By
Robert P. Reiser and Larry W. Thompson
Robert P. Reiser, PhD is a cognitive behavioral therapist in private practice focusing on treatment of individuals and families with serious mental illness and a Fellow of the Academy of Cognitive Therapy. He supervises graduate clinicians in training and provides workshops, consultation, and technical assistance with a goal of improving treatment of bipolar disorder and schizophrenia in community mental health settings. Dr. Reiser currently works as a consultant with the Felton Institute in San Francisco providing supervision and training for clinicians and case managers using cognitive behavioural therapy for psychosis (CBT-P), and supervises medical residents at the University of California, San Francisco in the Department of Psychiatry. .
Larry W. Thompson, PhD received his doctorate from Florida State University in 1961. Since then he has held the rank of Professor at three universities, Duke University, University of Southern California, and Stanford University. Dr. Thompson’s recent interests have focused on the problems and issues involved in transporting evidenced-based psychotherapeutic interventions from the research laboratory into community settings .
The past 10 years have seen a dramatic increase of interest in psychosocial treatments of bipolar disorder. There is now substantial empirical evidence suggesting the effectiveness of such treatments. However, this accumulated information has not yet been transferred into clinical practice in many settings.
Help is now at hand. This compact volume brings to the practitioner a comprehensive, evidence-based approach to the treatment of bipolar disorder that is practical, easily accessible, and can be readily applied in clinical practice.
This practitioner’s guide begins by describing the main features of bipolar disorder and considerations for differential diagnosis based on DSM-IV and ICD-10 criteria. Following this, current theories and models are described, along with decision trees for evaluating the best treatment options. The volume then guides the reader through a systematic, integrated approach to treatment based on the best of recent research. The authors describe a structured directive therapy that is also collaborative and client centered. Special considerations, including managing suicide risk, substance misuse, and medication non adherence, are addressed. The volume is rounded off by the inclusion of clinically oriented tools and sample forms.
| After completing this course, you’ll be able to: | |||
Chapter 1: Description |
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| 1 | List the four mutually exclusive categories into which bipolar disorders are grouped. | ||
| 2 | Describe the symptoms of bipolar II disorders. | ||
| 3 | State what percent of bipolar patients attempt suicide and what percent are successful. |
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| 4 | State at what age bipolar disorder tends to occur. | ||
| 5 | State the most influential risk factor for the development of the disorder. | ||
| 6 | Discuss the role of pharmacotherapy in eliminating symptoms of bipolar disease. | ||
| 7 | Discuss the role of anxiety in bipolar disorder. | ||
| 8 | State how bipolar disorder is diagnosed. | ||
| 9 | Briefly describe several assessment tools for mania. | ||
| 10 | Describe the Hamilton Rating Scale for Depression. | ||
Chapter 2: Theories and Models of Bipolar Disorder |
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| 11 | List specific strategies of psychoeducational programs and their effectivness. | ||
| 12 | State the treatment approach which appears to be the most broadly effective in open and closed trials. | ||
Chapter 3: Diagnosis and Treatment Indications |
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| 13 | State the best treatment for acute episodes of bipolar disease. | ||
Chapter 4: Treatment |
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| 14 | State the use of lithium. | ||
| 15 | Describe the three phases in the course of a structured treatment program. |
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| 16 | Describe the requirements of a collaborative model. | ||
| 17 | State the fourth important feature in the initial phase of treatment. | ||
| 18 | State the first item on the agenda at a therapy session. | ||
| 19 | Describe mood monitoring. | ||
| 20 | Discuss several steps of a thought record. | ||
| 21 | State why signs of depression may be particularly difficult to identify. | ||
| 22 | List several “Do’s” for interviewing the manic or hypomanic patient, according to Table 21. | ||
| 23 | Discuss sleep loss as a precursor to a serious episode. | ||
| 24 | List several advantages of “booster sessions.” | ||
| 25 | Discuss the “maintenance guide.” | ||
| 26 | Discuss the findings of Miklowitz and colleagues (1988). |
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| 27 | List the primary and ongoing task of therapy. | ||
| 28 | List the 2 clinical considerations and risk factors for people with bipolar disorder. | ||
| 29 | Describe the interviewing technique after a suicide attempt. | ||
| 30 | Discuss motivational interviewing. | ||
| 1. | Description | ||
| 1.1 | Terminology | ||
| 1.2 | Definition | ||
| 1.2.1 | Additional Considerations in the Classification and Diagnosis of Bipolar Disorders | ||
| 1.2.2 | Implications for Clinical Practice | ||
| 1.3 | Epidemiology | ||
| 1.4 | Course and Prognosis | ||
| 1.5 | Differential Diagnosis | ||
| 1.5.1 | Differential Diagnosis of Bipolar I and II Disorders Versus Major Depressive Disorders | ||
| 1.5.2 | Differential Diagnosis of Bipolar I Versus Bipolar II Disorder | ||
| 1.5.3 | Differential Diagnosis of Bipolar I Disorder Versus Psychotic Disorders (Schizoaffective Disorder, Schizophrenia, and Delusional Disorder) | ||
| 1.5.4 | Differential Diagnosis of Bipolar Disorder (Current Episode Manic or Mixed) Versus Substance-Induced Mood Disorder | ||
| 1.5.5 | Differential Diagnosis of Bipolar I and II Disorders Versus Borderline Personality Disorder | ||
| 1.5.6 | Differential Diagnosis of Bipolar I and II Disorders Versus Attention Deficit Disorders | ||
| 1.5.7 | Differential Diagnosis of Bipolar I and II Disorders Versus Antisocial Personality Disorder | ||
| 1.6 | Comorbidities | ||
| 1.7 | Diagnostic Procedures and Documentation | ||
| 1.7.1 | Tools to Assist in the Assessment of Bipolar Disorder: Mania | ||
| 1.7.2 | Tools to Assist in the Assessment of Bipolar Disorder: Depression | ||
| 1.7.3 | Taking a good history | ||
| 2 | Theories and Models of Bipolar Disorder | ||
| 2.1 | Biologically Based Disease Models | ||
| 2.2 | General Psychoeducation and Illness Management Strategies | ||
| 2.3 | The Interpersonal and Social Rhythm Hypothesis: Social Rhythm Disruption as a Potential Catalyst for Bipolar Episodes | ||
| 2.4 | Family-Based Treatment Approaches | ||
| 2.5 | Cognitive-Behavioral Treatment Approaches | ||
| 2.5.1 | Basco and Rush Cognitive-Behavioral Treatment of Bipolar Disorder | ||
| 2.5.2 | Lam, Jones, Hayward and Bright (1999): Identifying Prodromes of Illness | ||
| 2.5.3 | Other Cognitive-Behavioral Treatment Strategies with Bipolar Disorder | ||
| 3 | Diagnosis and Treatment Indications | ||
| 3.1 | Decision Tree for Determining Optimal Treatments | ||
| 3.2 | Treatment Options | ||
| 3.2.1 | Treatment Options for Young Adult | ||
| 3.2.2 | Treatment Options for High Risk Presentation | ||
| 3.2.3 | Treatment Options for Repeated Episodes of Mania/ Hypomania (see the case of Bill in Section 4.1.5) | ||
| 3.2.4 | Treatment Options for Persistent Subsyndromal Depression and Dysthmia (see the case of Tanya in Section 4.4.2) | ||
| 4 | Treatment | ||
| 4.1 | Methods of Treatment | ||
| 4.1.1 | Biological Approaches to Treatment of Bipolar Disorder | ||
| 4.1.2 | Psychosocial Approaches to Treatment of Bipolar Disorder: General Remarks | ||
| 4.1.3 | Overall Structure and Course of Therapy | ||
| 4.1.4 | Initial Phase of Treatment: Orientation and Engagement | ||
| 4.1.5 | Middle Phase of Treatment: Skill Building- Filling up the Tool Box | ||
| 4.1.6 | Final Phase: How to Maintain Treatment Gains | ||
| 4.2 | Mechanisms of Action | ||
| 4.2.1 | Targeted Psychoeducation and Illness Management Strategies | ||
| 4.2.2 | Monitoring of Activities and Moods | ||
| 4.2.3 | Social Rhythm Disruption as a Catalyst for Bipolar Episodes | ||
| 4.2.4 | Family-Focused Treatment | ||
| 4.2.5 | Cognitive-Behavioral Treatment Approaches | ||
| 4.3 | Efficacy and Prognosis | ||
| 4.4 | Variations and Combinations of Methods | ||
| 4.4.1 | Family-Based Treatment and Family Management | ||
| 4.4.2 | Self-Help Approaches Incorporating the Recovery Model | ||
| 4.5 | Problems in Carrying Out the Treatment | ||
| 4.5.1 | Suicide Risk Assessment and Management | ||
| 4.5.2 | Improving Treatment Adherence | ||
| 4.5.3 | Treatment of Patients with Co-Occurring Substance Use Disorders | ||
| 4.6 | Summary | ||
| 5 | Further Reading | ||
| 6 | References | ||
| 7 | Appendix: Tools and Resources | ||
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