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Bipolar Disorder / Reading and Sharing

Bipolar disorder is a complex brain disorder in which moods range from periods of mania followed by episodes of depression (Ferri, 2018). Unfortunately, the management of the disease has no specific combination of psychosocial and medication regime that works well for everyone’s mood instability. So, therefore, the right combination to manage a particular patient’s mood instability takes time and can change over time due to the patient’s noncompliance with medication and frustration with treatment.

The prevalence accounts for about 2.6% of the adult population of these nearly 83% of the adult United States population is considered severe. Some data reports that females are at a higher risk for depression and rapid mood swings while males have a higher risk for mania (ISNA, 2017). The prevalence of bipolar disorder among U.S. adults aged 18 or older an estimated 2.8% of U.S. adults had bipolar disorder in the past year, and adolescents aged 13-18 are estimated at 2.9% of having bipolar disorder, with 2.6%  considered severe (NIH, 2017). About 10% of patients who attend primary care setting are at risk for bipolar, and 25% of the more difficult depression cases are likely to be undiagnosed as a bipolar disorder (Epocrates, 2017).

The pathophysiology of the bipolar affective disorder, or manic-depressive illness, has not been determined, and no biologic markers are identified to correspond with the disease state. However, twin, family, and adoption studies all indicate that bipolar disorder has a significant genetic component and stressors or triggers that contribute to the phenotypic expression of the underlying mood shifts.  In like manner, the structural finding with the use of magnetic resonance imaging shows abnormal brain regions, neurochemical changes that regulate mood shifts and increased periventricular white matter hyperintensities compared with healthy individuals (Epocrates, 2017).

To diagnosing a bipolar disorder, there should be a thorough clinical assessment of the patient psychosocial status, medical and psychiatric comorbidities, current and past medications as well as medication compliance, and substance use. A detailed review of symptoms, symptom severity, and their effects on daily functioning in combination with the use of a standard tool such as the young mania scale rating to assess the severity of the manic episode. Associated symptoms for manic or hypomanic episodes are grandiosity, diminished need for sleep, excessive talking, racing thoughts, distractibility, increased level of goal-focused activity at home, at work, or sexually extreme pleasurable events, often with painful consequences. On the other hand with significant depression the episodes last two weeks, the person experiences depressed mood that manifests as a loss of pleasure or interest. Included is weight loss or gain, hypersomnia or insomnia, psychomotor retardation or agitation, Loss of energy, feelings of worthlessness or excessive guilt, decreased concentration or marked indecisiveness and preoccupation with suicide (Soreff, 2017).

The treatment plan is based on the severity of the disorder and when patients are severely affected without insight into their illness may require urgent psychiatric hospitalization to assure their safety and that of others. With a patient who is not rapidly cycling and is nonpregnant, the mania or hypomania with agitation treatment is an intramuscular injection of a neuroleptic or benzodiazepine and if no agitation with hypomania, mild mania or moderate mania to severe, monotherapy mood stabilizers and atypical antipsychotics are recommended. However, in acute bipolar depression the support for antidepressant as an effective treatment lacks controlled studies so, therefore, a combination of olanzapine/fluoxetine is used. The rapid cycling nonpregnant patients require deliberate planning, and patience, so the focus is on mood stabilizers and removing exacerbation factors like illicit drugs, alcohol, stimulates. When pregnant patients have been diagnosed with the disorder, a referral to a psychiatrist and obstetrician is implemented. The test included in the examination is a valid questionnaire that identifies mental disorders or bipolar depression along with obtaining CBC, TFTs, serum vitamin D, and a toxicology screen to rule out other causes of the mood symptoms. Follow up of bipolar disorder requires lifelong treatment, management with frequent monitoring, rating scales of mood and health questionnaire to measure the response to depression as well as monitoring the patients weekly who are discharged from the hospital.

Education should be provided to the family or friends to alert the patient and the clinician, should warning signs of relapse emerge. The patient should work with their health provider to identify individual patterns of relapse, recurrence, and changes in sleep to prevent a total decline. Also, the patients should be encouraged to speak openly about their experience of bipolar illness, feelings of stigma, and any adverse effects of the medications that may threaten adherence and sustained mood stability. Avoidance of situations or stressors known to trigger strong, negative emotions, based on their own experience and unhealthy relationships, poor living conditions, or stressful jobs may easily overwhelm their fragile state of recovery. Some patients need reminders or pill-boxes, a scheduled sleep routine, proper eating, and moderate exercise which should become a regular part of daily living. Other resources that should be provided by the healthcare provider is community organizations, and patient advocacy groups such as the National Alliance for Mental Illness or the Depression Bipolar Support Alliance, both organizations can foster recovery for the patient and their family (Epocrates, 2017). In conclusion, treatment and management of bipolar disorder are challenging because of the recurrent nature of the condition, diagnosing the disease accurately and the safety factors for the patient and others.

 

 

References:

Benarous, X., Consoli, A., Milhiet, V., Cohen, D. (2016). Early interventions for youths at high risk for bipolar disorder: A developmental approach. European Child and Adolescent Psychiatry, 25, 217-233.

Bipolar disorder (2017) National institute of mental health. Retrieved  https://www.nimh. nih.gov/health/statistics/bipolar-disorder.shtml

Bipolar disorder in adults-Epocrates Online (2017). Retrieved https://online.epocrates.com/

Ferri, F. (2018). Fred’s Clinical Advisor 2018. Elsevier: Philadelphia, PA.

Gooding, C. & Wolford, K. (2013) Bipolar disorder. Retrieved https://eds-a-ebscohost-com.lib.kaplan.edu/eds/detail/detail?vid=1&sid=3dca9565-038c-4471-b87d-73a81e5b5ded%40sessionmgr4010&bdata=JnNpd

ISNA Bulletin. (2017). Bipolar disorder: Implications for nursing practice. Indiana State Nurses Association 43,(4), 12-15.

Soreff, S. (2017). Bipolar affective disorder clinical presentation. Retrieved https://emedicine. medscape.com/article/286342-clinical

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