Catherine Ness – Bipolar Disorder: Integrative Treatment Strategies for Lasting Recovery and Stabilization

Outline

Mood on a Continuum: Conceptualizing the Bipolar Spectrum

• Neurobiological underpinnings of Bipolar Disorder
• An acute condition or a chronic, progressive disease?
• Prognosis: Age of onset, importance of early intervention
• Limitations of the research and potential risks
• Understanding the bipolar patient

Clinical Assessment: How to Accurately Diagnose a Frequently Misdiagnosed Disorder

• DSM-5®: Bipolar I, Bipolar II and Cyclothymic Disorders; specifiers
• Manic, mixed and depressive episodes
• Current evidence based assessment tools: SCID, MDQ, GBI, CICI3
• Do most clients present with depression or mania?
• 5 key questions to ask at intake
• How to effectively gather family mental health history
• Tools to detect underreporting of symptoms
• ”Unofficial” signs of mood lability
• How to recognize psychosis
• Differential diagnosis: ADHD, Schizoaffective Disorder, substance abuse and personality disorders

Integrative Treatment Model: Clinical Interventions to Increase Engagement, Stabilize Symptoms and Prevent Relapse

• Psychoeducation
  • Tools to promote acceptance of diagnosis; implications of getting better
  • Differentiate between moodiness and Bipolar Disorder
  • Medications and medication compliance issues
• Family Therapy
  • Compliance and communication
  • Identification of triggers and prodromal symptoms
  • Create an individualized action plan
• Cognitive-Behavioral Therapy (CBT)
  • Teach clients how cognition changes with mood
  • Identification or triggers and prodromal symptoms
  • Create an individualized action plan
• Interpersonal and Social Rhythm Theory (IPSRT)
  • Sleep hygiene, routine and circadian rhythms
  • Mood and cognition charting
  • Grief related to social role changes
• Mania Management
  • Safety assessment
  • Communication with support network
  • Frequency of monitoring
• Identify and Mange Personal Deficits
  • How managing deficits decreases relapse
  • Strategies to improve social connectedness
  • Common cognitive deficits; their impact on stabilization
  • Skills for managing cognitive deficits

Clinical Considerations

• Suicide and self-harm: Assessing for risk
• Crisis Intervention: Which symptoms warrant hospitalization?
• Prodromal symptoms: Red flags to listen for in session
• Children and adolescents: DMDD v. Bipolar Disorder

Comprehensive, Step-by-Step Case Conceptualization

• 40 y/o female – depressed presentation, vague history, excessive spending
• 23 y/o male – hyperverbal, angry, depressed, chronic marijuana use