BIPOLAR DISORDER

Management

Management

• Bipolar disorder is a complex and chronic illness. • It produces major shifts in mood and energy. • It impairs all areas of a person’s life, including

work, relationships and daily functioning. • Fortunately, however, effective treatment exists,

and you can get better.• The goal of treatment is not to cure the disorder

but rather to control the symptoms and the course of the disorder.

Hospitalization

The indications for inpatient treatment in a person with bipolar disorder include the following:

• Danger to self• Danger to others• Total inability to function• Total loss of control

Pharmacotherapy

Treatment for bipolar disorder can be divided into 3 general categories:

Acute treatment: focuses on suppressing current symptoms

Continuation treatment: Prevents a return of symptoms during the same maniac or depressive episode

Maintenance treatment: Prevents a recurrence of symptoms

PROGNOSIS

GOOD PROGNOSIS

• Length of manic phases (short in duration)

• Late age of onset• Few thoughts of suicide• Few psychotic symptoms• Few medical problems• Family H/O bipolar disorder

BAD PROGNOSIS

• Poor job history• Substance abuse• Psychotic features• Depressive features

between periods of mania and depression

• H/O attempts to end life• Male sex

Categories of drugs used

• Mood Stabilizers• Anti-psychotics• Anti-depressants• Anti-convulsants• COMBINATION DRUGS Symbax : Antidepressant fluoxetine +

Antipsychotic olanzapine

It’s a balancing act!

LITHIUM

• Preparations: Lithium carbonate Lithium citrate Lithium sulphate

Mechanism of Action

• The most widely accepted hypothesis is:

• Inhibition the enzyme inositol monophosphatase, leading to higher levels of inositol triphosphate.

Adverse drug reactions

• Most common side effect: Fine tremors• Nausea & headache • Dehydration and electrolyte imbalance • Lithium induced diabetes insipidus and

hypothyroidism• LITHIUM is a TERATOGEN(Ebstein’s anomaly)• The risks of long-term medication use must

be weighed against the risk of relapse.

Psychotherapy

• Behavioral therapy. This focuses on behaviors that decrease stress.

• Cognitive therapy. This type of approach involves learning to identify and modify the patterns of thinking that accompany mood shifts.

• Interpersonal therapy. This involvesrelationships and aims to reduce strains that the illness may place upon them.

• Social rhythm therapy. This helps you develop and maintain daily routines.

Support Groups

Better understanding of the illness, share their concerns, and learn how to best manage them

Receive encouragement, learn coping skills, and share concerns

• Patient feels less isolated as a result• Family members and friends may also benefit

from a support group