Bipolar Disorder: A Biopsychosocial Overview
mdl.psych.northwestern.edu
Source: Touched by Fire, Jamison, 1996
Bipolar Disorder: Epidemiology
• Elevated suicide, divorce, work impairment, substance
use
• 6th leading cause of disability worldwide
(Murray & Lopez,
1996).
• Accounts for nearly half the inpatient mental health
care costs in the US (Kent et al., 1995).
Roadmap: A series of Questions
Four Questions about Bipolar Disorder
1. What is it?
2. What is its stigma?
3. Is there a blood test?
4. What are its treatments?
Roadmap: A series of Questions
Four Questions about Bipolar Disorder
1. What is it?
2. What is its stigma?
3. Is there a blood test?
4. What are its treatments?
Mood disorder involving severe mood swings
Depression
Mania
Severity
Cyclothymia
Bipolar II Disorder Bipolar I Disorder
Erratic depressive
and hypomanic
symptoms
MDE and
Hypomanic
Episodes
Manic Episode
No Manic Episode
MDE not
necessary for
diagnosis
No MDE
~ 2-4 percent of population has bipolar spectrum diagnosis
Misdiagnosis of Bipolar Disorder
% of Patients Misdiagnosed
60
60
50
40
26
30
18
17
20
14
11
10
0
Unipolar
Depression
Anxiety
Disorder
Schiz
Hirschfeld, et al. J Clin Psychiatry 64: 161-174, 2003
Personality
Disorder
Subst.
Abuse
SchizoAffective
Age-of-Onset of Bipolar Disorder
Pediatric Bipolar Disorder
- 10-20% onset < 10 yo
- Controversial (40-fold increase)
- Difficult to differentiate from ADHD
Roadmap: A series of Questions
Four Questions about Bipolar Disorder
1. What is it?
2. What is its stigma?
3. Is there a blood test?
4. What are its treatments?
- Predicts worse course and social isolation
- Limit social interactions
- Social isolation in caregivers
Grief for the Loss of the Healthy Self
Roadmap: A series of Questions
Four Questions about Bipolar Disorder
1. What is it?
2. What is its stigma?
3. Is there a blood test?
4. What are its treatments?
PFC
Limbic
PFC
Limbic
- Common to many psychiatric disorders
- Biology of positive emotion may yield cues more specific to bipolar
‘Wanting’ Circuit in the Brain
Ventral Striatum
Bipolar disorder characterized by a hypersensitivity in the wanting circuit
Reward-Processing in Bipolar Disorder
Reward-Related Brain Activity:
MDD < Comparison
Comparison
MDD
Forbes et al., 2009, Am J Psychiatry
-Bipolar disorder and unipolar depression characterized by distinct profiles in
the wanting or reward circuit
-Biomarkers and treatment
Roadmap: A series of Questions
Four Questions about Bipolar Disorder
1. What is it?
2. What is its stigma?
3. Is there a blood test?
4. What are its treatments?
Bipolar disorder may not be curable but it is livable
Psychosocial Treatments for Bipolar Disorder
Cognitive Behavioral Therapy
Family-Focused Therapy
IPSRT
mdl.psych.northwestern.edu