Bipolar Disorder and Treatments

8/20/2019 Bipolar Disorder and Treatments

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Bipolar Disorder andTreatments

Kristina Macdonald, Amy MacHarg,Tabitha Mason,

Angela Mcfalls,Jessica McMichael


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Bipolar Disorder’s Criteria

According to the AmericanPsychiatric Association’s

Diagnostic and StatisticalManual of Mental Disorders,fourth edition (DSM!"#$%&i'olar Disorder ischaracteried by the

occurrence of one or moreMa)or De'ressi*e +'isodesaccom'anied by at least oneManic +'isode-


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What Is Bipolar Disorder?

A mood disorder that alters.

/eelingsThoughts

&eha*iors

Perce'tions(0ithin e'isodes of mania and de'ression# &i'olar Disorder is 're*iously 1no2n as Manic De'ression


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Clinical Presentations

Most commonlydiagnosed bet2eenages of 34 and 56

Mania, Hy'omania,Psychosis, de'ression


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Characteristics of Mania

/eeling of being able to do anything

7ittle slee' is needed /eeling filled 2ith energy8ot caring about financial situationsDelusions Substance abuse The DSM!" has a list of sym'toms and three or more must be

'resent


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Characteristics of Hypomania

/eeling of creati*ity

Don’t 2orry about 'roblems seriously /eeling as if nothing can bring you do2n

Ha*e confidence in yourself

Similar to Mania e9ce't Hy'omania is of lesser intensity


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Characteristics of Psychosis

Poor attention and concentration

Sus'iciousness Social 2ithdra2al

/eeling that things around you ha*e changed

Describing the diagnosis 2ith 'sychosis is usually used toclarify the se*erity of the state of the disorder


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Characteristics of Depression

Slee' more than you normally 2ould

/eeling of tiredness:rying uncontrollably0ithdra2ing from acti*ities you once en)oyed Staying in bed for days0eight 7oss;0eight


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The Two Sides of Bipolar Disorder

&i'olar !

+'isodes of full maniaalternating 2ithe'isodes of ma)orde'ression

Diagnosed in 'atientsty'ically in early 5=’s

&i'olar !!

+'isodes of ma)orde'ression andhy'omania


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Eal!ation of Patient

Ma1e sure no other medical condition is causingmood or thought disturbance

Perform a 'hysical e9amination > 7oo1 for 'ossibility of substance abuse > Trauma to brain > Seiure disorders

Perform mental health e*aluation > Mental status e9amination (MS+#

Assesses mood and cogniti*e abilities Safety of indi*idual +9amines forms of 'sychosis


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Eal!ation of Patient Cont"

Sub)ecti*e e9'erience of 'atient

/amily’s 'sychiatric history


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Prealence

7ifetime? 3@ Males and /emales ? no difference Age ? all ages

> Highest 're*alence is in the 34 to 56 year age grou'

/irst degree relati*es ? incidence of &P increases

Affects roughly 3;3== adults "ery little data about 1ids and teenagers 7in1ed to disturbed electrical acti*ity in the brain (


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Bipolar Disorder

Difficulties(


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What Ca!ses Bipolar?

8o single cause may e*er be found for bi'olardisorder Among the biological factors obser*ed in

bi'olar disorder, as detected by using imaging cansand other tests, are the follo2ing. > B*er secretion of cortisol, a stress hormone

> +9cessi*e influ9 of calcium into brain cells

> Abnormal hy'eracti*ity in 'arts of the brain associated 2ithemotion and mo*ement coordination and lo2 acti*ity in'arts of the brain associated 2ith concentration, attention,inhibition, and )udgment (0ell :onnected, 5==5#


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How Serio!s is Bipolar Disorder?

According to 0ell:onnected, 5==5.

is1 for Suicide > An estimated 3C5=@ of 'atients 2ho suffer from bi'olar

disorder and do not recei*e medical attention commitsuicide !n a 5==3 study of &i'olar ! disorder, more than C=@ of

'atients attem'ted suicide$ the ris1 2as highest duringde'ressi*e e'isodes

Patients 2ith mi9ed mania, and 'ossible 2hen it is mar1ed byirritability and 'aranoia, are also at 'articular ris1

Many young children 2ith bi'olar disorder are more se*erely illthan are adults 2ith the disorder According to a study in 5==3,

5C@ of children 2ith the disorder are seriously suicidal


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Serio!sness of Disorder Cont#

Thin1ing and Memory Problems >

!n a 5=== study, it 2as re'orted that bi'olardisorder 'atients had *arying degrees of'roblems 2ith short and longterm memory,s'eed of information 'rocessing, and mentalfle9ibility

(Medications used for bi'olar disorder, ho2e*er,could ha*e been res'onsible for some of theseabnormalities and more research is needed toconfirm or refute these findings#


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Substance Abuse >

:igarette smo1ing is 're*alent among bi'olar'atients, 'articularly those 2ho ha*e freuent orse*ere 'sychotic sym'toms Some e9'ertss'eculate that, as in schio'hrenia, nicotine usemay be a form of selfmedication because of its

s'ecific effects on the brain > E' to F=@ of 'atients 2ith bi'olar disorder abuse

other substances (most commonly alcohol,follo2ed by mari)uana or cocaine# at some 'oint

in the course of their illness


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+ffect on 7o*ed Bnes >

!t is *ery difficult for e*en the most lo*ing familiesand caregi*ers to be ob)ecti*e and consistentlysym'athetic 2ith an indi*idual 2ho 'eriodicallyand une9'ectedly creates chaos around them

> Bften family members feel socially alienated bythe fact of ha*ing a relati*e 2ith mental illness,and they conceal this information fromacuaintances


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+conomic &urden >

!n 3GG3, the 8ational !nstitute of Mental Healthestimated that the disorder cost the country 6Cbillion, including direct costs ('atient care,suicides, and institutionaliation# and indirectcosts (lost 'roducti*ity, and in*ol*ement of the

criminal )ustice system# > !n one ma)or sur*ey, 3I@ of 'atients had noinsurance and 3C@ 2ere unable to afford medicaltreatment


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Treatment of Bipolar Disorder

$a fo!r phase process%

+*aluation and diagnosis of 'resenting

sym'toms Acute care and crisis stabiliation for

'sychosis or suicidal or homicidal ideas oracts

Mo*ement to2ard full reco*ery from ade'ressed or manic state

Attainment and maintenance of euthymia

This four 'hase 'rocess 2as according to (Himanshu P E'adhyaya, M&&S, MS,5==5#


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Treatments

!n'atient :are Assess the 'atient

Diagnose the condition

+nsure safety of 'atient and others > This care is necessary for.

Psychotic features

Suicidal or homicidal ideations


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Treatments

Antide'ressant thera'y

Mood stabilier > 7ithium carbonate > Sodium di*al'roe9 > :arbamae'ine

Anti'sychotic Agents > is'eridone > Halo'eridol


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Treatments

+lectrocon*ulsi*e thera'y (+:T# >

!n'atient basis > Se*ere cases

> Patient reuires hos'italiation often/aster than medications for thera'eutic res'onses

Memory loss before and after treatmentsI4 sessions

Medications are still reuired in maintenance 'hase oftreatment


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Mood Sta&ili'ers$(padhyaya)*++*%

Mood Stabilier :ommon Ad*erse+ffects

Doses S'ecial :oncerns

7ithium carbonate

(+s1alith :,7ithobid#

7ethargy or sedation,

tremor, enuresis,2eight gain, o*erthy'othroidism occursin C3=@ of 'atients

I==F== PB tid;id

Must be ad)usted bymonitoring serumle*el and 'atientres'onse

Hy'othyroidism,

diabetes insi'idus,'olyuria, 'olydi'sia

Sodium di*al'roe9;*al'roic acid(De'a1ote,

De'a1ene#

Sedation, 'lateletdysfunction, li*erdisease, 2eight gain

3=5= mg;1g;d

Must be ad)usted bymonitoring serum

le*els

+le*ated li*erenymes or li*erdisease, bone

marro2 su''ression

:arbamae'ine

(Tegretol#

Su''ressed 0&S,diiness,dro2siness, rashes,li*er to9icity(rarely#

5== mg PB bid Mustbe ad)usted bymonitoring serumblood le*els

DrugDruginteractions, bonemarro2 su''ression


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Mood Sta&ili'ers Cont"


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Mood Sta&ili'ers Cont"

/elbamate(/elbatol#

7i*er Disease,'hotosensiti*ity

, headache,somnolence

8ot+stablished

A'lasticanemia

"igabatrin(Sabril#$

!n*estigationaldrug

0eight gain,agitation,insomnia

8ot+stablished

En1no2n


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Psychotherapy

!s not an effecti*e treatment by itself, but can

be used in addition to medicationTy'es of thera'y include.

cogniti*e beha*ior thera'y

'sychoeducation

inter'ersonal thera'y

multifamily su''ort grou's


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Co,nitie Behaior Therapy

More effecti*e 2ith the de'ressi*e 'art of

bi'olar disorder %!n*ol*es identifying irrational thought

'atterns and altering themL to better reflectreality- Acti*ities such as %daily mood logs-

can hel' (0il1inson 5==5#


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Psychoed!cation

7earning signs and sym'toms of his;her

disorder$ 2hat triggers mood alterationMore useful for mania

&eing able to identify signs and sym'toms ofmania is hel'ful in the 're*ention of a %full

blo2n manic e'isode- (0il1inson 5==5#


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Interpersonal Therapy

Hel's to im'ro*e social s1ills and thereby

'ro*ides 'atients 2ith more stability ininteracting 2ith others

Acti*ities include.

role 'laying

modeling

%guided in *i*o 'ractice- (0il1inson 5==5#


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M!lti-family Therapy

Parent in*ol*ement in a child 2ith &D byteaching the child.

rela9ation techniues

anger management

decisionma1ing s1ills

communication;listening s1illsseeing that children don’t become %*ictims of

their illnesses- (0il1inson 5==5#


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.n .lternatie Com&ination

A combination of lithium and *al'roate canbe effecti*e in treatment if monothera'y fails


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Treatment for Children and

.dolescents

7ithium is one of the original treatments for bi'olarstates in youth

!n a study in 2hich chlor'ramine (thoraine# 2asused, a''ro9imately I=@ to C=@ of youths had anim'ro*ement 2ith mood stabiliing

!n /raier et al’s 5==3 e9'eriment, an eight 2ee1

study of using olana'ine monothera'y in 5Ichildren and adolescents sho2n that there 2eresignificant im'ro*ements of mania and de'ressionon doses ranging from 5C mg;day to 5= mg;day


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Treatment Trends in the Elderly

The number of ne2 lithium users 'er year fellfrom FCI to 543 in 5==3 for older 'atients

The number of di*al'roe9 users rose from34I in 3GGI to 3=G= in 5==3

Though there has been a decline in elderly

lithium 'atients using lithium, lithium 2illcontinue to be a mainstay until other moodstabiliers are researched more e9tensi*ely


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Choosin, the site of Treatment

According to the American Psychiatric Association, 5===. Bne of the first decisions the 'sychiatrist must ma1e is the

o*erall le*el of care that the 'atient reuires > Acute e'isodes of bi'olar disorder are freuently of suchse*erity that 'atients reuire treatment in either a full or'artial hos'ital setting (The least restricti*e setting that isli1ely to allo2 for safe and effecti*e treatment should bechosen#

!f the 'atient is lac1ing the ca'acity to coo'erate 2ith treatment > Patients 2ho are unable to care for themsel*es adeuately,coo'erate 2ith out'atient treatment of their mood disorder,or 'ro*ide reliable feedbac1 to their 'sychiatrist regardingtheir clinical status are candidates for full or 'artialhos'italiation, e*en in the absence of a tendency to2ardintentional selfharm


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Site of Treatment Cont#

!f the 'atient is at ris1 for suicide or homicide > Patients 2ith suicidal or homicidal ideation reuire close

monitoring Patients at high ris1 may benefit fromhos'italiation, during 2ith close obser*ation, restrictedaccess to *iolent means and more intensi*e treatment are'ossible

!f the 'atient lac1s 'sychosocial su''orts

> eco*ery from acute bi'olar e'isodes is aided by anen*ironment that encourages safety, constructi*e acti*ity,'ositi*e inter'ersonal interactions, and com'liance 2ithtreatment !f the home en*ironment lac1s these features ore9'oses the 'atient to undesirable or dangerous acti*ities,such as alcohol or drug abuse, admission to a hos'ital or an

intensi*e day 'rogram may be necessary


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Wor/s Cited

&i'olar Disorder (5==5# Well Connected A.D.A.M. Inc. etrie*ed from 2222ellconnected com

Dinan, Timothy


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Wor/s Cited Cont#

Srinath, a)ee* J et al (5==I, /ebruary# The !nde9 Manic +'isode in Ju*enileBnset &i'olar Disorder. The Pattern of eco*ery Canadian Journal ofPsychiatry. "ol 64 (3# etrie*ed Bct 55, 5==I, from +&S:B AcademicSearch +lite Database

Sternstein, Aliya Q

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Bipolar Disorder and Treatments

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