1. Bipolar Disorder: A Biopsychosocial Overview

2. mdl.psych.northwestern.edu

3. Source: Touched by Fire, Jamison, 1996

4. Bipolar Disorder: Epidemiology Elevated suicide, divorce, work impairment, substance use 6 th 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).

5. 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?

6. 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?

7. Depression Mania Mood disorder involving severe mood swings

8. Severity CyclothymiaBipolar II DisorderBipolar I Disorder Erratic depressive and hypomanic symptoms MDE and Hypomanic Episodes Manic Episode No MDE No Manic EpisodeMDE not necessary for diagnosis ~ 2-4 percent of population has bipolar spectrum diagnosis

9. Unipolar Depression Anxiety Disorder Schiz Personality Disorder Subst. Abuse Schizo- Affective % of Patients Misdiagnosed Misdiagnosis of Bipolar Disorder 60 26 18 17 14 11 Hirschfeld, et al. J Clin Psychiatry 64: 161-174, 2003

10. Age-of-Onset of Bipolar Disorder Pediatric Bipolar Disorder - 10-20% onset < 10 yo - Controversial (40-fold increase) - Difficult to differentiate from ADHD

11. 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?

12. - Predicts worse course and social isolation - Limit social interactions - Social isolation in caregivers Grief for the Loss of the Healthy Self

13. 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?

14. PFC Limbic - Common to many psychiatric disorders - Biology of positive emotion may yield cues more specific to bipolar

15. Ventral Striatum ‘Wanting’ Circuit in the Brain Bipolar disorder characterized by a hypersensitivity in the wanting circuit

16. Reward-Processing in Bipolar Disorder

17. Reward-Related Brain Activity: MDD < Comparison Forbes et al., 2009, Am J Psychiatry ComparisonMDD -Bipolar disorder and unipolar depression characterized by distinct profiles in the wanting or reward circuit -Biomarkers and treatment

18. 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?

19. Bipolar disorder may not be curable but it is livable

20. Psychosocial Treatments for Bipolar Disorder Cognitive Behavioral Therapy Family-Focused Therapy IPSRT

21. mdl.psych.northwestern.edu