Brief presentation of Bipolar Disorder for VCU Graduate School of Social Work from Mental Health in Social Work, 2nd ed., Corcoran & Walsh, 2015

1. Bipolar Disorder
Jacqueline Corcoran, Ph.D.
From: Mental Health in Social Work
(Pearson, 2014)
http://www.jacquelinecorcoran.com

2. Prevalence
2.1% (National
Comorbidity Study)

3.  Bipolar I
At least one manic episode,
usually accompanied by a
major depressive episode.
 Bipolar II
Characterized by one or more
major depressive episodes
accompanied by at least one
hypomanic episode.

4. DDiiffffeerreennttiiaall DDiiaaggnnoosseess
 MDD
• Just depressive episodes
• If there is a hx of at least one manic or hypomanic episode =
BP
 Cyclothymic Disorder
• experience of numerous episodes of hypomanic and
depressive symptoms that don’t meet criteria for MDD
• possibility of developing bipolar disorder

5. Bipolar in Children
 Non-episodic, chronic, rapid-cycling mixed state
featuring agitation, excitability, labile affect, aggression,
and irritability with child’s age-appropriate functioning
significantly impaired
 Frequent comorbidity with ADHD & CD
 Disruptive mood dysregulation disorder (DSM V)

6. Comorbidity
 Suicide: 10-15%
 School truancy, school failure,
occupational failure, divorce
 Other diagnoses
• Eating Disorders
• ADHD
• Anxiety Disorders
• Substance-Related Disorders (60% risk)
 Borderline Personality Disorder
 Medical disorders

7. Etiology:
biological factors predominate
 First-degree relatives elevated rates of Bipolar I Disorder (4-24%),
Bipolar II Disorder (1-5%), and MDD (4-24%)
 Twin and adoption studies - evidence of genetic influence
 Polygenic models promising but core of BPD remains elusive
 Limbic system
 Amount of norepinephrine, serotonin, gamma-aminobutyric acid
neurotransmitters are abnormal
 Actions of thyroid and other endocrine glands also account for nervous
system changes
 Biorythms (body’s natural sleep and wake cycles) are erratic - may cause
or result from chemical imbalances
 Damage to areas in brain responsible for emotional activity

8. OtherC Roisukr sFeactors
 Stressful life events (onset and course)
 Early onset
 10% rapid cycling
 Families with high EE
 Lack of social support
 Number of previous episodes
 History of anxiety
 Persistence of affective symptoms even
when mood is relatively stable
 Poor occupational functioning

9. Medication
 Mood-stabilizing meds sometimes prescribed with
antipsychotic meds to treat BP I
 Antidepressants - BP II

10. Lithium Carbonate
 Improvements in 70% of clients
 Relatively short half life - must be taken more than once
per day
 Takes 2-3 weeks to establish effect
 Doesn’t preclude possibility of recurrence
• 36% recurrence rate in 5 yrs.
• Combinations (with antidepressant, antipsychotic, &
anticonvulsant drugs) may help
 Lithium prescribed for 1 year after first or second
episode, permanent after third episode

11. Importance of
Monitoring Blood
Levels
 Difference between therapeutic and
toxic levels is not so great
 Monitoring monthly for 1st 4-6
months, every 6 mos. after that
 Symptoms: thirst, weight gain,
fatigue, hand tremor, muscle
weakness, confusion, diarrhea,
dizziness, nausea, slurred speech,
spastic muscle movements

12. Anticonvulsants:
Carbamazephine
 Blocks norepinephrine reuptake, may also break
down GABA
 Advantages over lithium
• stabilize mood in 2-5 days
• as effective for stabilizing
• more effective for maintenance
• has a greater antidepressant effect
 Side effects problematic - 50% not taking a year later

13. Anticonvulsants, cont.:
Valproate
 Comparable to lithium
 May be better than carbamazepine for rapid cycling
 Trend toward prescribing anticonvulsants as initial
tx strategy

14. Medication Used with
Children
 Lithium, carbamazepine,
and valproate all used
with children
 Prospects of chronic
weight problems and
long-term effects on
kidney function need to
be considered

15. Psychoeducation
 Coming to terms
• Reduce medication non-adherence
• Enhance social and
occupational functioning
• Enhance family and social
support
• Identify stresses that may
trigger mood episodes

16. Individual
Psychotherapy
 Interpersonal therapy
• interpersonal conflicts major source of
depression
• also assumes sleep/wake cycle and social
rhythms influence course
 CBT
• challenge cognitions that may activate
episodes and be related to medication
compliance