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Common problems caused by bipolar disorder (LLL & FDD)
- Low self-esteem
- Loss of intimate relationships
- Loss of job
- Family conflict
- Dependence on others
- Denial (of illness)
Causes for denial and quitting medication
Patients go through an up-phase and believe they are better or aren't sick.
Reasons why patients don't comply with meds (PASDD)
- Personal autonomy
- Adverse side effects
- Social stigma
- Drug and alcohol use
- Desire to experience mania
Client and family education includes (NIMP HAKR)
- Nature of illness
- Importance of maintaining social structure/routines.
- Precipitants of episodes
- Roles of professionals
- Keeping intimate relationships
- How to get help
- Alcohol and drugs
3 Stages of Bipolar disorder (CSR)
How should case workers accommodate for these stages?
Maintaining flexibility and adjusting their interaction with client's based on their needs at a certain stage.
What type of interventions are needed in the stabilization stage?
- Task-oriented interventions
- to help the patient return to normal functioning.
What type of contact would be required in the remission stage?
Just follow-up about every other to check on meds or monitoring.
- At least 1 week of abnormal mood; usually a persistently elevated mood expansive or irritable mood.
- Manic episode and a major depressive episode.
- Must be experiencing first manic episode to be diagnosed (depression can make it hard to tell)
Mood disturbance should have 3 of these symptoms (IGDPFDIPE):
- Inflated Self-esteem
- Decreased need for sleep
- Pressure of speech
- Flight of ideas
- Increased goal-directed activities
- Psycho-motor agitation
- Excessive pleasurable activities which could be dangerous
Bi Polar Hallucinations
No hallucinations during the mood disturbance and none for at least 2 weeks without mood disturbance.
Bipolar (young) patients are more likely to exhibit what symptoms during depression:
- Hypersomnia (increased sleep)
- Increased appetite
- psychomotor retardation
- (different than unipolar depression)
Bipolar I disorder (single manic episode)
Diagnosis for the first manic episode
Bipolar I disorder (recurrent)
Is diagnosed of manic episodes are separated by at least 2 months w/o significant symptoms.
- A feature of Bipolar I disorder when there are 4 episodes of mood disturbance over a 12 month period.
- More common among females.
- Not common, but can happen over a week or a day.
Bipolar II Disorder
- Major depressive episodes and hypomanic episodes.
- elevated mood lasting 4 days and is different than usual non-depressed mood.
- 3 or more manic symptoms for 4 days.
Similar to a manic episodes, but less sever and less frequent than manic episodes.
Characteristics of Biploar II
- Major Depressive episodes
- Hypomanic episodes
- Not severe enough to cause significant impairment in functioning
- Is noticed by others that client is not themselves
- Sub effective disorder
- Chronic mood disturbance for at least 2 yrs.
- Hypomania and Depression
- Does not meet the criteria for manic or depressive episodes
Dx id not made if there is mania or depression for the first 2 years of the disorder
Disputes about Cyclothima
- Considered a mild form of Bipolar
- Some think that it is psychological not neurological
- May persist even after client has returned to normal functioning
- May cause clients to stop therapy and/or go off meds.
Pharmalogical Treatments- Bipolar
- Anti-Psychotic Drugs
- Anti-convulsive Drugs
- Very effective in treating bipolar
- Basically just sea salt in high concentrations
- Can be dangerous for the liver
Anti-Psychotic Drugs (Bipolar)
- Also very effective in treating bipolar
- Olanzapine (Zyprexa)
- Aripiparzole (Abilify)
- Risperidone (Risperdal)
- Ziprasidone (Geodon)
- Clozapine (Clorazil)
Anti-convulsive Drugs (Bipolar)
- Effective in treating manic episodes.
- Carbamzepine (Tegratol)
- Depkene and Depakote
- Useful for initiation of treatment in crisis phase. Tapered down as the manic episode subsides
Why should SSRI's not be given to those suffering from Bipolar?
- SSRI's can induce manic episodes because they increase seritonin (which is already high in mania).
- Other anti-depressants should be considered.