Jul 14, · Bipolar disorder: Etiology, diagnosis, and management. Journal of the American Association of Nurse Practitioners, 18, – /jx. [Google Scholar] Morisky, D. E., Ang, A., Krousel‐Wood, M., & Ward, H. J. (). Predictive validity of a medication adherence measure in an outpatient blogger.com by: 22 Bipolar Disorder research papers on psychological disorders can be custom written for college and university students. Bipolar disorder research papers point out that the disease affects nearly one percent of the United States population. Since this is such a prolific psychological disorder, bipolar disorder research papers will want to include elements of the disease and its subcategories Bipolar Disorder is a mental illness that has many effects on the human body and mind. Known as manic-depressive disorder, bipolar disorder is most commonly found in young adults, and in some cases, children as well (Gallagher, , 35). Statistics show that bipolar disorder affects about four million people in the United States, and is becoming one of the most common disabilities in the United
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Try out PMC Labs and tell us what you think. Learn More. This review article provides an overview of the frequency, burden of illness, diagnosis, and treatment of bipolar disorder BD from the perspective of the advanced practice nurses APNs. Because the manic or depressive symptoms of BD tend to be severe and recurrent over a patient's lifetime, the condition is associated with significant burden to the individual, caregivers, and society.
Clinician awareness that BD may be present increases the likelihood of successful recognition and appropriate treatment, bipolar disorder papers. A number of pharmacological and nonpharmacological treatments are available for acute bipolar disorder papers maintenance treatments, with the prospect of achieving reduced symptom burden and increased functioning for many patients.
Awareness of the disease burden, diagnostic issues, bipolar disorder papers, and management choices in BD has the potential to enhance outcome in substantial proportions of patients. Bipolar disorder BD is a chronic illness associated with severely debilitating symptoms that can have profound effects on both patients and their caregivers Miller, These costs include the direct costs of treatment and indirect costs from reduced employment, productivity, and functioning Dilsaver, Given the burden of illness to the individual and to society, there is an urgent need to improve the care of patients with BD.
There is a growing recognition of the substantial contribution that advanced practice nurses APNs such as nurse practitioners NPs and clinical nurse specialists CNSs can make in the recognition and care of patients with BD Culpepper, ; Miller, Most patients with BD present initially to primary care providers, but—through a lack of resources or expertise—many do not receive an adequate evaluation for possible bipolar diagnosis Manning, Patients with BD are also likely to have other psychiatric and medical comorbidities, and, therefore, rely on their primary care provider for holistic care Kilbourne et al.
APNs, by their training and experience, are well suited to facilitate optimal patient care in collaboration bipolar disorder papers the other healthcare team members Bauer et al. An especially important role for APNs within primary care lies in the care of the patient, while specialists manage the bipolar illness.
It is essential that these two specialties collaborate in order to stay abreast of each other's current phase of treatment.
There are two major types of BD. Bipolar I disorder BD I is defined by the presence of at least one episode of mania, bipolar disorder papers bipolar II disorder BD II is characterized by at least one episode of hypomania and depression. The main distinction between mania and hypomania is the severity of the manic symptoms: mania results in severe functional impairment, it may manifest as psychotic symptoms, bipolar disorder papers, and often requires hospitalization; hypomania does not meet these bipolar disorder papers American Psychiatric Association, While a mood episode may consist solely of manic or depressive symptoms, it may also include a combination of these symptoms.
Rapid cycling is a term describing the occurrence of at least four mood episodes within 1 year. Identification of rapid cycling is important, because these patients are less responsive to treatment. Successful assessment and treatment by the healthcare team requires knowledge of the episodic nature of BD.
If presenting to primary care, these patients may require immediate referral to specialist hospital care because of the risk of harm to self or others, bipolar disorder papers. For this reason, all patients presenting with depressive symptoms should be assessed for a history of manic or hypomanic symptoms Cerimele et al.
The Mood Disorder Questionnaire MDQ, Table 2 and the Composite International Diagnostic Interview, version 3. A comprehensive recent review of the screening bipolar disorder papers in BD is provided by Hoyle, Elliott, and Comer Adapted from Hirschfeld et al.
The clinical interview, besides establishing the bipolar diagnosis, represents an important element in treatment planning, by helping to select the optimal medication s bipolar disorder papers the optimal site of treatment—either within primary care or by involving specialist psychiatric support.
Open dialogue between the healthcare worker and patient represents an essential element of patient interviews, bipolar disorder papers. Other elements of the patient interview should include a physical examination and laboratory tests, with the particular aim to exclude disorders that can mimic bipolar symptoms, for example, hypothyroidism or hyperthyroidism, infection, and substance misuse Krishnan, Psychiatric disorders e.
In establishing a BD diagnosis, it can be very informative to ask family members or close friends to provide a description of the patient's symptoms with, of course, the patient's consent.
Lack of insight is a characteristic of patients with BD, and hypomanic symptoms, in particular, may not be considered a manifestation of the illness by the patient. This is also an opportunity to assess the burden that family or friends may be experiencing as well as their current relationships with the patient National Collaborating Centre for Mental Health [UK], Because MDD is more common than BD, and because MDD and BD have similar symptoms, it is very common for BD to be misdiagnosed as MDD Manning, ; Miller, Most importantly, patients with BD who are misdiagnosed with MDD may be treated with conventional antidepressant monotherapy.
Discussing the diagnosis with the patient is critical to laying a foundation for effective treatment. The acceptance of a BD diagnosis may be difficult and often occurs over time, bipolar disorder papers. The initial diagnosis is frequently provisional, and requires additional observations or confirmatory historical information.
It can also be expected that patients will show resistance to the diagnosis, bipolar disorder papers, possibly because of the social stigma of having a mental illness. One of the best tools to facilitate acceptance of the diagnosis is motivational interviewing, which is a form of counseling that elicits and strengthens the patient's motivation for change through a process of collaboration and rapport.
Motivational interviewing was developed for patients bipolar disorder papers an alcohol or drug problem, but has been applied more broadly in recent years Laakso, Pharmacological treatment is fundamental for successfully managing patients with BD. For acute episodes, the objective is symptom reduction, with the ultimate goal of full remission. For maintenance treatment, the bipolar disorder papers is to prevent the recurrences of mood episodes. Medications used in the treatment of BD include mood stabilizers e.
Table 3 lists the medications that are approved by the U, bipolar disorder papers. Food and Drug Administration FDA in treating the different phases of BD. Lithium was the first agent to be used in the treatment of BD. In particular, lithium has shown efficacy in preventing recurrence of manic episodes and it is the only medication correlated with a reduced risk of suicide in BD, bipolar disorder papers. A study that reduced the lithium dosage to increase its tolerability reported no benefit from using lithium plus optimized personalized treatment when compared to optimized personalized treatment alone Nierenberg et al.
Sodium valproate is the most commonly used mood stabilizer. It has a more rapid onset of action than lithium bipolar disorder papers the acute treatment of mania, and was superior to placebo as an acute therapy in the largest study performed to date Bowden et al, bipolar disorder papers.
A study of lamotrigine in acute mania reported no significant difference from placebo Frye et al. Lithium requires regular monitoring of blood levels, bipolar disorder papers, because the therapeutic window is narrow. Lithium can cause progressive renal insufficiency and thyroid toxicity.
The most common adverse events associated with lithium include tremors as well as gastrointestinal problems such as nausea, vomiting, and diarrhea. Carbamazepine is associated with reduced tolerability during rapid dose titration and its potential for interaction with other psychiatric and nonpsychiatric medications further limits its use Grunze et al. Lamotrigine has been studied specifically in relation to fetal cleft palate formation; however, bipolar disorder papers, the evidence remains unconvincing.
For acute bipolar depression, however, few atypical antipsychotics have demonstrated efficacy. The safety and tolerability profiles of the atypical antipsychotics have been well characterized in patients with BD. The relative risk of these effects differs between individual atypical antipsychotics, bipolar disorder papers. For example, the risk of adverse metabolic effects is reported to be greatest with olanzapine and lowest with ziprasidone, and intermediate with quetiapine and risperidone Perlis, Given the propensity of atypical antipsychotics to adversely affect weight, lipid levels, and other metabolic parameters, it is important to monitor patients regularly Hirschfeld et al.
The proper use of conventional antidepressants is an area of controversy in the treatment of BD Pacchiarotti et al. Another unresolved issue is whether maintenance treatment that includes antidepressants is effective for the prevention of recurrence Pacchiarotti et al. While full consensus is currently absent, there is wide agreement that antidepressant monotherapy should be avoided in patients with BD I and patients with BD II with two or more concomitant core manic symptoms, while antidepressants should be avoided entirely in patients with rapid cycling or those being treated for a mixed episode Pacchiarotti et al.
Interestingly, among the psychosocial treatments, the strongest evidence for effectiveness is for group psychoeducation of patients and caregivers Colom et al.
These therapies can help patients improve adherence to their medication, enhance their ability to recognize triggers to mood episodes, and develop strategies for early intervention. BD impacts all aspects of a person's life, causing severe disruption to relationships, employment, and education. Peer support can be very helpful in dealing with the consequences of these effects through sharing of experiences, where patients can discover that others have had similar experiences and can have hope for recovery, stability, and a satisfying life.
Support groups, bipolar disorder papers by national organizations, may be available locally or regionally. There is also a wealth of resources available online Table 4. A number bipolar disorder papers commonly encountered challenges can contribute to suboptimal outcomes in BD. An awareness of these bipolar disorder papers and the implementation of proactive strategies can help to maximize adherence to care and the benefits of treatment.
Medication bipolar disorder papers is a significant problem in primary care medicine generally, and in patients with BD in particular. Reasons for nonadherence among patients with BD include the following: a denial of the diagnosis, bipolar disorder papers, especially in those with predominant mania; a lack of belief that the medications being offered are necessary or effective; and a wish to avoid the real or imagined adverse effects of medications Devulapalli et al.
The complexity in treating patients with BD is increased by the high rates of cooccurring psychiatric disorders, in particular anxiety disorders and substance use disorders Grant et al, bipolar disorder papers.
The importance of these cooccurring conditions cannot be overstated; they are bipolar disorder papers with both exacerbations of BD and poor treatment outcomes Grant et al, bipolar disorder papers. Although it may be prudent to refer such patients to specialist bipolar disorder papers, the first critical step is to make a correct diagnosis and to help these patients to bipolar disorder papers the problem and the need for treatment.
Patients with BD have an elevated prevalence of medical morbidities, including obesity, diabetes, cardiovascular disease, and hepatitis Kilbourne et al.
The authors concluded that unrecognized OSA may play a major role in the mortality and morbidity of BDs. All patients diagnosed with a BD should be screened with an OSA questionnaire. For example, depression typically deprives patients of the motivation and energy to engage in treatment for chronic medical conditions. Women are at high risk of BD recurrence during pregnancy, especially if medications are discontinued, as well as during the postpartum period.
Balancing the risk of medications against the need to prevent a mood episode requires active collaboration between the healthcare providers and the patient McKenna et al. Atypical antipsychotics, with the exception of lurasidone, are rated FDA pregnancy category C, meaning that they have not been shown to be either safe or unsafe for use during pregnancy; lurasidone is classed in pregnancy category B based on current data. Alcohol abuse in patients with BD is associated with further elevation in the risk of suicide, particularly in the presence of concurrent drug use disorders.
A study that investigated this association concluded that higher suicide attempt rates in patients with BD I and alcoholism were mostly explained by higher aggression scores, while the higher rates of attempted suicide associated with other drug use disorders appeared to be the result of higher impulsiveness, hostility, and aggression Sublette et al. This study, similar to previous reports, found that earlier age of bipolar onset increased the likelihood that alcohol use disorder would be associated with suicide attempts, bipolar disorder papers.
Effective clinical management of substance use disorders has the potential to reduce the risk of suicidal behavior in these patients with BD. BD continues to represent a substantial burden to patients, their care providers, and society.
Management of BD poses a bipolar disorder papers to all healthcare providers, including the APNs. A suspicion of BD increases the likelihood of successful diagnosis. Emphasis should be placed on accurately identifying manic, hypomanic, and depressive episodes. A number of bipolar disorder papers and nonpharmacological treatments are available for acute and maintenance treatments. Healthcare providers should be aware of the efficacy and safety profiles of each of these agents, with the aim to achieve the most effective utilization of the approaches available in the management of patients with BD.
An awareness of these aspects in BD—disease burden, bipolar disorder papers, diagnostic issues, and management choices—can enhance outcome in substantial proportions of patients.
Depressive and Bipolar Disorders: Crash Course Psychology #30
, time: 10:00Bipolar Disorder Essays: Examples, Topics, Titles, & Outlines
Bipolar I disorder starts on average at 18 years and bipolar II disorder at 22 years. 9,14 A community study using the Mood Disorder Questionnaire (MDQ) revealed a prevalence of percent. 15 The National Comorbidity Study showed onset typically between 18 and 44, with higher rates between 18 and 34 than 35 and 1 In a survey of members of the DBSA, more than half of the patients did not seek Cited by: 28 Words: Length: 5 Pages Topic: Psychology Paper #: Bipolar Disorder: Genetics, Environment and Remedies According to the American Family Physician journal, "Bipolar Disorder is an illness that causes extreme mood swings. This condition Jan 29, · Bipolar Disorder Chuck Is a. Words: Length: 2 Pages Document Type: Term Paper Paper #: Read Full Paper. A depressive episode is clinically diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer
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