PHR2002 BIP _ FI VC FINAL

LIBERTAS SAPI UNIVERSITY OF LINCOLN 2080

Management of Bipolar Disorder MPharm PHR2002

Introduction to Bipolar Disorder

Bipolar disorder is a serious and often lifelong mental health condition characterized by alternating periods of mania/hypomania and depression. Its impact on individuals can be profound, significantly affecting their overall function and quality of life. Individuals with bipolar disorder frequently grapple with the complexities of their identity, facing internal conflicts between the more impulsive, high-energy aspects of their personality and the lower, more withdrawn states. Quotations from notable individuals like Kay Redfield Jamison and Stephen Fry highlight the confusion and emotional turmoil experienced by those living with bipolar disorder.

Learning Objectives

At the end of this session, you should be able to:

• Identify symptoms of bipolar disorder.

• Discuss treatment options for bipolar disorder and evaluate their pros and cons.

• Select appropriate treatments based on national guidelines, available evidence, and individual patient factors.

• Identify and resolve pharmaceutical care issues for patients with bipolar disorder.

Understanding Bipolar Disorder

Definition

Bipolar disorder is characterized by significant mood swings, including manic or hypomanic phases (periods of elevated mood and increased energy) and depressive episodes. Unlike regular mood swings, the extremes of bipolar disorder can last for several weeks or longer, influencing a person's ability to function effectively in daily life.

Epidemiology

Bipolar disorder is relatively common, with about 1 in 100 people being diagnosed with the condition at some point in their lives. It typically develops during late adolescence or early adulthood, and the prevalence is nearly equal in men and women. However, manic episodes are less common than depressive episodes, which may occur more frequently.

Causes

genetic factors: family history is a strong risk factor, with first-degree relatives having a eight fold higher risk compared to baseline population.

environmental factor: these may act as triggers, traumatic and stressful life events in early childhood and adulthood

Neurochemical factors: chemical imbalances in the brain.

Factors Influencing Development

The exact cause of bipolar disorder is not fully understood. However, several factors contribute to its development:

• Genetic Factors: Family history plays a significant role, with first-degree relatives having a substantially higher risk of developing the disorder.

• Environmental Factors: Stressful or traumatic life events can trigger episodes.

• Neurochemical Factors: Imbalances in brain chemistry may contribute to the disorder.

Symptoms

Manic and Depressive Episodes

Individuals with bipolar disorder experience various symptoms depending on whether they are in a manic or depressive phase. Common symptoms of mania include:

• Elevated mood or irritability.

• Accelerated thoughts and speech.

• Decreased need for sleep.

• Distractibility and grandiosity. In depressive states, symptoms may resemble those of major depression and can include lethargy, sadness, and lack of interest.

Types of Bipolar Disorder

DSM-V Classification

According to the DSM-V, there are two primary types of bipolar disorder:

1. Bipolar I Disorder: Involves at least one manic episode, which may be preceded or followed by hypomanic or major depressive episodes.

2. Bipolar II Disorder: Characterized by at least one hypomanic episode and one major depressive episode, but does not include a full-blown manic episode.

Comorbid Conditions

Bipolar disorder frequently coexists with other mental health conditions, such as anxiety disorders and ADHD. This comorbidity can complicate the management of symptoms and the effectiveness of treatments.

Suicide Risk

The risk of suicide is significantly elevated in individuals with bipolar disorder. Nearly half of those affected have attempted suicide at least once, with 10-15% completing suicide, particularly during depressive episodes.

Assessment and Diagnosis

Screening in Primary Care

The diagnosis of bipolar disorder is crucial and requires comprehensive patient history and symptom evaluation. NICE guidelines emphasize thorough history-taking over the use of standardized questionnaires in primary settings. Key questions can help identify manic episodes and symptoms of increased energy or risk-taking behavior.

Treatment and Management

Initial Management

Upon diagnosis, it is essential for individuals to be referred to specialist mental health services for appropriate treatment. Urgent referrals are indicated in cases of severe mania or depression, particularly where risk to self or others exists. Once stabilized, patients may transition back to primary care for ongoing management.

Psychological and Drug Therapies

• Psychological Therapies: NICE recommends specific therapies designed for bipolar disorder, including Cognitive Behavioral Therapy (CBT) and interpersonal therapy. These therapies should be provided by professionals experienced in managing bipolar patients.

• Drug Therapies: The management of bipolar disorder using medication is complex and should be conducted by specialists. Lithium remains the first-line treatment, with others including valproate and various antipsychotics considered based on patient needs and specific scenarios.

Lifestyle Modifications

In addition to pharmacological treatments, lifestyle modifications are crucial. Maintaining adequate sleep, exercise, and a balanced diet can significantly influence mood stability and overall mental health.

Long-Term Management

Effective long-term management focuses on preventing future episodes and minimizing symptoms between episodes. Ongoing psychological intervention and regular monitoring of medication efficacy, side effects, and patient health are integral in maintaining stability.

Conclusion

Understanding bipolar disorder's complexities is essential for effective management and treatment. As mental health practitioners, approaching treatment with a comprehensive, patient-centered strategy is vital for improving outcomes and enhancing patients' quality of life.