Bipolar Disorder: A Biopsychosocial Overview

mdl.psych.northwestern.edu

Source: Touched by Fire, Jamison, 1996

Bipolar Disorder: Epidemiology

• Elevated suicide, divorce, work impairment, substance use

• 6th leading cause of disability worldwide (Murray & Lopez, 1996).

• Accounts for nearly half the inpatient mental health care costs in the US (Kent et al., 1995).

Roadmap: A series of Questions

Four Questions about Bipolar Disorder

1. What is it?

2. What is its stigma?

3. Is there a blood test?

4. What are its treatments?

Roadmap: A series of Questions

Four Questions about Bipolar Disorder

1. What is it?

2. What is its stigma?

3. Is there a blood test?

4. What are its treatments?

Depression Mania

Mood disorder involving severe mood swings

Severity

Cyclothymia Bipolar II Disorder Bipolar I Disorder

Erratic depressive and hypomanic symptoms

MDE and Hypomanic Episodes

Manic Episode

No MDE

No Manic Episode MDE not necessary for diagnosis

~ 2-4 percent of population has bipolar spectrum diagnosis

0

10

20

30

40

50

60

Unipolar Depression

Anxiety Disorder

Schiz Personality Disorder

Subst. Abuse

Schizo-Affective

% o

f P

atie

nts

Mis

diag

nose

d Misdiagnosis of Bipolar Disorder

60

26

1817

1411

Hirschfeld, et al. J Clin Psychiatry 64: 161-174, 2003

Age-of-Onset of Bipolar Disorder

Pediatric Bipolar Disorder

- 10-20% onset < 10 yo - Controversial (40-fold increase)

- Difficult to differentiate from ADHD

Roadmap: A series of Questions

Four Questions about Bipolar Disorder

1. What is it?

2. What is its stigma?

3. Is there a blood test?

4. What are its treatments?

- Predicts worse course and social isolation

- Limit social interactions

- Social isolation in caregivers

Grief for the Loss of the Healthy Self

Roadmap: A series of Questions

Four Questions about Bipolar Disorder

1. What is it?

2. What is its stigma?

3. Is there a blood test?

4. What are its treatments?

PFC PFC

Limbic Limbic

- Common to many psychiatric disorders

- Biology of positive emotion may yield cues more specific to bipolar

Ventral Striatum

‘Wanting’ Circuit in the Brain

Bipolar disorder characterized by a hypersensitivity in the wanting circuit

Reward-Processing in Bipolar Disorder

Reward-Related Brain Activity: MDD < Comparison

Forbes et al., 2009, Am J Psychiatry

Comparison MDD

-Bipolar disorder and unipolar depression characterized by distinct profiles in the wanting or reward circuit

-Biomarkers and treatment

Roadmap: A series of Questions

Four Questions about Bipolar Disorder

1. What is it?

2. What is its stigma?

3. Is there a blood test?

4. What are its treatments?

Bipolar disorder may not be curable but it is livable

Psychosocial Treatments for Bipolar Disorder

Cognitive Behavioral Therapy

Family-Focused Therapy

IPSRT

mdl.psych.northwestern.edu