6.2 Bipolar Disorder

Chapter 6.
2
pp. 130-136
BIPOLAR &
RELATED
DISORDERS
Presentation and Discussion by: Noriko May N. Manarin
BIPOLAR DISORDER
it is a mood disorder, wherein
the person is experiencing
shifts of their mood (in
extremes) and having difficulty
distinguishing their feelings in a
'normal' duration and intensity.
BIPOLAR DISORDER
it can present differently in individuals.
The manic or depressive phases can

last for varying periods of time, and
may even be mixed
i.e. experienced in quick succession
or even simultaneously.
BIPOLAR DISORDER
Sometimes an individual may not recognise
the signs that they are unwell; the feelings of
happiness and purpose that can accompany a
manic state may not lead them to believe
anything is wrong.
These dramatic changes in mood and
behaviour may be more noticeable to those
around them.
TYPES OF DEPRESSION
UNIPOLAR BIPOLAR
DEPRESSION DEPRESSION
also been known as
sadness and ‘manic’ depression in
hopelessness reference to manic
experienced by the symptoms which make
individual for most of it distinct from unipolar
the day, on most days. depression
UNIPOLAR DEPRESSION
The disorder ranges from mild to
moderate or severe.
Those with the disorder often find
they no longer enjoy activities they
used to find pleasurable.
Their mood may or may not be
noticeable to those around them.
UNIPOLAR DEPRESSION
They may appear angry, withdrawn or tearful.
Individuals with unipolar depression may also
experience change in appetite (including weight loss
or gain) and sleep disturbances (insomnia or
excessive sleeping).
UNIPOLAR DEPRESSION
Along with these changes come feelings of fatigue and
exhaustion and reduced concentration which make normal
functioning difficult.
In some cases, individuals may also experience psychomotor
agitation; physical movements such as pacing or
handwringing.
BIPOLAR DEPRESSION
Instead of remaining at one ‘pole’
(i.e. the lows associated with
depression), the moods of someone
with bipolar involve a marked swing
between depressive symptoms and
manic symptoms.
MANIC SYMPTOMS DEPRESSIVE SYMPTOMS
Changes in mood Changes in mood
Long period of feeling euphoric or ‘high’ Long period of feeling sadness and
Rage; irritability despair
Loss of interest in enjoyable activities
Changes in behavior
Becoming easily distracted, having
Changes in behavior
racing thoughts Struggling to concentrate or remember
Sudden interest in new activities or easily
projects Withdrawing from activities or friends
Over-confidence in one’s abilities Fatigue or lethargy
Speaking quickly Finding it difficult to make decisions
Sleeping less or appearing not to need Change to appetite or sleeping
sleep patterns
Engaging in risky behaviours (e.g. Considering or attempting suicide
gambling, sexual promiscuity)
BECK DEPRESSION INVENTORY
21-item self-report measure
assess attitudes and symptoms of depression such as:
feelings of guilt and hopelessness and physiological
symptoms such as fatigue and weight loss.
each item in the inventory consists of at least four statements, of
which the person taking the test must choose the one that best
fits how they have been feeling during a recent period of time.
the test is used to determine the severity of the disorder
10: mild depression
19–29 moderate depression
30 or more indicating severe depression.
BIOLOGICAL EXPLANATION
Biological: genetic and neurochemical (Oruc et al. 1997)
First degree relatives such as parents and siblings share 50% of

their DNA.
31 and 70 years of age with a diagnosis of bipolar disorder (42

participants: 25 female and 17 male) were drawn from two
psychiatric hospitals in Croatia.
A control group of 40 participants with no personal or family

history of mental health disorders matched for sex and age were
also included in the study.
16 of the bipolar group also had at least one first degree relative
who had been diagnosed with a major affective disorder such as
bipolar.
there were no significant associations in the sample

However, serotonin as a neurotransmitter is understood to be
sexually dimorphic.
any differences between males and females of any species
which are not just differences in organs or genitalia. These
differences are caused by inheriting either male or female
patterns of genetic material.
polymorphisms in these genes could be responsible for an
increased risk of developing bipolar disorder in females only.
Polymorphism: a variation in a gene or genes. Rather than

the term ‘mutation’ which suggests a unique change,
polymorphism refers to the different expressions that may
be present in a normal population, even if that expression
occurs infrequently.
Treatment and management of depression
Biochemical: MAOIs and SSRIs
Monoamine oxidase inhibitors (MAOIs) is an anti-

depressant that inhibit the work of an enzyme known as
monoamine oxidase.
Monoamine oxidase is an enzyme responsible for breaking
down and removing the neurotransmitters norepinephrine,
serotonin and dopamine, which causes emotional
irregularities.
Side effects: headaches, drowsiness/ insomnia, nausea,
diarrhea and constipation.
Selective Serotonin Reuptake Inhibitors (SSRIs) is an anti-

depressant that act on the neurotransmitter serotonin to
stop it being reabsorbed and broken down once it has
crossed a synapse in the brain.
Biological: ELECTRO-CONVULSIVE THERAPY (ECT)
ECT is used to manage symptoms of depression tends to be

a last resort, if the patient has not responded well to
biochemical or other forms of therapy such as CBT.
Biological: ELECTRO-CONVULSIVE THERAPY (ECT)
Administered in short sessions, so the benefits of treatment

can be quite short term, in contrast to a ‘maintenance’
effect created by on-going drug therapy.
This means that relapse rates are just as high as in

individuals who cease antidepressant use; it is likely that
an individual will experience a reoccurrence of symptoms
which necessitate further treatment.
COGNITIVE EXPLANATION
Cognitive (Beck, 1979)
Cognitive Distortion
automatic process which develops as a result of earlier life

experiences, through developing schemas.
Schema = Early life experiences + learning
adverse events activate the potential underlying assumptions,

creating a negative bias towards new events.
Cognitive Distortion = adverse events + negative bias

LEARNED HELPLESSNESS AND ATTRIBUTION STYLES
(Seligman et al. 1988)
Learned helplessness is behaviour that occurs as a result

of a person having to endure an unpleasant situation,
when they perceive the unpleasantness to be inescapable.
Learned helplessness = unpleasant situation + inescapable

feelings
LEARNED HELPLESSNESS AND ATTRIBUTION STYLES
(Seligman et al. 1988)
Attributional style’ or ‘Explanatory style’: as life

experiences teach us to develop trust or distrust in our
environments, so we develop particular patterns of thinking
towards the world and ourselves.
Attributional Style (Life Experiences = patterns of thinking)

Cognitive Restructuring (Beck, 1979)
Cognitive restructuring aims to gain ‘entry into the

patient’s cognitive organisation’
a talking therapy, based on one-to-one interactions
between the patient with depression and their therapist.
It involves techniques such as questioning and identifying
illogical thinking to determine and change the patient’s
ways of thinking.
Beginning Processing Final

train the patient is able
explaining patient to to employ
the theory of observe and cognitive
depression record their restructuring
thoughts; for themselves
& reduction of
symptoms
This is practised outside therapy

sessions, to help them identify
such thoughts as they occur in a
real-life context.
‘reality testing’ for patients is to
investigate and begin to notice
negative distortions in thinking
for themselves.
‘reattributing’- a technique in therapy where they discuss

whether the cause of problems or failures the patient has
experienced are internal or external.
Cognitive therapy is now a well-established way to

manage depression, particularly in cases where drug
treatment is unsuitable. Wiles et al. (2013) showed that it
can reduce symptoms of depression in people who fail to
respond to antidepressants.
Rational Emotive Behavioural Therapy (REBT) (Ellis, 1962)
Rational Emotive Behavioural Therapy (REBT) is a

psychological approach to treatment based on the
principles of Stoicism.
Stoicism is a philosophy, one of the principles of which is
that in the majority of cases, the individual is not directly
affected by outside things but rather by their own
perception of external things.
Goal of therapy: help individuals create and maintain
constructive, rational patterns of thinking about their lives.
Rational Emotive Behavioural Therapy (REBT) (Ellis, 1962)
Ellis argues that the tendency to

hold on to irrational and unhealthy
beliefs is ingrained in people over
time, and thus REBT has a great
focus on the present, with little
concern for exploring past
experiences as would
psychoanalysis.
MAIN DIFFERENCE BETWEEN CBT & REBT
CBT REBT
modify current behavior & modify current core beliefs
thought processes (cognition) addressing emotional
focuses on changing their disturbance and cognitions (has
thoughts to be both)
addresses cognitive distortions focuses on evaluating irrational
(primarily) beliefs
letting them discover highly directive, persuasive, and
misconceptions about confrontative (disputing the
themselves ‘reported irrational beliefs)
Thank You
Do you have
any questions?

6.2 Bipolar Disorder

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Chapter 6.

The manic or depressive phases can

First degree relatives such as parents and siblings share 50% of

31 and 70 years of age with a diagnosis of bipolar disorder (42

A control group of 40 participants with no personal or family

there were no significant associations in the sample

Polymorphism: a variation in a gene or genes. Rather than

Monoamine oxidase inhibitors (MAOIs) is an anti-

Selective Serotonin Reuptake Inhibitors (SSRIs) is an anti-

ECT is used to manage symptoms of depression tends to be

Administered in short sessions, so the benefits of treatment

This means that relapse rates are just as high as in

automatic process which develops as a result of earlier life

Schema = Early life experiences + learning

adverse events activate the potential underlying assumptions,

Cognitive Distortion = adverse events + negative bias

Learned helplessness is behaviour that occurs as a result

Learned helplessness = unpleasant situation + inescapable

Attributional style’ or ‘Explanatory style’: as life

Attributional Style (Life Experiences = patterns of thinking)

Cognitive restructuring aims to gain ‘entry into the

Beginning Processing Final

This is practised outside therapy

‘reattributing’- a technique in therapy where they discuss

Cognitive therapy is now a well-established way to

Rational Emotive Behavioural Therapy (REBT) is a

Ellis argues that the tendency to

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