Bipolar Disorders Treatment

Treatment for Bipolar Disorder: Early Diagnosis and Timely Support

In past decades, bipolar disorder was called manic depression and this term is still sometimes used. This name came from the fact that agitated states called “mania” are the hallmark of bipolar disorder and people suffering from this condition also often experience severe episodes of depression. Although more often emerging in adulthood, it can emerge in adolescence and even childhood. Until the 1990s it was considered extremely rare among adolescents. This was partly because sometimes the first sign of bipolar disorder in adolescents is a depressive episode, with mania occurring only later in life. Further complicating diagnosing mood disturbances in young people is the fact that not all periods of significant mood disturbance in adolescents progress represent the fullbipolar disorder syndrome.
A startling trend towards overdiagnosis of bipolar disorder in young people during the 1990s and 2000s caused the American Psychiatric Association to define a new diagnosis for children and adolescents – Disruptive Mood Dysregulation Disorder (DMDD) – differentiating DMDD from true bipolar disorder in youth.

Bipolar disorder is one of the psychiatric disorders with the strongest evidence of underlying biological mechanisms and an underlying genetic risk. Of course, as with all psychiatric conditions, environmental factors also significantly impact the onset and progression of bipolar disorder. These factors include life stressors and other non-genetic influences that interact with genetic predispositions to affect the overall risk of developing the disorder. Because of its known underlying neurobiological dimension, bipolar disorder almost always requires medication for stabilization and often long term preventive use to avoid recurrent episodes.

Obviously expert diagnosis and experience with these conditions is essential for obtaining the right treatments. There is good evidence that early, correct diagnosis limits the harmful impact of untreated symptoms.

Evidence-based therapy for bipolar disorder works. A full range of treatments – including medication, psychotherapy, family/social/community support, and more – can help patients manage symptoms and live full, productive lives.

AT BACA, WE UNDERSTAND HOW TO DIAGNOSE AND TREAT BIPOLAR DISORDER. WE HELP PATIENTS AND THEIR FAMILIES DEVELOP THE SKILLS REQUIRED TO MANAGE DISRUPTIVE SYMPTOMS.

In addition, the time from onset of symptoms to accurate diagnosis and treatment in the past often exceeded five years. During that time, many people with bipolar disorder and their families lost hope they’d ever find their way back to health and wellness. Our skilled clinicians at BACA know all the latest treatment techniques, but more importantly, they give patients and families the hope they need to heal, grow, and thrive.

What is Bipolar Disorder?

The American Psychological Association define bipolar disorder as follows:

“Bipolar disorder is a serious mental illness in which common emotions become intensely and often unpredictably magnified. Individuals with bipolar disorder can quickly swing from extremes of happiness, energy, and clarity to sadness, fatigue, and confusion. All people with bipolar disorder have manic episodes, which are abnormally elevated or irritable moods that last at least a week and impair functioning, not all become depressed.”

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) identifies five types of bipolar disorder:

1. BD-I
2. BD-II
3. Cyclothymic disorder
4. Other specified bipolar and related disorders
5. Unspecified bipolar and related disorders

Here are the diagnostic criteria for each type of bipolar disorder.

Bipolar I disorder (BD-I)

This type of bipolar disorder is characterized by a mixture of manic episodes, depressive episodes, and hypomanic episodes. To meet diagnostic criteria, patients must report at least one manic episode preceded or followed by a hypomanic episode or major depressive episode. Hypomanic or depressive episodes are not required for diagnosis.

A manic episode is defined as:

“A distinct period of persistently elevated or irritable mood with increased activity or energy lasting for at least 7 consecutive days or requiring hospitalization.”

If mood is elevated, three or more of the following criteria must be present for diagnosis. If mood is irritable, at least four of the following criteria must be present for diagnosis:

• Inflated sense of self/grandiosity
• Decreased need for sleep
• Compulsion to talk continuously/more talkative than usual
• Racing thoughts/constant flood of ideas
• Extreme distractibility
• Increased goal-directed activity related to social interactions, work, school, or sex
• Increased psychomotor agitation
• Escalating risky/destructive behavior in various areas of life: spending/shopping, sexual activity, business/work

In addition, episodes must not be attributable to substance use or a medical condition. In some cases, manic episodes result in significant social, academic, or occupational function and require emergency hospitalization.

Bipolar II disorder (BD-II)

This type of bipolar disorder is characterized by the presence of at least one current or past “hypomanic” episode, one major depressive episode, and no history of an episode meeting full criteria for amanic episode.

A hypomanic episode is defined as:

“A distinct period of persistently elevated or irritable mood with increased activity or energy lasting for at least 4 consecutive days.”

If mood is elevated, three or more of the following criteria must be present for diagnosis. If mood is irritable, at least four of the following criteria must be present for diagnosis:

• Inflated sense of self/grandiosity
• Decreased need for sleep
• Compulsion to talk continuously/more talkative than usual
• Racing thoughts/constant flood of ideas
• Extreme distractibility
• Increased goal-directed activity related to social interactions, work, school, or sex
• Increased psychomotor agitation
• Escalating risky/destructive behavior in various areas of life: spending/shopping, sexual activity, business/work

In addition, episodes are an unequivocal change in function uncharacteristic of the individual and observable by others, do not cause significant impairment in daily function, and must not be attributable to substance use, a medical condition, or psychosis.

To meet diagnostic criteria for BD-I, a depressive episode is not required. However, to meet criteria for BD-II, at least one depressive episode is required. In the context of diagnosis for bipolar disorder, a depressive episode is defined by the presence of 5 or more of the following symptoms daily or nearly every day for at least two weeks. The symptoms must be a distinct change from typical, baseline function for the individual:

• Self-reported sad/low mood most of the day
• Sad/low mood most of the day, reported by others
• Anhedonia, or the inability to experience pleasure, most of the day
• Significant weight loss not related to dieting or decrease in appetite
• Significant weight gain not related to increase in appetite
• Sleep problems: too little or too much
• Agitation
• Fatigue/low energy
• Feelings of worthlessness
• Excessive feelings of guilt
• Problems concentrating
• Problems making decisions
• Recurring thoughts of death
• Recurring suicidal ideation without a specific plan

BD-I and BD-II are the most common types of bipolar disorder, but there are three more types for patients and families to know about.

Cyclothymic disorder

This type of milder bipolar disorder is characterized by hypomanic and depressive symptoms that aren’t as severe as those present in people with BD-I or BD-II. To meet criteria for cyclothymic disorder, patients must have hypomanic symptoms that don’t meet criteria for full hypomanic episodes, and depressive symptoms that don’t meet criteria for major depressive episodes. These hypomanic and depressive symptoms must be present over a period at least 2 years in adults and 1 year for people under age 18, and never meet full criteria for major depressive, manic, or hypomanic episodes.

Specified bipolar and related disorders

This type of bipolar disorder is characterized by bipolar-like symptoms that don’t last long enough and aren’t severe enough to meet full criteria for BD-I, BD-II, or cyclothymic disorder. Patient experiences may include:

• Hypomanic episodes and major depressive episodes that don’t last long
• A major depressive episode with hypomanic symptoms that don’t reach the threshold for hypomania
• A hypomanic episode with no prior major depressive episode
• Cyclothymic symptoms of duration less

Unspecified bipolar and related disorders

This type of bipolar disorder is characterized by the presence of symptoms associated with bipolar and related disorders, but don’t cause clinically significant distress or result in impairment in social, academic, occupational, or other important areas of life, and do not meet the criteria for any bipolar category described above.

Treatment for Bipolar Disorder at BACA

Evidence shows the most effective treatment for bipolar disorder is a combination of medication, psychotherapy, psychoeducation, and lifestyle changes.

Medication

Clinicians may prescribe separate medications for manic episodes, mixed episodes, and depressive episodes.

Medications for manic episodes may include:

• Mood stabilizers, e.g., Lithium, Depakote (valproate), Lamictal (lamotrigine)
• Second generation neuroleptics including, aripiprazole, olanzapine, quetiapine

Medications for mixed episodes may include:

• Mood stabilizers, e.g., Lithium, Depakote (valproate), Lamictal (lamotrigine)
• Second generation neuroleptics including, aripiprazole, olanzapine, quetiapine

Medications for depressive episodes may include:

• Mood stabilizers, e.g., Lithium, Depakote (valproate), Lamictal (lamotrigine)
• Second generation neuroleptics including, aripiprazole, olanzapine, quetiapine
• Antidepressants, but cautiously to avoid triggering manic episodes

Individual Psychotherapy

Evidence-based psychotherapeutic techniques include, but are not limited to:

• Cognitive Behavioral Therapy (CBT)
• Family-focused Therapy
• Interpersonal and social rhythm therapy

Group Psychoeducation Classes

Psychoeducation workshops and classes at BACA may include:

• Facts about bipolar disorder
• The science of mental health treatment
• Healthy relationships
• Boundary setting
• Conflict resolution
• Distress tolerance

Lifestyle Changes

We work with our patients and their families to create a life that supports positive mental health and long-term recovery. For many people, this means making changes to their daily routine. We teach patients and families important facts about:

• Healthy eating
• Sleep hygiene
• Exercise and activity routines
• Stress reduction techniques, such as mindfulness or meditation
• The value of peer support and a social support network

Treatment Plans at BACA: Comprehensive, Individualized, Integrated

At BACA, we treat the whole person. Our goal is total health and wellness. Our treatment plans include most, but not all, of the following:

• Individual, group, and family therapy
• Weekly individual psychiatry sessions
• Education about bipolar disorder and bipolar disorder treatment
• Lifestyle changes
• Classes and workshops for family
• Medication, if needed

At BACA, we take the time to learn about each patient and understand what works for them. We design a treatment plan that focuses on strengths, addresses challenges, and gives each individual the best chance of managing the symptoms of bipolar disorder and achieving stable, sustainable, long-term recovery.

BACA MATH:

INTUITIVE, INSIGHTFUL CLINICIANS + INNOVATIVE EVIDENCE-BASED THERAPEUTIC TECHNIQUES = EFFECTIVE TREATMENT FOR BIPOLAR DISORDER