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Helping People With Bipolar Disorder in an Outpatient Clinic

Introduction

Bipolar disorder is a chronic and common mental illness that affects about 5.7 million American adults. It is also known as manic-depressive illness. Although the first symptoms may show up during childhood. The illness usually develops in late adolescence or early adulthood. The main feature of the illness is the unusual shifts in the person’s mood, energy, and ability to function. The symptoms of the illness can be so severe that they can result in damaged relationships, poor job or school performance, and even suicide. The good news however is that bipolar disorder can be treated. With prompt and adequate treatment, the affected person can lead a full and productive life.

Symptoms

Bipolar disorder is characterized by dramatic mood swings. The patient’s mood changes from very high, irritable, hyperactive, or excited to to low, sad, depressed or hopeless, and then back again, often with periods of normal mood in between. The mood changes are accompanied by severe changes in energy and behavior. The periods of “highs” are called manic episodes and the periods of “lows” are called depressed episodes. When the patient experiences the classic recurrent episodes of mania alternating with depression, the illness is called Bipolar I Disorder. If there is no severe episode of mania, the illness is called Bipolar II Disorder. Such patients only experience a mild continuous form of mania called hypomania, alternating with depression.

Manic Episode

A patient is said to have a manic episode if there is elevated mood plus at least three or more of the following symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present:

· Increased energy, activity, and restlessness

· Excessively high or euphoric mood

· Extreme irritability

· Distractibility and inability to concentrate

· Racing thoughts and talking very fast

· Jumping from one idea to another

· Inadequate sleep

· Unrealistic confidence and belief in one’s abilities

· Poor judgment

· Spending sprees

· Excessive sexual drive

· Abuse of drugs, particularly cocaine, alcohol, and sleeping medications

· Intrusive and aggressive behavior

· Denial that anything is wrong

Depressive Episode

A patient is said to have a depressive episode if five or more of the following symptoms last most of the day, nearly every day, for a period of 2 weeks or longer:

· Sad or empty mood

· Feeling of hopelessness or helplessness

· Feelings of guilt

· Feeling of worthlessness

· Loss of interest or pleasure in activities once enjoyed (Anhedonia)

· Low energy level or feeling of fatigue

· Difficulty in concentrating, remembering, making decisions

· Restlessness or irritability

· Sleeping too much (Hypersomnia) or inability to sleep (Insomnia)

· Poor appetite or overeating with/without unintended weight loss or gain

· Chronic pain or other persistent physical discomfort without physical illness or injury

· Thoughts of death or suicide, or suicide attempts

Causes of Bipolar Disorder

· There is no single cause for bipolar disorder.

· Sometimes, there is a genetic basis to the illness because it has been observed that it tends to run in families. It appears that many different genes act together and in combination with other factors to cause Bipolar

· An individual whose parent has Bipolar I Disorder stands a 25% increased risk of developing Bipolar Disorder.

· An individual whose parent has Bipolar II Disorder has a 5% increased risk

· Other possible causes apart from genes include biological, biochemical and environmental factors.

· A major biological factor is when there is too little, too much, or a problem in the functioning of brain chemicals called neurotransmitters such as GABA, Serotonin and Dopamin.

Treatment

· The best treatment is a combination of medication and psychotherapy

· The treatment has to be continuous and long-term (years) to be effective

· It is best to be treated by a psychiatrist or psychiatric nurse practitioner

· Medications used include variety of mood stabilizers and anticonvulsants that have mood-stabilizing effects.

· Examples of common medications used for Bipolar disorder are Lithium, Depakote, Tegretol, Lamictal, Neurontin, and Topamax.

· Atypical antipsychotic medications such as Clozaril, Zyprexa, Risperdal, Seroquel and Geodon, are being evaluated for their mood-stabilizing effect and as possible treatments for bipolar disorder. For example, Clozaril appears to be helpful as a mood stabilizer for people who do not respond to lithium or anticonvulsants and Zyprexa appears effective for acute manic episode.

· Patients must always first talk to their psychiatrist, nurses practitioner or pharmacist before starting any new medication for bipolar disorder.

· Side effects of Bipolar Disorder medications include weight gain, nausea, tremor, reduced sexual drive or performance, anxiety, hair loss, movement problems, or dry mouth.

Psychotherapy

· In addition to medications, Bipolar Disorder is best treated with psychotherapy. This is provided by a licensed psychiatrist, nurse practitioner, psychologist, social worker, or counselor.

· Frequency of therapy sessions depends on the severity of each patient’s illness.

· Types of therapy employed include cognitive behavioral therapy (CBT), psychoeducation, family therapy, and interpersonal and social rhythm therapy (ISRT)

Reference:

1. NIMH – http://www.nimh.nih.gov

2. [http://WWW.futurefocusbiz.com]

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