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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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Serio!sness of Disorder Cont#
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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Serio!sness of Disorder Cont#
+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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Serio!sness of Disorder Cont#
+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