1. BIPOLAR REALITY SHIFTING THE CLINICAL FOCUS OF THE DISORDER ANDREW JAMES ARCHER, LCSW 1

2. Energy ManiaDepressionAnxiety CONTAINMENT 2

3. Paternal Family Hx: Suicide, D+A *21 *20*30 *31 3 Red = Bipolar Disorder - *Age of onset=~21

4. 4

5. WHAT ARE THE SIGNS? 5

6. BIPOLAR I DISORDER 6 MDD PTSD Borderline Pers. Dis.

7. Containment Acceptanc e Recover y VEHICLE FOR TREATMENT 7 (CAR)

8. 1980‘871990 Zyprexa, Abilify, Seroquel, etc. DSM-III unipolarbipolar

9. “MEDICATION NONADHERENCE” 9 60% stop medication in their lifetime Between 40 and 60% within first year after hospitalization

10. PLACEBO EFFECT 10 “It now seems beyond question that the traditional account of depression as a chemical imbalance in the brain is simply wrong.” (Kirsch, 2011) “…there is little evidence to suggest that they [antidepressants] produce specific pharmacological benefit for the majority of patients with less severe acute depressions.” (Fournier et al., 2010)

11. CALABRESE ET. AL (2003) 11 “The proportions of patients who were intervention-free for mania at 1 year were lamotrigine 77%, lithium 86%, and placebo 72%.” “…intervention-free for depression at 1 year were lamotrigine 57%, lithium 46%, and placebo 45%.”

12. U.S. MH DISABILITY RATES (WHITAKER, 2010) 0.2 1.86 3.38 13.75 19.69 1850 1903 1955 1987 2003

13. RE-INSTITUTIONALIZATION 13 (Torrey et al., 2014)

14. ACCEPTANCE 14 Eye Movement Desensitization & Reprocessing (EMDR)

15. Thought Belief/ Schema/ Attributions ATTACHMENT 15

16. DANIEL J. SIEGEL 16 The embodied and relational process that regulates the flow of energy and information. The mechanism of energy and information flow throughout the extended nervous system distributed throughout the entire body. The sharing of this flow.

17. RECOVERY 17 Mindfulness

18. PleadingInsanityBook.com AndrewJamesArcher.com andrewjames.archer@gmail.com @ajarcher Thank you. QUESTIONS?