1. Bipolar Disorder BrainU 2012 Human Neurological Disorders Tehmeena Qamar and Sandra Muellner

2. Measurable brain changes Amygdala Hippocampus Prefrontal Cortex Cerebellum Causes??? **Complex interaction of genetics and environment.

3. Characteristics of bipolar disorder Each of you will receive a card with a characteristic that you can act out and/or describe. Work together to discuss and categorize your characteristic according to manic or depressive symptoms. Move to the group that best fits your symptom. Was this easy or difficult? Why? http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/ http://faculty.washington.edu/chudler/bipolar.html

4. Mania (the "high"): In this phase, the person experiences an abnormally elevated mood (lasting for a week or more), but they also experience at least three of the following symptoms: 1.Inflated self-esteem 2.Reduced need for sleep 3.Excessive talkativeness 4.Racing thoughts 5.Distractability 6.Activities done to excess (for example, spending money) 7.Pursuit of risky behaviors or activities Depression (the "low"): Mania can quickly and without warning change to a depressive episode. In addition to a general sad mood, a person in the depressive stage may experience: 1.Loss of interest in activities they previously enjoyed 2.Changes in appetite resulting in weight gain or loss 3.Changes in sleep patterns resulting in difficulty sleeping or oversleeping 4.Agitation 5.Loss of energy 6.Trouble concentrating or thinking 7.Repeated thoughts of suicide or death These episodes of mood changes can also be accompanied by:1.psychosis: an altered mental state that is characterized by hallucinations (hearing or seeing something which is not really there). An example of a hallucination is seeing a large purple floating rat and believing it is real.2.delusions: believing something about yourself that is not true. An example of a delusion is believing that you have the ability to fly.

5. Signs and Tests Personal Medical History/Medications Family Medical History Family’s Behavior Views History of Mood Swings Thorough Examination for Check of Illnesses Lab Tests for Thyroid Problems and Drug Levels –Drug Use/Abuse Maybe Symptom Observation of Moods and Behaviors/Mood Charting http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/

6. Goals of Treatment Periods of Mania & Depression return in most patients even with Treatment Remission, normal function, reduction of medications or therapy Goals: –Prevention of movement between phases –Avoiding Hospital Stay –Help patient function as well as possible between episodes –Prevent Self Injury and Suicide –Make episodes less frequent and severe http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/

7. Treatment and Options Mood Stabilizer are generally used first –Carbamazepine, Lamotrigine, Valproate, Lithium Atypical Anti-pscyhotics: Zyprexa, Risperdal, Abilify (Weight Gain) Anti-depressant to treat depression Anti-seizure medication Anti-psychotic & Anti-anxiety drugs to manage mood problems –Benzodiazepine Electro-Convulsive Therapy (ECT) Trans-cranial Magnetic Stimulation (TMS) Hospitalization for Mood Stabilization & Behavior Control Psychotherapy Treatment in children & adolescents – undecided Family/Caregiver Education and Support

8. Ethical Questions Conversation about Treatment of Children with Bipolar Disorder Agreement? Research on children: brain scans, medication Confidentiality issues: when to report threats Untreated: Legal, Financial, Relationship, Work Performance Problems – Societal Issues and Implications Stigma http://www.mayoclinic.com/health/bipolar-disorder/DS00356/DSECTION=complications

9. Current Controversies Increased diagnosis and treatment in children Major diagnostic tool leads to misdiagnosis with major depressive disorder http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2504732/?tool=pmcentrez http://ps.psychiatryonline.org/article.aspx?volume=52&page=51

11. Impact on Learning Both mania and the resulting grandiosity makes learning seem irrelevant Depression isolates individual possibly resulting in increased absences Inability to pay attention affect group and individual work Hospitalizations, self-injury and suicidal thoughts/attempts result in extended absences http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/

12. In Conclusion For further understanding: You Tube Bipolar Disorder: My Story http://www.youtube.com/watch?v=Q_XWa0BVc uw Our thanks to Dr. Gail Bernstein at the University of Minnesota Dept. of Child and Adolescent Psychology