Mental Health Partners

Bipolar Disorder Schizophrenia Article Review Anna-Lisa Greenwade Family Psychiatric NP-BC

Neurobiology of Bipolar
Bipolar disorder Genetic Environmental/Psychosocial Kindling Depression: Monoamine receptor hypothesis DA, 5HT, NE Malfunctioning circuits HPA activation CRF glucocorticoid (Hypo)mania: Deficient GABA & increased Glutamate Increased activity of DA, 5HT, & NE Influx of Calcium into cells Nerve cell hyperfiring and neuronal death
(Stahl, 2009; Kaplan & Saddock, 2009; Weber, 2010)

Literature Review: Nonpharmacological

IPSRT & FFT (RCT) 30 session intensive therapy vs. 3-session PE: improved overall & relationship functioning, life satisfaction compared to PE alone (Miklowitz et al., 2007) Group PE (RCT) 6 month Group PE benefits over 5 yrs.: hospitalization, number of (hypo)manic, depressive episodes (Colom et al., 2009) Limitation: exclusions of co-morbid dx or substance abuse

Pharmacological
Back to neurobiology and why the medication works

Expert Consensus & Psychopharmacology Rationale

Guidelines British College of Psychopharmacology EB Guidelines: antidepressant recommendations CANMAT (2007): maintenance in BD II APA Guidelines: Limitations

Cost, Access, & Advocacy

Bipolar Illness Burden (Hirschfield, 2005) Lost employment 6th top disabling condition; 25% attempt suicide Misdiagnosis & co-morbidities 70% of Bipolar treatment costs occur outside mental health sector (Baer et al., 2006) Waiting lists at Colorado community mental health centers CO's annual mental health spending is 25% below national average (Colorado, 2009) Individuals with serious mental illness are dying 25 years early
(AHRQ, 2010)

Reimbursement issues Behavioral Health Maintenance Organizations (BHMOs): can prohibit billing from non-mental health settings

Framing Practice: Early Intervention

Changes in brain structure over time with Bipolar Brain grossly intact initially: decline in volume with reoccurrence (Berk, et al., 2010) Early identification

References
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Bowden CL, Calabrese JR, Sachs G, Yatham LN, Asghar SA, Hompland M, Montgomery P, Earl N, Smoot TM, DeVeaugh-Geiss J: A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder. Arch Gen Psychiatry 2003; 60:392400
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