Bipolar Disorder: Diagnostics and Treatment - Essay Example

BIPOLAR DISORDER Lynne Bipolar Disorder Bipolar disorder is a psychiatric situation defined as recurrent episodes of significant disturbance in mood. This disorder is characterized by periods of excitability (mania) alternating with periods of depression (Upadhyaya, 2006; Wikiepedia 2007). These changes in the mood at times are very abrupt and unexpected. This shifting of mood from one extreme to another works on a scale, which may capture depressive episode to a level of very high debilitation to maniac episodes. Diagnosis (NIMH, 2007;Upadhyaya, 2006) Clinical Features Physical Examination Psychiatric Examination Lab Studies: Initial tests for substance and alcohol abuse are usually necessary to exclude drugs and alcohol as causative agents for behavior. No specific blood or other laboratory tests aid the mental health professional in diagnosing bipolar disorder. Of interest, serum cortisol levels may be elevated, but this is not of diagnostic or clinical value. Thyroid studies may help assure the clinician that an altered mood is not secondary to a thyroid disorder. The clinician may order tests of serum blood chemistries, such as basic metabolic panels and liver function tests, to help assess renal and hepatic health before starting or continuing certain medications to help regulate or ameliorate bipolar symptoms. Mania and depression both may involve states of malnutrition secondary to the psychiatrically diminished awareness of or ability to maintain one's health and well-being. Thus, a metabolic panel along with, in extreme cases, levels of thiamine, albumin, and prealbumin may help determine the extent of self-neglect and compromised nutritional state. After pharmacotherapy is implemented, periodic laboratory tests may be required to monitor drug levels and to ensure that no adverse response to the medication is harming renal or hepatic function. Imaging Studies: Neuroimaging modalities are currently not helpful in diagnosing bipolar disorder. Rather, the clinical presentation of symptom clusters, as defined in the DSM-IV TR, plus family and genetic histories guide the mental health clinician in diagnosing psychiatric conditions. Neuroimaging studies of child and adolescent patients with bipolar disorder are few. MRI studies of children and adolescents with bipolar I disorder have shown enlarged ventricles and an increased number of hyperintensities compared with healthy control subjects. The pathologic and clinical significance of these findings is unknown. In MRI studies, in a study by Darsi (1999) found that the area of the thalamus was substantially decreased in youths with bipolar disorder or schizophrenia compared with healthy control subjects. Studies in adults revealed similar findings. The diagnosis of bipolar disorder or schizophrenia cannot be made on the basis of this volume difference on MRI. Nonetheless, reduced thalamic volume is consistent with clinical symptoms of poor attention, difficulty in filtering simultaneous stimuli, and dysregulation of mood, all of which symptoms found in patients with both of these major mental illnesses. Whether a structural or functional deficit in the thalamus may be causal or contributory to the pathophysiology of these mental disorders remains unknown. Other Tests: A baseline ECG may be needed before a psychotropic medication is started because some are known to alter QT intervals or other features of the cardiac rhythm. Symptoms of Bipolar Disorder Bipolar disorder causes dramatic mood swings from overly high and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression. (Upadhyaya, 2006; Wikiepedia, 2007; NIMH, 2007). Symptoms of mania (or a manic episode) include (NIMH, 2007; Upadhyaya, 2006;, Wikiepedia, 2007): Increased energy, activity, and restlessness Excessively high, overly good, euphoric mood Extreme irritability Racing thoughts and talking very fast, jumping from one idea to another Distractibility, can't concentrate well Little sleep needed Unrealistic beliefs in one's abilities and powers Poor judgment Spending sprees A lasting period of behavior that is different from usual Increased sexual drive Abuse of drugs, particularly cocaine, alcohol, and sleeping medications Provocative, intrusive, or aggressive behavior Denial that anything is wrong A manic episode is diagnosed if elevated mood occurs with 3 or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, 4 additional symptoms must be present. Symptoms of depression (or a depressive episode) Include (NIMH, 2007; Upadhyaya, 2006;, Wikiepedia, 2007): Lasting sad, anxious, or empty mood Feelings of hopelessness or pessimism Feelings of guilt, worthlessness, or helplessness Loss of interest or pleasure in activities once enjoyed, including sex Decreased energy, a feeling of fatigue or of being slowed down. Difficulty concentrating, remembering, making decisions Restlessness or irritability Sleeping too much, or can't sleep Change in appetite and/or unintended weight loss or gain Prevalence of Bipolar Disorder The overall prevalence of bipolar I disorder in adolescents is approximately 1%, whereas the prevalence in children is 0.2-0.4% (Upadhyaya, 2006). This disease process has been correlated with some characteristics of patients including age. In majority of the cases, the age of onset of bipolar disorder is around the age of 20-30 years in early adulthood stage. This age bracket is followed by even a younger group, 15 -19 years, as far as the frequency of bipolar disorder is concerned (Upadhyaya, 2006). Nursing interventions (Mueller, 2007). 1. Observe the client every 15 minutes while suicidal; remove all dangerous, sharp objects from room. 2. Reinforce that she is worthwhile, a) Assist the client in evaluating the positive as well as the negative aspects of her life b) Encourage the appropriate expression of angry feelings. c) Schedule regular periods of time throughout the day for recreational/occupational therapy, encourage client to groom self, offer praise for completing grooming. d) Ensure client's participation in taking mood-stabilizing medications. Watch client swallow medication. 3. Engage client in interpersonal therapies, cognitive-behavioral therapy, 4. Encourage client to attend group therapy, and journal episodes. Medications for Bipolar Disorder (NIMH, 2007; Upadhyaya, 2006;, Wikiepedia, 2007): Psychopharmacology Lithium carbonate Carbamazepine Clonazepam Valproic acid Lamotrigine Gabapentin Oxcarbazepine Topiramate Verapamil Antipsychotics Chlorpromazine Olanzapine Risperidone Aripiprazole Ziprasidone Quetiapine Bipolar disorder can put an enormous strain on relationships with family and friends of thise whoi are affected by this disorder.. When a patient is depressed, he or she may isolate him/her self from the people who care about. When there is a manic or hypomanic episode, patient might frighten or alienate them. But relationships with friends and family are crucial to staying healthy. To keep these lines of communication open. Here are some suggestions. Educate your family and peers. Friends and family may not know much about bipolar disorder, or they may have a lot of wrong impressions. They should be explained what it is and how it affects. Create a support team. Obviously, there is no need to keep everybody infromed abou the situation but there should be more than one person who should know. It's much better to have a number of people who can be approached in a crisis. Placing all the responsibility on one person is simply too much. Make a plan. Patient is needed to accept that during a mood swing, his or her judgment might be impaired. He or she could really benefit from people looking out for the patient. At the same time loved ones also need to be careful not to push too hard. Listen. After all that a patient is through, he or she may not want to hear the concerns of family and friends. But the fact is that condition does affect the people around a patient. During a manic or depressive phase, a patient may have upset people whom he or she care about. So it should be tried to hear them out and see things from their point of view (Mueller, 2007). Talk to children. If a patient has kids, he or she should find a way to tell them what's happening. They're likely to sense that something is wrong anyway; keeping them in the dark might just make it scarier. Explanation of condition by the patient or some close family member in a way that's appropriate for their age. Say that it's a disease that affects mood, but that getting treatment for it (Mueller, 2007). REFERENCES Mueller, R. (2007). Nursing Interventions In The Diagnosis Of Bipolar Disorder. Searchwarp. Retrieved September 7, 2007 from http://searchwarp.com/swa138146.htm NIMH (2007). Bipolar Disorder. National Institue of Mental Health. Retrieved September 7, 2007 from http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-publication.shtml Upadhyaya, H.P. & Fields, M.C. (2006). Mood Disorder: Bipolar Disorder. eMedicine. Retrieved September 7, 2007 from http://www.emedicine.com/ped/topic240.htm Wikiepedia, the free encyclopedia. (2007). Bipolar Disorder. Wikiepedia, the free encyclopedia. Retrieved September 8, 2007 from http://en.wikipedia.org/wiki/Bipolar_disorder Read More