Destructive Behavior Ebooks Catalog

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.

Married To Mania Summary

Rating:

4.6 stars out of 11 votes

Contents: Ebook
Author: Julie Fast
Price: $39.00

My Married To Mania Review

Highly Recommended

I usually find books written on this category hard to understand and full of jargon. But the author was capable of presenting advanced techniques in an extremely easy to understand language.

This e-book served its purpose to the maximum level. I am glad that I purchased it. If you are interested in this field, this is a must have.

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Pharmacological Treatment of Bipolar Disorder and Mania

Lithium is a mood stabilizer that has been used as a treatment for bipolar disorder in the United States since 1970 and was being used in other countries even earlier. It is an effective medication for both the treatment of acute mania and the prevention of the recurrence of both manic and depressive symptoms in bipolar disorders (Keck & McElroy, 1998). Belmaker (2004) and Keck and McElroy (1998) reviewed numerous studies showing that lithium reduces the symptoms of acute mania. Like antipsychotic medications, mood stabilizers work by influencing neurotransmitter activity in the brain. Freeman and Stoll (1998) report that polypharmacy, or the use of multiple medications, is common in the treatment of refractory bipolar disorder, a term used to describe conditions that do not respond readily to a single medication. Very few controlled studies on the use of combinations of mood stabilizers have been conducted. The interactions of such combinations can be useful, but can also be very...

Psychosocial Treatments of Bipolar Disorder

Colom, Vieta, Martinez, Jorquera, and Gasto (1998) review and critique the different types of psychotherapy employed in the treatment of bipolar disorder. To date, none have established efficacy in controlled clinical trials regarding outcomes such as hospitalization, relapses, or suicidal behavior. This is in contrast to the numerous controlled studies highlighting the effectiveness of medication. Instead, a psychoeducational approach, either individually or in a group, seems to be the most promising.

Course of Bipolar Disorder When Taking Lithium

What typically transpires when someone with bipolar disorder takes lithium Compared to many of the clinical studies described earlier, the results from the field are mixed and disappointing. Lithium does not seem to consistently reduce the risk of recurrence of manic episodes as often as might be expected. Silverstone, McPherson, Hunt, and Romans (1998) examined the effectiveness of lithium in preventing recurrent episodes of bipolar disorder over a 2-year period following hospital discharge. Results showed that overall, 67 had a relapse. While a major reason for this may have been poor compliance by study participants, some even discontinuing the lithium, it is clear that this drug is not effective in many cases.

Bipolar Disorder

Knowledge about bipolar disorder, a serious mental illness that is characterized by depressive episodes and manic episodes, has grown extensively since the 1970's. Advanced neurobiological research and assessment techniques have shown the biochemical origins and genetic element of this disorder. Recent research indicates the ways in which stress may play a role in precipitating recurrence of episodes.

Dsmivtr Criteria for Bipolar I Disorder

Psychotic symptoms such as delusions, severe paranoia, and hallucinations may accompany a manic episode. These symptoms may lead to a misdiag-nosis of another psychotic disorder such as schizophrenia. However, skilled clinicians can make a differential diagnosis between schizophrenia and bipolar disorder. The initial episode of bipolar disorder is typically one of mania or elation, although in some people a depressive episode may signal the beginning of the disorder. Episodes of bipolar disorder can recur rapidly within hours or days or may have a much slower recurrence rate, even of years. The duration of each episode, whether it is depression or mania, varies widely among individuals but normally remains fairly consistent for each individual.

Short Term Course of These Diseases

What is the probable short-term prognosis for someone suffering from a severe mental illness For some, accurate diagnosis and effective treatment take place rapidly. But for others, this process can be difficult, making the time it takes to receive effective treatment extremely lengthy. Certainly, for most persons who develop schizophrenia the initial phase before effective treatment has begun can be the most devastating and the most frightening. As you will see, determining how to treat these diseases can be a very complicated process. In addition, during the initial stages of the disease the individual is often very unstable, making an accurate diagnosis even more difficult (Chen, Swann, & Johnson, 1998 Wiersma et al., 1998). For example, many people who are given a diagnosis of a mood disorder will later be diagnosed with schizophrenia. At the same time, those with a diagnosis of schizoaffective disorder are most likely to have their diagnosis changed at a subsequent psychiatric...

The Experience of Hospitalization

After being discharged from the hospital, what is the likelihood of rehospitalization One of the most illustrative articles on this topic was published by Anthony, Cohen, and Vitalo (1978). By comparing the reported recidivism (rehospitalization) rates from the studies available at the time (see Table 3.1), the authors demonstrated that the probability of relapse in the short term (1 to 5 years) is very high. An examination of Table 3.1 reveals that as the follow-up period increases from 3 months to 5 and 10 years, the corresponding cumulative rate of recidivism also increases from 10 to 15 to as high as about 75 . Clearly, if you have been hospitalized because of a serious mental illness, the chance you will need rehospitalization at some point in time is very high. This high risk of relapse is true of schizophrenia, schizoaffective disorder, major depression, and bipolar disorder.

Sources for Further Study

Depression in Late Life. 3d ed. New York Springer, 2002. A comprehensive review of the treatment of depression among the elderly. Covers epidemiology, pharmacology, depression and cognitive impairment, unipolar and bipolar disorders, bereavement, and existential depression. See also Bipolar Disorder Cognitive Behavior Therapy Cognitive Therapy Depression Diagnosis Drug Therapies Mood Disorders Suicide.

Understanding Course Treatment and Outcome What the Staff and Consumers Dont Know Can Hurt Them

The bewildering and sometimes confusing array of information regarding course, treatment, and outcome highlights the need for consumers and their families, as well as staff, to be informed about medications, symptom relief, and so forth. Illness self-management and recovery strategies such as those mentioned earlier make up an important aspect of the PsyR process. Consider the issue of continuing medication after someone is symptom free. We know that continuing medication during time periods of remission significantly reduces the likelihood of relapse for people with schizophrenia as well as bipolar disorder,

Endocrinological Aspects

Thyroid disorders also strongly affect mood. A study to evaluate the prevalence of mental disorders in 93 inpatients affected by different thyroid diseases during their lifetimes, by means of standardized instruments, showed higher rates of panic disorder, simple phobia, obsessive-compulsive disorder, MDD, bipolar disorder and cyclothymia in thyroid patients than in the general population 54 . These findings may suggest either that thyroid abnormalities effect secondary mood changes, or that the co-occurrence of mental and thyroid diseases may be the result of common biochemical abnormalities. possibility that the observed effects of lithium on THR gene expression may be related to its therapeutic efficacy in the treatment of bipolar disorders.

The symptoms and their treatments

Further, medications developed for use with dermatological treatment can also have dangerous side effects, which can include triggering psychiatric symptoms, and for this reason they often require careful monitoring. For example, isotretinoin used in the treatment of acne has been linked to depression (Kellett & Gawkrodger, 1999 Ng & Schweitzer, 2003) and Dapsone, another dermatological medication, has been linked to manic-depression (Gawkrodger, 1989 Zhu & Stiller, 2001).

DSMIV Diagnostic Criteria

Borderline Personality Disorder Borderline patients react with rage and emptiness when feeling abandoned. Dependent patients react with more submissive behavior when feeling abandoned. Self-destructive behavior and unstable relationships are unique to Borderline patients.

Prospective Memory in Affective Disorders

Overview There is nearly a complete lack of studies investigating prospective memory in affective disorders such as major depression or bipolar disorder, although some studies have addressed this issue in nonclinical samples (see Kliegel, J ger, et al., 2005 see Kliegel & J ger, 2006, for a review). As impairments in retrospective memory (Austin, Mitchell, & Goodwin, 2001 Burt, Zembar & Niederehe, 1995 Rogers et al., 2004) and executive functions (Channon, 1996 Elliott et al., 1997 Robertson & Taylor, 1985) have been found in major depression and bipolar disorder (Quraishi & Frangou, 2002), one can expect prospective memory deficits in patients suffering from affective disorders.

Historical Context

Clifford Beers was an articulate and intelligent Yale graduate who suffered from bipolar disorder, then called manic-depressive illness. Shortly after his graduation from college in the early 1900s, he suffered a mental collapse that resulted in his being hospitalized in several of what were then called mental asylums. Though much of the neglect and mistreatment of patients common in Dix's time had been eliminated, Beers soon discovered that confining patients in strait-jackets and choking them into unconsciousness were still very much a part of mental health care in American psychiatric hospitals. Beer's mistreatment and his recovery in spite of it became the basis of his 1908 bestseller, A Mind that Found Itself. Two of Beers' staunchest and most influential admirers turned out to be James and famed psychiatrist Adolph Meyer. Meyer coined a new name for what was then commonly called madness mental hygiene. That same year, the Society for Mental Hygiene was founded, soon followed by...

Which Therapy Is Best

Researchers approach the question of which therapy is best in the context of specific disorders. No one therapy is recommended for every disorder. For instance, behavior therapy has proven to be highly successful with phobias, cognitive therapy shows good results with depression, and a trial of medication is usual for schizophrenia and bipolar disorder.

Dimensions of the problem

Of the ten leading causes of disease burden in young adults (in the 15A4 year age group) four were neuropsychiatric conditions. In 1998, alcohol dependence, unipolar major depression, bipolar disorder and schizophrenia were among the leading causes of disease burden in adults aged 15A44 years.

Prevalence Of Mental Disorders Among Homeless People

In most studies of homeless populations, the lifetime prevalence of mental disorders is 28-37 3.3-5 for severe cognitive disorders (dementia), 7.813 for schizophrenia, 8.2-17.5 for severe depressive disorders, and 5 for bipolar disorder. In addition, a pooled lifetime prevalence estimate from diverse studies indicates that 56 of homeless people in their lifetime will meet criteria for a substance-related disorder 30 .

The Use Of Health Care Services By The Homeless Mentally

International comparisons of use of the health system are extremely difficult, because each research group uses its own methods and definitions. We did not compare our results with the Spanish data 27 because that study did not provide this particular information. The German study 5 used the lifetime hospitalization rate for mental disorders as a measure of care, obtaining 34.5 in general hospitals and 27.6 in psychiatric hospitals. These rates are double ours (13.1 and 10 ). Data from the UK 6 show lower rates of hospitalization for mental disorders (15 ) and lower use of psychotropic drugs (32 versus 42.4 for depressive disorders). The St Louis study 32 allows a better comparison except for bipolar disorder, our hospitalization rates are higher, and rates for overall instances of care are twice as high for schizophrenia and depressive disorders and three times higher for substance-related disorders. These comparisons are approximate, but it seems that patterns of care for homeless...

Valproic Acid Depakote

It is effective for bipolar disorder, schizoaffective disorder, and cyclothymia. It is also used for impulse control disorders and aggression in demented or mentally retarded patients. C. Valproic acid is more effective in rapid cycling and mixed state episode bipolar disorder than lithium.

The Stress VulnerabilityCoping Competence Model

The stress vulnerability coping competence model was proposed by two individuals who are well known in the field of psychiatric rehabilitation, William A. Anthony and Robert Paul Liberman (1986). An elaboration of the diathesis stress model described earlier, the stress vulnerability coping competence model provides both a theory about the cause of severe mental illness and an explanatory framework for the impact that psychiatric rehabilitation and treatment interventions can have on the symptoms and functional level of people who have psychiatric disabilities. The model proposes the following Individuals inherit or otherwise acquire a vulnerability (sometimes referred to as diathesis) to major mental illnesses such as schizophrenia, major depression, or bipolar disorder. This vulnerability results in abnormal development of brain structures and processes or an unusual type of stress reaction.

The Symptoms of Mental Illness

Mental illnesses may present a wide variety of symptoms. The symptoms of the severe mental illnesses can be classified into two categories positive symptoms and negative symptoms. Positive symptoms refer to what is added to the individual because of the disease. Psychoses, the faulty interpretation of reality due to incorrect sensory perceptions (hallucinations) or thoughts (delusions), are good examples of positive symptoms. Negative symptoms refer to things that the individual has lost because of the disease. Social withdrawal and an inability to experience pleasure, anhedonia, are typical examples of the kinds of negative symptoms someone with severe mental illness might experience. The great majority of persons experiencing these conditions are diagnosed with schizophrenia or a bi-polar disorder (manic depression). Chapters 2 and 3 will cover the cause, symptoms, and treatment of mental illness in more depth.

HPT Axis Dysfunction in Patients with Primary Psychiatric Disorders

HPT axis abnormalities have also been reported in bipolar disorders. Both elevated basal plasma concentrations of TSH and an exaggerated TSH response to TRH have been demonstrated 15, 16 . There is also evidence that bipolar patients with the rapid cycling subtype have a higher prevalence of hypothyroidism (grades 1, 2 and 3) than bipolar patients without rapid cycling 17, 18 . A blunted or absent evening surge of plasma TSH, a blunted TSH response to TRH 19, 20 , and the presence of antithyroid microsomal and or antithyroglobulin antibodies 21, 22 have also been demonstrated in bipolar patients.

Some Ineffective Treatments

Insight-oriented, psychodynamic therapies can be defined as those that use interpretation of unconscious material and focus on therapeutic transference. In the treatment of serious mental illnesses of all types, this form of psychotherapy has been found to be generally ineffective. Actually, some studies have found psychodynamic treatments to be harmful. The consensus is that these therapies should no longer be used to treat schizophrenia (Lehman & Steinwachs, 1998), bipolar disorder (Keck & McElroy, 1998), or major depression (Craighead et al., 1998a). There is, however, a role for providing support through individual counseling identified in the research of Hogarty (1993). Effective individual counseling with people who have severe mental illness generally focuses on support, the person's present life situation (rather than past experiences), and problem solving.

The History of the Self Help Movement

Over the years, Recovery Inc. has grown into an international organization totally run by its members. In meetings, members share examples of everyday life situations where they have applied Recovery Inc. principles. They share their stories in four steps. In the first step the members summarize situations that trigger emotional distress. In the second step members specify symptoms that they experienced. The third step involves relabeling diagnoses, symptoms, and stressful situations using Recovery Inc. terminology. For example, a person diagnosed with bipolar disorder might stop referring to himself as a manic-depressive and instead say, I am an average nervous person. This part of the process helps members to cognitively reframe symptoms and situations that they previously experienced as devastating into manageable aspects of their day-to-day functioning. The last step involves members speculating on how they would have handled the situation before they learned self-help techniques...

Course of Mood Disorders

Although there is some evidence that the course of schizophrenia does not progressively worsen for the majority of individuals with that diagnosis, some studies suggest that the course of chronic or recurrent mood disorders may worsen over time (Kessing, 1998 Kessing, Andersen, Mortensen, & Bolwig, 1998). Outcomes studies of 2 to 5 years' duration have found that for individuals with bipolar disorder, recurrent episodes lead to deterioration in both social and vocational functioning (Keck & McElroy, 1998). This observation may seem unexpected to some mental health professionals. Generally speaking, between acute episodes of mood disorders, there is a greater remission of symptoms than is typically found in schizophrenic disorders (APA, 1994). That is, the person with a mood disorder is likely to be symptom free between acute episodes. Interestingly enough, this does not necessarily imply that the course of a mood disorder is less serious or less virulent. Kessing and his colleagues...

From Melancholy to Prozac

In the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (rev. 4th ed., 2000), a common diagnostic tool, unipolar depression is divided into the categories Dysthymic Disorder, Major Depressive Disorder-Single Episode, and Major Depressive Disorder-Recurrent, while bipolar depression is divided into Bipolar I Disorder, Bipolar II Disorder, Cyclothymic Disorder, and Bipolar Disorder Not Otherwise Specified (NOS). In most articles, the term depression refers to unipolar depression only. Because unipolar depression is much more common than bipolar depression, it is likely that it will continue to attract a larger share of research attention in the future.

Borderline Personality Disorder

Gabbard (2000) cites that childhood maltreatment is considered an etiological factor in BPD. The symptoms of BPD include fears of abandonment, unstable and intense relationships, disturbance in identity, self-destructive behavior, recurrent suicidal and self-injurious behavior, unstable affect, feelings of emptiness, intense anger, transient psychosis, and dissociation (Allen, 2001). The causal or precise etiological relationship between trauma and BPD has not been fully delineated yet, but promising lines of research indicate that the same biological underpinnings of PTSD may be active in BPD. Marsha Linehan and colleagues' diathesis-stress model is considered a good model although it requires more empirical investigation.

Medical Models of Abnormality

The medical model ushered in humane treatment for people who hitherto had been persecuted as agents of the devil. Some of the advances in treatment for psychological problems include antipsychotic medication, which can reduce hallucinations and help a person with schizophrenia avoid hospitalization lithium, which can moderate the debilitating mood extremes of bipolar disorder antidepressants, which can relieve the chronic pain of depression and antianxiety drugs, which can relieve the acute stress of anxiety disorders. These kinds of advances help the day-to-day lives of many people.

Epidemiology of Cyclothymic Disorder

Thirty percent of patients have a family history of bipolar disorder. A. Mood stabilizers are the treatment of choice, and Lithium is effective in 60 of patients. The clinical use of mood stabilizers is similar to that of bipolar disorder. (Also see Mood Stabilizers, page 112).

Critical evaluation of the theory

The concept of need itself is also problematic. Needs seem to be things that organisms require in order to function however, people and animals often strive for things that they don't require at all. Curiosity and playfulness are examples, as are tendencies toward self-destructive behavior. One solution to this difficulty is to propose the existence of a very large number of needs, one for each observed behavior, but then the only way to prove that these needs exist is to show that organisms engage in behavior to satisfy each need another example of circular reasoning. More recent theories of motivation have tended to move away from the concept of needs because of this problem.

Personality Types and Freedom Escape

Destructive individuals reduce anxiety and insecurity by destroying other persons or things. Fromm suggested that ideally people derive satisfaction and security through constructive endeavors, but noted that some people lack the skill and motivation to create and therefore engage in destructive behavior as an impoverished substitute for constructive activities.

Benefits to Peer Providers and Mental Health Systems

Laura, a 38-year-old woman who currently works as a peer advocate on a PACT team, was diagnosed with bipolar disorder when she was 24. A college graduate with a degree in English, Laura hoped for a career in publishing. She had some success as an assistant editor when she was in her early 20s, but her illness interrupted her career and by the time she was 30 she wondered if she could even hold a job. After experiencing success as a cofacilitator of a self-help group, Laura decided to apply for the PACT team position. After 2 years working as a peer provider, she says, It was one of the best decisions I ever made. For many years my illness got in the way of my career. I felt sorry for myself and thought I was a failure. Now I see that my illness has helped me to become a more compassionate person who can make a difference in other people's lives. My job has done wonders for my self-esteem. I feel like every time I help someone I am taking a step forward in my own recovery.

Schizophrenia And Other Cognitive Disorders

GRK3, a candidate gene for mania and psychosis identified through a convergent functional approach 5 , has been implicated in dampening signal transduction from G-protein-coupled receptors in neuronal and other tissues, and is present in human lymphocytes. There are some preliminary data indicating alterations of its levels in lymphocytes from patients with bipolar disorders 5 , and it may deserve further scrutiny in subtypes of schizophrenia also, as a possible peripheral marker.

Magnetic Resonance Imaging

Brain Has Structure Magnet

Comparisons of brain MRI data generally find more morphological deviations in schizophrenic patients than in those with affective disorders or alcohol abuse 32, 33 . The most consistent structural change in depressive patients is the observation of deep subcortical hyper-intensities in patients with severe and old-age depression 34, 35 . In some studies, expansion of the ventricular system and reduction of prefrontal lobe volumes have also been observed 36 . Although authors of the latter study found reduced volumes of the left hippocampus in depressed patients, such a change has been questioned by other authors 37 . In a structural brain MRI study of depressed children, Steingard et al. 38 found a significantly lower frontal lobe volume in the depressive patients with early onset. The incidence of cavum septum pellucidum, which has often been regarded as a neurodevelopmental anomaly, has been found to be higher in patients with schizophrenia. Shioiri et al. 39...

How Are Schizophrenia and Mood Disorders Different

While schizophrenia is characterized by its psychotic symptoms, and a mood disorder is characterized by its emotional or affective symptoms, the distinction between the two diagnostic categories is not always so clear. For example, both Robert and Mark who were diagnosed with bipolar disorders experienced grandiose delusions. They said their thoughts raced quickly, and Mark said that at times he heard voices. Consider what happened to Dave Dave had racing thoughts, imagined he was a Mafiosi and, at other times, a saint. He spoke quickly and incoherently. At times he would suddenly become sullen and withdrawn. He was treated with antipsychotic medication for many years, without much improvement and many side effects. He died in the state hospital. Later on, when his daughter was diagnosed with bipolar disorder, manic type, it occurred to the other members of the family that their father may have been incorrectly diagnosed as having schizophrenia and, therefore, improperly treated all...

Seasonal affective disorder SAD

Although mood fluctuations are a normal part of life, individuals with bipolar affective disorder experience extreme mood changes. Bipolar affective disorder, or bipolar disorder (also called manic-depressive disorder), has been identified as a major psychiatric disorder characterized by dramatic mood and behavior changes. These changes, ranging from episodes of high euphoric moods to deep depressions, with accompanying behavioral and personality changes, are devastating to the victims of the disorder and perplexing to the loved ones of those affected. Prevalence rates have been estimated at about 1.6 (0.8 to 2.6) percent of the American population. The disorder is divided fairly equally between males and females. Clinical psychiatry has been effective in providing biochemical intervention in the form of lithium carbonate to stabilize or modulate the ups and downs of this illness. However, lithium treatment has only been effective for approximately 70 percent of those to whom it is...

Mood Disorders

Depressive episodes are characterized by extreme sadness or emptiness lasting most of the day, everyday, for a period of 2 weeks or longer. Manic episodes are marked by an elevated mood, in which the person feels excessively up or high, and occasionally excessively irritable, for a period of a week or more. In a mixed episode, a person meets the criteria for both types of episodes, cycling through depressive and manic phases of the illness. When an individual experiences one or more recurrent episodes of depression, he or she may be diagnosed with major depression, recurrent (APA, 2000). Individuals who experience more than one instance of two out of the three types of episodes may have what is known as bipolar disorder, formerly called manic-depression. Both major depression and bipolar disorder may or may not have some of the psychotic features described earlier, such as hallucinations and delusions. Of course, what is so remarkable are the extremes in symptoms within the same...

Impact

The impact of bipolar disorder is considerable. Some believe that the illness puts people on an emotional roller coaster in which their ups and downs are so severe that resulting behavior can have its own disastrous consequences. For example, people suffering from episodes of mania sometimes use drugs, alcohol, money, or sex to excess, then later have to deal with an additional set of problems and trauma brought about by their behavior and impulsiveness. Organizations such as the National Alliance for the Mentally Ill (NAMI) and support groups such as the Depressive and Manic Depressive Association (DMDA) have provided a way for people with bipolar disorder to share their pain as well as to triumph over the illness. Many people have found comfort in knowing that others have suffered from the mood shifts, and they can draw strength from one another. Family members and friends can be the strongest supporters and advocates for those who have bipolar disorder or other psychiatric...

Summary

Individuals who are served in psychiatric rehabilitation programs have various psychiatric diagnoses including schizophrenia, schizoaffective disorder, bipolar disorder, and recurrent major depressive disorder. Generally speaking, within PsyR programs, the most common diagnoses are schizophrenic disorders, while in the general population, mood disorders are more common. Details of the criteria of these diagnoses are reported in the American Psychiatric Association's DSM-IV-TR manual (APA, 2000). These disorders are long term and characterized by episodes of acute illness followed by periods of residual symptoms and remission. In the acute phases of these disorders and occasionally at other times, the resulting symptoms have serious behavioral manifestations, and often come to preoccupy the sensory and cognitive experience of the individual.

Tissue Remodelling

Additional evidence implicates the PFC in addition to the hippocampus as a site of neuropathology in depression. The PFC may be involved in stress-mediated neurotoxicity because stress alters PFC functions and glu-cocorticoid receptors, the PFC is directly interconnected with the hippocampus, and metabolic alterations are present in the PFC in depressed patients. Post-mortem studies in major depression and bipolar disorders provide evidence for specific neuronal and glial histopathology in mood disorders 8 . Three patterns of morphometric cellular changes were observed in that

Joses Story

Jose is a 36-year-old man who has struggled with bipolar disorder for more than 10 years. After graduating from high school, Jose got a job selling office supplies and attended a community college at night. He obtained a certificate in computer programming that helped him to get a better job at a computer software company. After a few years in this job, Jose realized that if he wanted to move up the career ladder he would need more education. He decided to pursue a bachelor's degree in computer science. Jose found the ordeal of dealing with admissions, registering for classes, and securing financial aid to be frustrating and annoying but no more so than the other students did. However, attending classes at night after working all day was very difficult. Jose had trouble falling asleep at night, which meant he was tired the next day. He found himself making mistakes at work and he started to feel extremely anxious. He was not aware that these were prodromal signs of serious mental...

Affective Disorders

Topographical considerations are important but little explored and may distinguish bipolar disorder from schizophrenia 238, 239 . Buchsbaum et al. 240 examined a bipolar patient through five regular and rapid switches from mania to depression, finding that changes in the P200 amplitude were synchronous with the switches, decreasing at the vertex and increasing occipitally with mania. Altered stimulus dependency relations, revealed with the P100, preceded the switch from depression to mania by 8-10 days. evidence of hyper-responsiveness, particularly in left-hand responses, and this coincided with higher self-rated depression. Larger left- than right-hand responses to non-signal stimuli had earlier been reported in endogenous depression 249, 250 . This was subsequently reported in college students described as subsyndromal and at risk for bipolar disorder 251 , in whom there was also a bias towards leftward conjugate eye movements in response to cognitive problems. Together the...

Postmortem Studies

The studies of the GABA system described in this section have been designed to provide the information regarding the disinhibitory interactions of this system with itself (GABA-to-GABA) and with the dopamine system. There are many different markers and methods that have been used to study the GABA system, including non-pyramidal cell counts 86, 133 , assays of GABA concentrations 134 , enzymatic 135 and ICC studies of glutamate decarboxylase (GAD) 136,137 , GABA receptor binding activity 84, 138-140 , the GABA transporter 141-145 , calcium binding 146-151 and other peptides, such as reelin 152, 153 . These studies have been providing overwhelming evidence that the GABA system is down-regulated in schizophrenia and, more recently, in bipolar disorder. Cell counting studies have indicated that an overt loss of GABAergic cells is a feature of bipolar disorder, but not schizophrenia. Nevertheless, patients with schizophrenia also show a defect of GABAergic neurotransmission, as suggested...

Anatomic Networks

Cajal-Retzius cells that may be GABAergic in nature 255, 256 . These neurons are the first to appear and are localized in layer I 257 . During early development of the cortex, they interact with Martinotti cells in deeper laminae and may play a role in the formation of laminar patterns 257 . In both schizophrenia and bipolar disorder, reelin and GAD67 mRNA have been found to be decreased in layer I and, to a lesser extent, layer II 152 . These latter findings are consistent with both a cell counting study 86 and highresolution analyses of GABAA receptor binding activity 169 showing preferential changes in layer II of the prefrontal cortex. The authors of these studies propose that a down-regulation of reelin expression in this region of schizophrenic and bipolar brain may be due to either a genetic or an epigenetic factor. Since this protein is reduced in both schizophrenia and bipolar disorder, it seems more likely that the changes noted might be related to an environmental factor...

DSM code 29689

Generations are affected by bipolar disorder. Serotonin, norepinephrine, and dopamine, brain chemicals known as neurotransmitters that regulate mood, arousal, and energy, respectively, may be altered in bipolar disorder. A diathesis-stress model has been proposed for some psychosomatic disorders such as hypertension and ulcers. This model has also been applied to bipolar disorder. In a diathesis-stress model, there is a susceptibility (the diathesis) for the disorder. An individual who has a diathesis is at risk for the disorder but may not show signs of the disorder unless there is sufficient stress. In this model, a genetic or biochemical predisposition toward the disorder (the bipolar diathesis) may lie dormant until stress triggers the emergence of the illness. The stress may be psychosocial, biological, neuro-chemical, or a combination of these factors. A diathesis-stress model can also account for some of the recurrent episodes of mania in bipolar disorder. Investigators suggest...

Unipolar depression

By Robert Burton in The Anatomy of Melancholy (1621), in which he noted that the inbred cause of melancholy is our temperature, in whole or part, which we receive from our parents and such as the temperature of the father is, such is the son's, and look what disease the father had when he begot him, his son will have after him. More than 350 years later, the role of family factors in depression was addressed in a major collaborative study in the United States. In what was called the National Institute of Mental Health Collaborative Study of the Psychobiology of Depression, a large number of standardized instruments were developed to assess prevalence and incidence of depression, life histories, psychosocial stressors, and outcome of depression. The family members of depressed persons were assessed along with the depressed individual. It was found that bipolar depression was largely confined to relatives of individuals with bipolar disorder. Unipolar depression, however, was common...

Rogers Story

Roger is a 45-year-old man with a dual diagnosis of bipolar disorder and substance abuse disorder. He jokes that he's recovering from substance abuse and the system, meaning the school system, the foster care system, and the legal system. As a child he moved from one foster home to another. Roger's school performance was generally mediocre. He occasionally did well on tests or assignments but more often barely passed. Most Roger's first arrest was for shoplifting a six pack of beer. He had no trouble convincing the judge that it was a teenage prank. The third time he was arrested the judge decided to keep him in jail overnight. The school refused to be involved since Roger had dropped out a few months earlier when he turned 16. In the jail cell Roger went wild screaming, cursing, punching his fists, and finally slamming his body into the cell wall over and over again. Roger only vaguely remembers what happened next the restraints with belts, the ambulance, the injection. He woke up in...

The Role of Stress

Stress Etiology

Stressful life events also play a role in the onset of episodes experienced by people diagnosed with bipolar disorder. However, research shows that psychosocial and environmental stressors are more evident prior to the onset of the early episodes of this illness. The influence of these stressors seems to play little or no role after the first few episodes (Goodwin & Jamison, 1990). Clearly the etiology of these disorders is complex and cannot be explained simply as extreme sensitivity to stress.

Tardive dyskinesia

For at least six months, and the individual must show marked impairment in a major area of functioning such as work or interpersonal relations. Further, the presence of other disorders, such as drug reactions or organic brain disorders associated with aging, must be ruled out. Thus, the diagnosis of schizophrenia typically involves a thorough physical and mental assessment. While no single individual symptom is necessary for a person to receive a diagnosis of schizophrenia, according to the DSM-IV-TR, the persistent and debilitating presence of bizarre hallucinations, which can include a hallucinated voice commenting on the individual or hallucinated conversations between two voices, is a strong indication of schizophrenia. The presence of delusions or hallucinations and loss of contact with reality is referred to as psychosis and is often present in schizophrenia, but psychotic symptoms can be seen in other mental disorders (for example, bipolar disorder or substance-induced...

Preamble

Experimental and theoretical studies are presented from a laboratory-scale thermal destruction facility on the destructive behavior of surrogate plastic and nonplastic solid wastes. The nonplastic waste was cellulosic while the plastic waste contained compounds such as polyethylene, polyvinyl chloride, polystyrene, polypropylene, nylon, rubber, and polyurethane or any of their desired mixtures. A series of combustion tests was performed with samples containing varying composition of plastic and nonplastic. Experimental results are presented on combustion parameters (CO, excess air, residence time) and toxic emissions (dioxin, furan, metals).

Schizophrenia

In a recent study, Sponheim et al. 104 examined EEG power abnormalities, brain morphology, oculomotor functioning, electrodermal activity, and nailfold plexus visibility in 112 patients with schizophrenia (54 first-episode, 58 chronic), 78 with non-schizophrenic psychosis (33 with bipolar disorder, 29 with a major depressive disorder and 16 with other psychoses) and 107 non-psychiatric controls. Almost all patients were receiving medication. The two patient groups were subdivided in high and low LFA (augmented low frequencies, diminished alpha factor). In the group of patients with schizophrenia, those with high LFA exhibited more negative symptoms, a wider third ventricle, larger frontal horns of the lateral ventricles, and larger cortical sulci than those with low LFA moreover, first-episode schizophrenic patients with high LFA showed worse oculomotor performance and chronic patients with high LFA had more deviant electrodermal activation. These associations were not observed in the...

Cluster B

Tive and negative feelings about significant people in their lives. This behavior is referred to as splitting and may contribute to the emotional instability displayed by these people. People with BPD often engage in self-destructive behavior, such as self-mutilation, suicidal acts, or drug abuse. Those with BPD report chronic feelings of emptiness.

Treatment Approaches

Medications have been developed to aid in correcting the biochemical imbalances thought to be part of bipolar disorder. Lithium carbonate is usually effective for approximately 70 percent of those who take it. Many brilliant and successful people have reportedly suffered from bipolar disorder and have been able to function successfully with competent and responsible treatment. Some people who have taken lithium for bipolar disorder, however, have complained that it robs them of their energy and creativity and said that they actually miss the energy associated with manic phases of the illness. This perceived loss, some of it realistic, can be a factor in relapse associated with lithium noncompliance. Other medications have been developed to help those individuals who are considered lithium nonresponders or who find the side effects of lithium intolerable. Anticonvulsant medications, such as Depakote (valproic acid), Tegretol (carbamazepine), and Lamictal (lamotrigine), which have been...

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