Question

Write a Minimum 2 paragraphs with in text citations from your book (APA) style Bipolar Disorder, Include: Age, signs and symptoms, treatment, patient teaching /considerations/interventions; or any other applicable information needed to best explain

Answer 1

#. Bipolar Disorder :-

the presence of at least two episodes of mood and activity levels are altered.

#. Causes of bipolar Disorder:-

Maybe an imbalance in biochemical substances. Genetics cannot fully explain, development of disease however might be due to a process of sensitisation or activation.

#. Sensitisation in Bipolar Disorder

first episodes are induced by a major change or stressful event, but each episode causes changes in brain that increase the chances to trigger the next episode, which result in spontaneous episodes

#. Genetics in Bipolar Disorder

Monozygotic T: 70% - 90%

Dizygotic T: 16% -35%

Chromosomes 18q and 22q of evidence of linkage w/ bipolar D

Locations include chromosomes X, 21, 6 and 4.

#. Social Epidemology of Bipolar Disorder

Stress that accompanies the first episode related to poor prognosis. Personality traits of dysthymia or cyclothymia inc. risk

#. Neurobiology of Bipolar Disorder

Role of hormones, NT´s, second messengers and expression mechanisms.

Intracellular genetics, changes in cerebral metabolism and density or receptors

There might be a dysregulation in modulation of the prefrontal circuit and the limbic system.

#. Bipolar Disorder in Clinical psychology

Episodes of depression are MORE frequent and lasting than episodes of mania

Sx´s of depression and mania occur together: mixed state

Sx´s can occur immediately only after another cyclisation.

4+ episodes in a year is most common

Mixed state in Bipolar Disorder

Sx´s of depression and mania occur together:

#. Manic episode categories

Hypomania

Mania

Mania with psychotic features

#. Common signs and symptoms :-

Mood: anger, anxiety, apathy, apprehension, elevated mood, euphoria, general discontent, guilt, hopelessness, loss of interest, loss of interest or pleasure in activities, mood swings, or sadness

Behavioural: aggression, agitation, crying, disorganised behaviour, excess desire for sex, hyperactivity, impulsivity, irritability, restlessness, risk-taking behaviours, or self-harm

Cognitive: delusion, false belief of superiority, lack of concentration, racing thoughts, slowness in activity, or unwanted thoughts

Psychological: agitated depression, depression, manic episode, or paranoia

Weight: weight gain or weight loss

Sleep: difficulty falling asleep or excess sleepiness

Also common: fatigue or rapid and frenzied speaking

#. Treatment :-

Treatment is different for the two types of episodes

maintenance treatment is also required and usually maintained by anti-manic agents which are effective

Acute mania treatment

euphoric, irritable, agitated, disinhibited, violent

All antipsychotics are effective as monotherapy for mania. doses comparable or slightly higher than schizo

Other antimaniac agents call "Mood Stabilizers" good for both mania and depression

Lithium

Valproic Acid

Carbamazepine

- Lithium

unknown mechanism and narrow therapeutic index requires close monitoring of blood levels especially during treatment initiation to prevent toxicity

excretion purely renal because its a salt, no protein binding. 1/2 life a day

long term risks: LMNOP

lithium, movement (tremor), nephrogenic DI, hypothyroid, pregnancy problems (can have pregnant woman on it but be careful)

watch creatinine

things that increase Lithium levels

thiazide diuretics! ACEI, AT1 antagonists, dehydration

negative loop with vomit and diarrhea and more concentrated then vomit and diarrhea more and downward spiral

- Valproic Acid

anticonvulsant also effective for bipolar

mechanism presumably related to GABAergic activity but not well understood

generally better tolerated than lithium

risks: hepatotoxic, thrombocytopenia, Teratogenicity (CANT GIVE TO PREGNANT WOMAN), pancreatitis and polycystic ovary. weight gain

- Carbamazepine

anticonvulsant also effective for acute treatment of mania and maintenance

used less than lithium or valproate

Risks: aplastic anemia, agranulocytosis, hepatotoxicity