Bipolar Disorder: A Biopsychosocial Overview

1
Bipolar Disorder A Biopsychosocial Overview
2
mdl.psych.northwestern.edu
3
Source Touched by Fire, Jamison, 1996
4
Bipolar Disorder Epidemiology

• Elevated suicide, divorce, work impairment,
  substance use
• 6th 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).

5
Roadmap A series of Questions

• Four Questions about Bipolar Disorder
• What is it?
• 2. What is its stigma?
• 3. Is there a blood test?
• 4. What are its treatments?

6
Roadmap A series of Questions

• Four Questions about Bipolar Disorder
• What is it?
• 2. What is its stigma?
• 3. Is there a blood test?
• 4. What are its treatments?

7
Mood disorder involving severe mood swings
Depression
Mania
8
Severity
Cyclothymia Bipolar II Disorder Bipolar I Disorder
Erratic depressive and hypomanic symptoms MDE and Hypomanic Episodes Manic Episode
No MDE No Manic Episode MDE not necessary for diagnosis
2-4 percent of population has bipolar spectrum
diagnosis
9
Misdiagnosis of Bipolar Disorder
60
26
of Patients Misdiagnosed
18
17
14
11
Unipolar Depression
Anxiety Disorder
Subst. Abuse
Schiz
Personality Disorder
Schizo- Affective
Hirschfeld, et al. J Clin Psychiatry 64 161-174,
2003
10
Age-of-Onset of Bipolar Disorder
Pediatric Bipolar Disorder - 10-20 onset lt
10 yo - Controversial (40-fold increase)
- Difficult to differentiate from ADHD
11
Roadmap A series of Questions

• Four Questions about Bipolar Disorder
• What is it?
• 2. What is its stigma?
• 3. Is there a blood test?
• 4. What are its treatments?

12

• Predicts worse course and social isolation
• Limit social interactions
• Social isolation in caregivers

Grief for the Loss of the Healthy Self
13
Roadmap A series of Questions

• Four Questions about Bipolar Disorder
• What is it?
• 2. What is its stigma?
• 3. Is there a blood test?
• 4. What are its treatments?

14
PFC
PFC
Limbic
Limbic
- Common to many psychiatric disorders - Biology
of positive emotion may yield cues more specific
to bipolar
15
Wanting Circuit in the Brain
Ventral Striatum
Bipolar disorder characterized by a
hypersensitivity in the wanting circuit
16
Reward-Processing in Bipolar Disorder
17
Reward-Related Brain Activity MDD lt Comparison
Comparison
MDD
Forbes et al., 2009, Am J Psychiatry

• Bipolar disorder and unipolar depression
  characterized by distinct profiles in the wanting
  or reward circuit
• Biomarkers and treatment

18
Roadmap A series of Questions

• Four Questions about Bipolar Disorder
• What is it?
• 2. What is its stigma?
• 3. Is there a blood test?
• 4. What are its treatments?

19
Bipolar disorder may not be curable but it is
livable
20
Psychosocial Treatments for Bipolar Disorder
Cognitive Behavioral Therapy
Family-Focused Therapy
IPSRT
21
mdl.psych.northwestern.edu