Bipolar Disorder
Bipolar disorder, also know as manic depressive disorder, manic depression, bipolar affective disorder, or bipolar spectrum, is characterized by mood swings, or separate and lasting periods of mania and depression (mood states). Depression is experienced as a sad, hopeless, low energy state. Mania lies at the opposite side of the mood spectrum, where the person experiences a state of euphoria, elation, and often greatly increased energy. These mood states may fluctuate frequently, but more often last for prolonged periods. There is much variability in the number of cycles throughout a person's lifetime, with some classified as “rapid cycling” (experiencing many episodes, sometimes yearly).
Bipolar Disorder is derived from both genetic and environmental factors. Research indicates that there is a large genetic component for bipolar illness. First manic episodes typically occur before age 30, but there are cases of later onset. Additionally, the bipolar spectrum runs in families. Children with a family member diagnosed with bipolar disorder are much more likely to develop this illness compared to children without an affected family member. Recent research indicates that a chemical or hormonal basis of bipolar disorder is likely, involving malfunctions in brain neurotransmitter substances.
Symptoms of bipolar disorder involve fluctuation between two mood states: mania and depression. Manic episodes typically involve dramatic rises in mood, with feelings of elation, increased energy, and a decreased need for sleep. A person experiencing a manic episode will often have racing thoughts, rapid and pressured speech, and poor judgment and planning. This, combined with impulsivity, often creates major problems for the person in the manic state. For example, they may leave school or ruin their business, go on expensive buying sprees, or make wild investments. They may engage in dangerous substance-related behaviors, or promiscuous sexuality. Most concerning is increased and dangerous suicidal activity, due to the combined agitation and impulsivity. Finally, in many cases of mania, the person may become grandiose, with a heightened sense of self-esteem. For about 70% of those suffering from Bipolar Illness, as the mania and accompanying sleep deprivation become more prolonged, the person may lose touch with reality and exhibit psychotic symptoms, such as hallucinations (false sensory experiences) or delusions (false beliefs).
Following the mania, depression will frequently occur. Persons with depression may experience feelings of hopelessness, worthlessness, irritability, restlessness, and sadness. Fatigue and insomnia may follow these feelings, leading to increased irritability and a loss of enjoyment of daily activities. Eating problems, difficulty concentrating, and somatic symptoms such as pain, headaches, and gastrointestinal problems may also occur. The length and depth of each depressive episode greatly varies. Some people are considered "rapid cyclers" experiencing several episodes in a given year. All episodes may be extremely debilitating both socially and vocationally..
How is Bipolar Disorder diagnosed?
Bipolar disorder should be diagnosed by a mental health professional, who performs a thorough evaluation which may include interviewing not only the Client but his or her family. The diagnosis of bipolar disorder is based on a specific history of occurrences of episodes meeting the criteria for depression and mania. A thorough evaluation of current symptoms is performed delineating how the manic and depressive episodes have interfered with the Client’s everyday living, including negative effects on family, friends, work or school. The Client’s family history is also explored, as well as any history of drug or alcohol abuse, which may interfere with treatment.
What is the Prognosis for Bipolar Disorder?
Bipolar disorder is a chronic illness that can be effectively managed with psychological treatment and medication. Research shows that medication, coupled with effective psychotherapy, sleep and stress management, and psychoeducation, can significantly improve the wellness of someone with bipolar disorder. Effective treatment is of paramount importance considering that persons with bipolar disorder are more likely to be non-compliant with medication or treatment. Persons with bipolar disorder suffer higher levels of stress and conflict and accordingly, persons with bipolar disorder have higher death rates from suicide, heart problems, and death from all causes than those in the general population. Clients who receive effective treatment, however, experience significant improvement in their ability to function normally in society, including an increase in the number of days they feel well, more rapid recovery from manic and depressive episodes and lower relapse rates. Effective treatment also improves survival rates, lowering the incidence of death from suicide and heart disease.
What Complications can Slow Recovery?
Persons with bipolar disorder are more likely to be non-compliant with medications or treatment. They may not take their medications appropriately, or not show up for treatment, sabotaging their chances for recovery. Up to sixty percent of people with bipolar disorder abuse substances (especially alcohol, marijuana or cocaine), during the course of their illness. Concurrent substance abuse dramatically interferes with effective psychological treatment. Furthermore, persons with bipolar disorder may have problems with family or loved ones, lacking an effective social support structure that is important to help with their recovery.
How Can Friends and Family Help?
The strength of the social network of a person with bipolar disorder, especially family and loved ones, is an important predictor of recovery. Family and friends need to educate themselves about bipolar disorder to understand when the person needs help the most. They can be a valuable resource in monitoring medications and being vigilant in watching for symptoms that might denote a relapse. Family members are likely to help a person with bipolar disorder enter a treatment facility, providing social and financial resources.
When Should a Client enter a treatment center?
When a person with bipolar disorder is having serious problems that are negatively impacting their daily school or work life and personal and family relationships, an intensive treatment program is an appropriate option. Oftentimes once per week psychotherapy or medication is ineffective at managing serious symptoms of bipolar disorder. A treatment facility, like PCH Treatment Center, can be a more effective option than simple outpatient therapy, especially when the person with bipolar disorder is not fully compliant or invested in that situation.
How does PCH Treatment Center treat Bipolar Disorder?
PCH Treatment Center realizes that Bipolar Disorder is a lifelong issue, with exacerbations and remissions. The Clinical Staff at PCH Treatment Center has extensive experience in dealing with this disorder. Dr. Jeff Ball has over 25 years in practice treating the spectrum of Bipolar Disorder. He served as a senior therapist in a clinical research project which looked at medication management in conjunction with family therapy in the treatment of Bipolar Disorder, working with Drs. Michael Goldstein and David Miklowitz, foremost experts in this field. In addition to Dr. Ball, PCH Treatment Center features several doctoral level psychologists who have significant expertise in dealing with Clients with Bipolar Illness.
Clients with Bipolar Disorder usually usually arrive at PCH Treatment Center taking one or more medications as there are a broad array of medications used to treat this disorder. Clients may be taking Lithium, antidepressants, anticonvulsants, antipsychotics, combination drugs, and even benzodiazepines. Dr. Bill Wirshing is the staff Psychiatrist at PCH Treatment Center, and he is an expert in psychopharmacology. It is Dr. Wirshing’s job to evaluate these often complicated and possibly inappropriate medication regimens and adjust them to find an effective treatment strategy.
In conjunction with medication management, a PCH Treatment Center psychoanalyst is assigned to each Client. In conjunction with Director Jeff Ball, Ph.D. and the treatment team, they develop an in depth treatment plan addressing not just symptoms, but the underlying issues in each Client. In the Intensive program, in addition to four psychotherapy sessions per week, Clients receive somatic experiencing and multiple group therapies, including sleep management, dialectical behavioral therapy, anger management, process group, and other valuable groups. Neurofeedback is also a cornerstone in the treatment of Bipolar Disorder, and Clients are able to utilize this technology throughout the week. Holistic modalities compliment the more intensive treatments, consisting of art therapy, yoga, mindfulness meditation, and others.
Depending on the severity of a person’s Bipolar Disorder, PCH Treatment Center offers several options for treatment. The Intensive Program, as mentioned, offers up to five individual therapy sessions per week, and is recommended for Clients who are experiencing significant complications of Bipolar Disorder in their lives. Our Day Treatment Program also offers intensive treatment for Clients with significant Bipolar symptoms, and our Evening Program allows Clients who work or are in school to attend evening sessions. PCH Treatment Center also features a family program. We understand that many families do not know how to deal with the inconsistencies and mixed messages family members with Bipolar Disorder may exhibit because of their mood cycling. We work with families, integrating with the Client in family only and group meetings (with other families experiencing similar issues) to instruct them how to detect the onset of new cycles, how to deal with symptom exacerbations, and what to do if symptoms get out of control. Psycho-education is critical for families and loved ones to deal with the impact of Bipolar Disorder within the household. Our goal at PCH Treatment Center is to return a Client with Bipolar Disorder to a level of stability within their work or school environment and at home with family and friends and loved ones.
