WK5Assgn_Alagbe_A

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1 Assessing And Treating Patients with Bipolar Disorder Adekemi Alagbe Walden University NURS 6630 Approaches to Treatment Dr. Reome April 2, 2022

2 Introduction Bipolar disorder, a persistent mental illness, causes OCD, hypomania, and depression. Mania and hypomania start abruptly and strongly. Manic episodes are more likely than hypomania to cause social, academic, and vocational problems. Mania sufferers are sometimes hospitalized due to their erratic behavior. The presence of mania or hypomania must be ruled out during the evaluation of patients with severe depression. It's likely that this person is depressed because of a history of such ailments. There is a high degree of correlation between the existence of connected traits and the likelihood of hypomanic or manic episodes occurring (Handrup, C. T., et al (2020). Chromosomal abnormalities can cause hormone and neurotransmitter imbalances that lead to bipolar disorder. Pharmacological and non-pharmacological treatments are available. Despite powerful treatments and long periods of remission, bipolar disorder is a chronic, lifelong condition with no cure (Cirone et al., 2021). This research examines first-episode bipolar disease prevalence and pathogenesis. This study will also examine the diagnostic criteria, unique populations, and special problems that set bipolar type one disorder apart from other forms of the disorder. The benefits and drawbacks of currently available pharmaceutical treatments for the illness, as well as strategies for its long-term care, will also be explored in the course of the research. Prevalence and Neurobiology of Bipolar I Disorder Manic depression (BD) type 1 is a severe mental illness characterized by alternating periods of extreme mania and depression. Consequences of developing type 1 BD are well- known to be both unpleasant and far-reaching. Patients with type 1 BD have been observed to have an extremely high suicide rate. Individuals who have undergone such changes often report feeling less satisfied with their lives and less productive than their non-altered colleagues. Young

3 adults and adults of both sexes have an equal risk of developing type 1 BD. Around one percent of the population has Behçet's illness, type I. (Jain & Mitra, 2022). Due to the lack of clarity in cyclothymic's phenomenology, epidemiological data on the condition is inconsistent, estimating rates between 0.5% and 6.3%. Incidence estimates for BD II are at 0.5%, with studies showing that the prevalence of BD I is roughly the same for men and women. However, men have a greater risk of experiencing mania and, thus, have a higher incidence of BD I. Women, on the other hand, have a higher risk of having BD II than men (Jain & Mitra, 2022). Although the average onset age of BD is between the ages of 18 and 20, certain studies have shown that it can occur in adults older than 25. This is supported by the data (Jain & Mitra, 2022). It might be challenging to pinpoint an exact onset age for BD because of the possibility of subsyndromal symptoms or misdiagnosis with another affective illness. Inappropriate treatment and delays at different stages of BD, which are linked to different neurological bases, may sustain subthreshold symptoms, functional and cognitive impairment, repeated mood episodes, and co-morbidities. This abnormal remodeling of the brain happens in tandem with the clinical and functional decline seen in BD, and is referred to as neuro progression (Scaini et al., 2020). Cognitive decline and alterations in brain structure are not always visible at the outset of illness, but they become more noticeable with repeated and prolonged illness. Immune system abnormalities, diminished neuropathic support, reduced cellular resistance, mitochondrial dysfunction, and increased oxidative stress have all been linked to neuro progression. Rapid neurodegeneration reduces treatment response, especially to cognitive behavioral therapy (Scaini et al., 2020). Several episodes can modify brain activity in a way that is difficult to reverse, increasing the likelihood of future episodes and reducing the effectiveness of

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4 treatment. Keep in mind that not everyone shows this progression; some people only show modest impairment in function or cognition. Many factors, including genetics, neurochemistry, and the environment, contribute to the development of BD. Twin studies show that 70%–80% of BD is heritable. Scaini et alinvestigation .'s confirmed this (2020). BD is more common in first- degree relatives, especially offspring, highlighting its genetic nature. Children of parents with BD have an increased likelihood of developing the disorder themselves as adults, and often display a variety of symptoms prior to receiving a formal diagnosis. This familial clustering suggests that inherited genes have a role, which might be explored further through molecular genetic investigations. Difference between Type 1 BD and Other BD Manic-depressive, cyclothymic, and drug or medication-induced bipolar disorder are the four kinds. Depression and mania are not always present in someone with bipolar illness. A hospital stay may be necessary if severe symptoms last longer than 24 hours. Mania is characterized by rapid shifts from euphoria to melancholy, distractibility, sleeplessness, and irrationality (Ljubic et al., 2021). The symptoms are obvious, making diagnosis easy. Hypomanic episodes span shorter than two weeks and are characterized by despair. People with bipolar two do not have full-blown manic symptoms that require hospitalization. To rule out other symptoms, a doctor may perform a physical checkup. The doctor will perform a complete mental health assessment after ruling out physical explanations. Specialists diagnose bipolar disorder using the DSM-5 criteria (Michalik & Kucharska, 2020). An episode of bipolar I disorder must last at least seven days, as outlined by the National Institute of Mental Health. Bipolar 2 requires manic and depressive periods. Hypomanic symptoms must last four days and dominate each day. Urine and

5 blood tests can eliminate several causes. When depressed, people seek treatment, which can confuse melancholy and elation. Special Populations and Considerations for Type 1 BD The debate surrounding the type 1 (BD) diagnosis in youngsters has reached a fever pitch. More children are getting diagnosed with BD after exhibiting symptoms like excessive mood dysregulation and chronic irritability, suggesting a rise in the prevalence of BD in some parts of the United States (Post & Grunze, 2021). Many children with BD also have oppositional defiant disorder (ODD), which has many traits with typical bipolar disorder and attention deficit hyperactivity disorder (ADHD). Several of the physiological effects of pregnancy, such as shifts in sleep, energy, and body weight, might coincide with the emotional swings that occur during pregnancy. After stopping treatment, pregnant women with bipolar disorder did not relapse at a higher rate than women without the disease (Conejo-Galindo et al., 2022). Because of these potential issues, it is important for the client and their partner to have an in-depth discussion regarding the client's bipolar disorder during pregnancy. Women who are pregnant have the option of continuing to take their current dose of antidepressants, reducing it, or stopping it altogether. It is also crucial to keep a look out for warning indications of non-classical mania in the elderly, such as cognitive impairment, confusion, and disorientation (Ljubic et al., 2021). Medication is often required while treating bipolar disorder, despite the lack of population-wide norms. Lithium, antipsychotics, carbamazepine, antidepressants, lamotrigine, and valproate are among the pharmacological treatments that have been shown to be effective in this patient population; however, pharmacological therapy may be investigated based on the client's unique presentation.

6 Similar to how depression is treated, albeit with lesser doses being advised at initially and progressively being increased. The ethical notions of voluntarism and autonomy may help psychotherapists find their way through challenging and complex situations (Osctaher, 2019). The capacity to make a free and informed decision absent of any external pressure is at the heart of the concept of voluntarism, which is closely tied to the concept of autonomy. When it comes to the latter, it's generally agreed that an adult has the cognitive maturity to make a deliberate, educated decision about whether or not to undergo a possibly life-saving treatment. When a patient refuses treatment, their mental capacity must be assessed in accordance with the concept of non- maleficence to make sure they won't experience irreversible harm as a result of their choice. Many people exhibit various symptoms, thus it's vital to look at cultural norms, beliefs, and behaviors to understand why. FDA/ Clinical Practice Guidelines approved pharmacological treatment Options for Bipolar I Disorder The only way to get an accurate diagnosis of bipolar disorder is to see a doctor in person and go through a battery of tests. While trying to determine if a patient is manic or hypomanic, doctors will usually ask about the patient's recent experiences. The patient's symptom pattern and the severity of the condition's worst episodes determine the subtype of bipolar disorder. Patients can choose from a wide variety of treatments, including medications to regulate mood, antidepressants, antipsychotics, dual-acting antidepressants, and anxiety medications. The goal of treatment is to help patients emotionally and physically. The goal of any therapeutic intervention ought to be the restoration of health. Mental health counseling, medication, support groups, and psychotherapy are all essential while addressing bipolar disorder. Treatment of bipolar disorder

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7 manic episodes typically involves lithium (Sheikh et al., 2021). Patients on lithium should take anti-inflammatory pain medicine or a pain reliever. Long-acting stabilizers include valproate, lamotrigine, and carbamazepine. Anticonvulsants are added to lithium medication for bipolar illness if it does not work. Both hypomania and mania can be treated with and prevented by taking powerful mood stabilizers like divalproex and carbamazepine. Manic episodes can be prevented with the help of antipsychotics and mood stabilizers. There are potential negative effects and FDA cautions associated with medications for bipolar 1 disorder. Lithium (Lithium Carbonate), valproate sodium (Depakote), and quetiapine fumarate have all been approved by the FDA for the treatment of bipolar I. (Seroquel). Antidepressants and mood stabilizers, among others, can have serious side effects (Butler et al., 2018). Weight gain is one of the potential side effects of taking mood stabilizers as prescribed. Using antidepressants or mood stabilizers might cause sexual dysfunction. Negative side effects, like nausea, vomiting, and diarrhea, are common among those who take mood-altering medicines (Nath & Gupta, 2022). Antipsychotic drugs can cause mild to severe physical side effects. There may be unwanted side effects such as sleepiness, lethargy, weight gain, swelling, nausea, and vomiting. There have been reports of patients on antipsychotics experiencing vision problems. Some drugs may cause negative effects such as heart failure and fainting. The Food and Drug Administration (FDA) has approved or issued warnings about a number of drugs for bipolar disorder (Butler et al., 2018). Tardive dyskinesia is a serious side effect of the antipsychotic drug Abilify (aripiprazole). The FDA has placed a "black box" warning on the medication, their strictest warning possible. There has been a lot of talk about how medications can help kids who are depressed. The FDA concluded following a review of clinical trial data that antidepressants increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults.

8 The need of monitoring blood cholesterol levels when switching drugs and other concomitant illnesses have both been addressed in recent advisories. This article may be useful for readers who are having problems narrowing down potential therapies for their ailment. Prescription 1 Patient: an adult Date: 4/2/2023 Medication: Valproic acid 250mg Amount and frequency: 250mg twice a day Route: oral Indication: bipolar disorder Refills: no refilll Provider’s signature: Prescription 2 Patient: an adult Date: 4/2/2023 Medication and strength: lithium carbonate (tablet): 1200mg Amount and frequency: 600 twice a day Route: Oral Route Indication: patients above seven years Refills: no refill Provider’s signature: Prescription 3 Patient: an adult Date: 4/2/2023

9 Medication and strength: carbamazepine 400mg Amount and frequency: 100ml 4 times daily Route: oral Indication: mixed and manic episodes in bipolar 1 disorder Refills: no refills Provider’s signature: Conclusion People with bipolar disorder often swing wildly between extremely elevated and depressed states of feeling. Research has shown that depressed people are more likely to entertain suicidal thoughts, withdraw from social interactions, and lose interest in formerly pleasurable pursuits. Medication can help with the symptoms of bipolar illness, which includes a genetic component. Substance abuse and an unhealthy lifestyle both contribute to the risk. People with these conditions can lead relatively normal lives with the use of antipsychotics and mood stabilizers. The healthcare system also needs to guarantee that diagnostic techniques are accurate and useful. Clients with bipolar disorder shouldn't second-guess themselves or isolate themselves when they need help.

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10 References Butler, M., Urosevic, S., Desai, P., Sponheim, S. R., Popp, J., Nelson, V. A., ... & Sunderlin, B. (2018). Treatment for bipolar disorder in adults: a systematic review. https://www.ncbi.nlm.nih.gov/sites/books/NBK532193/table/ch2.tab1/ Cirone, C., Secci, I., Favole, I., Ricci, F., Amianto, F., Davico, C., & Vitiello, B. (2021). What do we know about the long-term course of early onset bipolar disorder? A review of the current evidence. Brain sciences, 11 (3), 341. https://www.mdpi.com/2076-3425/11/3/341 Conejo-Galindo, J., Sanz-Giancola, A., Álvarez-Mon, M. Á., Ortega, M. Á., Gutiérrez-Rojas, L., & Lahera, G. (2022). Postpartum Relapse in Patients with Bipolar Disorder. Journal of Clinical Medicine, 11 (14), 3979. file:///C:/Users/JULIA/Downloads/jcm-11-03979-v2.pdf Handrup, C. T. (2020). Understanding Bipolar Disorder: What is bipolar disorder, and why is it so difficult to diagnose? American Nurse Journal, 15 (11), 26. Jain, A., & Mitra, P. (2022). Bipolar affective disorder. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK558998/ Ljubic, N., Ueberberg, B., Grunze, H., & Assion, H. J. (2021). Treatment of bipolar disorders in older adults: a review. Annals of general psychiatry, 20 (1), 45. https://doi.org/10.1186/s12991-021-00367-x Mayo Clinic. (2022). Lithium (Oral Route). https://www.mayoclinic.org/drugssupplements/lithium-oral-route/proper-use/drg- 20064603 Michalik, K., & Kucharska, K. (2020). Implementation of deep neural networks in facial emotion perception in patients suffering from depressive disorder: Promising tool in the

11 diagnostic process and treatment evaluation. In Science and Information Conference (pp. 174- 184). Springer. Nath, M., & Gupta, V. (2020). Mood Stabilizers. https://www.ncbi.nlm.nih.gov/books/NBK556141/ Ostacher, M. J. (2019). Ethical Issues in the Diagnosis and Treatment of Bipolar Disorders. FOCUS, A Journal of the American Psychiatric Association, 17 (3), 265-268. https://focus.psychiatryonline.org/doi/10.1176/appi.focus.20190010 Post, R. M., & Grunze, H. (2021). The Challenges of Children with Bipolar Disorder. Medicine (Kaunas, Lithuania), 57 (6), 601. https://doi.org/10.3390/medicina57060601 Scaini, G., Valvassori, S. S., Diaz, A. P., Lima, C. N., Benevenuto, D., Fries, G. R., & Quevedo, J. (2020). Neurobiology of bipolar disorders: a review of genetic components, signaling pathways, biochemical changes, and neuroimaging findings. Brazilian Journal of Psychiatry, 42, 536-551. https://www.scielo.br/j/rbp/a/4pR74J7vkqQcQ746366fN9c/? lang=en&format=pdf Sheikh, M., Qassem, M. & Kyriacou, P. A. (2021). Optical Determination of Lithium Levels in Artificial Interstitial Fluid for Treatment Management of Bipolar Disorder. 2021 43rd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC), 2021, DOI: 10.1109/EMBC46164.2021.9630680 ISSN 2694-0604

WK5Assgn_Alagbe_A

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