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Au Psy492 M7 A2 Semmens P


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Au Psy492 M7 A2 Semmens P

  1. 1. A Review of the Different Treatments for Bipolar Disorder, Including Medications and Psychotherapy Priscilla L. Semmens Advanced General Psychology PSY492 UD Instructor: Jay Greiner October 23, 2009
  2. 3. What is Bipolar Depression? <ul><li>Bipolar Disorder (BD) is a serious disability affecting many individuals in today’s society. Individuals with BD suffer from severe depression along with manic episodes. Some symptoms of depression include feeling sad or hopeless, weight loss or weight gain, insomnia or hypersomnia, worthlessness, and suicidal thoughts. “Bipolar disorder is a severe and chronic mental health problem characterized by recurrent episodes of depression and mania, and high levels of mood symptoms and functioning difficulties during inter-episode periods” (Jones & Burrell-Hodgson, 2008, p. 1). More people are experiencing symptoms of bipolar disorder. </li></ul>
  3. 4. Statistics <ul><li>“ BD affects an estimated 3.7 % of the United State population (Stoner et al., 2007, p. 72) with a recognized 15% risk of successful suicide” (Ceron-Litvoc, Soares, Geddes, Litvoc, & de Lima, 2009, p. 1). “Suicide is the third ranking cause of death” (Miklowitz & Taylor, 2006, p. 1). “The annual average suicide rate in men and women diagnosed with bipolar disorder was recently estimated to be more than twenty times that of the general population (0.40%/year versus 0.017%/year)” (McElroy, Kotwal, Kaneria, & Keck, 2006). </li></ul>
  4. 5. Medications- Lithium <ul><li>Lithium monotherapy is believed to be first-line pharmacological intercession for treating mania and mixed episodes (Ceron-Litvoc et al., 2009). Fountoulakis et al. (2007) state Lithium is useful for all phases of BD and it helps with suicide prevention and is more effective against mania with a response rate of forty percent. Lithium shows effective results with prevention of manic relapses (Young, 2008). Lithium demonstrated evidence to support long-term use with reducing manic episodes, compared with a placebo, the medication was effective in preventing relapse because of a mood episode (Smith et al., 2007). </li></ul>
  5. 6. Carbamazepine <ul><li>Carbamazepine has been suggested as an efficacious treatment for mania and depression and is the only treatment of bipolar mania approved by the FDA (Ceron-Litvoc et al., 2009 & Fountoulakis et al., 2007). Ceron-Litvoc et al., (2009) compared carbamazepine with lithium in seven trials and the average serum intensity of both medications in study was generally parallel. Sixty-two percent of carbamazepine patients and fifty-nine percent lithium patients showed similar anti-manic effects (Ceron-Litvoc et al., 2009). It was suggested that lithium or carbamazepine prescribed alone was effective in short term treatment of mania (Ceron-Litvoc et al., 2009). Overall, carbamazepine is as effective as lithium in acute manic symptoms, however it is not prescribed as much due to drug interactions (Young, 2008). </li></ul>
  6. 7. Valproate <ul><li>Fountoulakis et al. (2007) states valproate is best treatment for manic episodes because it has a more robust antimanic effect than lithium in rapid cycling and mixed emotions with a response rate of fifty percent for acute mania. Valproate showed evidence to support long term use with minimizing manic relapses (Smith et al., 2007). </li></ul>
  7. 8. Antipsychotics <ul><li>First generation antipsychotics are considered to be the traditional treatment for acute mania and second generation antipsychotic do not stimulate depression (Fountoulakis et al., 2007). Studies support their effectiveness in all segments of bipolar illness, either as monotherapy or as an addition to mood stabilizers (Fountoulakis et al., 2007). Some antipsychotic are Olanzapine, risperidone, quetiapine, ziprasidone and aripiprazole which have been approved by the FDA for the treatment of acute mania” (Fountoulakis et al., 2007). Olanzapine can be taken long term for manic episodes and preventing relapse because of a mood episode (Smith et al., 2007). </li></ul>
  8. 9. Psychotherapies Psychoeducation (PE) <ul><li>PE aims to offer BD patients with an abstract and realistic approach to accepting and dealing with the results of their disease and lets them to enthusiastically work together with the physician in some aspects of treatment (Colom & Vieta, 2004). Several goals of PE are enhancement of adherence, improvement of illness management skills, the reduction of suicide risk and the improvement of social and occupational function and quality of life (Colom & Vieta, 2004). “Early detection of promodromal signs was shown to be efficacious in preventing mania, but not depression, and in increasing time to relapse (Colom & Vieta, 2004). </li></ul>
  9. 10. Family Focused Therapy <ul><li>Miklowitz and Taylor (2006) state the objectives of Family Focused Therapy (FFT) is to help the family recognize suicidal behavior, which is a nine month, twenty-one session outpatient intervention that involves the patient, their parents, spouse, siblings and/or children. FFT is important because families that endure a lot of stress and conflict or poor parent-child communication and low perceptions of support are linked with completed and/or attempted suicides. Participants of FFT were able to survive the full study duration without the return of depression or mania (fifty-two percent) (Miklowitz & Taylor, 2006). In addition, individuals in FFT were less likely to require hospitalization when they did relapse (Miklowitz & Taylor, 2006). </li></ul>
  10. 11. Cognitive Behavioral Therapy <ul><li>The therapeutic approach of CBT is the development of cognitive and behavioral skills to understand and monitor links between mood and behavior to facilitate detection of early warning signs for mania and depression, acceptance skills to reduce risk of relapse, stability in sleep pattern, and moderation of achievement behavior (Jones & Burrell-Hodgson, 2008). In addition, Slee et al. (2007) states that BD patients are taught cognitive behavioral concepts, emotion regulation, interpersonal effectiveness, distress tolerance, core mindfulness and self-management skills with CBT. Colom and Vieta (2004) found between forty and seventy-five percent of patients had improved with CBT (Colom & Vieta, 2004). Overall, CBT showed an improvement in the adoption of self-control skills by the end of the therapy (Jones & Burrell-Hodgson, 2008). “The ultimate aim is to provide a framework that encourages practitioners to look for these mechanisms of change in the context of their work with BD patients” (Slee et al., 2007, p. 180). </li></ul>
  11. 12. ISPRT <ul><li>ISPRT is a treatment aimed to maintain regular daily activities and stability in personal relationships for BD patients (Colom & Vieta, 2004). IPSRT is based on the suggestion that interferences in every day routines and problems in interpersonal relationships can result in return of the manic and depressive episodes (Colom & Vieta, 2004). During treatment, therapist’s will help the BD patient recognize how change in daily routines can affect their moods, how to handle stressful situations and maintain positive relationships with people. IPSRT experience less depressive slips, earlier revitalization from depression and fewer threshold depressive symptoms, helps with bipolar suicide and prodomal indicators revealed to be successful in preventing mania (Colom & Vieta, 2004). </li></ul>
  12. 13. <ul><li>After reviewing the literature, I have found there are various types of treatment for BD patients. The treatments include medication and psychotherapy. I believe the best treatment for BD patients would be lithium along with a combination of FFT and PE. The medication acts as a mood stabilizer. “Lithium prophylaxis combined with supportive care management has been shown to reduce suicide risk in bipolar patients and is a first line treatment for patients exhibiting suicidal risk” (Rizvi & Zaretsky, 2007, p. 500). FFT will help the patient and their family reduces suicide attempts. The application of FFT that is specific to suicide risk and behaviors is pertinent (Rizvi & Zaretsky, 2007). </li></ul>
  13. 14. References <ul><li>Ceron-Litvoc, D., Soares, B., Geddes, J., Litvoc, J., & de Lima, M. (2009, January). Comparison </li></ul><ul><li>of carbamazepine and lithium in treatment of bipolar disorder: A systematic review of </li></ul><ul><li>randomized controlled trials. Human Psychopharmacology: Clinical and Experimental , </li></ul><ul><li>24 (1), 19-28. Retrieved September 12, 2009, doi:10.1002/hup.990 </li></ul><ul><li>Colom, F., & Vieta, E. (2004, December). A perspective on the use of psychoeducation, </li></ul><ul><li>cognitive-behavioral therapy and interpersonal therapy for bipolar patients. Bipolar </li></ul><ul><li>Disorders , 6 (6), 480-486. Retrieved September 13, 2009, doi:10.1111/j.1399- </li></ul><ul><li>5618.2004.00136.x </li></ul><ul><li>Fountoulakis, K., Vieta, E., Siamouli, M., Valenti, M., Magiria, S., Oral, T., et al. (2007, </li></ul><ul><li>October). Treatment of bipolar disorder: A complex treatment for a multi-faceted </li></ul><ul><li>disorder. Annals of General Psychiatry , 6 . Retrieved September 13, 2009, from </li></ul><ul><li>PsycINFO database. </li></ul><ul><li>Jones, S., & Burrell-Hodgson, G. (2008, November). Cognitive-behavioral treatment of first </li></ul><ul><li>diagnosis bipolar disorder. Clinical Psychology & Psychotherapy , 15 (6), 367-377. </li></ul><ul><li>Retrieved September 12, 2009, doi:10.1002/cpp.584 </li></ul><ul><li>McElroy, S., Kotwal, R., Kaneria, R., & Keck, P. (2006, October). Antidepressants and suicidal </li></ul><ul><li>behavior in bipolar disorder. Bipolar Disorders , 8 (52), 596-617. Retrieved September 13, </li></ul><ul><li>2009, doi:10.1111/j.1399-5618.2006.00348.x </li></ul>
  14. 15. References cont. <ul><li>Miklowitz, D., & Taylor, D. (2006, October). Family-focused treatment of the suicidal bipolar </li></ul><ul><li>patient. Bipolar Disorders , 8 (52), 640-651. Retrieved September 13, 2009, </li></ul><ul><li>doi:10.1111/j.1399-5618.2006.00320.x </li></ul><ul><li>Rizvi, S., & Zaretsky, A. (2007, May). Psychotherapy through the phases of bipolar disorder: </li></ul><ul><ul><li>Evidence for general efficacy and differential effects. Journal of Clinical Psychology , 63 (5), 491-506. Retrieved September 12, 2009, doi:10.1002/jclp.20370 </li></ul></ul><ul><li>Slee, N., Arensman, E., Garnefski, N., & Spinhoven, P. (2007). Cognitive-behavioral therapy for </li></ul><ul><ul><li>deliberate self-harm. Crisis: The Journal of Crisis Intervention and Suicide Prevention , </li></ul></ul><ul><ul><li>28 (4), 175-182. Retrieved September 13, 2009, </li></ul></ul><ul><li>doi:10.1027/0227-5910.28.4.175 </li></ul><ul><li>Smith, L., Cornelius, V., Warnock, A., Bell, A., & Young, A. (2007, June). Effectiveness of </li></ul><ul><li>mood stabilizers and antipsychotic in the maintenance phase of bipolar disorder: A </li></ul><ul><li>systematic review of randomized controlled trials. Bipolar Disorders , 9 (4), 394-412. </li></ul><ul><li>Retrieved September 12, 2009, doi:10.1111/j.1399-5618.2007.00490.x </li></ul><ul><li>Young, L. (2008, November). What is the best treatment for bipolar depression?. Journal of </li></ul><ul><li>Psychiatry & Neuroscience , pp. 487,488. Retrieved September 19, 2009, from </li></ul><ul><li>Psychology and Behavioral Sciences Collection database. </li></ul>