Descartes Li

3-10-2013 12-07-35 PMDr. Descartes Li is the Director of the UCSF Bipolar Program and co-Director of the UCSF Electroconvulsive Therapy Service. His work involves teaching both UCSF Psychiatry residents as well as UCSF medical students. He has been in clinical practice since 1997 and also speaks Mandarin Chinese. 

Dr. Li received his M.D. from the UCSF School of Medicine and went on to complete his residency training in psychiatry at UCSF as well. He gives numerous talks and presentations in both academic and community settings. His areas of interest include bipolar disorder, electroconvulsive therapy, cultural psychiatry, and suicide.

He is a member of the Association for Academic Psychiatry (AAP) and received a Master Educator certificate for completing the three-year AAP Workshop Series. He also completed a two-year Faculty Fellowship in Educational Scholarship (UCSF Department of Psychiatry). In 2008, he received the Award for Excellence in Teaching from the UCSF Academy of Medical Educators (UCSF). He is a dedicated teacher and public speaker.

Dr. Li, how did you up specializing in the treatment of people with mood disorders?

I find it interesting all the different ways that people have learned to manage and cope with these conditions. I am often inspired by how they cope.

What do you do as director of the bipolar program at UCSF?

I run the mood disorders clinic. It is primarily a resource for the community and for the trainees at UCSF. A lot of what we do is provide patients and psychiatrists with second opinions. We have a very limited capacity to treat people and try to limit those folks to one to two years of treatment. Those who want to be treated are seen by 2nd through 3rd year residents. .

I also run a short term psychoeducational group for people with bipolar disorder. It is 8 weeks long. And groups begin in September and in December. It is derived from the Barcelona psychoeducational group program, but their groups are 20 weeks long, we have condensed the material into an 8 week program.

There is a monthly support group for those who have been through the psychoeducational group. Luriko Ajari co-leads this group. Everyone in the group has to have a psychiatrist. It is primarily for people to talk about what they have learned. Group members stay in the group for at least a year and many members have been involved for a number of years. 

What is your experience of how people recover from the effects of very serious bipolar disorder or depression?

I have been inspired by how people who have “hit bottom” can work their way back up. It can be a multi-year process, it isn’t out of the question for it to take five or even ten years. In the beginning the effort can seem hopeless. But gradually people work their way back. Now I feel much more positive about impossible or hopeless situations. If people keep at it they can find solutions to terrible and overwhelming problems. 

We discussed the psychoeducational group some more, it is from the Barcelona program. (Editor’s note – The Barcelona Psychoeducation Program, designed by Dr. Colom and co-workers is nowadays the strongest evidence-based psychoeducational program for bipolar patients.  His book “Psychoeducation Manual for Bipolar Disorder” has been published in several languages including English, Spanish, Italian, French and Polish). The eight week program covers the nature of mood disorders, mood charting and how to do it, medications, sleep,  and communications skills (that section is led by Cannon Thomas a UCSF psychologist and also deals with the issue of how to talk about bipolar with others).

Dr. Li has become very interested in sleep issues in bipolar. He has worked with Alison Harvey, a psychologist at the University of California, Berkeley, who has come up with program of 8 2 hour sessions on sleep for people with bipolar. Those who take the program demonstrated considerable sleep  and mood improvement.

For people with more serious or urgent problems he mentioned his interest in an intervention called Intensive Sleep Retraining for chronic insomnia. The program involves having people repeatedly go to sleep and then wake up over the course of 8 hours.

Dr. Li, what are the key factors in long term success for people with mood disorders?

Persistence. People who stick with the treatment and can make small changes in their lifestyle, who keep plugging away at it…

I think that at least in an informal way mood charting is important, especially in the beginning. After you have learned the skill it is OK to stop doing it for a while and then do it episodically when they are doing worse

What are the most common issues that you find when you do second opinions?

When we first started we had many patients with bipolar who were on multiple antidepressants and no mood stabilizers and not doing well… our most common recommendation then was to start mood stabilizer and perhaps stop antidepressants and lots of them got better.

Now there are more complicated patients who have soft bipolar. What do you call the folks who have “bipolarish” disorder? I am more reluctant to diagnose them as having bipolar even though in terms of patient treatment you often have better outcomes if you treat them as though they are bipolar rather than just depressed.