Bipolar Disorder bridges the gap between mood disorders and psychotic disorders and is characterised by abnormal moods or exaggerated mood swings.
There are two types of Bipolar Disorder:
- Bipolar I Disorder is most closely aligned with the traditional “manic-depression” though lifetime experience of a major depressive episode and psychosis are not requirements for diagnosis.
- Bipolar II Disorder, historically considered the “milder” form of the disorder, is characterised by lifetime experience of at least one major depressive episode and one hypomanic episode.
Assessing and Diagnosing Bipolar Disorder
A number of screening tools are available, eg the Bipolar Disorder Self-Assessment Test (Black Dog Institute) which is available as an online tool, and as a Clinician Version to download and print.
For diagnostic purposes however, your psychologist will not rely on screening tools alone and will use your time together to gather information about your symptoms, their onset, severity and duration, and other factors, both historical and current that might impact on your diagnosis.
For a diagnosis of Bipolar I Disorder, a manic episode is the key indicator. Someone experiencing a manic episode might experience:
- Elevated (“high”) mood;
- Increased energy;
- Racing thoughts;
- Inflated self-esteem;
- Decreased need for sleep;
- Increased goal-directed activity;
- Increased risk-taking.
The presence of hypomanic episodes (less extreme “highs”) and depressive episodes is also common in Bipolar I Disorder but not required for diagnosis.
People with Bipolar II Disorder commonly experience hypomania and depressive episodes. Between extreme moods, they might have times where their mood is relatively stable.
Specific Issues in Middle Adulthood
There are no diagnostic specifiers or considerations particular to middle adulthood, however research indicates an increase in depressive symptoms for women with Bipolar Disorder during menopausal transition. Further, a number of the medications used to treat Bipolar Disorder have an impact on physiological outcomes (eg bone density).
Given pharmacotherapy is relied upon in the treatment of Bipolar Disorder, menopause may compound the physiological impacts of medication as well as the associated fluctuations in mood.
Treatment for Bipolar Disorder
Historically, psychotherapy was not considered relevant in the treatment of Bipolar Disorder as it was considered a largely biological condition. However there is now evidence that a number of psychological interventions may be effective in the treatment of Bipolar as an adjunct to psychopharmacological treatment. Note most available research into treatment for Bipolar Disorder does not distinguish between Bipolar I and Bipolar II.
Mood stabilisers (eg Lithium) are used as a primary treatment, supplemented by antidepressant and anti-anxiety medications to provide acute care during mood episodes and encourage long-term mood stability.
Cognitive Behaviour Therapy, Interpersonal Therapy, Family Therapy, Mindfulness-based Cognitive Therapy, and Psychoeducation all have Level II evidence (at least one properly designed randomised controlled trial) for the treatment of Bipolar Disorder. Many of these interventions share key elements, which has made evaluating their individual role more difficult. The common shared themes are:
- Education about bipolar disorder;
- Regularising daily activities;
- Reducing substance misuse;
- Enhancing medication adherence;
- Identifying and managing early warning signs of relapse.
A Wellbeing Plan (similar to a relapse prevention plan) is highlighted as a particularly important treatment component and can include:
- Coping with stressful situations;
- Lifestyle changes;
- Regular routine;
- Early warning signs – and what to do when they appear;
- Triggers – how to avoid them or minimise their impact;
- Medication compliance.
Bipolar Disorder and Menopause
For women experiencing the menopausal transition, learning about, preparing for and/or accepting the significant physiological and associated emotional changes they are likely to experience may be a key component of treatment. This may be of even greater importance for women whose prescribed medication requires review and/or change as a result of the impact of side effects during the transitional period. Your psychologist can discuss the impact of all of these changes and develop strategies with you to manage the transition as part of your treatment plan.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorder, 5th Edition. Washington, DC: APA Press.
- Australian Psychological Society (2010). Evidence-based Psychological Interventions in the Treatment of Mental Disorders: A Literature Review 3rd Ed. Sydney: APS
- Drake, M.E. (2014). DSM-5 Category: Bipolar and Related Disorders. Retrieved: http://www.theravive.com/therapedia/Bipolar-I-Disorder-DSM–5-296-(ICD–10–CM-Multiple-Codes)
- First, Michael B., Spitzer, Robert L, Gibbon Miriam, and Williams, & Janet B.W. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). Washington, D.C.: American Psychiatric Press, Inc.
- Khalif, S., Singh, V., Muzina, D.J. (2010). Bipolar Disorder. Cleveland Clinic Centre for Continuing Education. Retrieved: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/psychiatry-psychology/
- Marsh, W.K., Templeton, A., Ketter, T.A., & Rasgon, N.L. (2008). Increased frequency of depressive episodes during the menopausal transition in women with bipolar disorder: Preliminary report. Journal of Psychiatric Research 42 (3): 247-251.
- Marsh, W.K., Ketter, T.A., & Rasgon, N.L. (2009). Increased depressive symptoms in menopausal age women with bipolar disorder: Age and gender comparison. Journal of Psychiatric Research 43 (8): 798-802.
- Marsh, W.K., Ketter, T.A., Crawford, S.L., Johnson, J.V., Kroll-Desrosiers, A.R., & Rothschild, A.J. (2012). Progression of female reproductive stages associated with bipolar illness exacerbation. Bipolar Disorders 14: 515 – 526.
- Otto, M.W., & Miklowitz, D.J. (2006). Bipolar Disorder. In J.E. Fisher, & W.T. O’Donohue, (Eds.). Practitioners Guide to evidence-based psychotherapy. New York: Springer Publishing Company.
- Soares, C.N., & Taylor, V. (2007). Effects and management of the menopausal transition in women with depression and bipolar disorder. Journal of Clinical Psychiatry 68: 16-21.