Bipolar Disorder

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Bipolar Disorder

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a condition in which people go back and forth between periods of a very good or irritable mood and depression. The "mood swings" between mania and depression can be very quick.

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Types of Bipolar Disorder

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- bipolar disorder type I (manic depression)
- bipolar disorder type II (hypomania)
- cyclothymia

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In most people with bipolar disorder ...

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*no clear cause for the manic or depressive episodes

but may be triggered by:

- Life changes such as childbirth
- Medications such as antidepressants or steroids
- Periods of sleeplessness
- Recreational drug use

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The manic phase may last...

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days to months.

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*symptoms of mania occur with bipolar disorder I.

*In people with bipolar disorder II, the symptoms of mania are similar but less intense.

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HIgh risk of _______ in bipolar dso.

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Suicide

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Sometimes the two phases overlap. Manic and depressive symptoms may occur together or quickly one after the other in what is called a ________.

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Mixed state

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main goals of treatment are to:

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Avoid moving from one phase to another

Avoid the need for a hospital stay

Help the patient function as well as possible between episodes

Prevent self-injury and suicide

Make the episodes less frequent and severe

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mood stabilizers, are usually used first:

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Carbamazepine
Lamotrigine
Lithium
Valproate (valproic acid)

*Lithium, the mainstay in the management of bipolar disorder,

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other drugs may be used

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Anti-seizures
(sodium valproate, carbamazepine or lamotrigine)

Antipsychotic drugs
(quetiapine, risperidone, olanzapine or aripiprazole)

and Anti-anxiety drugs (benzodiazepines) for mood problems

Anti-depressants

*People with bipolar disorder are more likely to have manic or hypomanic episodes if they are put on antidepressants. Because of this, antidepressants are only used in people who also take a mood stabilizer.

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if Bipolar Dso does not respond to medication

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Electroconvulsive therapy (ECT)

*uses an electrical current to cause a brief seizure while the patient is under anesthesia.

*the most effective treatment for depression that is not relieved with medications.

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most often used after ECT.

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Transcranial magnetic stimulation (TMS) uses high-frequency magnetic pulses to target affected areas of the brain.

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Getting enough _________ is very important in bipolar disorder.

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sleep

*A lack of sleep can trigger a manic episode

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Abrupt stoppage of medication or taking it the wrong way may lead to Complications:

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Alcohol and/or drug abuse

Problems with relationships, work, and finances

Suicidal thoughts and behaviors

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Bipolar I disorder

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----> a mood disorder that is characterized by at least one manic or mixed episode.

*sometimes occurs along with episodes of hypomania or major depression as well.

It is a sub-diagnosis of bipolar disorder, and conforms to the classic concept of manic-depressive illness.

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Bipolar II disorder

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---> characterized by at least one hypomanic episode and at least one major depressive episode;

*never experienced a full manic episode

*depressive episodes can be more frequent and are more intense than hypomanic episodes

*more severe and distressing than Bipolar I with respect to episode frequency and overall course.

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Cyclothymia

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a mild form of bipolar disorder (manic depressive illness) in which a person has mood swings over a period of years that go from mild depression to emotional highs.

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highest risk for suicide among the bipolar spectrum?

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Bipolar II

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higher degree of relapse?

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Bipolar II

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Treatment of choice for Bipolar II

or the most common medication for Bipolar Dso?

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Lithium

*usually prescribed for 6 months

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For lithium to be effective...

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the dosage must be correct!

if not --->side effects ----> tell doctor asap!

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While taking lithium

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regular bld test (q 3mos) ---> lithium toxicity

kidney & thyroid fxn (q 2-3 mos) if Lithium is being adjusted.

*No NSAID's unless prescribed by doctor.

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Meds not prescribed for pregnant women with bipolar disorder:

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valproate – there is a risk to the foetus and the subsequent development of the child

carbamazepine – it has limited effectiveness and there is risk of harm to the foetus

lithium – there is a risk of harm to the foetus, such as cardiac problems

lamotrigine – there is a risk of harm to the foetus

paroxetine – there is a risk of harm to the foetus, such as cardiovascular malformations

long-term treatment with benzodiazepines – there are risks during the pregnancy and immediately after the birth, such as cleft palate and floppy baby syndrome

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Psychological treatment

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PSYCHOEDUCATION to help you find out more about bipolar disorder

Cognitive Behavioural Therapy (CBT), which is most useful when treating depression

Family Therapy, a type of psychotherapy that focuses on family relationships (such as marriage) and encourages everyone within the family or relationship to work together to improve mental health