alternate Diagnoses

• Mixed Episode- When depression occurs
  concurrently during the manic phase.
• Hypomania- Identical to Mania but the duration of
  the manic episode is shorter, lasting at least 4
  days (rather than at least 1week),
  hospitalization is not required, and delusions or
  hallucinations are not present.
• Cyclothemia- a period of at least 2 years of
  hypomania and depressive episodes (which does not
  meet the full criteria for major depression).

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Facts- Bipolar in childhood

• When manic, children and adolescents, are more
  likely to be irritable and prone to destructive
  outbursts than to be elated or euphoric.
• Unlike Adults, Children with Bipolar typically
  cycle rapidly across the emotional spectrum
  multiple times throughout the day.
• When depressed, children typically present with
  somatic complaints (eg.headaches, stomachaches,
  or tiredness) poor performance in school,
  irritability, social isolation, and extreme
  sensitivity to rejection or failure. (National
  Institute of Mental Health).

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Causes

• Lots of speculation and studies
• Genetics- of all the mental disorders Bipolar has
  the strongest evidence of a genetic basis for the
  disorder (twin and adoption studies).
• Brain lesions
• Hypothyroidism
• Multiple Sclerosis
• Substance abuse- frequently Cocaine or
  amphetemines.

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Treatment

• Medicine- Lithium is successful in remitting
  manic episodes in 60-90 of classic Bipolar.
• Anti-seizure medications- with rapid cycling
  patients.
• Medication compliance- many stop because
  unwilling to give up the highs, feel better, or
  believe meds not needed.
• Therapy and support groups.

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Medication

• Mood disorders and medications used to treat them
  can affect a childs
• Attendance
• Alertness and concentration
• Sensitivity to light, noise and stress
• Motivation and energy available for learning

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Other associated mental disorders.

• Anorexia/ Bulemia nervosa
• Social phobia
• Panic disorder
• AD/HD

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Differentiating Bipolar from ADHD

• A child with Bipolar differs from ADHD
• Problems with attention and sitting still
• excessive temper outbursts
• Frequent mood fluctuations (irritable to calm)
• Psychiatric evaluation
• experience in bipolar disorder, particularly if
  there is a family history of the illness. 
• This evaluation is especially important since
  medications prescribed for ADHD may worsen manic
  symptoms.

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What can I do to stay well?

• The Storm in My Brain Kids and Mood
  Disorders(Bipolar Disorder and Depression)
• Follow your doctors instructions about taking
  medicine.
• Remember, it may take awhile before you start to
  feel better.
• Find out what the illness makes you do or say or
  think. Tell your parents and your doctor if those
  things come back so you can get help right away.
• Draw pictures or write about how you feel.
• Talk with other kids who have the same illness.

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What can I do to stay well?

• Tell your parents or teachers if you are worried
  about things that happen at school or with
  friends.
• Take a walk, ride your bike, go for a swim.
• Eat healthy foods, exercise, and get plenty of
  sleep.
• If you feel depressed, tell someone.
• Go outside in the sunshine or watch funny movies.
• Go to bed and get up at the same time every day.

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Suicide and Bipolar

• 10-15 of persons with Bipolar successfully
  commit suicide.
• Signs of suicidal ideation/intent
• New or worse depression (persons with Bipolar
  typically attempt suicide during the depression
  phase.)
• Giving away possessions or making plans for a
  future when they are gone
• Talk of unbearable feelings or situations
• New or more thoughts of suicide or death
• Sudden appearance of serenity, following the
  decision by the person to commit suicide.

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What you can say that helps

• You are not alone in this. Im here for you.
• I understand you have a real illness and thats
  what causes these thoughts and feelings.
• You many not believe it now, but the way youre
  feeling will change.
• I may not be able to understand exactly how you
  feel but I care about you and want to help.
• When you want to give up, tell yourself you will
  hold on for just one more day, hour, minute
  - whatever you can manage.
• You are important to me. Your life is important
  to me.
• Tell me what I can do now to help you.
• I am here for you. We will get through this
  together.

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Avoid saying

• Its all in your head.
• We all go through times like this.
• Youll be fine. Stop worrying.
• Look on the bright side.
• You have so much to live for why do you want to
  die?
• I cant do anything about your situation.
• Just snap out of it.
• Stop acting crazy.
• Whats wrong with you?
• Shouldnt you be better by now?

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What can you do?

• Keep a daily diary of your childs mood, energy,
  behavior, statements of concern, treatment
  response and sleep. Share these with the doctor.
• Prioritize symptoms and address them in order of
  severity.
• Anticipate or avoid stressful situations, limit
  frightening movies and TV shows, and be prepared
  to leave events early as necessary.
• Avoid bright lights, noise, large stores and
  groups, which can be over-stimulating.
• Use gentle music, relaxation tapes, dim lights,
  warm baths and massage to help with falling
  asleep.

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Some helpful strategies

• Educate yourselfLearn about mood disorders and
  the side effects of treatments prescribed for
  your student(s).
• Identify and reduce stressors sensory overload,
  boredom, bullying, homework, competition.
• Identify a person and place at school/dorm where
  the child can go if symptoms become overwhelming.
• Excuse tardiness and absences due to fatigue,
  anxiety, depression, and other symptoms.
• Request in-service training on strategies to help
  students with mood disorders.

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More helpful strategies

• Remember that low voices and a calm demeanor are
  more effective than confrontation.
• Facilitate frequent communication between home
  and school with a back-and-forth notebook, phone
  calls, or e-mail.
• Provide unlimited access to drinking water and
  bathroom.
• Encourage expression and learning through art,
  music and creative writing.
• Be flexible with assignments, homework, and
  testing techniques.

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Congratulations!!

• You just completed Mental Health Bipolar
• Please take a moment now to complete the rest of
  the requirements to earn CPDU credits.
• To earn CPDU credits you must
• Complete the Mental Health Bipolar Quiz
  (located on the main e-learning page next to the
  link for this training module, labeled Bipolar
  Quiz)
• Complete one activity of your choice from the
  list at the end.
• Complete a brief (1 page) reflection
• Complete the evaluation form
• Submit all of the above with the CPDU checklist
• Up to two extra CPDUs can be earned for
  additional activities.