Amanda Bynes Diagnosed as Bipolar

Approximately 3 weeks after being placed on a psychiatric hold, former actress Amanda Bynes was released from the Pasadena hospital after a court hearing. According to TMZ, the hearing officer “felt Amanda was stable enough so she could NOT be held involuntarily, so he ended the 30-day hold that had been granted last week and Amanda walked out the front door.” Amanda is under the temporary conservatorship of her mother, Lynn Bynes. Her father, Rick, was not included in this conservatorship as Amanda continues to accuse her father of sexual abuse, something the family has vehemently denied.

Now Amanda is tweeting that she has been diagnosed with bipolar disorder. She is receiving treatment under the care of a psychologist and a psychiatrist:

amanda tweet 11_4

She added, “My lawyer said if I comply with the courts and take my meds and see my psychologist and pyshchiatrist weekly then I will get unconserved.”

Here’s hoping that Amanda continues to see her doctors and take her medications.

Why does she need to see a psychologist and psychiatrist? What’s the difference?

A psychiatrist is a medical doctor (MD) who has graduated from medical school and then went on to finish a four year psychiatric residency program. As an MD, they are licensed to practice medicine and to prescribe medications. A psychologist is not a medical doctor, although they usually have a PhD or PsyD (doctorate) in clinical psychology. Doctoral programs typically take five to seven years to complete and most states require an additional one or two year long internship in order to obtain a  license to practice.  With some rare exceptions, clinical psychologists are not licensed to prescribe medications.

Both psychiatrists and psychologists are qualified and to practice psychotherapy (talk therapy).

Psychiatrists and psychologists often work in tandem to care for a patient. A psychologist may recommended a patient be seen by a psychiatrist in order to receive medications. Psychiatrists often refer patients to fellow psychotherapists and psychologists to receive counseling and/or talk therapy.

There are many more psychologists than psychiatrists in the US, approximately 100,000 vs. 25,000. This partially explains why many private practice psychiatrists find themselves doing primarily medication management, referring patients to psychologists and other mental health providers (such as clinical social workers, CSWs) for psychotherapy. They may also concentrate on treating patients with more severe conditions, such as schizophrenia or severe depression, who will require close medical/medication monitoring.

What is psychotherapy?

Psychotherapy, or “talk therapy”, is a way to treat people with a mental disorder by helping them understand their illness. The main form of talk therapy for mood disorders such as depression is called CBT – cognitive behavioral therapy (see below).  It teaches people strategies and gives them tools to deal with stress and unhealthy thoughts and behaviors.  Psychotherapy helps patients manage their symptoms better and function at their best in everyday life.  Cognitive behavioral therapy can be just as effective as antidepressant drugs.

Sometimes psychotherapy alone may be the best treatment for a person, depending on the illness and its severity. Other times, psychotherapy is combined with medications. Therapists work with an individual or families to devise an appropriate treatment plan.

What are the different types of psychotherapy?

Many kinds of psychotherapy exist. There is no “one-size-fits-all” approach.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a blend of two therapies: cognitive therapy (CT) and behavioral therapy. CT was developed by psychotherapist Aaron Beck, M.D., in the 1960’s. CT focuses on a person’s thoughts and beliefs, and how they influence a person’s mood and actions, and aims to change a person’s thinking to be more adaptive and healthy. Behavioral therapy focuses on a person’s actions and aims to change unhealthy behavior patterns.

CBT helps a person focus on his or her current problems and how to solve them. Both patient and therapist need to be actively involved in this process. The therapist helps the patient learn how to identify distorted or unhelpful thinking patterns, recognize and change inaccurate beliefs, relate to others in more positive ways, and change behaviors accordingly.

CBT has been used in the treatment of depression, anxiety disorders, bipolar disorder, eating disorders and schizophrenia.

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT), a form of CBT, was developed by Marsha Linehan, Ph.D. At first, it was developed to treat people with suicidal thoughts and actions. It is now also used to treat people with borderline personality disorde (BPD). BPD is an illness in which suicidal thinking and actions are more common.

The term “dialectical” refers to a philosophic exercise in which two opposing views are discussed until a logical blending or balance of the two extremes—the middle way—is found. In keeping with that philosophy, the therapist assures the patient that the patient’s behavior and feelings are valid and understandable. At the same time, the therapist coaches the patient to understand that it is his or her personal responsibility to change unhealthy or disruptive behavior.

DBT emphasizes the value of a strong and equal relationship between patient and therapist. The therapist consistently reminds the patient when his or her behavior is unhealthy or disruptive—when boundaries are overstepped—and then teaches the skills needed to better deal with future similar situations. DBT involves both individual and group therapy. Individual sessions are used to teach new skills, while group sessions provide the opportunity to practice these skills.

Interpersonal Therapy

Interpersonal therapy (IPT) is most often used on a one-on-one basis to treat depression or dysthymia (a more persistent but less severe form of depression). The current manual-based form of IPT used today was developed in the 1980’s by Gerald Klerman, M.D., and Myrna Weissman, M.D.

IPT is based on the idea that improving communication patterns and the ways people relate to others will effectively treat depression. IPT helps identify how a person interacts with other people. When a behavior is causing problems, IPT guides the person to change the behavior. IPT explores major issues that may add to a person’s depression, such as grief, or times of upheaval or transition. Sometimes IPT is used along with antidepressant medications.

IPT varies depending on the needs of the patient and the relationship between the therapist and patient. Basically, a therapist using IPT helps the patient identify troubling emotions and their triggers. The therapist helps the patient learn to express appropriate emotions in a healthy way. The patient may also examine relationships in his or her past that may have been affected by distorted mood and behavior. Doing so can help the patient learn to be more objective about current relationships.

Family-focused Therapy

Family-focused therapy (FFT) was developed by David Miklowitz, Ph.D., and Michael Goldstein, Ph.D., for treating bipolar disorder. It was designed with the assumption that a patient’s relationship with his or her family is vital to the success of managing the illness. FFT includes family members in therapy sessions to improve family relationships, which may support better treatment results.

Therapists trained in FFT work to identify difficulties and conflicts among family members that may be worsening the patient’s illness. Therapy is meant to help members find more effective ways to resolve those difficulties. The therapist educates family members about their loved one’s disorder, its symptoms and course, and how to help their relative manage it more effectively. When families learn about the disorder, they may be able to spot early signs of a relapse and create an action plan that involves all family members. During therapy, the therapist will help family members recognize when they express unhelpful criticism or hostility toward their relative with bipolar disorder. The therapist will teach family members how to communicate negative emotions in a better way.

FFT also focuses on the stress family members feel when they care for a relative with bipolar disorder. The therapy aims to prevent family members from “burning out” or disengaging from the effort. The therapist helps the family accept how bipolar disorder can limit their relative. At the same time, the therapist holds the patient responsible for his or her own well being and actions to a level that is appropriate for the person’s age.

Generally, the family and patient attend sessions together. The needs of each patient and family are different, and those needs determine the exact course of treatment. However, the main components of a structured FFT usually include:

  • Family education on bipolar disorder
  • Building communication skills to better deal with stress, and
  • Solving problems together as a family.

Source: NIMH

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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