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BiPolar Explained

BiPolar Explained

Bipolar is a condition that wreaks havoc on those that it affects. If you suffer from Bipolar, chances are that your family suffers right with you. No matter if you are that family member trying to learn to cope or you are the person that has been diagnosed, there is hope out there.

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Married To Mania

This eBook is the key to knowing if you are married to a bipolar spouse, and gives you the keys to what to do about it. Often, being married to a bipolar spouse can be one of the hardest things you go through in your life because emotions in your house can change drastically, and completely without warning. This book gives you the tools to deal with unexpected anger outbursts and guilt that many spouses feel. This book will teach YOU how to deal with feelings of guilt that you may feel towards yourself, even though you have done everything you possibly can to make your marriage work. When you get this eBook, you can order a physical copy of the book and get FREE shipping. Also, you get two bonus eBooks when you order: The Spouse's Guide to Bipolar Disorder Vocabulary, which give you the tools you need to talk to doctors and psychiatrists, and The Bipolar Disorder Rolodex which gives you the latest in bipolar disorder research. It is hard to go through a bipolar marriage without help; now you don't have to.

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Author: Julie Fast
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Schizophrenia and Bipolar Disorder

Bipolar disorder is characterized by episodes of depression and mania, elevated or irritable mood, and symptoms such as rapid thoughts, grandiose ideas, and reckless behavior. Population, twin, and adoption studies provide evidence for the role of genetics in the etiology of bipolar disorder. First-degree relatives have about a 7 to 10 percent risk of having the disorder once one family member is diagnosed. The concordance rate for monozygotic twins is 60 to 65 percent, and for dizygotic twins the rate is 10 to 15 percent, the same as for non-twin siblings. One of the first bipolar disorder molecular genetic studies implicated chromosone 11, but this finding was not replicated in several other studies. A similar failure to replicate occurred with the initial reports of linkage on the chromosome X. Regions on chromosome four are reported to show strong evidence of linkage to some bipolar families. Major efforts in the last few years have been focused on chromosome seven and eighteen....

Differences Between Adult Adolescent And Childonset Bipolar Disorder

The DSM-IV criteria for mania were developed from data on adults with bipolar disorder and do not consider the differences between bipolar adults and bipolar children and adolescents. Paediatric bipolar disorder has been described as atypical when compared to adult bipolar disorder. The similarities in the clinical presentation of adults with mixed states and preadolescents diagnosed with mania have been noticed. Several authors have drawn a comparison between the ''virulent'' form of the disorder in adults (with absence of discrete episodes) and the severe course observed in many pre-pubertal children 37,47,48 . On 27 April, 2000, the National Institute of Mental Health (NIMH) Developmental Psychopathology and Prevention Research Branch, in collaboration with the Child and Adolescent Treatment and Prevention Intervention Research Branch, convened a small roundtable meeting to discuss research issues on the diagnosis of pre-pubertal bipolar disorder 49 . A proposal from this meeting...

Management Of Bipolar Disorder In The Youth

Management of bipolar disorder is complicated and needs to be individually tailored to the needs of the individual child and family. A treatment plan should take into account the fact that the child's symptoms will vary with developmental and environmental changes. Also, symptoms may vary due to the fluctuating nature of the disorder. Therefore, successful treatment plans for bipolarity in children require flexibility and openness by the treating clinician. In addition, parents should be aware of the possible educational impairment associated with bipolar disorder. Bipolar children and adolescents are at risk for learning disabilities 48 . Therefore, psychoeducational testing is important in the comprehensive treatment plan once the child's mood is stable. A bipolar child can be unfocused, unmotivated and lethargic because of mood symptoms, and impulsive, inattentive, anxious or disabled because of comorbid conditions. Prescribed medication may also result in cognitive dullness,...

Bipolar Disorder

There is increasing evidence that abnormalities in phospholipid signal transduction are important in bipolar disorder. To date, most of this evidence has come from investigations of the mechanisms of action of the established drugs for bipolar disorder lithium and valproate. This evidence suggests that there are abnormalities in the lipid-related protein kinase signal transduction systems and also in the PLA2 and PLC systems (Manji et al., 1999 Manji & Lenox, 1999 Ikonomov & Manji, 1999 Stoll & Severus, 1996).

Longitudinal Course Of The Disorder Outcome Studies

The long-term outcome of children and adolescents with bipolar disorder has not been well studied. Results to date suggest that this is a recurrent illness with substantial morbidity. Adolescents with bipolar disorder are less responsive to treatment compared to bipolar adults 35,58,59 . Lewinsohn et al. 22 interviewed 893 adolescents and then reassessed them at the age of 24. At baseline, 18 had bipolar disorder, 14 had sub-syndromal bipolar disorder, and 275 had major depression. Out of the bipolar group, 27 had a recurrence by the age of 24. Only 1 of adolescents with major depression switched to bipolar disorder by the age of 24. Adolescents with bipolar disorder and sub-syndromal bipolar disorder had significant impairment in psychosocial functioning by the age of 24. However, none of the subjects with the sub-syndromal condition developed bipolar disorder during the 6-year follow-up period. Strober et al. 60 investigated the course of bipolar disorder in a 5-year prospective...

The Risk For Mood Disorders

Studies on the risk for early-onset bipolar disorder in the offspring of bipolar patients are made more difficult by the relative uncertainty of the phenomenology of bipolar disorder in childhood, given the developmental differences of the disorder in prepubertal patients, including atypicality of phenomenology 39 , and the high frequency of comorbidity, mainly with ADHD 40 . More recently a new effort was made to develop diagnostic criteria for different phenotypes of juvenile mania 41,42 , and to produce methodological guidelines, including inclusion and exclusion criteria, for clinical studies in child and adolescent patients with bipolar disorder 43 . An early study found that the risk of developing an affective disorder for first-degree relatives of bipolar probands was 27 if one parent, and 74 if both parents had a bipolar disorder 44 . A meta-analysis of studies conducted before 1997 showed that bipolar offspring (both children and adults) are at 2.7 times higher risk for...

Adhd And Other Disruptive Behaviour Disorders

Childhood-onset bipolar disorder is frequently associated with or preceded by oppositional defiant disorder, conduct disorder or, more frequently, ADHD 40,48,50,51 . The reasons for the association between bipolar disorder and ADHD remain unresolved. It is presently unclear whether this association is a true comorbidity, or a consequence of a diagnostic overlap between the two disorders, or if ADHD is a prodromal condition in the course of bipolar disorder, or a complication of bipolar disorder. Several studies support the finding that adolescent-onset bipolar disorder shows less comorbidity with disruptive behaviour disorders than prepubertal-onset bipolar disorder 40,48,52 . More recently, ADHD has been found as an antecedent in 50 of patients with prepubertal bipolar disorder, compared to 8.7 of patients with adolescent-onset bipolar disorder 52 , suggesting that ADHD may be an antecedent or an early sign of a very early-onset bipolar disorder. Wozniak et al. 50 interviewed 46...

Differential Diagnosis And Comorbidity

The differential diagnosis of a manic episode may include a broad range of psychiatric conditions depending upon the age of the child. For example, sexual abuse is especially important in the differential diagnosis during the childhood years, because manic hypersexuality is often manifested in children by self-stimulatory behaviours including frequent masturbation. Thus, obtaining a careful history of whether the child could have been abused or exposed to adult sexual behaviours is important. Specific language disorders need to be differentiated from flight of ideas. Because of greater perceptual distortions in bipolar illness during adolescence, schizophrenia is a major differential diagnosis 53 . Differentiation is greatly aided by a family history of mania, which is more probable for bipolar disorder than schizophrenia 36 . being a manifestation of elation. Furthermore, very rapid cycling, which is according to some researchers a hallmark of child and adolescent bipolarity 38 , can...

Prevalence Of Bipolarity In Children Underdiagnosis Overdiagnosis Misdiagnosis

Over the past two decades, the underdiagnosis and misdiagnosis of childhood bipolar disorder have been noted by several authors 10 . Gammon et al. 11 interviewed 17 adolescent inpatients and their mothers using the Schedule for Affective Disorders and Schizophrenia for School-aged Children and Adolescents, Epidemiological Version (K-SADS-E), and found that 5 of the 17 adolescents (29 ) satisfied DSM-III criteria for bipolar disorder or atypical bipolar disorder (bipolar II). These teenagers were not clinically diagnosed to have bipolar disorder. Data from adult studies support the idea of underdiagnosis and mis-diagnosis during childhood. For example, 60 of bipolar adults report that their first symptoms occurred in childhood or adolescence, but there was a delay in diagnosis and treatment. In one report, the initial treatment for bipolar disorder was delayed an average of 10 years from the onset of symptoms 12 . It has been estimated that between one and two thirds of individuals...

Treatment Implications

Psychoeducational as well as psychotherapeutic interventions on children and their parents (either affected or not) can help them to manage life experiences or family stressors. On the pharmacological side, lithium did not result to be superior to placebo in the treatment of 30 prepubertal children with depression and a positive family history of mood disorders (40 with a parent with bipolar disorder, 40 with a more distant bipolar familiality and 20 with family history of major depression only) 92 . Divalproex has been openly studied in bipolar offspring with mood or behavioural disorders and mild affective symptoms, but without a fullblown bipolar disorder 93 of the 23 subjects who completed the study, 18 (78 ) were considered responders according to the Clinical Global Impression (CGI) improvement score (very much or much improved). The majority of responders improved within the first 4 weeks of treatment. These preliminary findings suggest a possible preventive pharmacological...

Temperament And Bipolar Vulnerability

Temperamental features can be predictors of later psychopathology 72,73 , and a difficult temperament (irregular biological rhythms, irritability, inflexibility) has been suggested to be a premorbid feature in children with bipolar disorder 74,75 . One of the authors of this chapter 76,77 described three temperamental profiles potentially predisposing to adolescent or adult-onset bipolar disorder the hyperthymic, cyclothymic and irritable types. These are characterized by excesses along the lines of exuberant, overconfident, over-energetic, impulsive, overtalkative, extraverted, meddlesome, uninhibited, stimulus seeking and mood labile traits. In an 11-year prospective study, high self-ratings of mood lability and energetic activity predicted bipolar II switching in depressed patients 46 . Kochman et al. 78 , using a new scale for cyclothymic-sensitive temperament, showed the same outcome in adolescent major depressions. Studies of offspring at risk for bipolar disorder have found...

Predictors Of Psychopathology

The majority of bipolar offspring will not develop bipolar disorder. It is therefore crucial to detect, from an early age, predictors of bipolar development in this high-risk population 1 . Early detection of a prodromal state may allow timely and specific interventions and prevention of a poorer outcome. Preschool children with depression and a family history of bipolar disorder show higher rates of restlessness or motor agitation, compared to depressed children without family history of bipolar disorder 86 . Follow-up studies are needed to investigate rates of later switching to mania. Subsyndromal bipolar disorder has been described in 6 of adolescents in the community, but a longitudinal assessment showed that none of the adolescents with subsyndromal mania met criteria for full-blown bipolar It has been hypothesized that bipolar offspring show deficits consistent with the syndrome of nonverbal learning disabilities (NLD) 8 . A recent test of this hypothesis showed that children...

Neurobiological Aspects

The longitudinal study of a high-risk population such as bipolar offspring may help to reveal possible markers of disease which distinguish subjects who will eventually develop bipolar disorder (or other psychopathologies) from subjects who will not. Even though it may be difficult to ascertain whether these markers predispose to the disorder, or if they are the first signs of the disorder, the identification of these markers could allow earlier diagnoses and timely interventions 1 . Unfortunately, relevant findings to date are extremely scarce. Another study using magnetic resonance spectroscopy (MRS) found that bipolar offspring with bipolar disorder had decreased N-acetyl-aspartate (NAA) to creatine (Cr) ratios in the right dorsolateral prefrontal cortex (DLPFC), while bipolar offspring with mood and disruptive behavioural disorder but not bipolar disorder had unchanged NAA Cr ratios in the same cerebral region 91 . Information about the NAA before the onset of bipolar disorder and...

Pharmacological Treatment

Mania in children is not easily modified without medication. Unfortunately, there are very few treatment options that are evidence based. In general, current pharmaceutical treatment of children and adolescents with bipolar disorder is based on clinical trials in bipolar adults 79,80 . It is common clinical practice to have patients continue on medications for a period of time following remission. However, the optimal length of maintenance treatment remains unclear, and available guidelines are based on limited consensus rather than controlled trial outcomes. There are only limited studies of mood stabilizers and antidepressants in children and adolescents 81 . Also, given the high rates of comorbid conditions, children with paediatric mania may require combinations of medications to adequately manage symptoms 82,83 . There is a risk of inducing a manic episode with the use of anti-depressants in children with undiagnosed bipolar disorder. Careful monitoring should be undertaken when...

Diagnostic Assessment

A thorough and extensive evaluation is necessary before diagnosing bipolar disorder in a child or adolescent. Such an evaluation requires a detailed history of both mood and non-mood symptoms and an appraisal of risk factors for bipolar disorder. A comprehensive face-to-face assessment of the child, including a mental status examination, is necessary to rule out pervasive developmental disorders, language and thought disorders, and psychotic symptoms. This assessment may take several hours to complete and could be done by a multidisciplinary team in one day or over several days. A detailed lifeline or timeline including onset, offset and duration of symptoms, stressful life events and history of treatment is helpful in establishing diagnosis. The diagnostic accuracy for bipolar illness in children and adolescents improves when DSM criteria are applied 65 . Clinical rating scales may be helpful in tracking the severity and course of target symptoms of mania. Such rating scales for...

Environmental Factors

Even if the familial transmission of bipolar disorder has been well established, the concordance rate between identical twins does not approach 100 , suggesting a combined role of genetic predisposition and environmental factors 67 . A bipolar parent with recurrent episodes is often dysfunctional, neglectful or absent, and this chronic or recurrent situation can influence the child's development 35,36 . Negative family interactions, including higher expressed emotions, have been proved to be predictive of relapse in bipolar adolescents and adults 68 , but studies considering the family environment in the presence of a bipolar parent, and its effect on offspring, are rare. Conrad and Hammen 69 evaluated the offspring of bipolar mothers and found that a better outcome was associated with social competence and a healthy father. Marital discord, parental divorce, a second parent with psychopathology, and chronicity of illness were predictors of psychopathology in children of bipolar...

Clinical Descriptions

This chapter will primarily focus on the manic hypomanic phase of bipolar disorder. The clinical features of bipolar depression have yet to be addressed in the paediatric population. Despite the acceptance of a child and adolescent variant of bipolar disorder, the diagnosis continues to be controversial. Experts have not yet agreed on all diagnostic criteria and treatment methods. There are questions about the presence and duration of episodes and the hallmark symptoms of mania and hypomania. The most common type of adult-onset bipolar disorder (classic presentation), with discrete episodes of depression and mania having a clear-cut onset and offset, appears to be less commonly seen in children. However, children and adolescents with full-blown bipolar illness have been described 11,25-30 . Children who exhibit discrete episodes of depression and mania respond well to lithium 31 . However, the natural course of paediatric bipolar disorder tends to be chronic and continuous rather than...


A literature search by Fristad et al. 116 , conducted in 2002, found that at present there are no psychosocial treatments empirically validated or otherwise for children with bipolar disorder. Preliminary data from the child group therapy programme, which was developed as part of multifamily psychoeducational groups (MFPGs), is promising 117 . Early-onset bipolar disorder produces a host of issues for all family members of the affected individual. These issues need to be addressed immediately and consistently in order to maximize the psychological well-being of all involved. Parents must become specialized caregivers to children affected by the disorder. Central to family-based interventions for bipolar disorder is the family's access to a clinician who is well versed in the manifestations of this disorder and who has the flexibility to adapt to the vicissitudes of this illness. Treatment plans must be tailored individually to the family's needs. Holder and Anderson have outlined...

Support Groups

Caregivers of children with bipolar disorder often suffer from emotional, physical and financial stress. A primary source of emotional stress is that of watching their child suffer from rejection by peers, school failure, rage attacks, suicide attempts and of coping with the total unpredictability of their child's behaviour. Families can become homebound out of dread of other public episodes of rages and obscenities in the ill child. A raging child is a risk for the physical safety of other family members he or she may damage property or run away into the street impulsively. Therefore, the caregivers of these children often live in a state of hypervigilance. Another source of emotional stress for these caregivers is navigating uncharted territories, i.e. new systems with their own language and rules. For example, many children with bipolar disorder require special education services or get involved in the juvenile justice system. This can leave the caregiver confused, misunderstood...

Internet Resources

Online support groups have been extremely useful in providing social support to parents who feel isolated 127 . Similar to in-person support groups, members of computer-mediated support groups receive information, advice, emotional support and contact with people in similar situations 128 . One positive outcome of the Internet groups was the creation of the Child and Adolescent Bipolar Foundation (CABF) in 1999 from the parent online support groups in the 1990s. The CABF website ( provides users with scientific information about diagnosis, symptoms and treatment of early onset bipolar disorder. Other aspects related to lives of bipolar disorder sufferers are also addressed. Other relevant websites are those of the Depression and Bipolar Support Alliance (DBSA) (, the National Alliance for the Mentally Ill (NAMI) ( and the National Institute of Mental Health (NIMH) (

European Views

A recent study 22 was carried out in 140 adolescent offspring, aged 12-21 years, of bipolar parents living in the Netherlands, 41 of whom (29 ) met diagnostic criteria for at least one current DSM-IV mental disorder. The most frequent diagnoses were mood disorder (14 , including 3 with a bipolar disorder), anxiety disorder (8 ), substance use disorder (6 ), ADHD (4 ) and disruptive behaviour disorder (4 ). A total of 61 subjects (44 ) met criteria for at least one lifetime diagnosis, namely mood disorder (27 , including 3 with bipolar disorder), anxiety disorder (11 ), substance use disorder (6 ), disruptive behaviour disorder (6 ) and ADHD (5 ). The Child Behavior Checklist (CBCL) 55 was used in these subjects and in controls from the general population, to assess behavioural and emotional problems, according to self-rating as well as parents' and teachers' evaluation. Higher scores were found for 8 of the 11 subscales of the self-administered CBCL (mostly concerning internalizing...

Mood Disorders

Mood disorders in children and adolescents are often severe and liable to cause significant morbidity and mortality 42,43 . For several years childhood depression was underdiagnosed, but today we are better able to identify and diagnose it in early childhood. Mania is undergoing the same process today. In certain cases, what was defined as ADHD or behaviour disorder turns out to be a ''covert mania''. In follow-up studies of ADHD and disruptive behaviours, a high frequency of mood disorders (including bipolar disorder) has been observed, which were diagnosed at a later stage in the child's life. Therefore, the greater our ability to refine the clinical criteria of mania in children and develop suitable scales, the better will we be able to identify maniform conditions at a younger age and differentiate them from ADHD and behaviour disorders. However, bipolar disorder, ADHD, disruptive behaviours and drug abuse are also likely to co-occur in the same subjects 44 . These subjects are...


At least 50 of children and adolescents suffering from major depression, and 90 of those suffering from bipolar disorder, will continue to suffer from it in adulthood. Pine et al. 51 showed that depressive symptoms in adolescence (even without the existence of major depression) strongly predict a major depressive episode in adulthood. Little is known of the longitudinal outcome of childhood-onset mania. Geller et al. 48 checked the outcome of 89 children with mania and found poor outcome low recovery rates and high relapse rates compared with adults. They could not rule out the hypothesis that childhood mania responds less well to mood stabilizers. Moreover, prepubertal onset is associated with rapid cycling and worse prognosis 52 . Early-onset and comorbidity cases are expected to suffer from this disorder in adulthood as well 52 .

Followup Studies

Prospective follow-up studies are rare in the literature on juvenile bi-polarity. One of the major problems in detecting bipolar disorder in children is the extent to which depressive states, temperamental moodiness, ''atypical'' mood swings with explosive moods and behaviour, and or ultra-rapid cycling represent variants and or precursors of clinically more recognizable bipolar disorder. This question cannot be resolved by cross-sectional observation. A family history of bipolar disorder may reinforce the bipolar nature of the presenting mood instability, but, in the absence of genetic markers, prospective follow-up is the ultimate clinical ''test'' available today for supporting a bipolar diagnosis in a child presenting with such instability. This is what one of the authors of this chapter attempted to accomplish in his mood clinic, where adult manic-depressive patients brought their children or younger siblings with what they deemed to be early signs of bipolarity, similar to what...

Cognitive Vulnerability In Context

What has the work on cognitive vulnerability to depression taught us That negative cognitive styles confer increased risk for clinically significant depressive disorders not only provides the first demonstration of a psychological vulnerability to depression, but suggests that purely biological approaches to understanding depression are likely to fall short. Indeed, our recent research indicates that even bipolar spectrum mood disorders (manic-depression, cyclothymia), which have traditionally been viewed as almost entirely genetic in origin, may also be influenced by cognitive styles for interpreting life events. Both hypomanic manic and depressive symptoms among bipolar individuals were predicted prospectively by individuals' cognitive styles and information processing in interaction with the occurrence of

Future Directions

Preventive strategies for first onset, relapse, and recurrence will remain important priorities for researchers, as well as the development of flexible psychosocial treatment algorithms that match the course of the illness, the treatment setting, and the target group. Several large NIMH-funded studies are currently under way which may significantly affect treatment standards for depressed adults (i.e., The Sequenced Treatment Alternatives to Relieve Depression STAR*D ) and patients with bipolar disorder (i.e., Treatment Enhancement Program for Bipolar Disorder STEP-BD ). It is most important to isolate the curative components of CBT that promote change and to identify the specific brain-behavior relationships. See also Bipolar disorder, Cognitive vulnerability to depression, Depression and personality disorders older adults, Depression general, Depression youth, Mood disorders bipolar disorder, Problem solving depression

Drug Treatment of Mania

The term ''bipolar disorder'' originally referred to manic-depressive illnesses characterized by both manic and depressive episodes. In recent years, the concept of bipolar disorder has been broadened to include subtypes with similar clinical courses, phenomenology, family histories and treatment responses. These subtypes are thought to form a continuum of disorders that, while differing in severity, are related. Readers are referred to the Diagnostic and Statisticial Manual of Mental Disorders of the American Psychiatric Association (DSM-IV) for details of this classification. Mania, manic-depression and depression, which comprise the affective disorders, are relatively common it has been estimated that there is an incidence of at least 2 in most societies throughout the world. There is good evidence to suggest that genetic factors play a considerable role in predisposing a patient to an affective disorder. In a seminal Danish twin register study, in which the incidence of affective...

Borderline Personality Disorder

The borderline personality is characterized by identity disturbance, feelings of chronic emptiness, impulsive or self-destructive behavior, and unstable intense interpersonal relationships. Loss of ego boundaries, an identity based on multiple contradictory unintegrated self-images that are experienced as an inner void, and aggression that breaks through defenses are key characteristics, according to Goldstein (1995). Distrust, all-or-nothing thinking, extreme sensitivity to unfair treatment, and an appearance of normality that quickly unravels under stress are additional features he discusses.

An Ethics of the InBetween

Another tension in trusting relations comes from the use of discourse on mental disorders to interpret behavior. When is it splitting a pathology, and when is it an accurate, if simplistic, representation of a racist world Indications of distress such as rage at the powerful bad Other, a sense of a fragmented self, and expressions of internalized oppression in the form of self-destructive behavior (all of which behavior might be taken as symptoms of BPD) should be neither pathologized, patronized, nor privatized. As Spillers says,

Social response reversal and the reaction to the anger of others

Psychopathy has long been considered a disorder of empathy (Hare 1991). However, I will argue not of the form of empathy described by the SRR model. There are marked differences between the functional impairments associated with, and the behavioral presentation of, acquired sociopathy and developmental psychopathy (see Blair 2004). However, in contrast, there appear to be marked similarities between the functional impairments associated with, and the behavioural presentation of, acquired sociopathy and childhood bipolar disorder (see Blair 2005).

Bipolar Affective Disorder

The cross-national relationships between lower prevalence rates of bipolar affective disorders and greater seafood consumption (Noaghuli, Hibbeln, and Weissman , unpublished data) are strongly consistent with the clinical intervention trial described by Stoll et al. (1999a) above. Bipolar spectrum disorders have the strongest, most well-defined relationship to seafood consumption in a nonlinear power regression with an apparent threshold of approximately 75 lbs person y. Below this level of consumption, the prevalence rates of bipolar disorder rise precipitously from 0.4 in Taiwan (81.6 lbs person y) to 6.5 in Germany (27.6 lbs person y) a nearly 60-fold difference in prevalence (Noaghuli, Hibbeln, and Weissman, unpublished data). Bipolar affective disorders I and II have similar nonlinear relationships.

Empirical Support For Cbt With Children

Evidence-based practice has become a common catchphrase within the educational and mental health professions. However, most of the literature on the use of CBT with children and adolescents has involved clinical populations rather than addressing the use of CBT in schools. The literature has shown CBT to be effective in the treatment of a number of childhood difficulties including depression, anxiety, and disruptive behaviors (see reviews in Kazdin & Weisz, 1998 Weisz & Jensen, 1999). There continues, however, to be a need for further investigation into a number of childhood difficulties including eating disorders, posttrau-matic stress disorder, bipolar disorder, substance abuse, school-related problems, and other health conditions (e.g., pain management, obesity). Additionally, further investigation is necessary regarding the provision of CBT in alternative settings such as a school system.

Therapeutic Implications

Based on the likelihood that bipolar disorder is related to phospholipid signal transduction problems, Severus and Stoll developed the idea that these might be modulated by omega-3 fatty acids (Stoll et al., 1996). They therefore set up a randomized study of highdose mixed EPA and DHA in partially treatment-resistant patients with rapid-cycling bipolar disorder. The EPA DHA preparations were found to be highly significant in preventing relapse and in improving depression (Stoll et al., 1999). This initially promising observation is now being followed up in much larger studies.

How Good Is the Evidence for Underlying in Utero Events

Since numerous adverse events are apparendy equally associated with different types of mental illness, it maybe speculated that it is not the type of insult (i.e., infection versus hypoxia) which is important to outcome, but rather the gestational timing of the initial insult. Insult severity, duration, and the additive effects of interactions between insults are also likely to be key factors. The similarity in neuropathology between many illnesses is consistent with the shared symptomology of these illnesses, which often makes diagnosis difficult. It is also consistent with the increasingly accepted concept that affective disorders and schizophrenia, at least, are not distinct illnesses per se, as Kraeplin first proposed, but rather represent a psychiatric continuum ranging from unipolar to bipolar disorder to schizoaffective psychosis all the way to schizophrenia.8 Neural impairment and injury, like psychiatric disorders, may be viewed as a continuum, with timing and severity of an...

Suggestion Laws Of See Frequency Law Of

Anomic - is based entirely on social issues. In the psychological domain, the hopelessness theory of suicidality emphasizes the developmental, emotional, and cognitive aspects of personal hopelessness, stress, depression, and vulnerability, as well as the psychosocial processes culminating in the suicidal act cf., major events effect - refers to the finding that in the case of personal disasters and emergencies, such as suicides, the rate of the occurrence of such behaviors is reduced prior to major events (such as important elections or sporting contests), and that the rate of occurrences of such behaviors (as suicide) increases following major catastrophes (such as earthquakes and floods) . Statistically, in the context of psychopathology, it is estimated that about 15 percent of individuals with major depression or bipolar disorder commit suicide each year. See also ANOMIE THEORY DEPRESSION, THEORIES OF PSYCHOPATHOLOGY, THEORIES OF. REFERENCES

Inheritance Patterns and Linkage Studies

Complex disorders such as schizophrenia and bipolar disorder usually do not follow classic Mendelian inheritance patterns, but they can frequently mimic a pattern of autosomal dominance with reduced penetrance. Explanatory models for these complex disorders include multifactorial inheritance (multiple genes with nongenetic components) and epistasis (few genes acting jointly). But, since the mode of inheritance is unknown, a range of analytic methods must be used to study the genetic aspects of these disorders. Linkage and allelic association studies are frequently methods used to investigate possible causal genes for complex psychiatric disorders. However, in large populations, there are likely to be several causal or susceptibility genes and nongenetic causes, as well. Historically, the first positive linkage study to have a major impact on psychiatry was the linkage of bipolar disorder to chromosome eleven in a large Amish family. However, a later assessment of the family failed to...

Selective Serotonin Reuptake Inhibitors Ssris

Since the introduction of fluoxetine (Prozac) in 1988, the SSRIs have become the most commonly prescribed antidepressants in the United States. Other SSRIs currently available include sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), and citalopram (Celexa). SSRIs are primarily indicated for treatment of major depressive episodes but also have utility in dysthymia and anxiety disorders including generalized anxiety disorder, panic disorder, and obsessive compulsive disorder. Because of their favorable side effect profile and relative safety in overdose, some have argued that institution of an SSRI by an emergency department physician may occasionally be appropriate if (1) the patient can be assessed to rule out general medical causes for the depression, (2) ongoing substance abuse can be ruled out, and (3) the patient can be followed in the emergency setting until picked up by another health care provider. However, this rationale has rightly been questioned because of the...

Psychiatric Evaluation

Some homeless patients without documented history of chronic psychiatric illness or substance dependence may present to the ED with psychiatric complaints. The stresses of sustaining life without a home are associated with a variety of diagnoses, including adjustment disorders, substance use, and major depression. 18 Alternatively, some homeless patients have a chronic history of psychiatric illness, including schizophrenia or bipolar disorder, that may be partially responsible for precipitating homelessness.19 The psychiatric assessment of homeless patients is important to providing adequate disposition of medical problems whose management may be compromised by mental illness. In addition, primary pharmacologic therapy can be evaluated or instituted in patients with chronic psychiatric disorders.

Description Of Treatment

The list of conditions treated in groups is extensive. Virtually all models of individual therapies have been used in group therapy. The highest use of intensive group models is with the more common conditions of depression, anxiety states, eating disorders, and personality disorders. Groups of a more supportive nature are widely used as an adjunctive treatment for more severe and chronic conditions such as bipolar disorder and schizophrenia.

Historical Overview

And attempted to explain the complexities of bipolar illness. In the second century ad Areteus wrote about patients who, in a state of euphoria, danced throughout the night, talked publicly, and acted overly self-confident then, for no apparent reason, shifted into a state of sorrow and despair. The fourth century bc Greek physicians lead by Hippocrates were perhaps the first to hypothesize that symptoms we now call bipolar disorder represented a neurological illness highlighted by major uncontrollable shifts in a person's mood. These early Greek scholars further taught that mental illness is caused by natural rather than spiritual forces, identified the brain as the major organ responsible for sanity and intellectual processes, attempted to classify major mental disorders, and developed crude medical treatments for mental disorders. Unfortunately, however, records from the ancient Egyptians, Greeks, Romans, Middle Ages, European Renaissance, and early American history indicate that...

Winnie Eng and Richard G Heimberg

Although the use of CBT as the sole treatment for unipolar depression has certainly been advocated, CBT is viewed as an adjunct to pharmacotherapy in the treatment of bipolar disorder. At the current time, very few studies have been conducted, but researchers are taking a greater interest in the application of CBT to this disorder. Monica Ramirez Basco and John A. Rush have published a CBT treatment manual for bipolar disorder that should facilitate research. Furthermore, a federally funded, multisite study is currently under way that is exploring the relative efficacy of CBT, IPT, and family-focused therapy for bipolar disorder.

Bdv And Human Disease

Recognition of BDV's broad experimental host range, and the observation that disturbances in behaviors in experimentally infected animals are reminiscent of some aspects of human neuropsychiatric diseases, including major depressive disorder, bipolar disorder, schizophrenia, and autism, led to the proposal that BDV might be implicated in their pathogenesis. Although there is consensus that humans are likely to be susceptible to BDV infection, the epidemiology and clinical consequences of human infection remain controversial. There have been no large, controlled prevalence studies. Furthermore, methods for diagnosis of human infection are not standardized thus, it is difficult to pursue meta-analysis. Most reports suggesting an association between BDV and human disease have focused on neuropsychiatric disorders, including unipolar depression, bipolar disorder, or schizophrenia however, BDV has also been linked to chronic fatigue syndrome, AIDS encephalopathy, multiple sclerosis, motor...

Impact Of Catecholamines On Behavior

Despite the fact that much of our knowledge regarding the impact of catecholamines on behavior has come from observations related to medication trials, recent advances in genetic techniques also further our hopes for future breakthroughs. Certain neurological illnesses, such as hereditary progressive dystonia and supranuclear palsies, have been linked to abnormalities in tyrosine hydroxylase gene expression. Pioneering efforts to investigate the genetic components of other neuropsychiatric conditions are under way. Two such illnesses may be schizophrenia and bipolar disorder. In these illnesses, classical modes of inheritance are not evident. However, there is clinical evidence via adoption, twin, and family studies that implicates a hereditary component to these illnesses. Being able to approach this problem from multiple perspectives employing the evolving fields of molecular biology and genetics may eventually result in the

The Limbic System And Psychiatric Disorders

These structures has been associated with a variety of psychiatric disorders, including depression, bipolar disorder, obsessive-complusive disorder, and schizophrenia. For example, structural changes have been noted in the hippocampal formation, medial thalamus, and prefrontal cortex in schizophrenic subjects. Observations from positron emission tomography indicate that the amygdala and related parts of the prefrontal cortex and medial thalamus are abnormally active in patients suffering from severe unipolar and bipolar depression. Cellular changes, especially in glial cells, have also been reported in the orbital and medial prefrontal cortex and amygdala in depressed subjects. Patients with lesions of these prefrontal areas have also been reported to have a relatively high incidence of depression. As noted previously, lesions of the ventromedial prefrontal cortex produce severe deficits in emotional reactions and in making choices.

Christine Maguth Nezu and Michelle A Peacock

In 2000 (Rush & Frances, 2000), practical clinical guidelines based on expert consensus and relevant research for treating persons with mental retardation suffering from major mental disorders were developed to assist clinicians in treatment decision making. Applied behavior analysis, managing the environment, and client and family education were the most highly recommended psychosocial treatments for many disorders including autism, attention-deficit hyperactivity disorder, conduct disorder, substance abuse and substance dependence, as well as target symptoms such as self-injurious behavior, aggression, and pica. CBT (e.g., anger management, assertiveness training, conflict resolution) was recommended as a first-line option for major depressive disorder, posttraumatic stress disorder, obsessive-compulsive disorder, and symptoms of anxiety. CBT was also recommended as a second-line option for bipolar disorder (manic phase), schizophrenia and other psychotic disorders, generalized...

Neuropsychological Testing

The clinical neuropsychological evaluation of patients with possible toxic encephalopathy necessitates that the clinician perform a careful and thorough examination of each patient. Many areas of cognitive function must be assessed so that exposure-related effects can be detected and other possible diagnoses comprehensively evaluated and ruled in or out. Because there is overlap between the behavioral effects of exposure to certain neurotoxic chemicals and those associated with developmental disorders (e.g., learning disabilities, attention deficit disorder), psychiatric conditions (e.g., posttraumatic stress disorder, bipolar disorder), neurological diseases (e.g., multiple sclerosis, cerebrovascular disease, primary progressive dementia, parkinsonism), and the exposure to ethanol, medications, and illegal drugs, the test battery must allow for consideration of these alternative or contributing conditions.

Pharmacogenetics and psychopharmacology

For more than 40 years, epidemiological studies have clearly demonstrated a tendency for diseases such as schizophrenia, bipolar disorder and autism to run in families. Thus it has been shown that such disorders are much more frequent in close relatives of patients than in the general population. For example, estimates of the increased risk of suffering from the disorder if the patient has a sibling with the disorder range from nine- to eleven-fold for schizophrenia and about sevenfold for those with bipolar disorder. These major psychiatric disorders show a significantly greater concordance rate in genetically identical twins. Thus the concordance rate for monozygotic twins in schizophrenia is approximately three times that observed in dizygotic twins. In bipolar disorder, the corresponding concordance rate is approximately eight times greater in monozygotic than in dizygotic twins. From such studies it has been calculated that between 60 and 80 of the liability of these two...

SPECT single photon emission computerized tomography scanning

An excellent anticonvulsant for generalized and focal seizures. Recently it has started to be used for nonconvulsive disorders, including migraine prevention and as a mood stabilizer for bipolar disorders. Valproic acid comes in Depakene and Depakote forms. Seizures controlled with this medication include myoclonic seizures, absence seizures, and mixed-type seizures. Side effects include initial transient sedation and abdominal pain (better tolerated with the Depakote form). It may also increase the appetite (causing weight gain), cause some transient hair loss (which improves with zinc supplementation), or cause liver and blood count abnormalities, although this is rare. Hyperammonemia and pancreatic dysfunction have also been reported. In children younger than 3, and especially younger than 2, valproic acid may cause a severe fatal liver disease in a frequency as high as 1 in 300. Many patients taking valproic acid may have an associated carnitine...

Economic Pressures on the Political System

Politicians at the present time are trying to balance the complaints about HMOs and managed care with the inevitability that the industry must be part of the solution if there is to be one. Along with the professional societies exerting pressure, by 2000 the National Alliance for the Mentally Ill (NAMI) emerged as a potent force advocating the strengthening of the 1996 mental health parity law. The bill under serious consideration in the year 2000, called the Mental Health Equitable Treatment Act, would require full insurance parity for schizophrenia, bipolar disorder, major depression, obsessive-compulsive and panic disorders, posttraumatic stress syndrome, autism, anorexia nervosa, and ADD. It takes its lead from the states that have passed some kind of parity law, and cuts directly to parity only for a list of disabling disorders, eliminating the diffuse nature of much mental health diagnosis and treatment. Thirty-four states had passed some kind of parity law by 2000, suggesting...

Mood Anxiety and Somatoform Disorders

The cooccurrence of migraine and psychiatric disorders has been studied extensively in several population-based and longitudinal surveys. Migraine is associated with both affective and anxiety disorders. Breslau and colleagues reported on the association of International Headache Society (IHS)-defined migraine with higher lifetime rates of affective disorder, anxiety disorder, illicit drug use disorder, and nicotine dependence. Migraine with aura was associated with an increased lifetime prevalence of both suicidal ideation and suicide attempts, controlling for sex, major depression, and other concurring psychiatric disorders. The relative risk for the first onset of major depression in migraineurs after the onset of migraine versus no prior migraine was 4.1 (95 CI, 2.2-7.4), whereas the relative risk for the first onset of migraine in persons with prior major depression versus no history of major depression was 3.3 (95 CI, 1.6-6.6). These data indicate that the lifetime association...

Key References for Further Reading

How does lithium work in manic depression Clinical and psychological correlates of the inositol theory. Ann. Rev. Med. 47 (1996) 47-60. Keck, P. E. and McElroy, S. L. Outcome of the pharmacological treatment of bipolar disorder. J. Clin. Psychopharmacol. 16 (Suppl.) (1996) 15-23.

The Genetic Epidemiology of ADHD

Family studies have provided evidence for the genetic heterogeneity of ADHD. Studies that systematically assess other psychiatric disorders suggest that ADHD and major depression often occur together in families that ADHD children with conduct and or bipolar disorders might be a distinct familial subtype of ADHD and that ADHD is familially independent from anxiety disorders and learning disabilities. It may therefore be appropriate to divide ADH children into those with and those without conduct and bipolar disorders, thus forming more familially homogeneous subgroups. In contrast, major depression may be a nonspecific manifestation of different ADHD subforms.

Self Wounding and Self Mutilation

Self-inflicted cutting can be part of either psychotic or nonpsychotic destructive behavior and is enhanced by alcohol or drug abuse (Fig. 29 refs. 56, 93, and 95-101). Self-cutting also occurs as a religious ritual or as a means for personal gain (e.g., malingering, insurance fraud 56,64,93,95,96 ). Self-wounding of the skin of the extremities (e.g., wrist slashing) is common (56,99,101). Self-wounding injuries are usually relatively minor. Superficial skin wounds in less pain-sensitive areas are observed, and

Kraepelins Theoryclassification See Psychopathology Theories Of

Physique and pyknic - refers to a plump, round-figured physique. A fourth, mixed type, dysplastic - referring to a rare or ugly physique, was described, also, that applied to a small group of deviant cases. Kretschmer related the incidence of physique types to the two kinds of psychosis in his patients and concluded that there was a strong biological affinity between manic-depression and the pyknic body build and a similar association between schizophrenia and the asthenic, athletic, and dysplastic body builds. Criticisms of Kretschmer's theory, in this case, focus on his failure to control adequately for differences in age between manic-depressives and schizophrenics. Thus, the common observation is suggested that with increasing age most people increase in weight and, thereby, are more likely to resemble Kretschmer's pyknic type. Also, inasmuch as manic-depression typically occurs later in life than does schizophrenia, this may account for the particular relationships Kretschmer...

Dimensions of Costs

Affective disorders are a common illness with 11 of the adult population in the United States suffering each year with an affective disorder. Of these patients, one half have major depression, one third dysthymia, and one sixth bipolar disorder. One fifth of Americans will have an affective illness during their lifetime. Green-berg and colleagues estimated the cost of depression in the United States in 1990, including both the direct costs of medical treatment and the indirect costs from mortality and reduced productivity, at 43 billion dollars. Several investigators have documented the greater disability and medical costs from depression than for other common medical conditions and other mental health disorders. In addition, depressed patients seek general medical care and have higher general medical costs than non-depressed patients.

Epidemiology And Cause

Bipolar disorders usually start in late adolescence and young adulthood. These illnesses, however, can appear any time between ages 5 and 50 and in rare cases beyond the age of 50. Research indicates that between 25 and 30 of the people who develop manic-depression as adults had one or more related symptoms before their 6th birthday. The more severe forms of bipolar illness (bipolar I disorder) are considered to be rare in prepubertal children. Only about 0.6 of adolescents are thought to have a bipolar I diagnosis, but estimates of teens with bipolar II disorder have reached as high as 10 . Estimates of the number of people with a bipolar disorder vary. This occurs in part because of diagnostic difficulties and because of the fact that many people who have mild symptoms either do not seek or do not receive professional attention. At any given time, about 8 of America's population is at risk for developing a mood disorder. Most studies estimate that between 1 and 2.5 of the U.S....

Cory F Newman

Bipolar disorder, known colloquially as manic-depression, is a heterogeneous affective disorder, apparently related to unipolar depression, but also involving varying degrees of euphoria, impulsivity, irritability, hyperactivity, agitation, and (sometimes) psychotic ideation. Less prevalent than unipolar depression, it strikes 0.8-1.6 of the adult population. Less is known about the incidence in childhood and adolescence, as the field is still trying to disentangle and otherwise understand the relationship between early onset bipolar disorder and childhood disorders such as conduct disorder (CD) and atten-tion-deficit hyperactivity disorder (ADHD). Bipolar illness appears to be represented equivalently between the genders, and across ethnic groups (Bauer & McBride, 1996). Symptom episodes involving depression and hypo-mania or mania often occur in cycles, thus causing serious, repeated psychological and general health problems for the sufferer. As the natural course of bipolar...


As depressive symptoms play a significant role in the course of bipolar illness, much attention is paid to patients' negative views of themselves, their lives, and their futures. Although it is important for patients to acknowledge that they have bipolar disorder and to engage in the proper treatment, it is not helpful if they make dire assumptions about their condition that make them feel helpless and hopeless. Thus, it is important to teach patients the basic cognitive therapy skills of recognizing their automatic thoughts and related beliefs, and rationally responding so as to reduce subjective stress, maintain a constructive outlook, and stay focused on goals in a productive manner. It is critical that individuals with bipolar disorder learn to utilize such skills in the face of their suicidal ideation and feelings, as well as when they maintain a sense of shame and stigma. For example, a patient who views himself as synonymous with his bipolar illness, and thus declares himself...

Empirical Findings

Linked to an increased onset of affective episodes in bipolar disorder. Additionally, the bipolar patients' cognitive styles play an important interactional role, thus supporting the contention that a cognitive case conceptualization is important even in the treatment of a disorder that seems to be so frequently driven by biological factors. In general, bipolar patients who demonstrate maladaptive thinking styles are more apt to develop affective symptoms, including both depressive and manic episodes. Specifically, there is some evidence that perfectionistic beliefs, poor autobiographical recall, excessive goal-directedness, and high degrees of both sociotropic and autonomy-related beliefs represent vulnerability factors that need to be addressed in cognitive therapy for bipolar disorder (see Newman et al., 2001, for an overview). Recently, a number of randomized, controlled trials have shown the promise that cognitive therapy holds for improving the overall treatment package for...


First, the phenomena of transmutation of reinforcing function is not a unique peculiarity of application of a particular stimulus. Therefore, seemingly irrational behavior may be maintained by events that would seem to have aversive properties and would not intuitively be expected to be positive reinforcers. When faced with seemingly irrational or self-destructive behavior, this possibility must be considered. The second caveat, however, is that it must not be assumed that any positive reinforcer can be transmuted into an aversive-type stimulus and vice versa according to a standard formula. At the least, the schedule parameters, the environment, and the course of training and experience will be different from agency to agency for it to function, on the one hand, as a positive reinforcer and, on the other hand, as an aversive-type event. At the most, it may simply be impossible to devise means to transmute the reinforcing or aversive function of some stimuli....


The FA model can help to identify enzymatic targets of centrally acting drugs, thus providing a reverse engineering approach for further drug discovery (Liang, Furhman, & Somogyi, 1998). Studies employing the model suggest that lithium may act against bipolar disorder by reducing arachidonate turnover within the brain by targeting transcription of an arachidonic-specific cPLA2.


Emotion has long defied precise definition, but it is useful in a general sense to regard emotion as those mental activities approximately equivalent to ''feelings.'' Emotions are powerful motivators in human life and clearly have their origin in brain activity. The neurosciences heretofore have not devoted as much attention to emotions as to cognition, but data are accumulating to indicate that this large group of human afflictions can be understood in terms of disorders of the brain, including those affecting cerebral white matter. White matter systems in the frontal and temporal lobes are most directly involved with emotion, and in particular, those tracts intimately connecting structures of the limbic system are thought to be of primary importance. Many individuals with cerebral white matter lesions experience changes in emotional status. Depression appears to be the most common syndrome, and it may result from white matter lesions interfering with the activity of...

Genetic Theories

For example, depression is up to three times more common in first-degree biological relatives of persons with the disorder than among the general population, and it is almost twice as common in first-degree biological relatives of persons with bipolar disorder. Moreover, children of parents with other psychiatric disorders, including anxiety and substance use disorders, are more than twice as likely to develop depression than are children of parents without psychiatric disorders. However, this support for a genetic contribution to depression is confounded with the increased likelihood of shared environment of first-degree biological relatives. Taken together, the evidence suggests that genetic factors play a contributory role in the etiology of depression, but nowhere near as primary a role as in some other psychiatric disorders (e.g., bipolar disorder and schizophrenia).

Childhood Onset

Even in the 1960s psychoanalytic theory hypothesized that children could not develop depression, let alone manic-depressive illness. This was founded on the assumption that depression results from unconscious superego conflicts. Because they thought children had not yet developed superegos, the assumption was that children also could not experience real depression. Today research documents that children, preteens, and adolescents can develop unipolar depression and bipolar disorders, but their course of illness and symptom patterns are often much different from these of adults. Manic-depression in children causes the general symptom categories found in adults but creates different patterns and behavioral problems. As an example, children have more chronic episodes distinguished by rapid and ultrarapid cycling. From the very beginning as infants many of these children behave differently from their peers. Mothers and nurseries report that the baby has long periods of crying,...

Family Studies

Most studies of bipolar disorder show that this illness tends to be familial, with significantly higher risk in relatives of bipolar probands compared to the general population. Kallmann reported that the lifetime risk for parents of bipolar probands was 23.4 and that for siblings was 22.7 , whereas for second-degree relatives the rates range from 1 to 4 . Winokur found that in sibs of bipolar patients, the lifetime risk for any mood disorder was 35 , whereas in their parents the risk was 34 .


As a philosophical approach that can be integrated with a wide range of psychological theories, feminist therapy is applied to a broad range of psychological problems, including those problems that are often defined as feminist (e.g., sexual and domestic violence, sexual harassment), as well as problems that are influenced by biological factors (e.g., bipolar disorder, schizophrenia, anxiety, depression). Approaches to dealing with the following issues have received the most extensive attention in the feminist therapy literature achievement and career issues, eating disorders, addictions, relationship issues, sexual assault and abuse, sexual harassment, family and domestic violence, trauma-related problems, depression, anxiety, and dissociative disorders.


Lithium carbonate is indicated for both acute mania and maintenance therapy in bipolar disorder. It also has utility in some cases of major depression (both unipolar and bipolar) and in some disorders characterized by episodic explosive outbursts or self-mutilation. Its mechanism of action is not exactly known, although it may relate to reducing dopaminergic function, enhancing serotonergic function, or reducing excessive signaling by the phosphytidylinositol system. The extensive pretreatment evaluation and long latency of action preclude the use of lithium as an emergency psychotropic medication. The emergency physician should be aware, however, of its side effects and signs of toxicity.


In the simplest terms, bipolar disorders occur from abnormalities in the brain's anatomy and chemistry. As a result, the brain is unable to orchestrate the dispatch and reception of chemical messages that direct, appropriately control, or modulate a person's mood. These are complex illnesses that cannot be explained by a single neurotransmitter or localized to one primary brain structure. Neurotransmitters are chemical messengers that carry electrical impulses between brain cells. Early research in the 1950s demonstrated that imipramine medication used for treating depression inhibited the re-uptake or increased levels of neurotransmitters known as neuro-genicamines (neuroamines). Re-uptake is the process whereby chemicals that remain after transmission from one cell to another are either stored in the neuron's presynaptic terminal or eliminated by glial cells. Norepinephrine and dopamine, considered the most important neurotransmitters in the neuroamine group, were thought to be the...

Human Brain Mania

Mania describes a state of high, perhaps frenzied, psychic and physical energy in which the patient shows hyperactivity, impulsivity, and disproportionate emotional reactions (often mirth, but also irritability). Mania, which may be regarded as the converse of depression, is rarely seen alone without the patient also experiencing depressive periods, alternating with the periods of mania. The cycle of mania and depression in bipolar disorder is many months, with more than four cycles in a year described as ''rapid cycling.'' The neurochemical basis of bipolar disorder is not known, although serotonin and norepinephrine are implicated, as they are in unipolar depression. Clues to the nature of the neurochemical dysfunction, and therefore clues to the nature of normal neurochemical function, are often found in the effective treatment regimes. The most effective treatment for bipolar disorder is chronic administration of the drug lithium carbonate. Lithium has a rapid and beneficial...


The brain's inability to control neurochemical functions may result in part from anatomic abnormalities. Individuals with bipolar disorders have specific areas of their brain that structurally differ from the neuroanatomy of individuals with no history of mental illness. Furthermore, there is growing evidence that differences in brain structure are also found among individuals with manic-depressive illness and other major diagnostic categories such as major depression and schizophrenia. University of Michigan researchers using positron emission tomography (PET) found that individuals with bipolar illness have a higher density of monoamine-releasing cells than people who do not have an affective disorder. These specialized cells are responsible for controlling the discharge of norepinephrine, serotonin, and dopamine. Magnetic resonance imaging (MRI) studies show that individuals with bipolar disorders have significantly enlarged lateral ventricles, frontal and temporal lobe sulci, and...

Personality Studies

Tendencies toward affective (mood) disorders, including psychotic depression and bipolar disorder type I (manic depression), also are clearly influenced by genetics. A lack of familial co-occurrence has established the separateness of schizophrenia from the affective psychoses. Unipolar depression and bipolar affective disorder do co-occur, and there may be a genetically influenced major depressive syndrome distinct from manic depression. The affective disorders probably include a diversity of genetic conditions.

Joel Yager

Many patients receiving antipsychotic or mood-stabilizing medications to treat conditions such as schizophrenia or manic-depressive illness (bipolar disorder) may gain weight as a side effect of these medications. Pharmaceutical companies are actively trying to find new types of medications with fewer weight-related side effects. Beyond these psychiatric conditions, a variety of serious general medical conditions need to be considered by clinicians evaluating patients with changes in appetite and weight. These include conditions causing poor appetite and weight loss such as cancers, HIV infections, tuberculosis, and diabetes as well as conditions causing weight gain, such as hypothyroidism and other endocrine problems and conditions causing the retention of fluids. Although all of these psychiatric and medical conditions are important and merit active treatment, discussion of their psychotherapeutic management is beyond the scope of this article.

Major Symptoms

The type of bipolar disorder a person has is largely determined by identifying the severity, number, type, and duration of manic and depressive symptoms the person has or is experiencing. Diagnosis of bipolar disorders is complicated by the fact that many symptoms of unipolar depression and manic-depression overlap. As an example, agitation and insomnia can occur in the depressed and in the manic state. Hypersomnia and psychomotor retardation, however, are observed more in bipolar than in unipolar depression. Mania is one of the most dangerous of the abnormal mood states, but fortunately it is not present in all forms of bipolar disorder. Mania or manic behavior produces extreme and dramatic symptoms that can endanger the person's social and economic well-being and cause the individual to take life-threatening risks. The early stages of mania are experienced as pleasant and uplifting. The person feels energetic, creative, highly spirited, and capable. In the beginning of a manic...

Jan Scott

Keywords cognitive therapy, bipolar disorders, manic depression Until recently, bipolar disorders (BP) were widely regarded as a biological illness that should be treated with medication (Scott, 1995a). This view is gradually changing for two reasons. First, in the past three decades, there has been a greater emphasis on stress-vulnerability models. This has led to the development of new etiological theories of severe mental disorders that emphasize psychosocial and particularly cognitive aspects of vulnerability and risk and also increased the acceptance of cognitive therapy (CT) as an adjunct to medication for individuals with treatment-resistant schizophrenia and severe and chronic depressive disorders (Scott, 2003). Second, although medication is the mainstay of treatment in BP, there is a significant efficacy-effectiveness gap. Mood stabilizer prophylaxis protects about 60 of individuals against relapse in research settings, but protects only 25-40 of individuals against further...

Stress And Onset

Stress does not appear to be a major factor in explaining why individuals develop a bipolar disorder. Additionally, research does not support the idea that the number of depressive or manic episodes experienced by a patient relates to that individual's pre-onset stress level. There is also little or no scientific evidence that bipolar episodes are related to stress through the brain's kindling process. Kindling refers to the brain at the cellular level learning from repeated episodes to automatically trigger an event such as a seizure. Studies show that, after a number of electrically stimulated seizures, spontaneous epilepsy will occur without the introduction of electrical stimulation. The popular brain kindling and behavioral sensitization theory hypothesized that bipolar patients become highly aware of stress. Environmental and behavioral symbols for stress are then linked to repeated depressive and manic episodes. Eventually the brain will automatically trigger a relapse with...


Schizophrenia and bipolar disorder Similarities in pathogenic mechanisms but differences in neurodevelopment. Int Clin Psychopharmacol 2002 17(Suppl 3) S11-19. 42. Beasley CL, Cotter DR, Everall IP. Density and distribution of white matter neurons in schizophrenia, bipolar disorder and major depressive disorder No evidence for abnormalities of neuronal migration. Mol Psychiatry 2002 7(6) 564-570. 57. Rajkowska G, Halaris A, Selemon LD. Reductions in neuronal and glial density characterize the dorsolateral prefrontal cortex in bipolar disorder. Biol Psychiatry 2001 49(9) 741-752. 79. Kinney DK, Yurgelun-Todd DA, Tohen M et al. Pre and perinatal complications and risk for bipolar disorder A retrospective study. J Affect Disord 1998 50(2-3) 117-124. 82. Moller HJ. Bipolar disorder and schizophrenia Distinct illnesses or a continuum J Clin Psychiatry 2003 64(Suppl 6) 23-27, discussion 28.


Other research studies have demonstrated the efficacy of cognitive therapy for generalized anxiety disorder, panic disorder, and hypochondriasis. It has also been shown to be effective for inpatient depression, posttraumatic stress disorder, substance abuse, phobias, social phobia, marital problems, and some personality disorders. Combined with pharmacotherapy, it is effective for the symptoms of bipolar disorder and even schizophrenia.

Moderating Affect

As extreme mood swings are characteristic and problematic aspects of bipolar disorder, cognitive therapists help their patients to take measures to moderate their emotionality. For example, the patients schedule their live's activities so that they are taking care of their chief responsibilities (balanced with family time, and rest and relaxation), but not to the extent that they are working frenetically or excessively. Similarly, patients are taught to reduce excessive arousal via the techniques of relaxation and breathing control. Self-instructional statements can be used to remind individuals with bipolar disorder to refrain from acting on bursts of anger and ardor, and instead to monitor the intensity and longevity of these moods prior to taking any action. The therapist must be sensitive to the patients' difficulties in managing their moods, acknowledging that high affect (and its concomitant urges to express them publicly) is quite a challenge to contain. Further, some patients...

Patient Variables

Patients with serious mental disorders, such as schizophrenia, schizoaffective disorder, and bipolar disorder, are typically treated primarily with psychotropic medications, suggesting the challenge these disturbances provide for psychotherapy alone. Personality disturbances also appear more resistant to change even in long-term treatments that last years.

Treatment Issues

When symptoms first start in children and adults, an extensive physical exam from a qualified physician is immediately required. Both depression and manic symptoms can stem from problems ranging from vitamin deficiencies or excess to major autoimmune, cardiovascular, gastrointestinal, endocrine, hematolo-gic, neurological, and pulmonary diseases or malignancies. Additionally, a long list of medications and drug interactions can cause manic-depressive behaviors. Commonly, bipolar symptoms caused by medical problems other than a neuropsychiatric disorder will improve as the person recovers from the primary physical illness. Once alternative medical problems are ruled out and the person is diagnosed with a bipolar disorder, psychotropic medications become the first and fundamental treatment method. Depression in bipolar disorders can be difficult to treat. Standard antidepressant medications, especially those known as tricyclics, can induce mania and rapid cycling in bipolar patients....

Zoo Animals

Unfortunately, not all of the animals in zoos are kept in a sound environment. Thus, another argument against zoos is that facilities in many zoos need significant renovation and more creative housing. It has been claimed that the zoo environment results in abnormal and self-destructive behavior. Many zoos, however, have made significant improvements over the old steel and concrete cages. Animals have been given more space and enriched habitats. Zoo Atlanta made many changes, but the most publicized is the change in the facility for housing the gorilla Willie B. from one of the worst in the United States to one of the best. In the new facility, Willie B. had access to green grass and trees, and was able to interact