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Bipolar and Related Disorders by

Bipolar Disorder

Cycles of mania and depression
Affects 2.6% of US population
Affects men and women equally
Occurs more frequently in people of higher socio-­eco­nomic status
Delusions and halluc­ina­tions may occur
Psychosis may be present
Hypomania
Milder degree of symptoms
Not as severe; no hospitalization
No psychotic features
Well: 53% of time
Depressed: 32% of time
Manic: 9% of time
Cycling: 6% of time

Etiology of Bipolar Disorders

Twin Studies
60-80% monozy­gotic, 10-20% dizygotic
Family Studies
1 Parent with BPD, 28% risk of child developing BPD
both parents with BPD 2-3x greater risk of child
Bioc­hemical factors
Norepi­nep­hrine and dopamine high during mania, low during depression
Serotonin remains low in both states
Neur­oan­ato­mical Factors
MRI reveal large third ventricles and subcor­tical white matter and perive­ntr­icular hyperi­nte­nsities

Lithium Carbonate

Client Teaching
Increase fluid intake - up to 2L/day
May be swelling in extremities
Metallic taste in mouth is normal
Monitor blood levels regularly
Signs and symptoms decrease longer client is on drug
Always report side effects
 

Bipolar I Disorder

Recurrent disorder where person has 1+ manic episodes with depressive episodes
More manic than depressive episodes
Mania is usually time-l­imited

Bipolar II Disorder

Recurrent major depressive disorders with hypomania
More depressive episodes than hypomanic episodes
Client never experi­ences full manic episode
More common in women than men

Cyclot­hymic Disorder

Mood distur­bance of at least 2 years
Numerous episodes of elevated mood
Do not meet criteria of hypomanic episode
Depressed mood not severe enough to meet MDD

Treatment for Bipolar Disorders

Medica­tion, education, support
Anti­manic Agents
ie. Lithium
Anti­con­vulsant Agents
Carbamazepine
Clonazepam
Valporic acid
Lamotrigine
Effective for clients who are cycling
Manage mania/­hyp­omania
Anti­dep­ressant augmented with antipsychotics
Risperidone
Olanzapine
Psychotherapy
Individual/group/family therapy
6-8 sessions reduce rate of relapse by 50%
ECT
Used with lithium to treat mania
 

Cycling Bipolar Disorder

Substa­nce­-In­duced Bipolar Disorder

Mood distur­bance r/t physio­logical effects of substance
Elevated, expansive or irritable mood
Inflated self esteem
Decreased need for sleep and distra­cti­bility
Alcohol, opioids, inhalants, hypnotics, anesth­etic, analge­sics, anti-c­onv­uls­ants, cardiac medica­tions, anti-p­ark­ins­onian agents, anti-ulcer agents, oral contra­cep­tives, muscle relaxants, steroids, sulfon­amides

Psycho­pha­rma­cology for Bipolar Disorder

Antimanic agents
Lithium Carbonate
Affects neurotransmitters
Maintained by serum levels
Must remain between 0.9-1.4mEq/L
Toxic if above therap­eutic range
 
Side Effects
Fluid retention, weight gain, metallic taste, fine tremors, thirst
Slurred speech, abdominal pain, convul­sions, incont­inence, coma
 
Signs of Toxicity
Vomiting, slurred speech, blurred vision, weakness, tinnitus, poor coordi­nation, diarrhea, poor coordi­nation
Side effects are reversible if drug is stopped and serum levels decrease

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