Psych 380 1nd Edition Lecture 12 Outline of Current Lecture I Manic episode Current Lecture I II III IV Manic episode a Elevated expansive or irritable mood excessive energy and drive lasts at least 1 week b Symptoms 3 4 if only irritable i Grandiosity ii Decreased sleep iii More talkative iv Racing thoughts flight of ideas v Distractibility vi Goal directed activity or psychomotor agitation vii Costly or unwise activities buying investing sex Bipolar disorder formerly Manic depressive disorder a No equilibrium in mood b Manic episodes consist of high energy then afterwards there is a week of deep depression peaks and valleys c 2 poles of the spectrum d bipolar disorder is one of the most worrisome conditions for suicide risk e high variability in mood f energized state can sometimes step over into psychosis g engage in risky behavior example given about former assistant a every once in a while he would miss a meeting b if he didn t take his medication he would start walking for no reason with no particular destination c he would walk until his feet bled d why would he stop taking his meds e When you are in the middle of a high you are more creative you are ecstatically happy you want to live on the edge Case study Sam a 40 years old b brought to therapy by his girlfriend These notes represent a detailed interpretation of the professor s lecture GradeBuddy is best used as a supplement to your own notes not as a substitute V VI c thought she loved him wanted to help him d he had uncontrollable episodes e she knew he had mania f he was a realtor 30 000 year g every once in a while he would act in a grandiose way h he had a plan to renovate an abandoned mill into luxury condos i when in a manic state he was very creative j this was periodic for Sam condos a called mayor b called governor c called the White House d operators at the white house get calls from psychologically disturbed individuals e operator funnels them appropriately f the extent to which he wanted to execute the plan was too far symptoms a sam wouldn t sleep for days i 72 hours without sleep cognitively and emotionally out of wack ii brain needs sleep iii lack of sleep throws fuel on fire iv makes the situation worse b talking a mile a minute i really fast and excessive c distractability i 1st session ii came with a brief case iii his brief case was full of hundreds of pieces of paper iv wanted to show him a George Carlin tape d Costly or unwise activities buying investing sex i Calls an advertisement to have a 4 some with another couple ii His girlfriend answered the door and said that this was the breaking point e People with bipolar disorder are seriously impaired i He doesn t want to go to therapy ii Girlfriend won t stay in relationship unless he goes to therapy f Another example i Woman brings her husband to the hospital ii He was a multimillionaire iii He was making a number of large investments on real estate iv Spending millions of dollars on down payments v Before going to the hospital they went into Bloomingdales to get new pajamas vi He told them he wanted to buy 20 of a certain lamp his wife had to stop him g What happens after manic events i People collapse after manic events ii Living with someone like this is exhausting iii Fine line when they are out of control h Video silver linings playbook i Main character Patrick ii Reading Hemmingway in the middle of the night iii He doesn t like the ending and throws the book out of the window iv Goes into his parents room and rants about it v He is incorrigible vi He goes to the psychiatrist vii His therapist plays a provocative song at the office viii This was his wedding song ix He walked into his wife cheating on him i How can this be treated i Start with normalizing daily routine ii Get back to a regular circadian rhythm iii People often have a hard time being in relationships because of their volatility have them work on their relationships j Interpersonal and social rhythm therapy i Theory interpersonal stress affects circadian rhythms routines and moods ii Therapy insight about disorder stabilize routines sleep wake cycles iii Attending to relationships iv Take medication k Need to stabilize Sam s life i He was staying up all night at the office ii He wasn t sleeping iii Needs to work on his relationship 1 he is going to burn out his girlfriend iv medication 1 mood stabilizer l kindling i every time you have a manic episode it makes you more vulnerable to have another one ii because of this we want to prevent them as soon as possible iii they are cumulative iv certain drugs can mess up your neurochemistry such as MDMA v predisposing yourself can lead to the occurrence of a breakdown m uphill battle he is going to lose his girlfriend unless he starts therapy i dr Halgin says he needs rest good nutrition ii He lays out a pattern of activities iii Medication VII VIII IX X XI 1 Lithium common 2 Stabilizes mood and prevents highs n Sam is resistant to medication because it makes him feel flat and bored i Why take the highs away ii They could kill him when he experiences a low depression o Sam wasn t always good about taking his medication i One time he came into therapy wearing a hello kitty watch ii Another time he ran into him at the Hampshire athletic club iii hey that s my shrink iv he still gets a little depressed p Sam responded well to low doses of lithium i Needs to checked that the lithium is therapeutic and not toxic q Sam would have episodes that caused him stress these would be predictors i Even with meds he was still vulnerable to episodes Major depressive disorder a Mood change at least 2 weeks 5 i Depressed mood most of the day nearly every day ii Diminished interest or pleasure iii Weight loss or gain or appetite loss gain 1 Don t have energy to eat iv Insomnia hypersomnia v Psychomotor agitation or retardation vi Fatigue or loss of energy vii Worthlessness or guilt may be delusional viii Diminished concentration or decisiveness ix Recurrent thoughts of death or ideation or attempt Suicide is now more overtly written about in an obituary a Talk more about how people chose to leave this world b It is talked about like it is the courageous thing to do Best resource NAMI a National association for mental illness b Laws involuntary hospitalization c People to turn to d People who can say this is where to get information Support groups a Know heartbreak someone in family who is mentally ill Why do doctors commit suicide a Physicians are twice as