Posted: September 22nd, 2023
ASSESSING AND TREATING PATIENTS WITH BIPOLAR DISORDER
ASSESSING AND TREATING PATIENTS WITH BIPOLAR DISORDER
Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for patients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) patients often present as depressive or manic but may have both; and 2) many symptoms of bipolar disorder are similar to other disorders. Misdiagnosis is common, making it essential for you to have a deep understanding of the disorder’s pathophysiology. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with bipolar disorder.
TO PREPARE FOR THIS ASSIGNMENT:
• Review this week’s Learning Resources, including the Medication Resources indicated for this week.
• Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring bipolar therapy.
THE ASSIGNMENT: 5 PAGES
For this assignment, you will write a 5-page paper on the topic of bipolar and bipolar and related disorders. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of your course-provided resources.
In your paper, you will choose one of the following diagnoses: Bipolar I, Bipolar II, Cyclothymic Disorder, Substance/Medication-Induced Bipolar and Related Disorder, Bipolar and Related Disorder Due to Another Medical Condition. Your paper will include discussion for your chosen diagnosis of bipolar and related disorders on the following:
• Prevalence and Neurobiology of your chosen disorder
• Discuss the differences between your chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria, including presentation of symptoms according to DSM 5 TR criteria
• Discuss special populations and considerations (children, adolescents, pregnancy/post-partum, older adult, emergency care) for your chosen bipolar and related disorder; demonstrating critical thinking beyond basics of HIPPA and informed consent with discussion of at least one for EACH category: legal considerations, ethical considerations, cultural considerations, social determinants of health.
• Discuss FDA and/or clinical practice guidelines approved pharmacological treatment options in relation to acute and mixed episodes vs maintenance pharmacological treatment for your chosen bipolar and related disorder
• Of the medication treatment options for your chosen disorder discuss side effects, FDA approvals and warnings. What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring
• Provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy.
FIND THE ATTACHED GRADING RUBRIC FOR GUIDANCE ON MARKS DISTRUBUTION
Bipolar Disorder: A Guide for Healthcare Providers
Bipolar disorder is a chronic and disabling mental illness characterized by extreme shifts in mood and energy levels. Effective diagnosis and management requires recognizing the complex nature of this condition and individualizing treatment for each patient. This guide aims to provide healthcare providers an overview of bipolar disorder and evidence-based strategies for assessment and care.
Prevalence and Neurobiology
Bipolar I disorder affects approximately 1-2% of the population worldwide (1). The exact causes are unknown, but genetic and environmental factors are implicated (2). Neuroimaging and postmortem studies point to abnormalities in brain regions involved in emotion regulation and reward processing, such as the prefrontal cortex and amygdala (3,4). Imbalances in neurotransmitters like dopamine and serotonin are also thought to play a role (5).
Diagnosis and Differential Diagnosis
Diagnosis is based on criteria outlined in the DSM-5 and involves a clinical interview to determine if a patient has experienced manic, hypomanic or depressive episodes (6). It can be difficult to distinguish bipolar disorder from conditions with similar symptoms such as major depressive disorder, borderline personality disorder or substance use disorders (7). A thorough history and longitudinal course are important to arrive at an accurate diagnosis.
Onset is often in late adolescence or early adulthood, but bipolar disorder can develop at any age (8). Children and adolescents may experience more frequent mood episodes, irritability, and mixed features (9). Pregnancy and postpartum periods confer increased risk for both mood episodes and rapid cycling (10). Older adults can experience “mixed states” of mania and depression or present with psychotic features (11). Cultural beliefs and lack of access to care also impact diagnosis and management of bipolar disorder globally (12).
First-line treatment for acute manic or mixed episodes includes mood stabilizers like lithium, valproate or second generation antipsychotics (13). Quetiapine, lurasidone, asenapine and cariprazine are FDA-approved as monotherapy or adjunctive options (14). For maintenance, lithium or lamotrigine are recommended as monotherapy, while quetiapine, risperidone and aripiprazole are options as adjuncts to lithium or valproate (15). Close monitoring is needed due to potential side effects like weight gain, metabolic changes or extrapyramidal symptoms.
Psychosocial interventions like cognitive behavioral therapy, family-focused therapy and psychoeducation are important adjuncts to medication (16). They can help patients gain insight, improve illness management skills and strengthen social support systems. Other supportive measures involve a healthy lifestyle with regular sleep, exercise and diet, as well as addressing any substance use or medical comorbidities. A multidisciplinary team approach tailored for the individual patient typically leads to the best outcomes.
Bipolar disorder is a chronic condition requiring comprehensive and coordinated care. With accurate diagnosis, treatment of acute episodes, preventive strategies and rehabilitation, patients can achieve remission and optimal functioning. Healthcare providers play a vital role in delivering evidence-based, patient-centered care for this serious mental illness.
Merikangas, K. R., et al. (2011). Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 50(10), 980-989.
Craddock, N., & Sklar, P. (2013). Genetics of bipolar disorder. The Lancet, 381(9878), 1654-1662.
Blumberg, H. P., et al. (2003). Amygdala and hippocampal volumes in adolescents and adults with bipolar disorder. Archives of general psychiatry, 60(12), 1201-1208.
Strakowski, S. M., et al. (2012). Functional magnetic resonance imaging of frontal lobe activation during working memory in euthymic bipolar disorder. Bipolar disorders, 14(6), 613-625.
Post, R. M. (2007). Kindling and sensitization as models for affective episode recurrence, cyclicity, and tolerance phenomena. Neuroscience & Biobehavioral Reviews, 31(6), 858-873.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Ghaemi, S. N., & Rosenquist, K. J. (2004). The emergence of the concept of mood disorders: historical overview. The Journal of clinical psychiatry, 65(11), 4-10.
Merikangas, K. R., et al. (2007). Lifetime prevalence of bipolar disorder in the national comorbidity survey replication. Archives of general psychiatry, 64(5), 543-552. homework help writing assignment service.
Pavuluri, M. N., et al. (2004). Pediatric bipolar disorder: a review of the past 10 years. Journal of the American Academy of Child & Adolescent Psychiatry, 43(9), 820-841.
Munk-Olsen, T., et al. (2009). New parents and mental disorders: a population-based register study. JAMA, 302(9), 982-989.
Mackin, P., & Young, A. H. (2004). Bipolar disorder in late life. Psychiatric Clinics, 27(3), 537-556.
Patel, V., & Sumathipala, A. (2001). International representation in psychiatric literature Study Bay Survey of six leading journals. British Journal of Psychiatry, 178(5), 406-409.
Grunze, H., et al. (2018). The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2015 on pharmacotherapy of acute mania. The world journal of biological psychiatry, 19(5), 340-366.
Yatham, L. N., et al. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar disorders, 20(2), 97-170.
Grunze, H., et al. (2018). The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2018 on the long-term treatment of bipolar disorders. The world journal of biological psychiatry, 19(5), 401-478.
Miklowitz, D. J., & Scott, J. (2009). Psychosocial treatments for bipolar disorder: cost-effectiveness, mediating mechanisms, and future directions. Bipolar disorders, 11(s2), 110-122.
ASSESSING AND TREATING PATIENTS WITH BIPOLAR DISORDER
Bipolar disorder is a serious mental illness that affects about 1% of the population worldwide. It is characterized by episodes of extreme mood swings, ranging from mania (a state of elevated mood, energy, and activity) to depression (a state of low mood, energy, and activity). These episodes can last for weeks, months, or even years, and can cause significant impairment in personal, social, and occupational functioning.
The diagnosis of bipolar disorder is based on several factors, including the patient’s history, psychological examination, mood charting, and criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The diagnosis can be challenging, especially in children and adolescents, who may have different patterns of symptoms and co-occurring conditions such as attention-deficit/hyperactivity disorder (ADHD) or behavior problems.
The treatment of bipolar disorder aims to reduce the severity and frequency of mood episodes, prevent relapse, and improve the quality of life of patients and their families. The treatment usually involves a combination of medications and psychological interventions. The medications include mood stabilizers (such as lithium, valproate, carbamazepine, or lamotrigine), antipsychotics (such as olanzapine, quetiapine, lurasidone, or cariprazine), antidepressants (such as sertraline, fluoxetine, citalopram, or venlafaxine), and antianxiety drugs (such as alprazolam, clonazepam, diazepam, or lorazepam). The medications help to balance the brain chemicals that regulate mood and behavior. The psychological interventions include psychotherapy (such as interpersonal and social rhythm therapy, cognitive behavioral therapy, psychoeducation, or family-focused therapy), electroconvulsive therapy (ECT), or transcranial magnetic stimulation (TMS). The psychological interventions help to enhance coping skills, improve relationships, increase awareness of triggers and early signs of mood episodes, and provide education and support.
The treatment of bipolar disorder requires close monitoring by a psychiatrist who specializes in diagnosing and treating mental health conditions. The treatment also requires collaboration between the patient, the family, and the health care team. The treatment may need to be adjusted over time depending on the patient’s response and side effects. The treatment is lifelong, as bipolar disorder is a chronic condition that can recur even after periods of remission.
Bipolar disorder is a complex and challenging condition that can have a profound impact on the lives of patients and their loved ones. However, with proper diagnosis and treatment, many patients can achieve stability and recovery.
“Bipolar disorder – Diagnosis and treatment – Mayo Clinic.” https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/diagnosis-treatment/drc-20355961. Accessed 22 Sep. 2023.
“Bipolar disorder – Diagnosis.” https://www.msn.com/en-us/health/condition/Bipolar-disorder/hp-Bipolar-disorder?source=conditioncdx. Accessed 22 Sep. 2023.
“Treatment – Bipolar disorder – NHS.” https://www.nhs.uk/mental-health/conditions/bipolar-disorder/treatment/. Accessed 22 Sep. 2023.
“Diagnosis for Bipolar disorder.” https://www.msn.com/en-us/health/condition/Bipolar-disorder/hp-Bipolar-disorder?source=conditioncdx. Accessed 22 Sep. 2023.