Bipolar And Related Disorders

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Bipolar- Disorders Included?

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bipolar I, bipolar II, cyclothymic disorder, substance/ medication-induced bipolar and related disorder, bipolar and related disorder due to another medical condition, other specified bipolar and related disorder, and unspecified bipolar and related disorder (APA, 2013).

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Bipolar- When does first episode occur?

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early 20's (occurs faster with individuals with a family history)

Bipolar disorders usually begin during the first half of life, usually before age 50, and tend to be recurring with episodes lasting an average of several months.

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Bipolar: Definition

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Bipolar disorder is characterized by the occurrence of one or more manic episodes or mixed episodes amid intermittent episodes of depression. Individuals suffering from bipolar disorder usually recover completely between episodes and may be symptom free for years. However, a few individuals may have frequent mood swings that can occur more than four times in a year (i.e., rapid cycling) with little mood stability between episodes. A distinction is made between bipolar I and bipolar II disorders in which bipolar I clients may experience more severe manic and depressed swings while bipolar II clients experience less extreme swings with hypomanic rather than manic episodes, respectively.

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Bipolar- DX of Bipolar I

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The diagnosis of bipolar I disorder involves a manic episode which may be preceded by and followed by a hypomanic or major depressive disorder. There are ten specifiers and a number of potential features. There are four different bipolar I diagnoses (current or most recent episode of manic, current or recent episode of hypomanic, current or most recent episode depressed, and current or most recent episode unspecified) and two bipolar II diagnoses.

the manic episode is not better accounted for by psychotic type disorders such as schizophrenia affective disorder, schizophrenia, schizophreniform disorder, delusional disorder or other specified or unspecified schizophrenia spectrum

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Bipolar I: Comorbidity

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anxiety

substance abuse

eating disorders

paraphilia

attention-deficit/ hyperactivity disorder

impulse-control disorders-gambling ,

conduct disorders

autism,

Tourette’s syndrome,

migraines

diabetes

obesity

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Bipolar II: Def

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Bipolar disorder, type II is characterized by at least one episode of hypomania (never a full manic episode) and at least one or more episodes of major depressive episode and at least one hypomanic episode.

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Bipolar II: Dx

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The diagnostic criteria for a bipolar II disorder is for a recurring mood episode consisting of one or more major depressive episodes (lasts two weeks) and at least one hypomanic episode (at least four consecutive days). The mood episodes require that five or more symptoms for Criterion A to be met for at least two weeks and one of the two symptoms must be either a depressed mood or loss of interest (p. 133). The mood is to be most of the time, nearly every day, and can be derived from a subjective report.

important for non-medical clinicians to make a careful assessment that includes a family history for possible bipolar disorder, before asking a medical consultant to consider prescribing anti-depressant medication.

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Bipolar: Treatment

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Pharmacotherapy generally treatment of choice( most effective)

Structured settings (might include reducing stimuli)

Behavioral family treatment showed promising results in relapse prevention in combination with pharmacotherapy.

sleep therapy for depression treatment

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Bipolar: Treatment with pharmacotherapy

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Pharmacotherapy is considered to be the most effective treatment to control and stabilize bipolar symptoms

Lithium has been demonstrated to reduce the risk of suicide.

Lamotrogine has been found to be most effective for treating bipolar depression.

non-use of antidepressants should be avoided in bipolar clients because they might trigger manic episodes, rapid cycling, anxiety attacks, or agitation.

***Important to monitor for possible side-effects of medications

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Bipolar: Monitoring

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Monitoring is important because of the high incidence of relapse, most often caused by noncompliance with prescribed medications.

37% of bipolar clients relapse within one year and that 73% will relapse within 5 years.

**Mood charting

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Bipolar- Effective Therapies

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Effective therapies include brief cognitive cognitive-behavioral

psychoeducational

interpersonal social rhythm therapies

These interventions are important because they can assist in increasing medication adherence, reduce relapse rates, shorten recovery time from the depression, and improve the overall functioning of the client

Mood charting is also recommended in order to recognize subtle mood changes and symptoms, trigger recognition, warning signs for acute episodes, and overall monitoring of the treatment protocol.

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Cyclothymic Disorder

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chronic disorder characterized by fluctuating moods involving numerous periods of hypomanic symptoms and numerous periods of depressive symptoms for at least two years.

These symptoms are of insufficient number, severity, pervasiveness, or duration to meet full criteria for manic or depressive episodes.

Criterion B requires that for a two-year period of time the hypomanic and depressive periods have been present for at least half the time and the client has not been without the symptoms for more than two months at a time (APA, 2013).

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Bipolar-Mania

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expansiveness, heightened sense of esteem, grandiosity, diminished sleep, pressured speech, and excessive energy.