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
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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 |
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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 |
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Side Effects
Fluid retention, weight gain, metallic taste, fine tremors, thirst
Slurred speech, abdominal pain, convulsions, incontinence, coma |
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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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