PCH Treatment Center offers day treatment and intensive treatment with residence for persons struggling with Bipolar Disorder. We have assembled a clinical staff of experts who specialize in treating Bipolar I, Bipolar II, Cyclothymia and Bipolar Disorder Not Otherwise Specified (BP-NOS) as well as depression and other mood disorders. Dr. Jeff Ball, Executive Director, has developed and managed comprehensive bipolar treatment programs in both academic and private settings. Dr. Ball worked with Dr. Michael Goldstein and Dr. David Miklowitz studying family therapy and medication management in the treatment of Bipolar disorder. Dr. Miklowitz, who is also a consultant to PCH Treatment Center, has authored an important book on managing Bipolar Disorder, The Bipolar Disorder Survival Guide. This book is required reading for all clients with Bipolar Disorder at PCH Treatment Center.
What is Bipolar Disorder?
Bipolar disorder, also known 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 individual 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).
What are the types of Bipolar Disorder?
Bipolar I Disorder is commonly diagnosed. It is characterized by manic or mixed episodes that last at least seven days, or by severe manic symptoms requiring hospital level containment. Frequently, depressive episodes occur as well, typically lasting at least 2 weeks. Bipolar II Disorder differs from Bipolar I by having a pattern of depressive episodes and hypomanic episodes without full-blown manic or mixed episodes.
Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when symptoms of the illness exist but those symptoms do not meet diagnostic criteria for either bipolar I or II. However, fluctuations in mood are clearly out of the person’s normal range of mood states. Cyclothymic Disorder, or Cyclothymia is a mild form of bipolar disorder involving episodes of hypomania as well as mild depression for at least 2 years. However, the hypomania or depressive episodes do not meet the diagnostic requirements for any other type of bipolar disorder.
What causes Bipolar Disorder?
Bipolar Disorder is derived from both genetic and environmental factors. Research indicates that there is a large genetic component for bipolar illness. A first manic episode typically occurs 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.
What are the Symptoms of Bipolar Disorder?
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. An individual 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 individual 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. People 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. Diagnosis requires a thorough evaluation which including interviewing the Client and when possible, his or her family. The diagnosis of Bipolar Disorder is based on a specific history of episodes meeting the criteria for depression and/or mania. A timeline can be created, delineating the onset of manic or depressive episodes. An understanding of how these mood states have interfered with the Client’s everyday living is important, addressing 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 commonly co-occurs. Bipolar disorder is often missed or misdiagnosed. There is significant overlap of symptoms with attention deficit disorder and certain personality disorders. Oftentimes, manic or hypomanic episodes have not been elucidated and a person may be undiagnosed or misdiagnosed with depression or other mood disorder.
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 psycho-education, can significantly improve wellness and daily functioning. Individuals with bipolar disorder are likely to be non-compliant with medication or treatment. Thus, it is extremely important to make the proper diagnosis, prescribe the appropriate medication, and education the client and family about this disorder. A person with bipolar disorder will suffer higher levels of stress and conflict in their work and home. 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 and may avoid 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.
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. PCH offers a full day treatment and an intensive treatment with residence housing.
How does PCH Treatment Center treat Bipolar Disorder?
PCH Treatment Center realizes that Bipolar Disorder is a lifelong issue, with exacerbations and remissions. 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. Dr. Miklowitz, a Professor of Psychiatry in the Division of Child and Adolescent Psychiatry at the UCLA Semel Institute, and a consultant to PCH Treatment Center, has contributed to the development of our immersive program for Bipolar Disorder. Dr. Miklowitz’ book The Bipolar Survival Guide, is provided to Clients and their families at PCH Treatment Center. PCH Treatment Center also features doctoral level individual psychologists who have significant expertise in dealing with Clients with Bipolar Illness. We offer specific programming for clients with Bipolar Disorder, including assignment of therapists with a strong background in treating Bipolar Disorder and groups tailored specifically around managing Bipolar Disorder.
Clients with Bipolar Disorder often arrive at The PCH Bipolar Disorder Treatment Center taking multiple 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. 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 medication regimens and simplify them to find an effective treatment strategy. Furthermore, it is important to find a medication regimen that the Client feels is functional and appropriate, minimizing undesirable side effects. In conjunction with medication management, a psychoanalyst is assigned to each Client. Clinical Director John Grienenberger, Ph.D and the PCH treatment team develop an in-depth treatment plan based on each client’s unique presentation.
In the Intensive program, in addition to four psychotherapy sessions per week, Clients attend one somatic experiencing session and multiple group therapies, including sleep management, dialectical behavioral therapy, anger management, process group, and other valuable group therapies. 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 our experiential arts program, yoga, mindfulness meditation, and more.
PCH Treatment Center offers several options for treatment of Bipolar Disorder. The Intensive Program with residence, as mentioned, offers up to five individual therapy sessions per week, and is recommended for Clients who are experiencing significant complications of of a mood disorder in their lives. Our Day Treatment Program also offers intensive treatment for Clients with significant bipolar symptoms who prefer to live independently or choose other living arrangements. PCH Treatment Center also features an integrated family program featuring extensive psycho-education and skills workshops. 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 to instruct them how to detect early warning signs, how to deal with symptom exacerbations, how to minimize stress and chaos in the household, 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. The goal of our Bipolar Treatment Center is to return our Client to a level of stability within their work or school environment and at home with family, friends and loved ones.
Dr. David Miklowitz
UCLA Semel Institute – Child and Adolescent Mood Disorders Program
Dr. David Miklowitz is Professor of Psychiatry in the Division of Child and Adolescent Psychiatry at the UCLA Semel Institute, a Senior Clinical Research Fellow in the Department of Psychiatry at Oxford University, and a consultant with PCH Treatment Center in West Los Angeles. The Child and Adolescent Mood Disorders Program provides diagnostic evaluations, second opinion consultation, and short-term treatments (medication management and various forms of psychotherapy) for youth who have symptoms of significant and impairing mood disorders and their families. The Program’s focus is on pediatric bipolar disorder (extreme high and low moods). We will see children from age 7 years to 17 yrs, 11 mos.