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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