Bipolar DisorderCycles 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 DisordersTwin 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 CarbonateClient 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 DisorderRecurrent disorder where person has 1+ manic episodes with depressive episodes | More manic than depressive episodes | Mania is usually time-limited |
Bipolar II DisorderRecurrent major depressive disorders with hypomania | More depressive episodes than hypomanic episodes | Client never experiences full manic episode | More common in women than men |
Cyclothymic DisorderMood 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 DisordersMedication, 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 DisorderMood 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 DisorderAntimanic 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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