Bipolar Disorder, Diagnosis and Nonpharmacological Therapies

In Part 1 of this video, Heather Flint, senior digital managing editor, Psych Congress Network, sits down with Psych Congress Steering Committee Member Craig Chepke, MD, FAPA, Medical Director, Excel Psychiatric Associates, Huntersville, NC, to discuss correctly diagnosing bipolar disorder as well as nonpharmacological therapies to incorporate into their treatment plan.

In the upcoming Part 2, Dr Chepke addresses tailoring treatment plans and offers his insights on the biggest challenges for other clinicians when treating patients with bipolar disorder.

Read the Transcript:

Heather Flint: Hello, Psych Congress Network. I am sitting today with Dr Craig Chepke. He has been presenting at Psych Congress 2021. He's going to sit and discuss bipolar disorder and his sessions on bipolar disorder with us today. Dr Chepke, thank you for being here.

Dr Craig Chepke: Thanks for having me, Heather. My name is Dr Craig Chepke. I'm a psychiatrist in the Charlotte, North Carolina area I’ve got some an adjunct faculty appointments with local universities. I'm also a steering committee member for Psych Congress.

Heather Flint: Can you briefly describe clinical signs that differentiate bipolar diagnosis from other mental health disorders?

Dr Chepke: Sure, that's a great question Heather, and I think, a little bit of a twist on it. The hallmark symptom of bipolar disorder is mania. A prolonged period defined in DSM as 7 days where someone has increased energy, increased goal-directed activity, decreased need for sleep, etc., and that this has to occur just once in a person's life to qualify for a diagnosis of bipolar disorder. 

That's what makes the diagnosis. But that is probably the least common symptom of bipolar disorder. Bipolar disorder is actually a syndrome that is predominantly of depression. That is a depressive illness that is punctuated by several episodes throughout the lifetime at a small percentage of mania. Also, to make it even more complicated, the person can have mixed features. 

If they have a manic episode, it can also be mixed in with depressive symptoms, or depressive episodes could be mixed in with some manic features. Pure mania is actually a very, very small sliver of the entire lifespan of the person with bipolar disorder, maybe 10 percent or so something around that nature. 

That's how we define the entire illness. The other 90 percent of symptoms are the ones that caused the most ability in general, over the whole lifespan. That's how we define bipolar disorder separate from the other conditions, such as major depressive disorder.

Heather Flint: How important is implementing non-pharmacological therapy, such as talk therapy, building routines, to help manage bipolar disorder?

Dr Chepke: That is absolutely critical, in my opinion, that I've seen that work extremely well with my patients because it's not just all about a pill. Bipolar disorder is a condition where there's an extreme disruption of routines. In terms of the sleep poor sleep not getting enough sleep is not only a symptom of mania, but it's also a trigger as well. 

I really caution my patients heavily to that you've got to make sure you're guarding and you're safeguarding your sleep. There are some psychotherapies that can actually promote that interpersonal social rhythm therapy has been shown in evidence-based fashion to benefit patients with bipolar disorder both in the acute episode but also for maintenance for prevention of future episodes. 

If you don't have a social rhythm therapy locally to your practice, you can just work with the patient on things like sleep hygiene, making sure that they're establishing good bedtime routines, going to bed, waking up as much as possible at the same time, every night and evening, and also just developing schedules and routines. 

That those routines are important things like remembering to take the medication exactly as they're supposed to and maintaining good adherence because that's very critical as well. 

Sometimes with oral medication, just a couple mis-doses of the medication could be enough to let the patient get to where they start to ramp up into a hypomanic or manic episode to where it sounds like a better and better idea to not take the pill the next day and the next day and the next day. 

Really making sure that there's a routine in place that becomes second nature muscle memory, for them to take those medications is critical, other than if, in the best-case scenario that can get on long-acting injectable psychotic which takes the guesswork away and they can just get the medication once a month, and then have it taken out of their hands.