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Bipolar Spectrum: Bringing Evidence into Practice

Cut through the hype about bipolar disorder. This seminar brings up-to-date evidence to the practical level: treating clients. How will the DSM- 5® changes affect diagnosis of bipolar disorders? Is the “bipolar spectrum” represented? We will use case examples to incorporate the DSM-5® changes in your diagnostic process without getting caught up in the details. This includes routinely assessing and documenting - simply and efficiently - bipolar markers that do not appear in the DSM®, to make your diagnoses rigorous and reliable.
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Information

Faculty:
James Phelps
Duration:
6 Hours 16 Minutes
Format:
Audio and Video
Copyright:
Jul 15, 2016

Description

  • Moving beyond “overdiagnosis” and “underdiagnosis” to accurate diagnosis
  • For patients with complex depressions but not mania: How does the DSM-5® mixed features specifier and Not Elsewhere Classified category apply?
  • Psychotherapy is now routine bipolar treatment -- but which techniques can you easily adopt?
  • Do chronotherapies and “natural” pills beat antidepressants for bipolar depression? Is it your job to offer them?
  • What is bipolar disorder anyway? Understand—in plain English— current research on its genetic, molecular and anatomic basis.

Cut through the hype about bipolar disorder. This seminar brings up-to-date evidence to the practical level: treating clients. How will the DSM- 5® changes affect diagnosis of bipolar disorders? Is the “bipolar spectrum” represented? We will use case examples to incorporate the DSM-5® changes in your diagnostic process without getting caught up in the details. This includes routinely assessing and documenting - simply and efficiently - bipolar markers that do not appear in the DSM®, to make your diagnoses rigorous and reliable.

The time has come for psychotherapy to stand alongside medication approaches in the routine treatment of bipolar disorder. We will review “chronotherapy,” Social Rhythm therapy, and several PsychoEducation techniques that you can immediately apply with clients. The controversial role of antidepressants in treatment of bipolar depression, and the role of therapists in guiding patients toward non-medication and “natural” treatments will complete this tour through Bipolar Controversies. Dr. Phelps will help you practice (safely) the use of these techniques and tools in a lively day of laughter and learning. You will emerge enthused and ready to use at least three new approaches with patients the very next day.

This seminar will provide you with the understanding and tools to:

  • Use up-to-date instruments like the Bipolarity Index, the Bipolar Spectrum Diagnostic Scale and the Hypomania Checklist
  • Differentiate bipolarity from anxiety disorders, ADHD, personality disorders, and substance use—with an eye on treatment differences
  • Help patients and families come to terms with multiple variations of bipolar disorder, from initial diagnosis to long-term management
  • Practice psychotherapy in concert with medications, including the 3 main medications used in bipolar depression
  • Position yourself with primary care providers who are using or developing a Medical Home model
  • Make bipolar disorder one of the conditions you’re comfortable identifying - and treating

Handouts

Outline

Over? Under? Or Accurate Diagnosis

  • Case example: the Brown Univ. “overdiagnosis” study
  • Compare the data in children/adolescents
  • Remembering 4 moods and 7 criteria for hypo/mania
  • Screening tools to efficiently gather information
  • DSM-5® hypomania-duration: still 4 days?

Eleven Non-Manic Bipolar Markers

  • Case example: not bipolar, but not unipolar?
  • Where did these non-manic markers come from? Who uses them? Should you?
  • How can you remember them? WHIPLASHED
  • Using a screening tool instead of memorizing
  • A system for reporting: The Bipolarity Index

Is there a “Bipolar Spectrum”?

  • Case example: implications for treatment
  • DSM-5®’s mixed features specifier : Is that a “spectrum” step?
  • What is the therapist’s role in guiding treatment?
  • How to educate patients/families? (and doctors?)

Differentiating bipolar from X,Y,Z

  • Case example: PTSD or bipolar or both?
  • The overlapping criteria problem
  • What will happen if you’re wrong?
  • Is it all about antidepressants?

What is “bipolar disorder” anyway?

  • Depression is not a moral weakness
  • One gene can make that much difference?
  • Fighting stigma with information
  • Where is depression located in the brain?

Treatment: A Big-Picture View

  • Case example: Balancing risk, benefit - and data!
  • Antidepressants can make bipolar disorder worse, 5 different ways
  • Psychotherapy is an integral component, not an add-on!
  • Non-medication mood stabilizers: An example in darkness
  • Remembering nine alternatives to antidepressants
  • Practicing in or in concert with a Medical Home model

Social Rhythm Therapy

  • Case example: What time to bed?
  • The Social Rhythm metric (easy)
  • Selling rhythm? What a challenge!
  • Selling darkness is easier
  • What to do about TV, Internet, texting

Using components of Triple Chronotherapy

  • Case example: Treating depression without medications
  • Three ingredients: Darkness, light, and timing
  • Is this do-able in your practice?
  • Why isn’t this more widely used?

Bipolar Therapy Manuals

  • Case example: Old therapist, new technique
  • What are you looking for? (BP I? BP II? Spectrum?)
  • Common ingredients list
  • Comparing four manuals: Which is yours?

Medication approaches

  • Case example: lithium or lamotrigine?
  • Why it boils down to 3 main options for depressed phases
  • FDA indications and “evidence-based medicine”: A Pharma’ scam?
  • Fish oil and NAC (n-acetlycysteine); can you suggest?
  • How about Vitamin D? tryptophan?

How bad are antidepressants?

  • Case example: Here’s why you should worry
  • Do antidepressants even work in bipolar disorder? (or unipolar?!)
  • Mixed states, rapid cycling are worse than “switching”
  • Speculation: “Kindling” and “tardive dysphoria”
  • Withdrawing antidepressants: 31 tricks from Dr. Tam Kelly

For fun, before we go

  • Have your darkness and eat it too
  • The science of virtual darkness
  • Accumulating evidence for efficacy
  • How to explain and prescribe virtual darkness

Faculty

Bipolar Spectrum: Bringing Evidence into Practice

James Phelps, MD Related seminars and products: 2

Director of the Mood Disorders Program

Samaritan Mental Health


James Phelps, M.D., specializes in complex mood and anxiety problems. He has focused on teaching about non-manic versions of bipolar disorder for over 10 years. His website, PsychEducation.org, receives 20,000 visitors a month. Dr. Phelps is the author of Why Am I Still Depressed?: Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorders (McGraw-Hill, 2006). He authored revisions of the diagnostic criteria for bipolar spectrum disorders for the International Society for Bipolar Disorders. He has published multiple articles and reviews for peer-reviewed journals, including the Journal of Affective Disorders and Chronobiology International. He was recently named Bipolar Disorders section editor for Psychiatric Times. He has received numerous awards for his teaching, including Teacher of the Year awards from both the Psychiatry and Family Medicine departments at the University of New Mexico, and from his current hospital’s residency program. Dr. Phelps received his M.D. from Case Western Reserve University. He completed his residency in psychiatry and a fellowship in medical education at the University of New Mexico. He holds an undergraduate degree in Human Biology from Stanford.

Speaker Disclosures:

Financial: James Phelps receives royalties as an author for McGraw-Hill Publishing. He receives a speaking honorarium from PESI, Inc.

Nonfinancial: James Phelps has no relevant nonfinancial relationship to disclose.