Psych 380 1nd Edition Lecture 12 Outline of Current Lecture I. Manic episodeCurrent LectureI. Manic episodea. Elevated, expansive or irritable mood & excessive energy and drive (lasts at least 1 week)b. Symptoms (3+, 4 if only irritable)i. Grandiosityii. Decreased sleepiii. More talkativeiv. Racing thoughts, flight of ideasv. Distractibilityvi. Goal directed activity or psychomotor agitationvii. Costly or unwise activities (buying, investing, sex)II. Bipolar disorder/formerly Manic depressive disordera. No equilibrium in moodb. Manic episodes consist of high energy, then afterwards there is a week of deep depression (peaks and valleys)c. 2 poles of the spectrumd. bipolar disorder is one of the most worrisome conditions for suicide riske. high variability in moodf. energized state can sometimes step over into psychosisg. engage in risky behaviorIII. example given about former assistanta. every once in a while he would miss a meetingb. if he didn’t take his medication, he would start walking for no reason, with no particular destinationc. he would walk until his feet bledd. 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 edgeIV. Case study; Sama. 40 years oldb. brought to therapy by his girlfriendThese 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.c. thought she loved him, wanted to help himd. he had uncontrollable episodese. she knew he had maniaf. he was a realtor – $30,000/yearg. every once in a while he would act in a grandiose wayh. he had a plan to renovate an abandoned mill into luxury condosi. when in a manic state, he was very creativej. this was periodic for SamV. condosa. called mayorb. called governorc. called the White Housed. operators at the white house get calls from psychologically disturbed individualse. operator funnels them appropriatelyf. the extent to which he wanted to execute the plan was too farVI. symptoms:a. sam wouldn’t sleep for daysi. 72 hours without sleep = cognitively and emotionally out of wackii. brain needs sleepiii. lack of sleep throws fuel on fireiv. makes the situation worseb. talking a mile a minutei. really fast and excessivec. distractabilityi. 1st sessionii. came with a brief caseiii. his brief case was full of hundreds of pieces of paperiv. wanted to show him a George Carlin taped. Costly or unwise activities (buying, investing, sex)i. Calls an advertisement to have a 4-some with another coupleii. His girlfriend answered the door and said that this was the breaking pointe. People with bipolar disorder are seriously impairedi. He doesn’t want to go to therapyii. Girlfriend won’t stay in relationship unless he goes to therapyf. Another example:i. Woman brings her husband to the hospitalii. He was a multimillionaireiii. He was making a number of large investments on real estateiv. Spending millions of dollars on down paymentsv. Before going to the hospital they went into Bloomingdales to get new pajamasvi. He told them he wanted to buy 20 of a certain lamp, his wife had to stop himg. What happens after manic events?i. People collapse after manic eventsii. Living with someone like this is exhaustingiii. Fine line; when they are out of controlh. Video; silver linings playbooki. Main character; Patrickii. Reading Hemmingway in the middle of the nightiii. He doesn’t like the ending and throws the book out of the windowiv. Goes into his parents room and rants about itv. He is incorrigiblevi. He goes to the psychiatristvii. His therapist plays a provocative song at the officeviii. This was his wedding songix. He walked into his wife cheating on himi. How can this be treated?i. Start with normalizing daily routineii. Get back to a regular circadian rhythmiii. People often have a hard time being in relationships because of their volatility – have them work on their relationshipsj. Interpersonal and social rhythm therapyi. Theory: interpersonal stress affects circadian rhythms, routines, and moodsii. Therapy: insight about disorder, stabilize routines, sleep/wake cyclesiii. Attending to relationshipsiv. Take medicationk. Need to stabilize Sam’s lifei. He was staying up all night at the officeii. He wasn’t sleepingiii. Needs to work on his relationship1. he is going to burn out his girlfriendiv. medication1. mood stabilizerl. kindlingi. every time you have a manic episode, it makes you more vulnerable to have another oneii. because of this we want to prevent them as soon as possibleiii. they are cumulativeiv. certain drugs can mess up your neurochemistry (such as MDMA)v. predisposing yourself can lead to the occurrence of a breakdownm. uphill battle – he is going to lose his girlfriend unless he starts therapyi. dr. Halgin says he needs rest, good nutritionii. He lays out a pattern of activitiesiii. Medication1. Lithium (common)2. Stabilizes mood and prevents highsn. Sam is resistant to medication because it makes him feel flat and boredi. 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 medicationi. One time he came into therapy wearing a hello kitty watchii. Another time he ran into him at the Hampshire athletic clubiii. “hey that’s my shrink!”iv. he still gets a little depressedp. Sam responded well to low doses of lithiumi. Needs to checked that the lithium is therapeutic and not toxicq. Sam would have episodes that caused him stress, these would be predictorsi. Even with meds he was still vulnerable to episodesVII. Major depressive disordera. Mood change (at least 2 weeks) (5+)i. Depressed mood most of the day, nearly every dayii. Diminished interest or pleasureiii. Weight loss or gain, or appetite loss/gain1. Don’t have energy to eativ. Insomnia, hypersomniav. Psychomotor agitation or retardationvi. Fatigue or loss of energyvii. Worthlessness or guilt (may be delusional)viii. Diminished concentration or decisivenessix. Recurrent thoughts of death, or ideation, or attemptVIII. Suicide is now more overtly written about in an obituarya. Talk more about how people “chose to leave this world”b. It is talked about like it is the courageous thing to doIX. Best resource: NAMIa. National association for mental illnessb. Laws – involuntary hospitalizationc. People to turn tod. People who can say this is where to get informationX.