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Journal Articles Course: Journal001/J1 Adult Bipolar Disorder

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This is a course based on reading freely available, peer-reviewed journal articles

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Read two journal articles and receive one CE credit for just $7. The full text of the journal articles can be obtained for free online via PubMed.com. The articles have been field tested and it should take approximately one hour total to read both articles. They are titled "Assessment Tools for Adult Bipolar Disorder" and "Psychosocial Disability in the Course of Bipolar I and II Disorders: A Prospective, Comparative, Longitudinal Study." Todd Finnerty, Psy.D. is the instructor for the course. Contact Dr. Finnerty with any questions via toddfinnerty@toddfinnerty.com or (330)495-8809.

Course objective #1: You will be able to describe the impact of Bipolar I and Bipolar II on psychosocial functioning

Course Objective #2: You will be able to list assessment tools for adult bipolar disorder

The articles can be obtained for free here:

Assessment Tools for Adult Bipolar Disorder:

Full text (author manuscript) on the web
Full text (author manuscript) PDF file
Authors: Miller, Christopher J.; Johnson, Sheri L.; Eisner, Lori
Abstract: "This article reviews the current state of the literature on the assessment of bipolar disorder in adults. Research on reliable and valid measures for bipolar disorder has unfortunately lagged behind assessment research for other disorders, such as major depression. We review diagnostic tools, self-report measures to facilitate screening for bipolar diagnoses, and symptom severity measures. We briefly review other assessment domains, including measures designed to facilitate self-monitoring of symptoms. We highlight particular gaps in the field, including an absence of research on the reliable diagnosis of bipolar II and milder forms of disorder, a lack of empirical data on the best ways to integrate data from multiple domains, and a shortage of measures targeting a broader set of illness-related constructs relevant to bipolar disorder."
Clinical Psychology 2009 Jun 1;16(2):188-201.

Psychosocial Disability in the Course of Bipolar I and II Disorders: A Prospective, Comparative, Longitudinal Study:

Full text on the web
Full text PDF file
Authors: Judd LL, Akiskal HS, Schettler PJ, Endicott J, Leon AC, Solomon DA, Coryell W, Maser JD, Keller MB.
Abstract: "CONTEXT: Evidence of psychosocial disability in bipolar disorder is based primarily on bipolar I disorder (BP-I) and does not relate disability to affective symptom severity and polarity or to bipolar II disorder (BP-II). OBJECTIVE: To provide detailed data on psychosocial disability in relation to symptom status during the long-term course of BP-I and BP-II. DESIGN: A naturalistic study with 20 years of prospective, systematic follow-up. SETTING: Inpatient and outpatient treatment facilities at 5 US academic centers. Patients One hundred fifty-eight patients with BP-I and 133 patients with BP-II who were followed up for a mean (SD) of 15 (4.8) years in the National Institute of Mental Health Collaborative Depression Study. MAIN OUTCOME MEASURES: The relationship, by random regression, between Range of Impaired Functioning Tool psychosocial impairment scores and affective symptom status in 1-month periods during the long-term course of illness from 6-month and yearly Longitudinal Interval Follow-up Evaluation interviews. RESULTS: Psychosocial impairment increases significantly with each increment in depressive symptom severity for BP-I and BP-II and with most increments in manic symptom severity for BP-I. Subsyndromal hypomanic symptoms are not disabling in BP-II, and they may even enhance functioning. Depressive symptoms are at least as disabling as manic or hypomanic symptoms at corresponding severity levels and, in some cases, significantly more so. At each level of depressive symptom severity, BP-I and BP-II are equally impairing. When asymptomatic, patients with bipolar disorder have good psychosocial functioning, although it is not as good as that of well controls. CONCLUSIONS: Psychosocial disability fluctuates in parallel with changes in affective symptom severity in BP-I and BP-II. Important findings for clinical management are the following: (1) depressive episodes and symptoms, which dominate the course of BP-I and BP-II, are equal to or more disabling than corresponding levels of manic or hypomanic symptoms; (2) subsyndromal depressive symptoms, but not subsyndromal manic or hypomanic symptoms, are associated with significant impairment; and (3) subsyndromal hypomanic symptoms appear to enhance functioning in BP-II."
Archives of General Psychiatry, 2005 Dec;62(12):1322-30.

CE Quiz Questions

The quiz questions that you will be asked are:

Question #1(True or False) The person taking this quiz is the one registered for the course and has reviewed the materials (you must answer "True").
Question #2The duration requirement for mania specifies that
1. symptoms last one week
2. symptoms must last 3 days
3. symptoms must last one week or require hospitalization
4. there is no duration requirement
Question #3Due to informal or poor screening, the authors note the average time between onset of symptoms and formal diagnosis is
a. more than 7 years
b. one week
c. seven weeks
d. one year
Question #4(True/False)The authors note that at least 3 studies have shown that people with Bipolar II disorder are at higher risk for suicide than those with Bipolar I or unipolar depression.
Question #5According to the authors, self report measures
a. Are the most reliable and valid way to make a bipolar diagnosis
b. do not provide diagnostic accuracy but help identify people who warrant more careful diagnostic interviews
c. have always been found to be accurate in all populations studied
d. do not exist for bipolar disorder
Question #6Which of the following can be used to track changes in symptoms over time as treatment progresses?
1. Young Mania Rating Scale
2. Bech-Rafaelsen Mania Rating Scale
3. Schedule for Affective Disorders and Schizophrenia- change version
4. all of the above
Question #7The authors indicate that self-monitoring tools can
1. Help track symptoms
2. reduce costs and increase patient investment in treatment
3. provide information on compliance and psychosocial functioning
4. all of the above
Question #8(True/False) The authors note that minor depressive symptoms have been found to be more disabling than hypomanic symptoms.
Question #9(True/False) The authors note that patients with Bipolar II may actually report experiencing improvement in psychosocial functioning when going from asymptomatic status to subsyndromal hypomanic symptoms.
Question #10(True/False) The authors note that depression symptoms in Bipolar I are at least as disabling, and sometimes significantly more disabling than manic symptoms at comparable levels of severity.
Question #11(True/False) The authors note that subsyndomal depressive symptoms do not lead to psychosocial impairment.

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