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BIPOLAR DISORDER
Management
Management
• Bipolar disorder is a complex and chronic illness.
• It produces major shifts in mood and energy.
• It impairs all areas of a person’s life, including
work, relationships and daily functioning.
• Fortunately, however, effective treatment exists,
and you can get better.
• The goal of treatment is not to cure the disorder
but rather to control the symptoms and the
course of the disorder.
Hospitalization
The indications for inpatient treatment in a person
with bipolar disorder include the following:
• Danger to self
• Danger to others
• Total inability to function
• Total loss of control
Pharmacotherapy
Treatment for bipolar disorder can be divided
into 3 general categories:
Acute treatment: focuses on suppressing
current symptoms
Continuation treatment: Prevents a return of
symptoms during the same maniac or
depressive episode
Maintenance treatment: Prevents a recurrence
of symptoms
PROGNOSIS
GOOD PROGNOSIS
• Length of manic phases
(short in duration)
• Late age of onset
• Few thoughts of suicide
• Few psychotic symptoms
• Few medical problems
• Family H/O bipolar disorder
BAD PROGNOSIS
• Poor job history
• Substance abuse
• Psychotic features
• Depressive features
between periods of mania
and depression
• H/O attempts to end life
• Male sex
Categories of drugs used
• Mood Stabilizers
• Anti-psychotics
• Anti-depressants
• Anti-convulsants
• COMBINATION DRUGS
Symbax : Antidepressant fluoxetine +
Antipsychotic olanzapine
It’s a balancing act!
LITHIUM
• Preparations:
 Lithium carbonate
 Lithium citrate
 Lithium sulphate
Mechanism of Action
• The most widely
accepted hypothesis is:
• Inhibition the
enzyme inositol
monophosphatase, lead
ing to higher levels of
inositol triphosphate.
Adverse drug reactions
• Most common side effect: Fine tremors
• Nausea & headache
• Dehydration and electrolyte imbalance
• Lithium induced diabetes insipidus and
hypothyroidism
• LITHIUM is a TERATOGEN(Ebstein’s anomaly)
• The risks of long-term medication use must
be weighed against the risk of relapse.
Psychotherapy
• Behavioral therapy. This focuses on behaviors
that decrease stress.
• Cognitive therapy. This type of approach
involves learning to identify and modify the
patterns of thinking that accompany mood
shifts.
• Interpersonal therapy. This
involvesrelationships and aims to reduce
strains that the illness may place upon them.
• Social rhythm therapy. This helps you develop
and maintain daily routines.
Support Groups
Better understanding of the illness, share their
concerns, and learn how to best manage
them
Receive encouragement, learn coping skills, and
share concerns
• Patient feels less isolated as a result
• Family members and friends may also benefit
from a support group

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Bipolar management

  • 2. Management • Bipolar disorder is a complex and chronic illness. • It produces major shifts in mood and energy. • It impairs all areas of a person’s life, including work, relationships and daily functioning. • Fortunately, however, effective treatment exists, and you can get better. • The goal of treatment is not to cure the disorder but rather to control the symptoms and the course of the disorder.
  • 3. Hospitalization The indications for inpatient treatment in a person with bipolar disorder include the following: • Danger to self • Danger to others • Total inability to function • Total loss of control
  • 4. Pharmacotherapy Treatment for bipolar disorder can be divided into 3 general categories: Acute treatment: focuses on suppressing current symptoms Continuation treatment: Prevents a return of symptoms during the same maniac or depressive episode Maintenance treatment: Prevents a recurrence of symptoms
  • 5. PROGNOSIS GOOD PROGNOSIS • Length of manic phases (short in duration) • Late age of onset • Few thoughts of suicide • Few psychotic symptoms • Few medical problems • Family H/O bipolar disorder BAD PROGNOSIS • Poor job history • Substance abuse • Psychotic features • Depressive features between periods of mania and depression • H/O attempts to end life • Male sex
  • 6. Categories of drugs used • Mood Stabilizers • Anti-psychotics • Anti-depressants • Anti-convulsants • COMBINATION DRUGS Symbax : Antidepressant fluoxetine + Antipsychotic olanzapine
  • 7.
  • 9. LITHIUM • Preparations:  Lithium carbonate  Lithium citrate  Lithium sulphate
  • 10. Mechanism of Action • The most widely accepted hypothesis is: • Inhibition the enzyme inositol monophosphatase, lead ing to higher levels of inositol triphosphate.
  • 11. Adverse drug reactions • Most common side effect: Fine tremors • Nausea & headache • Dehydration and electrolyte imbalance • Lithium induced diabetes insipidus and hypothyroidism • LITHIUM is a TERATOGEN(Ebstein’s anomaly) • The risks of long-term medication use must be weighed against the risk of relapse.
  • 12. Psychotherapy • Behavioral therapy. This focuses on behaviors that decrease stress. • Cognitive therapy. This type of approach involves learning to identify and modify the patterns of thinking that accompany mood shifts. • Interpersonal therapy. This involvesrelationships and aims to reduce strains that the illness may place upon them. • Social rhythm therapy. This helps you develop and maintain daily routines.
  • 13. Support Groups Better understanding of the illness, share their concerns, and learn how to best manage them Receive encouragement, learn coping skills, and share concerns • Patient feels less isolated as a result • Family members and friends may also benefit from a support group