Ch 13,24

Bipolar 1 Disorder

• Most severe form of bipolar disorder
• Highest mortality rate of the three bipolar disorders
• At least one manic episode (hallucinations, delusions, high energy)

Bipolar II Disorder

• At least one hypomanic episode (1 day or longer with 3 behaviors, mania outside of norms, no hallucinations)
• At least one major depressive episode

Cyclothymic Disorder

• Alternating symptoms of mild to moderate depression for at least 2 years (adults)
• Rapid cycling possible

Hypomania

• Lower level, less dramatic than mania
• Tends to be euphoric and often increases functioning
• Usually accompanied by excessive activity and energy

Bipolar 1 Disorder - Associated Disorders

• Nearly all anxiety disorders are associated with bipolar 1, affecting about 75% of individuals with this disorder (panic attacks, social anxiety disorder, phobias)
• Substance abuse is present
• Other disorders may complicate clinical presentation:
  • ADHD
  • All disruptive, impulse-control, or conduct disorders
  • Bipolar II Disorder

Bipolar II Disorder - Associated Disorders

• 75% of individuals with bipolar II have comorbid anxiety disorders
• Eating disorders, particularly binge-eating disorder
• Substance use disorders

Bipolar Assessment

• Mood:
  • Altman's Self-Rating Mania Scale
• Behavior:
  • Can be manipulative or demanding for staff
  • Splitting (need unity)
• Thought Processes and Speech patterns:
  • Speech is pressured, circumstantial, tangential, flight of ideas
  • Thought content: delusions
    • Grandiose delusions
    • Persecutory delusions
• Cognitive Dysfunction:
  • Cognitive Deficit
• Discomfort is common

Bipolar Assessment Guidelines

• Danger to self or others
• Need for protection from uninhibited behaviors
• Need for hospitalization
• Medical Status:
  • Coexisting medical conditions
• Acute Phase (↑ Mania), Maintenance Phase

Bipolar Implementation: Depressive vs. Manic Episodes

Depressive Episodes

• Hospitalization for suicidal, psychotic, or catatonic signs.
• Medication concerns about bringing on a manic phase.

Manic Episodes

• Hospitalization for acute mania (bipolar 1 disorder) and communication challenges.

Bipolar Communication Strategies

• Provide safety
• Use firm and calm approach
• Use short, concise explanations
• Identify expectations in simple, concrete terms
• Hear and act on legitimate complaints

Pharmacotherapy - Manic Episodes

• Avoid excessive caffeine & over-the-counter medications (NSAIDs)
• Side effects: loss of appetite, dizziness, headaches, nausea/vomiting/diarrhea, change in urination, thirst, hand tremors, dry mouth
• Anticonvulsants:
  • Valproate (Depakote)
  • Carbamazepine (Equetro)
  • Lamotrigine (Lamictal)
• Second-Generation Antipsychotics (Short term) (Acute Psychosis)
  • Olanzapine
  • Disperidone
  • Quetiapine
  • Ziprasidone
  • Aripipra
  • Cariprazine

Integrative Therapy

• Omega-3 fatty acids:
  • Cod liver oil, fish oil
• No evidence to support use in treating mania
• May improve depressive symptoms

Brain Stimulation Therapies

• Electroconvulsive therapy (ECT)
• Repetitive transcranial magnetic stimulation (rTMS)

Psychological Therapies

• Cognitive-Behavioral Therapy (CBT)
• Interpersonal and Social Rhythm Therapy
• Family-Focused Therapy

Personality Disorders

• Cluster A:

  • Paranoid: Long-standing distrust of others, they don't want help, need psychotherapy, not group, avoid being overly friendly
  • Schizoid: Long-standing pattern of social withdrawal, expressionless emotion, don't socially interact well, introvert, no range of
  • Schizotypal: Don't blend in, strange or odd beliefs, anxiety

• Cluster B:

  • Borderline: Most challenging, severe impairment, dysfunction!
  • Avoidant: Low self-esteem, shy