WHAT IS BIPOLAR DISORDER Bipolar disorder, known as
manic-depressive illness, is a brain disorder that causes unusual
mood changes, energy, activity levels, and ability to carry out
day-to-day tasks. Characterized by the occurrence of at least one
manic or mixed- manic episode during patients lifetime. Patients
may have one or more depressive episodes May return to their normal
state of well- being during intervals between these episodes
Symptoms are different from the normal ups and downs that everyone
goes through from time to time.
http://www.nimh.nih.gov/health/publications/bipolar-disorder/index.shtml
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BIPOLAR ONSET Symptoms may occur in early childhood, early
teens, 40 or 50 years of age, as late as seventies or eighties
(very rare) Any race, ethnic group, or social class can develop
features of bipolar. Recently, children have been diagnosed as
young as toddlerhood..
http://www.bipolarcentral.com/articles/articles-931-1-Age-of-Onset-Influences-Bipolar-Prognosis.html
http://bipolarsymptoms.org/bipolar-statistics/
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FACTS ABOUT BIPOLAR DISORDER According to National Institute of
Mental Health: 5.7 million/ 2.6% the adult population in the United
States is diagnosed with bipolar disorder. According to World
Health Organization, bipolar disorder is the sixth leading cause of
disability in the world. Bipolar disorder is the most expensive
behavioral health care diagnosis, costing more than twice as much
as depression per affected individual ( CDC)
http://www.cdc.gov/mentalhealth/data-stats.htm Women tend to have
more depressive episodes and more mixed episodes than men. Women
are three times more likely to experience rapid cycling of bipolar
disorder than men. One in five people with bipolar disorder will
commit suicide
http://bipolarsymptoms.org/bipolar-statistics/#IN2.dpuf
/bipolarsymptoms.org/bipolar-statistics
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GENETICS/ CAUSE Bipolar disorder runs in families. Research
suggests people with such genes are more likely to develop bipolar
disorder than others. Children with a parent or sibling who has
bipolar disorder are much more likely to develop the illness,
compared to children who do not have a family history of bipolar
disorder. Not all children with family history of bipolar disorder
develop the illness. Many factors, rather than just a single cause,
may act together to produce the illness or increase risk for
Bipolar disorder. http://www.nimh.nih.gov/health/topics/bipolar-
disorder/index.shtml
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BIPOLAR I According to DSM IV- TR Bipolar 1 is characterized by
one or more Manic or Mixed Episodes, usually accompanied by Major
Depressive episodes,
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MANIA According to DSM IV-TR Manic Episode is defined as an
abnormally and persistently elevated, expansive and irritable mood
lasting at least 1 week or less (if hospitalization is required)
Mood disturbance should accompanied by at least three additional
symptoms such as: Inflated self- esteem or grandiosity Decreased
need for sleep Pressured speech Flight of Ideas, or racing thoughts
Distractibility Increased involvement in activities with painful
consequences ( drugs, indiscriminate sexual encounters with
strangers, gambling, spending sprees, reckless driving, foolish
business investments, trouble with law If mood is irritable rather
than elevated four of the above symptoms must be present. (DSM IV-
TR)
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MANIA CONT. Grandiose delusions Religious delusions are very
common, may think they are prophets, elected by God, for a hidden,
purpose. Prosecutory delusions are quite common Irritable mood, may
get into furious rage of screaming, swearing, and assaultive
behavior. May become dangerously, hostile. Are regretful when no
more manic Mood may shift to anger or depression
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BIPOLAR DEPRESSION According to DSM IV TR: Five or more of the
following symptoms must be present during the last 2 weeks period
and present a change from previous functioning level. Depressed
Mood, most of the day, every day ( feeling sad, or empty, tearful).
Diminished interest in activities that were once enjoyed.
Significant weight gain or loss. Insomnia or hypersomnia almost
everyday. Psychomotor agitation.
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BP DEPRESSION CONT. Loss of energy and feeling fatigued.
Feeling of worthlessness and excessive guilt. Unable to concentrate
or indecisiveness. Recurrent thoughts of death and thoughts of self
harm without a specific plan or suicide attempt. Depressive
symptoms may last moments, hours, or more rarely days.
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MIXED EPISODE Lasting at least 1 week in which the criteria are
met both for a Manic Episode and for a Major Depressive Episode
nearly every day ( DSM IV TR) Rapid alternating moods Sadness
Irritable Euphoric Agitation Insomnia Appetite decreased/ increased
Psychotic features Suicidal ideations Mood disturbance must cause
marked impairment in social or occupational functioning or Need for
hospitalization (DSM IV- TR)
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BIPOLAR II Characterized by one or more major depressive
episodes accompanied by at least one Hypomanic episode. (DSM IV
TR)
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HYPOMANIA A distinct period of an abnormal, persistently
elevated, expansive or irritable mood at least last for 4 days. The
period of abnormal mood must accompanied by at least three or more
of the following symptoms: Inflated self- esteem ( uncritical self
confidence) Grandiosity ( non- delusional) Decreased need for sleep
More talkative than normal, pressure to continue talking Flight of
ideas or racing thoughts Distractibility
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HYPOMANIA CONT. Psychomotor agitation Excessive involvement of
pleasurable activities that lead to painful consequences Delusion
and hallucinations are not present Hypomanic episodes are not
severe enough to cause marked impairment in social and occupational
functioning Does not require hospitalization Increased efficiency
or creativity for some people
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CYCLOTHYMIC DISORDER Characterized by at least 2 years of
numerous periods of hypomanic symptoms that do not meat criteria
for Manic episode and numerous periods of depressive symptoms that
do not meet criteria for Major Depressive Episode(DSM IV- TR)
Usually begins in adolescence or early adult life Equally common in
men and in women 15% - 50% people will subsequently develop bipolar
1 or II disorder http://www.ncbi.nlm.nih.gov/pubmedhealth
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DISRUPTIVE MOOD DYSREGULATION DISORDER A relatively new
diagnosis in the mental health field, recently added in DSM V
addition. According to (Zepf FD, Holtmann 2012) Diagnostic criteria
for disruptive mood dysregulation disorder, proposed for DSM-5 A
severe recurrent temper outbursts in response to common stressors,
which are: Manifest verbally or behaviorally, such as in the form
of verbal rages, or physical aggression towards people or property.
Grossly out of proportion in intensity or duration to the situation
or provocation. Inconsistent with the childs developmental level. B
Temper outbursts occur, on average, three or more times per week. C
Mood between temper outbursts is persistently negative (irritable,
angry, and/or sad) nearly every day
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DISRUPTIVE MOOD DYSREGULATION DISORDER D Criteria A-C have been
present for at least 12 months and symptoms have been absent for
less than 3 months at a time E Symptoms exists at least two
settings (at home, at school, or with peers) and must be severe at
least in one setting. F Aged 6 years or older G Onset before 10
years of age H & I Does not meet criteria for another mental
disorder (e.g., bipolar, major depression, psychosis) but it can
coexist with oppositional defiant disorder ADHD, conduct disorder
or substance use disorder (Zepf FD Holtmann 2012)
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TREATMENT Bipolar disorder requires ongoing treatment even when
the patient feels better. The treatments for bipolar disorder may
consist of: Hospitalization Medications Individual, group or family
therapy Psychoeducation participation in support groups Substance
abuse treatment
http://www.mayoclinic.com/health/bipolar-disorder
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MEDICATIONS Medications may consist of Mood Stabilizers,
Antipsychotics and Antidepressants.
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TREATMENT Anticonvulsants (mood-stabilizers) Mood stabilizers
are the cornerstone of treatment and work for both depressive and
manic symptoms. (Lithobid) Lithium, is effective in stabilizing
mood and preventing extreme highs and lows Has been used for many
years Periodic blood tests are required (lithium can cause thyroid
and kidney problems) Common side effects Restlessness, dry mouth
and digestive issues
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MOOD STABILIZERS CONT. Abilify (Apriprazole) antipsychotic Side
Effects:
Nausea,Vomiting,Constipation,Headache,Dizziness,Akathisa,Anxiety,insomnia
Depakote ( Divalproex) Side Effects: Drowsiness, Diarrhea,
Constipation,Changes in menstrual periods, Tremor, Hair loss,
Weight gain, Unpleasant taste Depakene Syrup ( Valproate) (oral
syrup) Diarrhea, Dizziness, Drowsiness, Hair loss, Blurred vision,
Ringing in ears, Suicidal thoughts
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MOOD STABILIZERS CONT. Tegretol ( Carbamazepine) Side effects:
Drowsiness,Dizziness,Unsteadiness,Nausea,Vomiting,Headache,Anxiety
Memory problems, Diarrhea, Heartburn,Dry mouth, Back pain Geodon
(Ziprasidone) Antipsychotic Side effects: Tiredness, Nausea, Upset
stomach, Dizziness,Restlessness, Abnormal muscle
movements,Increased cough
MOOD STABILIZERS CONT. Thorazine ( Chlorpromazine)
Antipsychotic treats mania Side effects: Dizziness drowsiness,
anxiety, sleep problems, breast swelling, weight gain, swelling
hand/ feet, blurred vision, sexual dysfunction, Trileptal
(Oxcarbazepine) Side effects: Headaches, dizziness, nausea,
fatigue, drowsiness, vomiting, viral infections, anxiety, loss of
coordination, heart burn, loss of appetite, low sodium levels in
blood, memory loss, urinary tract infections, Topamax ( Topiramate)
Side effects: double vision, involuntary eye movement, painful,
irregular periods, drowsiness, water retention, weight loss, dry
mouth, decreased white blood cells, Zyprexa ( Olanzapine)
antipsychotic Side effects: weight gain, increased appetite,
headache, dizziness, drowsiness, memory problems, loss of bladder
control, back pain, numbness,
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ANTIPSYCHOTICS Antipsychotics are used as a short-term
treatment to control psychotic symptoms such as hallucinations or
delusions or mania symptoms. They treat bipolar depression, along
with demonstrating long-term value in preventing future episodes of
mania or depression.
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ANTIPSYCHOTICS Antipsychotics: Abilify (aripiprazole) Clozaril
(clozapine) requires weekly or biweekly blood test monitoring.
Geodon(ziprasidone) Risperdal (risperidone) Saphris (asenapine)
Seroquel (quetiapine) (specifically approved by (FDA) for treating
bipolar disorder) Zyprexa (olanzapine)
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SIDE EFFECTS OF ANTIPSYCHOTIC MEDICATIONS Common side effects
of antipsychotic medications include: Weight gain Sleepiness
Tremors Blurred vision Rapid heartbeat Involuntary facial or body
movements High cholesterol levels Increased risk of diabetes
Blurred vision Dry mouth Drowsiness Muscle spasms or tremors
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ANTIDEPRESSANTS Common SSRIs are used Prozac (fluoxetine)
Zoloft (sertaline) Paxil (paroxetine) Luvox (fluvoxamine) Celexa
(citalopram) Symbyax (Seroquel and olanzapine-fluoxetine
combination) FDA-approved to treat bipolar depression
http://www.webmd.com/bipolar-disorder/antidepressants-for-bipolar
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ANTIDEPRESSANTS Wellbutrin ( Buproprion) Sometimes used
first-line treatment for bipolar disorder with mood stabilizer
Effective for combating depressive episodes, Less risk of
precipitating manic episodes (compared to SSRI antidepressants)
Side effects: dry mouth, constipation, headaches, and insomnia.
http://www.mentalhelp.net
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SIDE EFFECTS OF ANTIDEPRESSANTS Side effects from SSRIs are
relatively mild: Nausea Headache Insomnia Sleepiness Nervousness
Tremors Increased sweating Dry mouth Sexual dysfunction
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THERAPIES Cognitive Behavior Therapy : Cognitive behavioral
therapy helps identify unhealthy, negative thoughts, beliefs and
behaviors by replacing them with healthy, and positive ones.
Teaches effective strategies to manage stress, and coping skills to
deal with upsetting situations.
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THERAPIES Family-focused therapy: Helps enhance family coping
strategies Teaches how to recognize early signs and symptoms of new
episodes Deals with patients feelings of anger frustration.
Improves patients communication among family members, Teaches
problem-solving skills. Interpersonal and social rhythm therapy
Helps improve relationships with others, manage daily routines, and
sleep schedules to protect against manic episodes.
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PSYCHOEDUCATION Psychoeducation: Provides awareness about
illness and treatment. Helps recognize signs of mood swings and
other signs of illness. Teaches when to seek early treatment in
order to avoid full-blown episodes in both group or individual
settings. Group therapy. Provides a forum to communicate with
others, patients learn from others in similar situations as theirs.
Helps build better relationships.
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THERAPIES Electroconvulsive therapy (ECT) Highly effective
treatment for severely depressive, manic, or mixed episodes.
Suggested for patients who do not see improvements in their
symptoms despite other treatment. Sometimes used when other medical
conditions, including pregnancy, make the use of medications risky.
Can cause temporary memory loss and confusion.
http://nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
Dialectical Behavior Therapy (DBT) Form of CBT developed by Marsha
Linehan, Ph.D. Developed to treat people with suicidal thoughts and
actions with bipolar disorder.
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CHALLENGES Pregnancy and bipolar can be difficult to manage:
Research found lithium/ Lamotrigine preferred mood stabilizers
during pregnancy Women should stay hydrated to prevent lithium
toxicity in themselves and the fetus. Careful monitoring of lithium
levels, during delivery and after birth is recommended
Breastfeeding should be avoided since Lithium/ lamotrigine are
secreted in breast milk.
http://www.healthyplace.com/bipolar-disorder/bipolar-women/pregnancy-and-bipolar-disorder-treatmentmanagement-
issues