1	Bipolar Disorders Examining Mr. Jones As A Case Study Kurt Takamine Term A, 2006 PSYC 328 Michael McGuire, Ph.D.
2	Overview of Bipolar Disorders Introductory Remarks Current Treatment Approaches and Options Case Study of Mr. Jones, the movie Analysis of Bipolar Disorder Depiction in Mr. Jones Concluding Remarks References
3	Introductory Remarks Bipolar Disorders are characterized by alternating: Major depressive episodes Manic or hypomanic episodes When the depression and mania (periods of elation are extreme Bipolar I When the depression and mania are not so extreme Bipolar II
4	Introductory Remarks (Continued) In the Depressive Phase, must exhibit four of these symptoms for at least two weeks
5	Introductory Remarks (Continued) In the Manic Phase, must exhibit three of these symptoms for at least one week unless hospitalized
6	Current Treatment Approaches and Options: Counseling Psychoeducation: The client is taught to note the signs of an impending episode For both manic or depressive events It levels out the episode before it progresses It is most effective when the family members are educated as well
7	Current Treatment Approaches and Options: Counseling (Continued) Family-Focused Treatment (FFT): Rea et al. (2003) compared FFT with Individual Therapy Only 12% of FFT clients were re-hospitalized 60% of Individual Therapy were re-admitted Perlick et al. (2004) confirmed this
8	Current Treatment Approaches and Options: Counseling (Continued) Cognitive Behavioral Therapy (CBT) Wright et al. (2005) found that: CBT protected clients from depressive episodes for 30 months CBT protected clients from mania for 12 months It was not clear why the prevention of mania was only effective for 12 months
9	Current Treatment Approaches and Options: Counseling (Continued) Interpersonal Therapy (IT) and Social Rhythm Therapy (SRT): Both therapies allow clients to regulate their schedules Food, sleep, exercise medication are monitored to ward off episodes IT helps keep the client focused on moderating one’s emotions with positive relationships
10	Current Treatment Approaches and Options: Medication The best results were obtained when medication and counseling were utilized in tandem Mood stabalizers (e.g., Lithium or Valproate) alone or with antidepressants were effective Quetinapine (Calabrese et al, 2005) was most promising as new generation drugs for Bipolar I and II Suppes et al., 1999 and Thase & Sachs, 2000 studied clozapine (Clozaril^®), olanzapine (Zyprexa^®), risperidone (Risperdal^®), and other antipsychotic agents for use in clinical settings.
11	Case Study of Mr. Jones, the movie Mr. Jones (Played by Richard Gere) was a Bipolar I individual (though not classified this way in the movie) The movie described Mr. Jones as “manic-depressive” Jones was charming, talented, affable, creative, charismatic, and promiscuous in his manic phase He was at times violent, and was forlorn, lifeless, and despondent during his depressive episodes He resisted taking his meds (Haldol), and would often be involuntarily hospitalized at those times
12	Case Study of Mr. Jones (Continued) The movie does not provide a strict time frame of events It does not appear that there is Rapid-Cycling between manic or depressive phases The movie presents him as being suicidal (or reckless) when he stands on a roof top Mr. Jones fits the profile of a Bipolar I personality He has a sexual affair with his therapist (Dr. “Libbie” Bowen), and she leaves her practice because of her love for Mr. Jones
13	Analysis of Bipolar Disorder Depiction in Mr. Jones In some ways, Mr. Jones accurately depicted Bipolar Disorder For example, the depressive and manic stages were depicted correctly Jones refused to take his meds, jeopardizing his treatment In other ways, there were problems in the movie His affair with his therapist was ethical problem It wasn’t clear if he was suicidal He was at first diagnosed with schizophrenia The therapy wasn’t clearly described
14	Concluding Remarks Bipolar Disorder affects 1% of the population Treatment modalities are still being currently debated and researched There is promising help for these individuals, but only if they follow the entire treatment protocol Mr. Jones, as a movie, was accurate in its depiction of the highs and lows of this condition, but was questionable in its other depictions of the mental health profession
15	Final Thoughts Would I recommend Mr. Jones as a movie describing Bipolar Disorder? Yes-Richard Gere’s performance makes Bipolar Disorder more comprehendible However, it should be pointed out that the therapy is not explicated, so it is not about treatment modalities Also, the ethical disparities are serious issues to contend with As long as one realizes that liberties are taken, it is a fine movie
16	References American Psychological Association. (2000). Diagnostic and statistical manual of mental disorders (4-TR ed.). Washington, DC: Author Blechert, J. & Meyer, T. D. (March, 2005). Are measures of hypomanic personality, impulsive nonconformity and rigidity predictors of bipolar symptoms? British Journal of Clinical Psychology, 44(1), 13-15. Brown, T. A., DiNardo, P. A., Lehman, C. L. & Campbell, L. A. (2001). Reliability of DSM-IV anxiety and mood disorders: Implications for the classification of emotional disorders. Journal of Abnormal Psychology, 110, 49-58. Calabrese, J. R., Keck, P.E., Macfadden, W., Minkwitz, M., Ketter, T.A., Weisler, R.H., Cutler, A. J., McCoy, M., Wilson, E., & Mullen, J. (2005). A randomized, double-blind, placebo-controlled trial of Quetiapine in the treatment of Bipolar I or II Depression. American Journal of Psychiatry 162, 1351-1360.
17	References (Continued) Dion, G. L., Tohen, M., Anthony, W. A., & Waternaux, C. S. (1988). Symptoms and functioning of patients with bipolar disorder six months after hospitalization. Hospital and Community Psychiatry, 39, 652-657. Figgis. Michael (Director), Jerry A. Baerwitz and Richard Gere (Executive Producers) (1993). R. Jones [Motion picture], Los Angeles. Frank, E. (1999). Interpersonal and social rhythm therapy prevents depressive symptomatology in bipolar I patients. Bipolar Disorders, 1(Suppl.1), 13. Henney, J. E. (2000). Risk of drug interactions with St. John's wort. From the Food and Drug Administration. Journal of the American Medical Association, 283(13): 1679. Moss, B. F. & Magaro, P. A. (September, 1989). Personality types and hetero- versus auto-hypnosis. Journal of Personality and Social Psychology, 57(3), 532-538.
18	References (Continued) National Institute of Mental Health. (2006, Feb 17). Bipolar Disorder. National Institute of Mental Health. Retrieved March 11, 2006 from http://www.nimh.nih.gov/publicat/bipolar.cfm Suppes, T., Webb, A., Paul, B., Carmody, T., Kraemer, H., Rush, A. J. (1999). Clinical outcome in a randomized 1-year trial of clozapine versus treatment as usual for patients with treatment-resistant illness and a history of mania. American Journal of Psychiatry, 156(8): 1164-1169. Thase, M. E. & Sachs, G. S.(2000). Bipolar depression: pharmacotherapy and related therapeutic strategies. Biological Psychiatry, 48(6), 558-572.
19	References (Continued) Perlick, D. A., Rosenheck, R. A., Clarkin, J. F., Maciejewski, P. K., Sirey, J., Struening, E., Link, B. G. (September, 2004). Impact of family burden and affective response on clinical outcome among patients with bipolar disorder. Psychiatric Services, 55(9), 1029-1035. Perlis, R. H., Brown, E., Baker, R. W. & Nierenberg, A. A. Clinical features of Bipolar Depression versus Major Depressive Disorder in large multicenter trials. The American Journal of Psychiatry, 163 (2), 225-232. Rea, M. M., Miklowitz, D. J., Tompson, M. C., Goldstein, M. J., Hwang, S., & Mintz, J. (2003). Family-focused treatment versus individual treatment for Bipolar Disorder: Results of a randomized clinical trial, Journal of Counseling and Clinical Psychology, 71, 482-492.