Assessing and Treating Patients With Bipolar Disorder
Assessing and Treating Patients With Bipolar Disorder
Individuals suffering from bipolar disorder face unexpected and sometimes perplexing symptoms daily. The disorder’s cause is still a mystery despite ongoing research. An imbalance in brain chemistry that affects mood regulation, specific brain characteristics, very stressful experiences, a history of abuse or trauma, and a family history of the disease or other mental disorders are some of the factors associated with bipolar disorder (Baldessarini et al., 2018). There are four basic types of bipolar disorder, each with specific features. The purpose of this paper is to assess the prevalence and neurobiology of bipolar I disorder, differentiate between bipolar I and bipolar II disorders, address specific groups, discuss FDA-approved treatment, and study medicines for the treatment of bipolar I disorder.
Prevalence and Neurobiology
A psychiatric disease known as bipolar disorder, often called manic-depressive disorder, is characterized by rapid changes between depressive and manic episodes. According to the National Institute on Mental Illness, bipolar illness often manifests in adolescence or the early stages of adulthood and affects 5.7 million persons in the United States (2.6% of the adult population) (Carvalho et al., 2020). The bulk of BD heritability is due to common, inconsequential polymorphisms. Many risk genes and genetic networks have been uncovered. Calcium signaling is important among inherited risk pathways and appears to have the most potential as a therapy. Digital technologies, as well as complicated mathematical and statistical studies, are being used to assess and interpret BD. These innovative methods of BD support and reflect a reframing of the disorder as one characterized by continuous instability in mood and neural circuitry.
Differences in Bipolar I and Bipolar II Disorder
The most prevalent bipolar types are 1 and 2. They also have a lot in common, particularly given that both can result in spells of hypomania and despair. There is, however, one significant distinction: mania is not a feature of bipolar disorder type 2; it is only a feature of bipolar disorder type 1 (Kato, 2019). This is significant since manic episodes can significantly impair your life and perhaps need hospitalization.
The DSM-5 and the ICD-11 kept the difference between BD-1 and BD-2. Both systems believe that BD-2 consists of recurrent major depressive episodes with mood and activity increases that are seldom more severe than hypomania and infrequently entail psychosis, especially during [hypo]manic stages (McIntyre et al., 2020). The DSM-5 does not, however, recognize the criteria for BD-2 that were provided for BD-1, including the polarity associated with the most recent events, the severity of events, the presence of mixed/psychotic features, or the extent of remission. Furthermore, it has been demonstrated that mood-stabilizing treatments can be effective in both BD-1 and BD-2. Although antidepressants commonly prove to be less effective and potentially destabilizing, antipsychotics and certain other antimanic treatments are generally not necessary for hypomania in BD-2.
Special Population and Considerations
Assessing and Treating Patients With Bipolar Disorder
Age and other physical characteristics may have an impact on how depression and bipolar illnesses manifest and are treated. The severity of mood symptoms in young children is less clear-cut than in adults, thus pharmaceutical treatment should be provided at modest dosages with thorough monitoring for adverse effects (Rhee et al., 2020). The diagnosis of depression in the perinatal population depends more on emotional than on physical symptoms because the latter may be a side effect of the gravid condition. In this demographic, treating mood disorders requires striking a fine balance between promptly alleviating negative symptoms and guarding against adverse drug reactions in children. For senior patients who mostly appear with chronic diseases or recent loss, it’s crucial to be sensitive to the possibility of depression. Due to age-retarded drug metabolism, mood problems may mimic physical complaints, and drugs should be taken carefully.
Clinicians may face particular legal and ethical issues while treating people with bipolar illnesses. For instance, due to their impulsivity, lack of understanding, and poor judgment, individuals with manic and mixed-mood states may be unable to offer informed consent or make wise decisions on their treatment (McIntyre et al., 2020). Moreover, some clinical manifestations, such as impatience, grandiosity, and delusional thinking, might endanger the therapeutic relationship. Moreover, due to the relapsing-remitting nature of the illness, patients may occasionally feel better and doubt the necessity of continuing therapy, thus putting the clinician’s treatment objectives at odds with the patient’s autonomy in decision-making.
According to statistics, those who have mental diseases experience worse social determinants of health. Some patients might not have jobs, have inadequate jobs, or have insecure jobs (Carvalho et al., 2020). The absence of employment usually results in a lack of money and, consequently, a lack of means to support oneself. Those with lesser incomes than those with higher wages have also been found to have poorer mental health. This might signal that the patient lacks access to running water, electricity, or money to buy food. Worse effects on mental health follow from this.
Pharmacological Treatment
Mood stabilizers and antipsychotics are a few of the drugs the FDA has approved for use in the treatment of the bipolar disorder (Baldessarini et al., 2018). One medicine should be begun at a time, with additional ones added as necessary, just like with any novel pharmacologic therapy. Use the smallest quantity possible if the patient reacts to one medication (Yalin & Young, 2020). It is also simple to determine which medications work the best or have the worst side effects. Risperidone 3 mg orally daily, Lamotrigine 200 mg orally daily, or Lithium 0.8 mg daily would be given as monotherapy, depending on the patient’s presentation (Rhee et al., 2020). Manic and mixed episodes are treated with risperidone. Lamotrigine or lithium is suggested for maintenance. The patient may also think about starting psychotherapy, particularly family-centered counseling.
The medicine used to treat bipolar illness, among other medications, can have dangerous side effects (Yalin & Young, 2020). Sleepiness, increased appetite, fatigue, coughing, urine incontinence, excessive saliva, diarrhea, ataxia, nausea, dizziness, tremor, acne, and dyspepsia are among the most prevalent side effects of risperidone (Baldessarini et al., 2018). Those with diabetes should take risperidone cautiously as it may result in hyperglycemia. Regular blood glucose checks are necessary. A month after the initial dosage and then every six months thereafter, CBC testing should be performed since risperidone has the potential to induce leukopenia, neutropenia, and agranulocytosis. Risperidone use may result in seizures, orthopnea, and a higher incidence of suicidal thoughts.
Lithium may cause tremors, seizures, lightheadedness, somnolence, agitation, arrhythmias, tachycardia, nausea, and many other serious adverse effects (Carvalho et al., 2020). Lithium toxicity can occur, thus it’s important to monitor levels often. Even extremely close to therapeutic levels, toxicity can still develop. Lithium use should be avoided by patients who are pregnant since it might affect the unborn child. Insufficient renal and cardiac performance is also a warning against using lithium (McIntyre et al., 2020). For patients, these labs ought to be additionally examined. A CBC and kidney function test should be examined after one month of therapy and then every 6 months after that
Proper Prescriptions
Conclusion
Although many individuals have a preponderance of one or the other, bipolar illnesses are characterized by bouts of mania and depression that may alternate. Sociocultural factors, alterations in brain neurotransmitter levels, and heredity may all be involved, even though the exact cause is unknown. A diagnosis is made by looking at the past. Treatment consists of psychotherapy and mood-stabilizing drugs.
References
Baldessarini, R. J., Tondo, L., & Vázquez, G. H. (2018). Pharmacological treatment of adult bipolar disorder. Molecular Psychiatry, 24(2), 198–217. https://doi.org/10.1038/s41380-018-0044-2
Carvalho, A. F., Firth, J., & Vieta, E. (2020). Bipolar Disorder. New England Journal of Medicine, 383(1), 58–66. https://doi.org/10.1056/nejmra1906193
Kato, T. (2019). Current understanding of bipolar disorder: Toward integration of biological basis and treatment strategies. Psychiatry and Clinical Neurosciences, 73(9), 526–540. https://doi.org/10.1111/pcn.12852
McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., Malhi, G. S., Nierenberg, A. A., Rosenblat, J. D., Majeed, A., Vieta, E., Vinberg, M., Young, A. H., & Mansur, R. B. (2020). Bipolar disorders. The Lancet, 396(10265), 1841–1856. https://doi.org/10.1016/s0140-6736(20)31544-0
Rhee, T. G., Olfson, M., Nierenberg, A. A., & Wilkinson, S. T. (2020). 20-Year Trends in the Pharmacologic Treatment of Bipolar Disorder by Psychiatrists in Outpatient Care Settings. American Journal of Psychiatry, appi.ajp.2020.1. https://doi.org/10.1176/appi.ajp.2020.19091000
Yalin, N., & Young, A. H. (2020). Pharmacological Treatment of Bipolar Depression: What are the Current and Emerging Options? Neuropsychiatric Disease and Treatment, Volume 16, 1459–1472. https://doi.org/10.2147/ndt.s245166