What’s New in Bipolar Disorder?
  1. Introduction:  Surge in Diagnosis since 1980.
  1. Epidemic?
B.        Changing criteria?
C.        Root of the problem is in diagnosis and treatment of depression.
D.        Similar subjective criteria method used to diagnose BPD as is in depression.
  1. Definitions.
  1. Bipolar disorder categories:
  1. BPD 1, the old manic depression;
  2. BPD 2;
  3. Cyclothymia;
  4. Depression with family history of BPD;
  5. Mania alone;
  6. BPD, other specified bipolar and related diseases.
  1. Criteria for BPD 1 (old manic depression):
    1. Period of more than one week of improved mood;
  1. Irritable, inflated sense of self-esteem with decreased need for sleep;
  1. Easily distracted with a pressing need to get things done;
  1. Spending money they do not have.  Disastrous sexual or moral choices are made;
  1. Mania is followed by depression.  Diagnosis of depression is required.
  1. Significant changes:
    1. A week long episode of mania is no longer required for hospitalization;
  1. Criteria for BPD2 are less restricted:
    1. Presence of one or more major depressive episodes;
    2. Presence or history of at least one hypomanic episode;
    3. No prior manic episode or mixed episode;
    4. Symptoms are not better accounted for by another disorder;
    5. The symptoms cause significant clinical distress or impairment in social, occupational or other areas of function.
  1. The key difference is between mania and hypomania, which makes applying the diagnosis much less difficult.
    1. A distinct period of persistently elevated, expansive, or irritable mood, lasting at least four days, that is clearly different from the usual non-depressed mood.
    2. During the period of mood disturbance, three or four of the following symptoms have persisted (four, if only irritable) and have been present to a significant degree:
      1. Inflated self-esteem or grandiosity;
      2. Decreased need for sleep (feels rested after three or four hours)
      3. More talkative than usual or feels pressure to keep talking;
      4. Flight of ideas or subjective experience that thoughts are racing;
      5. Distractibility;
      6. Increase in goal-directed activity (social, work, school, sexually) or psychomotor agitation;
      7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (buying sprees, sexual indiscretions.

  1. Represents change in function level, observed by others.
  2. Not severe enough to cause marked impairment in social or occupational functioning and does not have psychotic features.
  1. This is the important dividing line!
    1. Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (medication, ECT, light therapy) should not count toward a diagnosis of BPD2 disorder.
    2. The problem is that most people labeled with depression are on antidepressant medication when labeled with BPD2.
  • “Instead of treating a new disease, we may simply be treating the side effects of a drug used to treat an old one.”
  1. What’s New in Research?
  1. Understanding bipolar disorders is important.  It shortens life!
  1. BPD is over-diagnosed.
  1. Most making the diagnosis fail to use the criteria;
  2. Not confirmed later;
  3. More likely to diagnose something treated with medication;
  4. Mood swings common to many DSM5 diagnoses.
  1. Pathology.
    1. Stem cell research;
    2. Schizophrenia and BPD have common pathology;
    3. MRI scanning with changes in the cerebellum, understanding lithium;
    4. Risk takers and MRI changes.
  1. Treatment.
    1. Lithium and non-responders;
    2. Counseling helps!  CBT and BPD;
    3. Anti-psychotic drugs change brains.
  2. Genetics.
    1. Connection between BPD and schizophrenia;
    2. Creativity, BPD, and genes;
    3. New genes.
  1. Marijuana, schizophrenia, and bipolar disorder:
    1. Which comes first?  BPD or pot?
    2. How does marijuana affect BPD course?
  1. Symptoms:  fuzzy thinking and BPD.
  1. Other.
  1. What can we do to help?
  1. Understand the difference between BPD1 and BPD2.
    1. Mania and hypomania;
    2. BPD1 is a disease;
    3. BPD2 is more likely a side effect.
  1. Understanding the importance of medication.
    1. BPD1 may require medication indefinitely;
    2. BPD2 may not benefit much from medications currently used;
    3. Side effects are very real.
  1. BPD1:
    1. Counseling from a chronic medical disease viewpoint;
    2. Need a John 11 view of suffering;
    3. Motive must change.  2 Corinthians 5:9;
    4. Growth and change;
    5. Anger;
    6. Worry;
    7. Gratitude;
    8. Christian service;
    9. Christian responsibility in health care.
  1. BPD2:  in the absence of classic mania:
    1. Look for a historical source;
    2. Consider over-diagnosed depression with medication side effects.  Remember 90/10.
    3. Look for behavior, thinking, and emotional responses to adverse events of life, and examine them through the lens of scripture;
    4. Look for the difference between normal and disordered sadness;
    5. Help the counselee see that difference;
    6. See point III, A-H.
    7. Help the counselee see the opportunity in the trial.
Complete bibliography available at www.goodmoodbadmood.com


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