This document discusses psychological perspectives on mania. It covers several topics:
- Biological mechanisms that may contribute to mania like cortisol levels and prefrontal dysfunction
- Inflammatory processes and cytokines that may be involved
- Psychological risk factors like life events, early environment, and current environment
- Thinking styles in bipolar disorder that can increase risk of mood episodes
- The role of life events and social support in relapses
- Parenting factors and childhood maltreatment that may increase bipolar risk
- Circadian rhythm dysregulation in bipolar disorder and its potential mechanisms
- Psychological interventions that have evidence like CBT, FFT, and psychoeducation
Clinical Psychology Case Formulation and Treatment Planning: A PrimerJames Tobin, Ph.D.
The aim of this primer is to support the learning of clinical case conceptualization and treatment planning for graduate students in clinical psychology, other trainees in the mental health professions, and early-career psychologists and mental health workers.
Etiology of schizophrenia. taniya thomas. msc 1stTaniya Thomas
its is about the various theories explaining the cause(aetiology) of schizophrenia. this includes biological theories, social theories and cognitive theories
This document summarizes Indian research on schizophrenia conducted from the 1960s to the 2010s. It outlines key areas of research including epidemiology, biological studies, treatment studies, and investigations of symptoms, course, and outcomes. Some landmark studies mentioned are the International Pilot Study of Schizophrenia, Determinants of Outcome of Severe Mental Disorders study, International Study of Schizophrenia, and long-term follow up studies of cohorts in Agra and Madras that found illness intensity decreases over time and outcomes are better than in developed countries.
Neurobiology and functional brain circuits in mood disordersSuman Sajan
Mood disorders involve biological abnormalities in brain circuits and neurotransmitter systems. Key circuits include the prefrontal cortex, orbitofrontal cortex, amygdala, hippocampus, striatum, and hypothalamus-pituitary-adrenal axis. In depression, these circuits demonstrate reduced activity of serotonin, norepinephrine, and dopamine which impacts mood, motivation, and emotional processing. Mania involves hyperactivity in the nucleus accumbens and prefrontal regions due to elevated serotonin and dopamine levels, leading to symptoms like grandiosity, risk-taking, and pressured speech. Neuroimaging supports changes in these brain regions and circuits in mood disorders.
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This was informed by several exam prep programs, and can be used like flashcards or as a presentation.
1. The document summarizes personality disorders from Clusters B and C based on DSM-5 and ICD-10 classifications.
2. Cluster B disorders include antisocial, narcissistic, histrionic, and borderline personality disorders. Key features and diagnostic criteria for each are outlined.
3. Neuroendocrinological aspects of borderline personality disorder are also discussed, focusing on the roles of oxytocin and sex hormones in its pathophysiology.
Cognition in schizophrenia is characterized by deficits in multiple domains that are present early in the illness and persist over time. These include impairments in attention/vigilance, verbal learning, visual learning, reasoning and problem solving, speed of processing, verbal fluency, immediate/working memory, and social cognition. Deficits in these areas of cognition are associated with functional disability and poor outcomes.
Clinical Psychology Case Formulation and Treatment Planning: A PrimerJames Tobin, Ph.D.
The aim of this primer is to support the learning of clinical case conceptualization and treatment planning for graduate students in clinical psychology, other trainees in the mental health professions, and early-career psychologists and mental health workers.
Etiology of schizophrenia. taniya thomas. msc 1stTaniya Thomas
its is about the various theories explaining the cause(aetiology) of schizophrenia. this includes biological theories, social theories and cognitive theories
This document summarizes Indian research on schizophrenia conducted from the 1960s to the 2010s. It outlines key areas of research including epidemiology, biological studies, treatment studies, and investigations of symptoms, course, and outcomes. Some landmark studies mentioned are the International Pilot Study of Schizophrenia, Determinants of Outcome of Severe Mental Disorders study, International Study of Schizophrenia, and long-term follow up studies of cohorts in Agra and Madras that found illness intensity decreases over time and outcomes are better than in developed countries.
Neurobiology and functional brain circuits in mood disordersSuman Sajan
Mood disorders involve biological abnormalities in brain circuits and neurotransmitter systems. Key circuits include the prefrontal cortex, orbitofrontal cortex, amygdala, hippocampus, striatum, and hypothalamus-pituitary-adrenal axis. In depression, these circuits demonstrate reduced activity of serotonin, norepinephrine, and dopamine which impacts mood, motivation, and emotional processing. Mania involves hyperactivity in the nucleus accumbens and prefrontal regions due to elevated serotonin and dopamine levels, leading to symptoms like grandiosity, risk-taking, and pressured speech. Neuroimaging supports changes in these brain regions and circuits in mood disorders.
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This was informed by several exam prep programs, and can be used like flashcards or as a presentation.
1. The document summarizes personality disorders from Clusters B and C based on DSM-5 and ICD-10 classifications.
2. Cluster B disorders include antisocial, narcissistic, histrionic, and borderline personality disorders. Key features and diagnostic criteria for each are outlined.
3. Neuroendocrinological aspects of borderline personality disorder are also discussed, focusing on the roles of oxytocin and sex hormones in its pathophysiology.
Cognition in schizophrenia is characterized by deficits in multiple domains that are present early in the illness and persist over time. These include impairments in attention/vigilance, verbal learning, visual learning, reasoning and problem solving, speed of processing, verbal fluency, immediate/working memory, and social cognition. Deficits in these areas of cognition are associated with functional disability and poor outcomes.
Obsessive-Compulsive and Related Disorders (DSM-V)Adesh Agrawal
The disorders those characterized by repetitive behavior, are included under this broad chapter in DSM-5. Here we prepared this PPT in which we tried to cover the whole topic in a very comprehensive and concise manner. We hope that this will help you to understand it in an easy way.
your further suggestions will be appreciated.
Schizophrenia is a major psychotic disorder characterized by delusions, hallucinations, disorganized speech and behavior. It has been defined and categorized in different ways over time. Current diagnostic criteria require symptoms for at least one month. The causes are thought to involve genetic and environmental factors. The disorder follows a variable course with acute episodes potentially followed by chronic or residual phases with negative symptoms. Diagnosis involves assessing for specified symptoms and impairment. Treatment aims to control symptoms and improve functioning.
Diagnosis And Treatment Of Attention Defect Hyperactivity Disorder (ADHD)Arwa H. Al-Onayzan
ADHD is diagnosed through clinical history, examination, and sometimes investigations. It is characterized by inattention, hyperactivity, and impulsivity. Treatment includes non-pharmacological options like behavior management as well as pharmacological options like stimulant medications which are the first-line treatment.
Neurocognitive disorders are defined as deficits in thought processes or memory due to brain dysfunction that represent a decline from previous functioning. There are several types including dementia, delirium, amnestic disorders, and permanent amnesia caused by conditions like head trauma or poisoning. Symptoms of dementia include memory impairment along with problems using language, objects, understanding sensory input, and executive functioning. Neurocognitive disorders are rare in children/adolescents but increase with age, affecting 1.4-1.6% of those aged 65-69 and 16-25% of those over 85.
Depression is the leading cause of disability world wide and is a major contributor to the overall global burden of diseases .At its worst depression can cause suicide .
There are effective psychological and pharmacological treatments for depression
Somatic Symptom & Related Disorders for NCMHCE StudyJohn R. Williams
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This was informed by several exam prep programs, and can be used like flashcards or as a presentation.
John Kane - Treatment-Resistant Schizophrenia: New Guidelines on Diagnosis an...wef
Presentation made at the live webinar hosted by the Schizophrenia Research Forum on the 21st of February, 2017 - http://www.schizophreniaforum.org/forums/treatment-resistant-schizophrenia-new-guidelines-diagnosis-and-terminology
Bipolar disorder - a psychological perspective (talk 1)Nick Stafford
This document provides an overview of bipolar disorder from multiple perspectives including the brain, cognition, circadian rhythms, life events, and dysfunctional beliefs. Key points include:
1) Brain imaging and studies show differences in brain structures and activity in areas related to mood regulation like the prefrontal cortex and limbic system between those with bipolar disorder and healthy controls.
2) Disruptions to circadian rhythms and sleep patterns are implicated in bipolar disorder through their effects on mood regulation.
3) Stressful life events and lack of social support are associated with increased risk of bipolar episodes, while positive social support predicts a better illness course.
4) Cognitive models suggest dysfunctional beliefs and information processing styles may
Treatment resistant schizophrenia & Treatment resistant depressionEnoch R G
This document discusses treatment resistant schizophrenia and provides guidelines for its management. It defines treatment resistance and outlines criteria from Kane and others. Factors associated with poor outcomes are biological, symptomatic, environmental, illness-related and pharmacological. The neurobiology of treatment resistant schizophrenia involves dopamine, glutamate, genetics and neuroanatomy. Management guidelines are provided from NICE and involve trials of clozapine as the gold standard treatment. Clozapine details include pharmacology, dosage, side effects, monitoring and predictors of response. Studies demonstrate clozapine's superior efficacy over other antipsychotics for treatment resistant schizophrenia.
This article aims to clarify misunderstandings around Sensate Focus, a technique developed by Masters and Johnson. Sensate Focus involves structured non-demand touching exercises and was intended to help clients overcome sexual difficulties by reframing sex as a natural function like breathing. However, confusion arose regarding its proper implementation. The authors, who were trained at Masters and Johnson's institute, explain the founders' conceptualization of sex as a natural function and how initial Sensate Focus was meant to be non-demand pleasure of oneself, not one's partner, in order to move clients towards optimal intimacy. They hope to accurately depict Masters and Johnson's approach to address misinformation.
Will talk about the severe psychological disorders-- The familiar name for all might be -"Schizophrenia" - it is not just one category but has multiple categories combined under -"Schizophrenia spectrum"
My forensic psychiatric research done in Indian jails shows most convicts under murder cases belong to schizophrenia spectrum (98% schizophrenia and 2% paranoid & schizoid personality disorders), and most have murdered their spouses, family members, friends or colleagues and surrendered themselves on the spot.
This presentation on the "Schizophrenia spectrum" has been particularly shared with you all to extend my message to help these affected people at the right time and maintaining their condition to prevent them from committing such crimes as there is no proper mental health care--Clinical, Legal or authoritative help available for convicts suffering from mental disorder.
The document provides an overview of the revisions made to the WISC-IV intelligence test. Key points include:
- The WISC-IV was revised based on new research on cognitive abilities and demographic shifts. Goals were to strengthen the four-factor model, improve clinical utility, and enhance psychometric properties.
- Changes include updated subtests, a new index structure of Verbal Comprehension, Perceptual Reasoning, Working Memory, and Processing Speed, and reduced testing time.
- Extensive standardization involved over 2,200 children and demonstrated improved reliability, with average subtest reliability ranging from .82 to .93 and composite scores from .88 to .97. Test-
Somatoform disorders involve physical symptoms that cannot be fully explained by medical factors and cause significant distress. Somatic symptom disorder involves preoccupation with fears of illness for 6+ months. Illness anxiety disorder is a preoccupation with being sick without actual symptoms. Conversion disorder involves psychological stress converting to motor or sensory symptoms. Treatment focuses on reassurance, psychotherapy, and addressing underlying psychiatric conditions.
This presentation is about geriatric Psychiatry awareness. it contains basic information about what is geriatric psychiatry, which are the main psychiatry disorder found in elderly and how to manage them?. it contains some detailed information about late life depression, delirium and dementia in geriatric population.
Protective factors against suicidal acts in major depression:Reasons for living, Journal Club Presentation in the Dept of Psychiatric Nursing, Kothamangalam
The document discusses changes to the diagnosis of personality disorders in DSM-5. It notes that only borderline personality disorder showed good reliability in DSM-5 field trials. It introduces new concepts like cross-cutting symptom measures and assessing personality functioning. An alternative dimensional trait model for personality disorders is presented in DSM-5 for research purposes only. ICD-11 beta criteria also take a dimensional approach without specific subtypes. The multiaxial system is removed from DSM-5.
Sytematic treatment enhancement program for bipolar disorder(step bd) (1)Dr Wasim
The STEP-BD study was a large, long-term outpatient study that evaluated treatments for bipolar disorder. Over 7 years it enrolled 4,361 participants ages 15 and older from 22 sites to evaluate which treatments were most effective for episodes of depression and mania and for preventing recurrence. The study assessed mood stabilizers, antidepressants, antipsychotics, and psychosocial interventions. It found that certain medications were not more effective than placebo for acute depression. Intensive psychosocial therapies improved relationship and life satisfaction compared to a brief control intervention. The study provided important longitudinal data on the course and comorbidities of bipolar disorder.
This document discusses psychotic disorders and schizophrenia. It defines schizophrenia as a serious mental illness characterized by illogical thoughts, bizarre behavior, and experiences like hallucinations. The diagnostic criteria for schizophrenia include symptoms like delusions and hallucinations. Positive and negative symptoms are assessed using scales. Treatment involves antipsychotic medications, including typical antipsychotics which block dopamine receptors, and atypical antipsychotics which are less likely to cause motor side effects but can increase risks like weight gain. Clozapine is reserved for treatment-resistant cases due to potential side effects. Patient counseling involves ensuring adherence to treatment and monitoring for side effects or relapse.
The document discusses the history and evolution of somatic symptom and related disorders. It describes how concepts like hysteria, hypochondriasis, and psychosomatic disorders developed before being categorized under somatic symptom disorder, illness anxiety disorder, conversion disorder, and other diagnoses in DSM-5. It provides details on the characteristic symptoms, thresholds, and specifiers for each DSM-5 disorder category. Theories on the causes of related conditions like pseudocyesis are also summarized.
Cognitive changes have been a defining feature of Sz since onset. A lot of research has been done in understanding these changes and its implication in developing novel methods of treatments. This ppt summarises the cognitive changes occurring in the brain.
Women differ widely in their reaction to childbirth. Some women are giving evidence of great distress and others maintaining a high degree of equanimity throughout labor. Dolorimetry is a laboratory method of measuring painfulness to obtain reliable estimates of spontaneous and experimentally induced pain intensity. Dim lights, peaceful surroundings, privacy, and warmth will create a calm environment for a woman to enjoy birthing experience. The comforting activities will relieve woman's fear about labor pain directly or indirectly. Many comforting activities are inexpensive.
This presentation gives you a basic overview to the psychological changes in a pregnant lady during the trimesters, at the end there are a couple of useful links for further reading about the topic.
Obsessive-Compulsive and Related Disorders (DSM-V)Adesh Agrawal
The disorders those characterized by repetitive behavior, are included under this broad chapter in DSM-5. Here we prepared this PPT in which we tried to cover the whole topic in a very comprehensive and concise manner. We hope that this will help you to understand it in an easy way.
your further suggestions will be appreciated.
Schizophrenia is a major psychotic disorder characterized by delusions, hallucinations, disorganized speech and behavior. It has been defined and categorized in different ways over time. Current diagnostic criteria require symptoms for at least one month. The causes are thought to involve genetic and environmental factors. The disorder follows a variable course with acute episodes potentially followed by chronic or residual phases with negative symptoms. Diagnosis involves assessing for specified symptoms and impairment. Treatment aims to control symptoms and improve functioning.
Diagnosis And Treatment Of Attention Defect Hyperactivity Disorder (ADHD)Arwa H. Al-Onayzan
ADHD is diagnosed through clinical history, examination, and sometimes investigations. It is characterized by inattention, hyperactivity, and impulsivity. Treatment includes non-pharmacological options like behavior management as well as pharmacological options like stimulant medications which are the first-line treatment.
Neurocognitive disorders are defined as deficits in thought processes or memory due to brain dysfunction that represent a decline from previous functioning. There are several types including dementia, delirium, amnestic disorders, and permanent amnesia caused by conditions like head trauma or poisoning. Symptoms of dementia include memory impairment along with problems using language, objects, understanding sensory input, and executive functioning. Neurocognitive disorders are rare in children/adolescents but increase with age, affecting 1.4-1.6% of those aged 65-69 and 16-25% of those over 85.
Depression is the leading cause of disability world wide and is a major contributor to the overall global burden of diseases .At its worst depression can cause suicide .
There are effective psychological and pharmacological treatments for depression
Somatic Symptom & Related Disorders for NCMHCE StudyJohn R. Williams
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This was informed by several exam prep programs, and can be used like flashcards or as a presentation.
John Kane - Treatment-Resistant Schizophrenia: New Guidelines on Diagnosis an...wef
Presentation made at the live webinar hosted by the Schizophrenia Research Forum on the 21st of February, 2017 - http://www.schizophreniaforum.org/forums/treatment-resistant-schizophrenia-new-guidelines-diagnosis-and-terminology
Bipolar disorder - a psychological perspective (talk 1)Nick Stafford
This document provides an overview of bipolar disorder from multiple perspectives including the brain, cognition, circadian rhythms, life events, and dysfunctional beliefs. Key points include:
1) Brain imaging and studies show differences in brain structures and activity in areas related to mood regulation like the prefrontal cortex and limbic system between those with bipolar disorder and healthy controls.
2) Disruptions to circadian rhythms and sleep patterns are implicated in bipolar disorder through their effects on mood regulation.
3) Stressful life events and lack of social support are associated with increased risk of bipolar episodes, while positive social support predicts a better illness course.
4) Cognitive models suggest dysfunctional beliefs and information processing styles may
Treatment resistant schizophrenia & Treatment resistant depressionEnoch R G
This document discusses treatment resistant schizophrenia and provides guidelines for its management. It defines treatment resistance and outlines criteria from Kane and others. Factors associated with poor outcomes are biological, symptomatic, environmental, illness-related and pharmacological. The neurobiology of treatment resistant schizophrenia involves dopamine, glutamate, genetics and neuroanatomy. Management guidelines are provided from NICE and involve trials of clozapine as the gold standard treatment. Clozapine details include pharmacology, dosage, side effects, monitoring and predictors of response. Studies demonstrate clozapine's superior efficacy over other antipsychotics for treatment resistant schizophrenia.
This article aims to clarify misunderstandings around Sensate Focus, a technique developed by Masters and Johnson. Sensate Focus involves structured non-demand touching exercises and was intended to help clients overcome sexual difficulties by reframing sex as a natural function like breathing. However, confusion arose regarding its proper implementation. The authors, who were trained at Masters and Johnson's institute, explain the founders' conceptualization of sex as a natural function and how initial Sensate Focus was meant to be non-demand pleasure of oneself, not one's partner, in order to move clients towards optimal intimacy. They hope to accurately depict Masters and Johnson's approach to address misinformation.
Will talk about the severe psychological disorders-- The familiar name for all might be -"Schizophrenia" - it is not just one category but has multiple categories combined under -"Schizophrenia spectrum"
My forensic psychiatric research done in Indian jails shows most convicts under murder cases belong to schizophrenia spectrum (98% schizophrenia and 2% paranoid & schizoid personality disorders), and most have murdered their spouses, family members, friends or colleagues and surrendered themselves on the spot.
This presentation on the "Schizophrenia spectrum" has been particularly shared with you all to extend my message to help these affected people at the right time and maintaining their condition to prevent them from committing such crimes as there is no proper mental health care--Clinical, Legal or authoritative help available for convicts suffering from mental disorder.
The document provides an overview of the revisions made to the WISC-IV intelligence test. Key points include:
- The WISC-IV was revised based on new research on cognitive abilities and demographic shifts. Goals were to strengthen the four-factor model, improve clinical utility, and enhance psychometric properties.
- Changes include updated subtests, a new index structure of Verbal Comprehension, Perceptual Reasoning, Working Memory, and Processing Speed, and reduced testing time.
- Extensive standardization involved over 2,200 children and demonstrated improved reliability, with average subtest reliability ranging from .82 to .93 and composite scores from .88 to .97. Test-
Somatoform disorders involve physical symptoms that cannot be fully explained by medical factors and cause significant distress. Somatic symptom disorder involves preoccupation with fears of illness for 6+ months. Illness anxiety disorder is a preoccupation with being sick without actual symptoms. Conversion disorder involves psychological stress converting to motor or sensory symptoms. Treatment focuses on reassurance, psychotherapy, and addressing underlying psychiatric conditions.
This presentation is about geriatric Psychiatry awareness. it contains basic information about what is geriatric psychiatry, which are the main psychiatry disorder found in elderly and how to manage them?. it contains some detailed information about late life depression, delirium and dementia in geriatric population.
Protective factors against suicidal acts in major depression:Reasons for living, Journal Club Presentation in the Dept of Psychiatric Nursing, Kothamangalam
The document discusses changes to the diagnosis of personality disorders in DSM-5. It notes that only borderline personality disorder showed good reliability in DSM-5 field trials. It introduces new concepts like cross-cutting symptom measures and assessing personality functioning. An alternative dimensional trait model for personality disorders is presented in DSM-5 for research purposes only. ICD-11 beta criteria also take a dimensional approach without specific subtypes. The multiaxial system is removed from DSM-5.
Sytematic treatment enhancement program for bipolar disorder(step bd) (1)Dr Wasim
The STEP-BD study was a large, long-term outpatient study that evaluated treatments for bipolar disorder. Over 7 years it enrolled 4,361 participants ages 15 and older from 22 sites to evaluate which treatments were most effective for episodes of depression and mania and for preventing recurrence. The study assessed mood stabilizers, antidepressants, antipsychotics, and psychosocial interventions. It found that certain medications were not more effective than placebo for acute depression. Intensive psychosocial therapies improved relationship and life satisfaction compared to a brief control intervention. The study provided important longitudinal data on the course and comorbidities of bipolar disorder.
This document discusses psychotic disorders and schizophrenia. It defines schizophrenia as a serious mental illness characterized by illogical thoughts, bizarre behavior, and experiences like hallucinations. The diagnostic criteria for schizophrenia include symptoms like delusions and hallucinations. Positive and negative symptoms are assessed using scales. Treatment involves antipsychotic medications, including typical antipsychotics which block dopamine receptors, and atypical antipsychotics which are less likely to cause motor side effects but can increase risks like weight gain. Clozapine is reserved for treatment-resistant cases due to potential side effects. Patient counseling involves ensuring adherence to treatment and monitoring for side effects or relapse.
The document discusses the history and evolution of somatic symptom and related disorders. It describes how concepts like hysteria, hypochondriasis, and psychosomatic disorders developed before being categorized under somatic symptom disorder, illness anxiety disorder, conversion disorder, and other diagnoses in DSM-5. It provides details on the characteristic symptoms, thresholds, and specifiers for each DSM-5 disorder category. Theories on the causes of related conditions like pseudocyesis are also summarized.
Cognitive changes have been a defining feature of Sz since onset. A lot of research has been done in understanding these changes and its implication in developing novel methods of treatments. This ppt summarises the cognitive changes occurring in the brain.
Women differ widely in their reaction to childbirth. Some women are giving evidence of great distress and others maintaining a high degree of equanimity throughout labor. Dolorimetry is a laboratory method of measuring painfulness to obtain reliable estimates of spontaneous and experimentally induced pain intensity. Dim lights, peaceful surroundings, privacy, and warmth will create a calm environment for a woman to enjoy birthing experience. The comforting activities will relieve woman's fear about labor pain directly or indirectly. Many comforting activities are inexpensive.
This presentation gives you a basic overview to the psychological changes in a pregnant lady during the trimesters, at the end there are a couple of useful links for further reading about the topic.
The document discusses the psychological changes that occur during pregnancy from the perspectives of the mother, social influences, cultural influences, and family influences. It notes that a mother's initial reaction may include a range of emotions and that acceptance of the pregnancy progresses over time. Socially and culturally, views of pregnancy and childbirth have changed from a medicalized experience to a more family-centered one. The attitudes of the couple, their cultural backgrounds, and family experiences all shape their outlook on pregnancy. The document also discusses preparing for motherhood and the emotional responses of both parents.
Challenges in obstetrics and gynaecology psychological perspectivekumar mahi
This document summarizes some of the key psychological challenges faced during various transitions in women's health, according to Dr. K. Kumar from the Center for Improving Relationship and Personal Effectiveness. It discusses early puberty, menstruation, pregnancy, infertility, menopause, and issues like depression, PTSD, and violence against women. For each transition, it outlines common physical and emotional symptoms and factors that influence adjustment, such as social support, stress, and acceptance of changes. Throughout, it emphasizes the importance of addressing both physical and psychological needs in women's healthcare.
in Malays, we called it meroyan. PPD can be divided into postpartum depression and postpartum psychosis. Only postpartum psychosis need treatment such as combination of anti-psychotic, anti depression and mood stabilizer
- Provide emotional support and
encourage expression of feelings
- Explain options for management
- Discuss autopsy and genetic
counseling
- Refer to bereavement counselor
- Follow up after delivery
The document summarizes the three stages of labor and delivery:
1) The first stage is dilation, where contractions dilate the cervix from 2-16 hours. Contractions increase in frequency and intensity to fully dilate the cervix to 10 cm.
2) The second stage is expulsion, where the woman pushes with contractions to deliver the baby. The baby's head first emerges, then the shoulders and body slip out.
3) The third stage involves delivery of the placenta and afterbirth, completing the labor process. Labor typically takes 15 hours total for a first birth but can range from 3 to 24 hours.
The document provides an outline for a course on caring for mothers, children, and families. The course covers topics like family structures, reproductive development, puberty, and the anatomy and physiology of the male and female reproductive systems. It aims to teach students to utilize the nursing process in caring for clients to promote health, assess risks, identify nursing diagnoses, plan interventions, implement care, and evaluate outcomes. The document outlines the various stages that will be covered, including pregnancy, labor/delivery, postpartum care, and care of newborns through adolescence.
This document provides information on the stages of labor and management of the first stage of labor. It discusses the normal progression through the latent, active, and transition phases of the first stage. It also covers monitoring during labor including vital signs, contractions, and fetal heart rate. Active management of labor is described which includes interventions like amniotomy and oxytocin if progress is unsatisfactory. The nurse's role in caring for the woman in the first stage is also summarized.
6.Normal Labor,Delivery And The PuerperiumDeep Deep
The document summarizes normal labor, delivery, and the postpartum period. It describes the four main factors that determine labor (contractions, pelvis, fetus, psychology). It then explains the stages of labor and delivery in detail, including first, second and third stages. It discusses management of each stage. It also covers the postpartum period known as the puerperium, including typical uterine bleeding, lactation, and involution over 6 weeks.
This document discusses obstetric analgesia options for labor pain. It describes:
1. Labor pain is intense and often worse than deep lacerations for many women. Regional techniques like epidural analgesia are recommended for pain relief during labor.
2. Epidural analgesia is the most common technique and involves threading a catheter into the epidural space to administer local anesthetics. Proper monitoring and maintenance is required to ensure adequate pain relief without motor block or hypotension.
3. Other options discussed include systemic opioids, inhaled gases, non-pharmacologic methods, and spinal or combined spinal-epidural techniques. The goal is providing effective pain management while avoiding negative effects on the
The document discusses various psychological changes and disorders that can occur during the postpartum period. It describes common changes like adjustment to new roles, postpartum blues, cultural influences on attachment. It also discusses postpartum disorders like depression, anxiety, stress reactions and trauma from delivery, postpartum OCD, PTSD and psychosis. Nursing interventions are focused on early detection and referral for treatment of any psychological issues and supporting positive parenting behaviors.
Mental disorders in pregnancy may be under-diagnosed and can seriously impact the health and well-being of the mother and baby. A multi-disciplinary team approach is important for predicting, detecting, and treating mental disorders during pregnancy, which include depression, anxiety disorders, psychoses, bipolar disorder, eating disorders, and others. Psychological therapy is generally preferred over pharmacological therapy during pregnancy and breastfeeding, though medication may be considered for severe cases if benefits outweigh risks. Close monitoring is important for high risk patients to support good mental health outcomes for both mother and child.
This document summarizes the normal labor and delivery process. It defines labor as beginning with regular uterine contractions and ending with childbirth. Labor involves three stages - first stage is cervical dilation from 0-10cm, second stage is birth of the baby, and third is delivery of the placenta. Key aspects of managing normal labor are admitting women in early labor, monitoring the fetus, allowing freedom of movement, and active management including amniotomy and oxytocin to shorten stages of labor. The goal is a safe birth for both mother and child with minimal medical intervention.
Puerperium is the period following childbirth during which the body tissues, specially the pelvic organs revert back approximately to the pre-pregnant state both anatomically and physiologically. puerperium begins as soon as the placenta is expelled and lasts for approximately 6 weeks when the uterus becomes regressed almost to the non-pregnant size.
Summary of psychiatric disorders during pregnancy & lactationHosam Hassan
This document discusses psychiatric disorders in pregnant and lactating women. It covers detection, prediction, and prevention of mental disorders before and during pregnancy. It also discusses management of mental disorders during pregnancy and lactation. The document provides an overview of common psychiatric disorders like mood disorders, psychotic disorders, substance abuse disorders, and postpartum psychiatric illnesses. It discusses the use of psychopharmacotherapy during pregnancy and lactation, covering medications like antipsychotics, antidepressants, mood stabilizers, and anxiolytics. It emphasizes the importance of a multidisciplinary approach and specialized services for treating mental health issues during this critical period.
Nursing management during labor and birth two dunncbear1996
This document provides an overview of nursing management during labor and birth. It discusses assessing the patient and fetus, managing pain, positioning during labor, and nursing care during each stage of labor including the first, second, third and fourth stages. Non-pharmacological and pharmacological pain management techniques are outlined as well as potential complications from interventions like epidurals. The document also provides examples of NCLEX questions related to labor and delivery nursing care.
The recognition of bipolar disorder in primary careNick Stafford
Bipolar disorder and the complexities of screening and diagnosis in primary care. How more accurate detection and an integrated care pathway with secondary care can improve the diagnosis and outcome of the treatment of the disorder.
The document discusses mood and behavior management for patients with bipolar disorder in skilled nursing facilities. It notes that those in skilled nursing often face isolation, health issues, and sleep disturbances that can trigger bipolar episodes. Effective management includes maintaining regular routines, treating underlying symptoms, using behavioral chain analysis to address triggers, and helping staff regulate their own emotions to avoid exacerbating patients' conditions.
Bipolar disorder can present in children and adolescents with manic, hypomanic, or depressive episodes. It is a chronic and disabling condition associated with impaired functioning. Treatment involves medication, psychoeducation, and psychotherapy to stabilize mood symptoms, improve coping skills, and prevent recurrences. Lithium, anticonvulsants, and second-generation antipsychotics are commonly used but require careful monitoring due to side effect risks.
This document provides an overview of a Masterclass on bipolar disorder presented by Dr. Nick Stafford. It includes sections on epidemiology, clinical findings, course of illness, ICD-11 and DSM-V criteria, symptom domains, severity levels for mania and hypomania, and factors related to bipolar disorder such as genetics, neurobiology, and treatment approaches. The Masterclass covers topics like mood thermostats, thyroid function, differential diagnosis, and factors that influence outcomes like family history, substance abuse and life events.
Mooddisordersmentalhealthnursingchapter16 Partii 091112080813 Phpapp02Arletha Thomas
The document discusses bipolar disorder and mood disorders. It covers biological, psychosocial and developmental theories of bipolar disorder. Symptoms of mania in children and adolescents are provided. Treatment strategies discussed include psychopharmacology, family interventions, and addressing comorbid conditions like ADHD. Nursing assessments, diagnoses, interventions, education and evaluations related to bipolar disorder and suicide risk are also summarized.
Mood Disorders Mental Health Nursing Chapter 16 Part Iilifeisgood727
The document discusses bipolar disorder and mood disorders. It covers biological, psychosocial and developmental theories of bipolar disorder. It also discusses symptoms, diagnosis, and treatment strategies for bipolar disorder including in children and adolescents. Treatment includes psychopharmacology, psychotherapy, electroconvulsive therapy and family interventions. The nursing process for patients with mood disorders or who are suicidal is also summarized including assessment, diagnoses, planning and evaluation.
Mooddisordersmentalhealthnursingchapter16 Partii 091112080813 Phpapp02Arletha Thomas
The document discusses bipolar disorder and mood disorders. It covers biological, psychosocial and developmental theories of bipolar disorder. Symptoms of mania in children and adolescents are provided. Treatment strategies discussed include psychopharmacology, family interventions, and managing comorbid conditions like ADHD. Nursing assessments, diagnoses, interventions, education and evaluations related to bipolar disorder and suicide risk are also summarized.
This document provides an overview of mood disorders including major depressive disorder and bipolar disorder. It discusses categories of mood disorders, symptoms, treatment, nursing assessments, nursing diagnoses, outcomes, interventions, and evaluations. Special populations such as the elderly are also addressed. Suicide is described in terms of risk factors and the nurse's role in prevention and response.
Seminar on approach to schizophrenia.pptxfiraolgebisa
This document summarizes a seminar on the approach to schizophrenia. It begins with an outline of the topics to be covered, including introduction, definition, clinical diagnosis, and management principles. It then provides details on the introduction, definition, clinical manifestations, outcome, etiology, diagnosis, and management of schizophrenia. Key points include that schizophrenia is a chronic and disabling mental illness characterized by positive symptoms like hallucinations and delusions, negative symptoms, cognitive impairment, and mood symptoms. Treatment involves acute stabilization with antipsychotic medication followed by long-term management to prevent relapse.
This document provides an overview of psychopathology and mental disorders. It discusses definitions and classifications of mental disorders, as well as diagnosis. Specific disorders like schizophrenia and mood disorders are examined in more detail. For schizophrenia, it describes symptoms, course, heritability, neuroanatomical deficits, and treatment approaches. For mood disorders, it distinguishes between depression and mania, provides DSM-IV criteria for major depressive disorder, and discusses prevalence and causal factors. Biological, psychological, and social aspects of mental disorders are considered throughout.
This document provides an overview of postpartum psychiatric disorders. It discusses the biological and psychological changes that occur after childbirth that can increase risks of mental illness. Common disorders include postpartum blues, postpartum depression, postpartum psychosis, and mother-infant relationship disorders. Diagnosis can be challenging and these disorders can seriously impact both mother and child if not properly treated. The document examines assessment tools, treatment guidelines, and the importance of prevention and early intervention.
Major depression is characterized by depressed mood and loss of interest or pleasure that lasts at least two weeks. About 15% of people experience major depression in their lifetime. Females experience depression twice as often as males. Depression has genetic, biological, psychological, and social causes. Treatment involves psychotherapy, antidepressant medication, electroconvulsive therapy, or light therapy. Nursing care focuses on safety, support, and education to prevent suicide and promote recovery.
OVERVIEW OF SOMATOFORM DISORDERS AND ITS MANAGEMENT.pptxValentinaEmeruwa
Somatic symptom disorder is characterized by physical symptoms that cannot be fully explained by a medical condition, along with excessive thoughts about the symptoms. It has a prevalence of 5-7% and is more common in women. The causes are unclear but may involve a low tolerance for physical sensations combined with a tendency to misinterpret them as signs of illness. Treatment focuses on cognitive-behavioral therapy and antidepressants to reduce somatic, anxiety, and depressive symptoms and improve functioning.
Bipolar disorder is a mood disorder characterized by episodes of mania and depression. It can cause shifts in mood, energy levels, and ability to function. The document discusses the diagnostic criteria for bipolar disorder according to the DSM-V, including symptoms of mania, hypomania, psychosis and depression. It also covers the prevalence of bipolar disorder, potential causes, evaluation process, treatment options including mood stabilizers, psychotherapy and alternatives if monotherapy fails. Treatment trends are discussed for children, adolescents, and the elderly population.
Bipolar disorder is characterized by recurrent episodes of mania and depression. It was previously known as manic depressive psychosis. Bipolar I involves severe mania and depression while Bipolar II involves hypomania and severe depression. The causes are genetic factors, neurochemical imbalances, and environmental stressors. Treatment involves mood stabilizing drugs like lithium, antipsychotics, psychotherapy, and lifestyle management to reduce symptoms and prevent recurrence.
Mood disorders are mental health conditions characterized by abnormalities in emotional state. The document discusses several types of mood disorders including unipolar depressive disorder, bipolar disorder, and dysthymic disorder. It provides criteria for diagnosing major depressive disorder and manic episodes. Biological factors like genetics and neurotransmitters as well as psychological and social factors are described as potential causes. Treatments discussed include pharmacotherapy with antidepressants and mood stabilizers, psychotherapy approaches like CBT, and alternative therapies such as ECT, TMS, and light therapy. Overall outcomes are generally good with recovery from episodes within a year though relapses can be reduced with maintenance treatment.
1) The document outlines the steps of differential diagnosis, beginning with determining if the presenting symptom is valid, ruling out substance use and medical causes, and determining the specific primary disorder.
2) Many disorders share common symptoms, making differential diagnosis challenging. Temporality, atypicality of symptoms, and comparing the full clinical picture to disorder criteria are important guides.
3) Ruling out alternative explanations is crucial before making a diagnosis, as psychiatric symptoms can be caused by various non-psychiatric factors. A thorough evaluation is needed.
Understanding Bipolar Disorder: Biopsychosocial Approaches to Mind Body HealthMichael Changaris
Explores psychological, medical and primary care treatment and self-care for bipolar disorder from the biological bases of brain function and medication management to the psychological integrated care and treatment plan for health complexity and bipolar treatment needs.
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Current approaches to treating mood disorders focus mainly on neurotransmitters like serotonin, norepinephrine, and dopamine. However, there are many limitations to this approach. Alternative biological systems may be involved, such as circadian rhythms, the melatonergic system, glutamatergic neurotransmission, the HPA axis, insulin resistance, the immune system, and oxidative stress. Novel therapies targeting these alternative systems show promise and may help address treatment-resistant cases.
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1) The document provides an overview of personality disorder and depression, including discussing borderline personality disorder as an example. It outlines current principles for managing personality disorders and depression.
2) For borderline personality disorder specifically, it discusses the diagnostic criteria, biological and psychosocial risk factors, and developmental model. It recommends psychological treatments like dialectical behavior therapy and describes principles for managing BPD as a GP.
3) For depression, it discusses the biology and psychology, principles of prescribing antidepressants according to severity and duration, and future treatment approaches targeting different systems like the glutaminergic and immune systems.
Evidence shows us that specialised mood disorder clinics deliver cost savings, better clinical outcomes and improved patient satisfaction. Presented to the Trent Division of the Royal College of Psychiatrists, November 2013, Sheffield.
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This document summarizes a seminar about mental illness and relationships. It discusses how mental illnesses like bipolar disorder can impact relationships. Key points include that bipolar disorder is associated with higher divorce and unemployment rates due to deficits in social cognition. Relationships are affected by mood states, communication styles, and comorbid issues like anxiety, substance abuse, and impulse control problems. Families with high "expressed emotion" like criticism see worse outcomes. Treatments discussed include psychoeducation, DBT, and ensuring low expressed emotion from families. Health professionals are urged to help with relationship assessments, education, and treatments.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
16. Instability Model of BD
Vulnerability to
Bipolar Disorder
(Genetic-
Biological)
Medication
adherence
Disrupted social
(circadian)
rhythms
Sleep disruption
RELAPSE
Life events
Goodwin & Jameson 2007
17. Extensions of the cognitive models
of unipolar depression
‘Manic defence’ hypothesis –
psychodynamic model
Dysfunctional
cognitive style
Information
processing
Onset
Course
Expression
Above and
beyond genetic
predisposition
Life events
Current
environment
(supportive,
non-supportive
social)
Early
environment
(parenting and
maltreatment
histories)
18. Theory and science
Psychological
theories of
bipolar
Empirical
psychology
research
20. Negative thinking styles
Self blame
when things
go wrong
Self, others,
wider world in
negative light
Ruminate
when low
Risky sexual
behaviour, use
of alcohol,
street drugs,
other health
risks
Alloy et al 1999, Jones et al 2005, Thomas et al 2007
21. Positive thinking styles
Elevated
mood
Increased
alertness,
activity,
decreased
sleep
Interpret
these as
true self
Engage in
more
behaviors
(taking on
more,
resting less)
Increase
likelihood
of
hypomania
Jones et al 2006
22. Thinking styles between episodes
Similar to those in
episode (esp. depressive)
Unstable Tendency to fluctuate
Can change substantially
across episodes
Rapid changes in self-esteem
& mood
Contrasting thinking
styles at the same time
•When hypomanic see an
opportunity to more whilst also
recognizing a risk of becoming
ill
Jones et al 2006
23. Decision making and planning
Deficits in bipolar disorder
More likely to make
impulsive decisions and less
likely to take into account
future consequence of
decision making
Tendencies can interact with
the thinking styles noted
above and increase the risk
of further mood disorders
Clark et al 2002; Murphy et al 2001, 1999; Swann et al 2004
25. Life events & social support
Stressful life events
Prior to the onset of
first episode
Hypomanic/Manic
relapses
Depressive relapses
Positive social support more positive course
Negative support high EE – worse course
26. Methodological flaws in research
Methodological flaws in studies
Retrospective – ‘effort after meaning’ bias;
causes/consequences?
No control for mood state at time of reporting
Self-report measures and problem of mood bias
No inclusion of an appropriate control
No distinction between high/low relapses
Identified mood episode first, then stressor
Admission / start of treatment as beginning of episode
27. Types of life events and mania
Negative life events
Frequency before mania
Predicting manic relapse
Schedule disrupting life events
Goal attainment life events
28. Life events & relapse - mechanisms
Destabilizing
effects on
sleep
circadian rhythms
social rhythms
Goal attainment
or goal striving
hypersensitive
Behavioural
Activation System
- BAS
Kindling model
29. Social support & bipolar - mechanisms
Bipolar individuals
experience less support
than controls
Poor social support
predicts greater relapses
and longer time to
recover
High EE is predictive of a
worse outcome
EE studies
• ↑symptoms ↑perception
of negative family
environment
30. Parenting attachment – BD, UP, C
Parenting
Bipolar
compared
to …
Unipolar Control
Maternal
affection
Less cf.
control
Less
Paternal
affection
No
difference
Over control
by either
parent
No
difference
Attachment
Bipolar
compared
to …
Unipolar Control
Explicit
attachment
to mothers
Less cf.
control
Less
… paternal
attachment
No
difference
… peer
attachment
No
difference
Implicit
attachment
to fathers
Less
Rosenfarb, Becker, Khan 1994
31. Parenting attachment – BP, ADHD, C
Bipolars compared to … ADHD Controls
Parent-child interaction Greater impairment Greater impairment
Maternal warmth Less Less
Maternal tension/hostility Greater Greater
Paternal tension/hostility Greater Greater
Friends (youths) Fewer Fewer
Social skills Poorer Poorer
Geller et al 2000
32. Childhood maltreatment
Method
Childhood stressful
events
Both physical and
sexual abuse
N=155
Demographically
matched controls
Controlling for
Report biases
Genetic 3rd variables
Current depressive
and manic
symptomatology
Family history of mood
disorder
Separate associations
Independent (fateful,
uncontrollable) vs.
dependent
Occurred prior to vs.
after the age of the
first mood episode
Results
ONLY SPECIFIC EVENT
CATAGORIES
ASSOCIATED WITH
BIPOLARITY:
Childhood
maltreatment (PA & SA
combined)
Achievement failure
events
Grandin, Alloy and Abramson 2007
33. Manic defence hypothesis
Unstable Low
Fragile self esteem Grandiose defence
Threat
Helpless
Negative
Mania
Life events
Positive
cognitions on
explicit
measures
Depressive
cognitions on
implicit
measures
Abraham 1911,1927; Adler 1964; Neale 1988
35. Circadian rhythms
• Onset & Recurrence
• Why circadian rhythms might be relevant
• How they are measured and interpreted
• Evidence for them in bipolar disorder
• Lack of bridging model
• Disruption of psychological factors
• A model that may go some way to serving
these functions
36. BD is inherently a cyclical illness with a
typical course of relapse and recurrence
The Stanley Foundation Bipolar
Network: results of the naturalistic
follow-up study after 2.5 years of
follow-up in the German centres.
152 Germans, 2.5 year FU from hospitalisation
72% bipolar I; 25% bipolar II
42 years SD +/- 13.5
Onset 24.4 years SD +/- 10.9
40% rapid cycling
27% stable
56% recurrence
12.8% sub-syndromal symptoms
Dittmann S et al. 2002
37. Diagnostic criteria mania & depression
Importance of sleep and
behavioural disturbances as
symptoms in both types of
episode
Depression – insomnia &
hypersomnia, withdrawal
from activities and agitation
or retardation
Mania – decreased need for
sleep and increased goal-directed
and pleasurable (
but high risk activities)
38. Sleep
Sleep disturbance is
the ‘final-common
pathway’ for mania
Antidepressants &
lithium effects on
sleep
• Sleep phase
advance or
deprivation for
bipolar depressives
Search for biological
causes of circadian
disturbance is
common
Psychological causes
are less studied
Why do some not
suffer (e.g. shift
workers …)
39. Circadian rhythms basics
24.18 hours under controlled lighting
conditions
Sleep
Melatonin
Core body temperature
control
Cortisol
Consistent across all ages of
adults
Circadian rhythms seen in cellular activity,
body temperature, alertness, fluctuations in
hormone secretion
40. Circadian rhythms
Oscillators
Entrained by external
zeitgebers and zeitstorers
=<2 oscillators found in
studies of free runners
Under normal conditions
these cycles are synchronized
together
Under free running
conditions they move in and
out of phase with each other
41. Oscillators
Weak & strong oscillators
Strong
drives cycles which are less sensitive to
environmental manipulations
(REM sleep, body temperature, cortisol secretion,
urinary potassium secretion)
Weak
(rest/activity cycle, sleep/wake cycle, sleep
associated neuroendocrine activity)
Phase advance of the strong
oscillator is implicated in
depression
Suprachiasmatic nucleus function
42. Circadian rhythms in mania &
depression
Peripheral & core body
temperature, cortisol,
prolactin, growth hormone,
dopamine, beta-hydroxylase,
3-methoxy-4-
hydroxyphenylglycol
Body temperature rhythms in
manic and depressed
patients do not fit the
sinosoidal patterns of
normals – difference in
rhythmic stability
Cortisol, GH, cortisol levels
(see p94)
DA beta-hydroxylase –
circadian pattern lost in
mania but not depression
Also see 3M4HPG
43. Sleep activity cycle as a measure of
circadian disturbance
• Sleep disturbance in
– Mania
– Hypomania
– Depression
– Inter-episode
• State of trait?
• REM, non-REM or both
• See clinical relevance in
AJP article
• Circadian system
• Clinical implications
• http://ajp.psychiatryonli
ne.org/article.aspx?arti
cleID=99957#Bipolar%2
0Disorder%20and%20Sl
eep%20Disturbance%20
Often%20Coexist
44. Actigraphic assessment of sleep and
activity
• http://www.ncbi.nlm.nih.gov/pubmed/15762
859
• http://www.jad-journal.com/article/S0165-
0327(03)00055-7/abstract
• http://onlinelibrary.wiley.com/doi/10.1111/j.1
399-5618.2006.00329.x/abstract
50. Integration of the roles of circadian
and psychological factors in bipolar
disorder
51. Implications of an integrative
multilevel model of bipolar disorder
• Circadian instability outside of episodes
• Importance of early intervention
• Development of internal attribution measures
• Learning to reattribute fluctuations to external
causes
56. Intervention studies that incorporate coping
with bipolar prodromes as a therapy component
Study Subjects Therapy Control Duration Outcome
Identify prodromes and seek
help early: Perry et al 1999
N=69.
I = 63; II=6
Relapsed in previous 12
months
Training to identify
prodromes.
Rehearse action plan when
recognized.
TAU – drugs, monitoring,
support from key worker
7-12 individual sessions Over 18months:
- Significantly longer time
to relapse
- No beneficial effects on
depression
Schmitz et al 2002 N=46 with comorbid
substance misuse
Psychoeducation about BD
and substance dependence.
Identification of prodromes.
Coping skills training.
Four brief clinic visits for
medication monitoring,
discuss compliance, SEs,
substance use and mood
symptoms
16 individual sessions of 60
minute cognitive therapy
Over 3 months:
- No difference in
substance misuse
- Improvement in mood
symptoms (significant)
- Better attendance &
compliance (trend only)
FFT. Miklowitz et al 2000,
2003
N=101 type I
Episode previous 3 months
Radom allocation:
1/3 FFT
2/3 Rx & crisis management
Psychoeducation
Identify prodromal signs
Relapse prevention plans
Problem solving
Communication training
Medications
2 sessions of family
education
Crisis management
9 months of FFT Over 24 months FFT:
- Fewer relapses
- Longer time to relapse
- Better medication
compliance
- Greater reduction in
mood symptoms
Cognitive therapy. Lam et al
2005
N=103 type I
At risk of relapse
12-20 sessions CT with
psychoeducation
Psychiatric outpatients on
mood stabilizers
6 months therapy with 2
booster sessions
Over 30 months:
Fewer bipolar relapses
Fewer days in episode
Lower depression scores &
less fluctuation of manic
symptoms
Better coping strategies
FFT 2. Rea et al 2003 N=53 type I recently
hospitalized
21 group sessions:
psychoeducation,
prodromal signs, relapse
prevention, problem-solving,
communication
training
Individual sessions over 9
months. (12 weekly, 6
fortnightly, 3 monthly)
General psychoeducation.
9 months Over 24 months:
Fewer hospitalizations
Fewer relapses
No differences in time to
relapses
Psychoeducation. Colom et
al 2003.
N=100 stable euthymic I
N=20 type II
YMRS<6
HAM-D <8
Group psychoeducation
Weekly
21 sessions
Medication in OPC
20x 90 minute non-structured
group sessions
21x 90-minute group
sessions weekly of 9-12
patients
Over 24 months:
Fewer relapses
Increased time to episode
Fewer hospitalizations
Shorter length of
hospitalizations
57. Prodromes in bipolar
• Inherent problems in defining prodromes in
mental health
• Methodological issues
• Empirical findings
– Can bipolar patients report prodromes?
– Common prodromes
– Length od prodromal period
58. Coping in bipolar disorder
• Importance of coping
• Primary and secondary appraisal
• Functions of coping
• Coping with prodromes
59. Coping strategies for prodromes of mania
Ten most frequently
endorsed strategies
Good coping group (N=21)
(%)
Poor coping group (N=15)
(%)
Modifying excessive
behaviour
62 0
Engaging in calming
activities
48 13
Take extra time to rest 43 0
See a doctor 29 7
Take extra medication as
19 7
previously agreed
Enjoy the feeling of a high 5 20
Continued to move about 0 27
Did nothing 0 27
Spend more money 0 20
Find more to do 0 20
Lam & Wong 1997
60. Coping strategies for prodromes of depression
The seven most frequently
endorsed strategies
Good coping group (N=17)
(%)
Poor coping group (N=12)
(%)
Get oneself and keep busy 53 0
Get social support and
29 0
meet people
Distract myself from
negative thoughts
24 8
Recognize and evaluate
unrealistic thoughts
24 0
Stay in be and hope it will
go away
6 53
Take extra medication
without prescription
6 17
Do nothing 0 25
Lam & Wong 1997
62. PE: Elemental mechanisms
• Awareness of the disorder
• Early detection
• Adherence with treatment
63. PE: Secondary mechanisms
• Controlling stress & psychosocial factors
• Avoiding substance use and misuse
• Achieving regularity in lifestyle
• Preventing suicidal behaviour
• Role of individual psychological factors
64. PE: Desirable objectives
• Increasing knowledge and facing the
psychosocial consequences of past and future
episodes
• Improving social and interpersonal activity
between episodes
• Sub-syndromal symptoms and impairment
• Increasing well-being and improving the
quality of life
68. CBT Evidence
• Administered in euthymic state, works better
– Than waiting for treatment
– Sometimes better than treatment-as-usual
– Than brief psychoeducation
• However
– It depends on the outcome
– If CBT has lasting effects
74. CBT Euthymic: A new German RCT
Cognitive Behavioural Therapy Supportive Therapy
20 sessions (each 50 minutes) 20 sessions (each 50 minutes)
9 months 9 months
Psychoeducation Psychoeducation
Mood diary Mood diary
Relapse analysis and individual early
Focus on current problems
warning plan
Behavioural strategies Client-centered perspective
Cognitive strategies
Problem solving and communication
skills
Meyer & Hautzinger, in press, Psycholog Medicine
82. Mindfulness
• Tibetan - “Familiarization”
• Mind watching the mind
• Stopping dangerous thoughts and feelings
• Nipping things in the bud
• Neutral observer
• Paying attention in a particular way …
• … on purpose
• … in the present moment
• Moment by moment by moment by moment …
Philippe Goldin, Google Tech Talks, 2008
http://www.youtube.c Kabat-Zinn 1994 om/watch?v=sf6Q0G1iHBI&feature=related
83. MBSR
Formal
meditation
practice
Informal
meditation
practice
Yoga /
Stretching
Philippe Goldin, Google Tech Talks, 2008
http://www.youtube.com/watch?v=sf6Q0G1iHBI&feature=related
84. Clinical interventions incorporating
Buddhist Meditation
Mindfulness Based Stress Reduction (MBSR)
• Kabat-Zinn
Mindfulness Based Cognitive Therapy (MBCT)
• Segal, Teasdale, Williams
Dialectic Behaviour Therapy
• Linehan
Acceptance and Commitment Therapy (ACT)
• Hayes, Stroshal, Wilson
Philippe Goldin, Google Tech Talks, 2008
http://www.youtube.com/watch?v=sf6Q0G1iHBI&feature=related
89. Elements of DBT in bipolar
• Mindfulness
• Increasing your awareness
• Choosing how to act vs. react
• Surviving a crisis without making it worse
• Why we need emotions
• What to do about your emotions
• The challenges of anxiety disorders
• Radical acceptance
• Being more effective in relationships
• Skills for family members of people with bipolar
93. What is it?
1. Which therapy is the best?
2. Which elements of the therapy is best?
3. Is one therapy better for bipolar I or II?
4. Does this mean that all patients with bipolar
disorder should have one of these therapies?
96. Medication adherence
• Use of antidepressants
• Medication is usually necessary & effective
• 20-62% relapse despite medication
• 23-52% stop taking their medication
– Complexities of medication treatments
– Monitoring of long term medication
– Adjusting to taking medication chronically
– Dealing with side effects
– Reduce dysfunctional attitudes
97. Subsyndromal symptoms
• Early identification of prodromal symptoms
• Preventing the symptoms
• Managing the symptoms
• Managing comorbidity
– Anxiety disorders
– Alcohol & Drug misuse
– Personality disorder
– Medical disorders
– Psychosocial problems
100. Heuristic model of mania
S
Internal / external
Stress / Critical life events
Dysfunctional beliefs / Negative
attributions
Changes in daily life and
rhythms
Changes in medication
Interpersonal conflict
O
Arousal
Disruption in
sleep
R
Increase in activity
levels
Positive affect and/or
irritability
C
Positive reinforcement
Negative reinforcement
Feedback from others
Medication adherence fluctuates
Meyer (2008)
102. SYSTEM POSITIVE
REINFORCEMENT
THREAT / NEGATIVE
REINFORCEMENT
Controlling stimuli External & internal cues for
reinforcement / reward
Cues for missing reward or
punishment
Specific systems Goal directed:
• Social
• Achievement
• Sexual
Irritability / active
avoidance
General systems
Behavioural Activation System (BAS)
• Motor activation
• Incentive motivation
Depue & Iacono (1989); Depue & Zald (1993)
103. Behavioural Activation System
BAS
increased
BAS
decreased
MOOD Elevated &
euphoric
Empty,
depressed
MOTIVATION Hedonia Interest & lust Loss of interest,
anhedonic
Need for
novelty
Involvement in
many activities
Avoidance of
stimulation
AROUSAL Energy Tired,
exhausted
Sleep Hypersomnia,
day sleep
Thought Slow, problems
with decision
making
Depue & Iacono (1989)
104. BAS as Mania/Depression
MANIA DEPRESSION
MOOD Elevated &
euphoric
Empty, depressed
MOTIVATION Hedonia Interest & lust Loss of interest,
anhedonic
Need for
novelty
Involvement in
many activities
Avoidance of
stimulation
AROUSAL Energy Tired, exhausted
Sleep Hypersomnia, day
sleep
Thought Slow, problems
with decision
making
105. BAS core process of mania
[e.g. Depue & Zald, 1993; Alloy et al., 2006; Johnson, 2005)
106. BAS Core process of mania
[e.g. Depue & Zald, 1993; Alloy et al., 2006; Johnson (2005)
107. CBT model for bipolar
Medication Individual deficits Stress
Thoughts
Basco & Rush, 1996; Meyer & Hautzinger, 2004
Individual
resources
Instability of
biological
rhythms
Hypomanic /
manic, mixed or
depressive
Prodromal symptoms
symptoms
Emotions Behaviour
108. CBT Euthymic: A new German RCT
Randomisation
THERAPY
For 9 months
20 sessions
N=38 CBT
N=38 ST
FOLLOW UPS
(every 3/6 months)
B
A
S
E
L
I
N
t0 t1 t2 t3 t4 t5
Blind ratings
Meyer & Hautzinger, in press, Psycholog Medicine
109. CBT Euthymic: A new German RCT
Log Rank (Mantel-Cox) χ2 = 0.004, n.s.
Meyer & Hautzinger, in press, Psycholog Medicine
110. Euthymic state: Relapse prevention
• Psychosocial interventions – often help in
preventing relapses, especially depressive:
• But (1) – Number of prior episodes, comorbid
conditions, length of therapy
• But (2) – outcome of studies was ‘any relapse’ or
‘time to first relapse’
• But (3) – f(mania) > f(depression) ; low power
111. Bipolar depression
• Sub-syndromal symptoms significantly improve
due to psychotherapeutic intervention but not
psychoeducation
– [e.g. Castle et al., 2009; Lam et al., 2000, 2003; Meyer
& Hautzinger, in press; Miklowitz et al., 2003; Scott et
al., 2001]
• Bipolar depression remits faster when treated
with psychotherapy
– [STEP-BD; Miklowitz et al., 2007]
112. Mania & Mixed States
• There is no evidence yet for psychotherapy to work in
treating acute manic episodes
• No studies have looked at the efficacy of psychosocial
interventions for treating mixed episodes
• For subsyndromal and hypomanic symptoms there is:
– positive (Lam et al. (2000, 2003); Scott et al. (2001)) and
– negative evidence (Miklowitz et al. (2003))
113. Elements of psychological therapy
• Sufficiently long psychoeducation group
– CBT
– FFT
– IPSRT
• Relapse prevention is the main goal
114. Lack of evidence in …
• Comorbidity
• Bipolar II disorder
• Effectiveness of 3rd wave CBT
• Other psychological approaches
• Effectiveness of psychological therapies under
routine clinical practice
119. Positive Effects & Creativity
• Speed of thinking
• Range of emotions experienced
• Increased motivation and energy
• Flash of inspiration
Touched with Fire. Jameson 1996