BIPOLAR-II DISORDER

Presented by: Bhavya Goyal

& Nandini Kukreja
 WHAT IS BIPOLAR DISORDER?
Bipolar disorder, often called manic-depressive illness in the past, is a mental illness involving episodes of mania
and depression. People affected by this disorder usually experience swings in mood from overly "high" (and often
irritable) to sad and hopeless and back again, with periods of normal or near-normal mood in between. These
mood swings can be intense and disruptive to a person's daily life, relationships, and overall functioning. There
are several types of bipolar disorder, including:

1. Bipolar I Disorder: This is characterized by at least one manic episode, which may be preceded or followed by
a hypomanic or major depressive episode. In some cases, individuals with Bipolar I may experience psychotic
symptoms during manic or depressive episodes.

2. Bipolar II Disorder: This involves at least one major depressive episode and at least one hypomanic episode,
but no full-blown manic episode. Hypomania is a less severe form of mania.

3. Cyclothymic Disorder (Cyclothymia): This is a milder form of bipolar disorder characterized by numerous
periods of hypomanic symptoms as well as periods of depressive symptoms. These symptoms must persist for at
least two years (or one year in children and adolescents).

4. Other Specified and Unspecified Bipolar and Related Disorders: These categories may include presentations
that do not fit neatly into the above classifications.
 WHAT IS THE DIFFERENCE BETWEEN BIPOLAR-I AND BIPOLAR-II?
DEPRESSIO MANIA HYPOMANIA PSYCHOSIS HOSPITALIZ- IMPACT ON
N SYMPTOMS ATION DAILY LIFE TREATMENT

BIPOLAR-I May or may At least one May present May May require Likely to Common
not be episode of symptoms of experience hospitalizatio interfere treatments
present mania, lasting hypomania. delusions or n during significantly include a
at least one hallucinations manic with daily combination
week. . episodes. functions. of medication
and therapy.
Some people
may require
medication to
treat
symptoms
specific to
psychosis.

BIPOLAR-II Depression No episodes Experiences Does not Possible Lower impact Common
lasting at of mania. symptoms of experience during on ability to treatments
least two hypomania. delusions or depressive manage daily include a
weeks. hallucinations episodes. functions. combination
Tends to be . of medication
longer and therapy.
lasting.
 SYMPTOMS OF BIPOLAR-II:
Bipolar II Disorder is characterized by episodes of depression and hypomania. Hypomania is a less severe form of mania,
and while it may not be as extreme as full-blown mania, it can still have a significant impact on a person's life. A person with
Bipolar disorder should have had at least one major depressive episode and at least one hypomanic episode, but you've
never had a manic episode. Here are the symptoms of Bipolar II Disorder:

Hypomanic Episode:

During a hypomanic episode, a person may experience a distinct period of abnormally elevated or irritable mood, as well as increased
energy and activity. Some common symptoms include:

1. Increased Energy: A noticeable increase in energy levels, leading to increased productivity and engagement in activities.

2. Decreased Need for Sleep: Feeling rested after very little sleep.

3. Elevated Mood: A sense of euphoria, feeling "high" or extremely positive.

4. Increased Talkativeness: Rapid speech, jumping from topic to topic.

5. Racing Thoughts: Thoughts may come quickly, making it difficult to focus on one thing for long.

6. Increased Goal-Directed Activity: A heightened sense of purpose and goal-directed behavior (which may become excessive or overly
ambitious).

7. Distractibility: Being easily distracted by external stimuli.

8.. Increased Risk-Taking Behavior: Engaging in activities that have a high potential for negative consequences (e.g., reckless driving,
excessive spending, sexual impulsivity).

Major Depressive Episode:

During a major depressive episode, a person experiences a period of low mood and a loss of interest or pleasure in most activities.
Some common symptoms include:

1. Depressed Mood: Feeling sad, hopeless, or experiencing a sense of emptiness.

2. Loss of Interest or Pleasure: Not finding joy or satisfaction in activities that were once enjoyable.

3. Changes in Appetite or Weight: Significant changes in eating habits, leading to noticeable weight loss or gain.

4. Sleep Disturbances: Changes in sleep patterns, such as insomnia or hypersomnia (sleeping too much).

5. Fatigue or Loss of Energy: Feeling persistently tired or lacking the energy to complete daily tasks.

6. Feelings of Worthlessness or Excessive Guilt: Feeling worthless, experiencing excessive guilt, or having a diminished sense of
self-worth.

7. Difficulty Concentrating or Making Decisions: Problems with focus, memory, or decision-making.

8. Psychomotor Agitation: Either feeling agitated and restless or slowed down in movements and thoughts.

9. Recurrent Thoughts of Death or Suicide: Thoughts of death, suicidal ideation, or suicide attempts.
 DSM 5 CRITERIA:
A. Criteria have been met for at least one hypomanic episode and at least one major
depressive episode

B. There has never been a manic episode.

C. The occurrence of the hypomanic episode(s) and major depressive episode(s) is not
better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder,
delusional disorder, or other specified or unspecified schizophrenia spectrum and other
psychotic disorder.

D. The symptoms of depression or the unpredictability caused by frequent alternation

between periods of depression and hypomania causes clinically significant distress or
impairment in social, occupational, or other important areas of functioning.
 HYPOMANIC EPISODE:
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally
and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the
day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three (or more) of the following
symptoms have persisted (four if the mood is only irritable), represent a noticeable change from usual
behavior, and have been present to a significant degree:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or
observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation. 7.
Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in
unrestrained buying sprees, sexual indiscretions, or foolish business investments).
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the
individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to
necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a
medication or other treatment).
 MAJOR DEPRESSIVE EPISODE:
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a
change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of
interest or pleasure.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or
hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable
mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated
by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or
decrease or increase in appetite nearly every day.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others; not merely subjective feelings of
restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely
self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as
observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, a suicide
attempt, or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important
areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or another medical condition.
CAUSAL FACTORS:
The exact causes of Bipolar II Disorder are not fully understood, but it is likely a complex interplay of genetic,
biological, and environmental factors. Here are some potential causal factors that have been identified:

1. Genetics: There is a strong genetic component to bipolar disorder, including Bipolar II. Having a family history
of bipolar disorder or other mood disorders increases the likelihood of developing the condition. However, it's
important to note that not everyone with a family history of bipolar disorder will develop the condition, and not
everyone who develops it has a family history.

2. Neurochemical Imbalances: Imbalances in neurotransmitters (chemical messengers in the brain) are believed
to play a role in mood disorders. In Bipolar II, there may be disruptions in the levels of neurotransmitters like
serotonin, dopamine, and norepinephrine.

3. Brain Structure and Function: Studies have shown differences in the brain structure and functioning of
individuals with bipolar disorder, including alterations in the prefrontal cortex, amygdala, and other regions
associated with mood regulation, emotion processing, and impulse control.

4. Hormonal Factors: Hormonal imbalances or changes in hormonal levels may contribute to the onset or
exacerbation of mood disorders. For example, hormonal changes during puberty, pregnancy, or menopause may
influence the course of Bipolar II.
CAUSAL FACTORS:
5. Stressful Life Events: Traumatic experiences, chronic stress, or significant life changes can trigger the onset of mood
episodes in individuals predisposed to bipolar disorder. These events can act as environmental stressors that interact with
genetic and biological factors.

6. Substance Abuse: Drug and alcohol abuse can exacerbate or trigger mood episodes in individuals with a predisposition
to bipolar disorder. Substance use can disrupt brain chemistry and increase the risk of mood instability.

7. Childhood Adversity: Early life experiences, such as childhood trauma, neglect, or abuse, have been associated with an
increased risk of developing mood disorders later in life, including Bipolar II.

8. Medical Conditions and Medications: Certain medical conditions (e.g., thyroid disorders) and medications (e.g.,
corticosteroids, antidepressants) can influence mood and may contribute to the development or exacerbation of Bipolar II.

9. Sleep Disruption: Irregular sleep patterns, including insufficient sleep or disruptions in circadian rhythms, can trigger
mood episodes in individuals with bipolar disorder.

It's important to note that while these factors may contribute to the development of Bipolar II Disorder, they do not guarantee
its onset. Additionally, not everyone with these risk factors will develop the disorder, and some individuals may develop
Bipolar II without any clear identifiable causes.
 CASE STUDY:
Subject Profile:

Name: Sarah
Age: 34
Gender: Female
Marital Status: Married
Occupation: Marketing Manager
Presenting Problem: Sarah has been experiencing mood swings, periods of
depression, and elevated energy levels for the past several years. She seeks
help to better understand her symptoms and to receive appropriate treatment.
Background Information:
Sarah is a 34-year-old marketing manager, married with two children. She has a
history of mood swings that have been impacting her personal and professional life.
Her family has noticed significant changes in her mood and behavior. She
experiences periods of intense sadness, low energy, and hopelessness, followed by
episodes of high energy, impulsivity, and irritability. These mood swings have been
occurring over the past five years, with episodes lasting a few days to a couple of
weeks.

Clinical Assessment:

Sarah sought help from a mental health professional to better understand her mood
symptoms. The assessment revealed the following:

1. Depressive Episodes: Sarah experiences recurring depressive episodes

characterized by profound sadness, low energy, feelings of worthlessness, and
loss of interest in her usual activities. These episodes often last for several days
to a couple of weeks, leading to difficulties in her work and family life.
2. Hypomanic Episodes: In between depressive episodes, Sarah has
periods of elevated mood, increased energy, and heightened creativity.
During these phases, she sleeps less, is more talkative, and exhibits
increased impulsivity. She often overspends, takes on too many tasks at
work, and has strained interpersonal relationships due to irritability.

3. Social and Occupational Impairment: Sarah's mood swings have caused

disruptions in her social life and work. She has faced difficulty maintaining
close relationships and has been confronted by colleagues and supervisors
regarding her erratic work behavior. She frequently calls in sick during
depressive episodes and exhausts herself during hypomanic phases.
Family History: Sarah's maternal grandmother had a diagnosis of bipolar
disorder, which suggests a genetic predisposition to mood disorders.
Diagnosis:

Based on the clinical assessment, Sarah has been diagnosed with Bipolar II
Disorder. This diagnosis is supported by her recurrent depressive episodes and
hypomanic episodes, with no history of full-blown manic episodes. Her family history
of bipolar disorder also raises the possibility of a genetic predisposition.

Treatment Plan:

The treatment plan for Sarah includes a combination of psychotherapy and

medication:

1. Psychotherapy: Sarah will engage in psychotherapy, primarily

Cognitive-Behavioral Therapy (CBT) and Interpersonal Therapy (IPT). CBT will
help her manage her mood symptoms, recognize triggers, and develop coping
strategies. IPT will focus on improving her interpersonal relationships and
communication skills.
2. Medication: A psychiatrist will prescribe mood stabilizers, such as lithium or
anticonvulsant medications, to help stabilize her mood swings. Antidepressants may be
cautiously introduced during depressive episodes, but closely monitored to prevent
inducing hypomanic episodes.

3. Lifestyle Management: Sarah will work on improving her sleep patterns, maintaining a
regular daily routine, and reducing stress to help manage her mood swings.

4. Support System: Involving Sarah's spouse and family in her treatment plan is crucial to
provide a supportive environment and to help them understand the condition and its
management.

Outcome and Follow-Up:

Sarah's progress will be closely monitored by her mental health professionals. Regular
follow-up appointments will be scheduled to assess her response to treatment, any
medication adjustments, and to track her overall functioning. With proper treatment
and support, Sarah can achieve mood stability and lead a fulfilling life despite her
diagnosis of Bipolar II Disorder.
TREATMENT APPROACHES:
Bipolar disorder cannot be cured; it is a lifelong or chronic condition. However, effective treatment is possible in many cases,
although even the most effective treatment does not prevent new episodes. The frequency of episodes ís usually reduced,
however, and this is important because the more episodes a person experiences the poorer the long-term outcome. The
primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy) to control
symptoms, and also may include education and support groups.

MEDICATIONS:
A number of medications are used to treat bipolar disorder. The types and doses of medications prescribed are based on your
particular symptoms.

Medications may include:

● Mood stabilizers. You'll typically need mood-stabilizing medication to control manic or hypomanic episodes. Examples of
mood stabilizers include lithium (Lithobid), valproic acid (Depakene), carbamazepine (Tegretol, Equetro, others), and
lamotrigine (Lamictal).
● Antipsychotics. If symptoms of depression persist despite treatment with other medications, adding an antipsychotic
drug such as olanzapine (Zyprexa), risperidone (Risperdal), etc. may help. Your doctor may prescribe some of these
medications alone or along with a mood stabilizer.
● Antidepressants. Your doctor may add an antidepressant to help manage depression. Because an antidepressant can
sometimes trigger a hypomanic episode, it's usually prescribed along with a mood stabilizer or antipsychotic.
● Antidepressant-antipsychotic. The medication Symbyax works as a depression treatment and a mood stabilizer.
● Anti-anxiety medications. Benzodiazepines may help with anxiety and improve sleep, but are usually used on a
short-term basis.
TREATMENT APPROACHES:
PSYCHOTHERAPY:

Psychotherapy is a vital part of bipolar disorder treatment and can be provided in individual, family or group settings. Several types of
therapy may be helpful. These include:

1. Interpersonal and social rhythm therapy (IPSRT). IPSRT focuses on the stabilization of daily rhythms, such as sleeping,
waking and mealtimes. A consistent routine allows for better mood management. People with bipolar disorder may benefit
from establishing a daily routine for sleep, diet and exercise.
2. Cognitive behavioral therapy (CBT). The focus is identifying unhealthy, negative beliefs and behaviors and replacing them with
healthy, positive ones. CBT can help identify what triggers your bipolar episodes. You also learn effective strategies to manage
stress and to cope with upsetting situations.
3. Psychoeducation. Learning about bipolar disorder (psychoeducation) can help you and your loved ones understand the
condition. Knowing what's going on can help you get the best support, identify issues, make a plan to prevent relapse and
stick with treatment.
4. Family-focused therapy. Family support and communication can help you stick with your treatment plan and help you and your
loved ones recognize and manage warning signs of mood swings.

OTHER TREATMENT OPTIONS:

Depending on your needs, other treatments may be added to your depression therapy.

1. During electroconvulsive therapy (ECT), electrical currents are passed through the brain, intentionally triggering a brief
seizure. ECT seems to cause changes in brain chemistry that can reverse symptoms of certain mental illnesses. ECT may be
an option for bipolar treatment if you don't get better with medications, can't take antidepressants for health reasons such as
pregnancy or are at high risk of suicide.
2. Transcranial magnetic stimulation (TMS) is being investigated as an option for those who haven't responded to
antidepressants.
FAMOUS CELEBRITIES THAT HAVE BIPOLAR DISORDER:

1. Honey singh- Singer

2. Selena Gomez- Singer
3. Demi Lovato- Singer
4. Mariah Carey- Singer
5. Halsey- Singer
6. Bebe Rexha- Singer
7. Kanye West- Singer
8. Vincent Van Gogh- Artist
9. Virginia Woolf- Writer
10. Ernest Hemingway- Novelist
11. Edgar Allan Poe- Writer and Poet
12. Robert Downey Jr- Actor
 SHOWS AND MOVIES THAT PORTRAY BIPOLAR
DISORDER:
1. Bipolar Rock ’n’ Roller
2. All She Ever Wanted
3. Silver Linings Playbook
4. Touched with Fire (2016)
5. Modern Love (Season 1, Episode 3: Take me as I am, Whoever I am)
6. Girl, Interrupted
7. Inside Out
8. Euphoria
9. All the bright places
10. Infinitely Polar Bear
11. The Informant!
12. Homeland
THANK YOU