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Bipolar Disorder (VK)


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Bipolar Disorder (VK)

  1. 1. Bipolar Disorder By Anny Dow, Period 3
  2. 2. It is a serious brain disorder An illness characterized by extreme changes in mood, behavior and energy levels Also called Manic-Depressive Psychosis (MDP) This serious mental illness involves mood swings that range anywhere from depression to mania Affects nearly 5.7 million Americans!!!
  3. 3. How Bipolar Disorder Affects the Body How Bipolar Disorder Affects the Body -it damages to the brain; certain parts of the brain A may be unbalanced in volume which can affect the brain’s F ability to learn, remember things, and function F -People with BPD tend to suffer from anxiety and panic, and usually also have another mental illness -People with BPD generally die about 7 yrs earlier than that of the average population, aside from suicide -Depression forms of BPD have been linked to be the causes of over-smoking, drinking, heart disease, heart attacks, high blood sugar, diabetes, bone loss, stroke, IBS, even cancer E C T S ! ! !
  4. 4. When and How do Most Get When and How do Most Get Bipolar? Bipolar? Most people become bipolar anytime from their late teens to their early twenties. There are some cases, which are becoming far more frequent lately, that kids get BPD. Studies show that bipolar children out of control than bipolar adults, often raging for hrs at a time. There is not a proven cause for BPD yet, but researchers do know that genes can cause a predisposition to the mental illness. Other possibilities include too much stress, overload of excitatory NT glutamate in the synapse. Some evidence also hints that a lack of vit and/or minerals cause BPD. These are all possibilities for BPD can range from person to person, so there is no solid cause.
  5. 5. How is a Person’s Life Life How is a Person’s DailyDailyAffected? affected? disease Having BPD is just like having any other (diabetes or heart disease). People with BPD suffer from manic and depressive episodes in their daily lives and have to constantly keep watch on their condition. Victims of the illness are usually extremely tired or overly hyper and are not in control of their brain functions. Their range of moods is abnormal. Without treatment, it worsens quickly. Life is an “emotional roller coaster” for the people with BPD. Fortunately, BPD comes with many treatment forms. With the proper medication, education, and support, people with BPD can manage and live normal lives.
  6. 6. Symptoms Symptoms of Bipolar Disorder Depression Form: Manic Form: - constantly feeling sad or worthless - increase in energy level - sleeping too much or too little - easily distracted P - feeling tired and having little energy - nonstop talking O -appetite and weight changes L -problems focusing A - thoughts of suicide B I R - less need for sleep - increased self confidence - focused on getting things done, but does not accomplish much - is involved in risky activities even though bad things may happen
  7. 7. What is the Cost of Treatment? What is the Cost of Treatment? BPD is not cheap to manage. More than a decade ago, the total cost of BPD was estimated to be up to $45 billion a yr. Most of the cost comes from reduced functional capacity and lost work. Compared with the general population, bipolar pts have higher rates of utilization of healthcare resources. The lost productivity of bipolar pts who have committed suicide was $8 billion of the $45 billion in costs recorded in 1991. Only about $7 billion was spent on direct pts care. Misdiagnosis also has to do with increased costs.
  8. 8. Famous People with Bipolar Disorder Hans Christian Anderson, writer. Sylvia Plath, poet. Ludwig Van Beethoven, composer. Edgar Allen Poe, writer. Lord Byron, poet. Axl Rose, musician. Charles Dickens, author. Robert Schumann, composer. Ralph Waldo Emerson, philosopher & poet. Mark Twain, author. Ernest Hemingway, writer. Vincent Van Gogh, Artist. Vivien Leigh, actress. Virginia Woolf, poet & novelist. Abraham Lincoln, 16th U.S. president. Frank Bruno, boxer. Marilyn Monroe, actress. Adolf Hitler, dictator. Isaac Newton, scientist & mathematician. Winston Churchill, politician. Florence Nightingale, nurse. Francis Scott Key Fitzgerald, writer. Ozzy Osbourne, singer. Courtney Love, musician & actress.
  9. 9. Cures/Treatments for Bipolar Disorder Cures/Treatments for Bipolar Disorder There is no actual “cure” for BPD yet, but with the help of various treatments and medications, people with BPD can live normally. These are just a few of the treatments for BPD: Medications: Mood Stabilizers- delay and relieve episodes of depression and mania Antidepressants- work with mood stabilizers to help slow depression Antipsychotics- helps treat mania and also severe cases of mania/depression Electroconvulsive therapy (ECT)- used to treat mania/depression Talk Therapy: Also known as psychotherapy, talk therapy can help people with BPD make sense of their thoughts and feelings. Through talk therapy, people can get valuable advice and support, regain their confidence, and reduce any strain or stress they may have. Self Care: Learning about BPD is the first critical step in self-care. Tracking and recording moods is also helpful. Avoiding things that may trigger depression/manic episodes and joining a mental illness support group are just a few other things that can help you lessen the stress of having BPD.
  10. 10. Altman Self-Rating Mania Scale (ASRM) is a 5-item self-reported diagnostic scale which can be used to assess the presence and severity manic and hypomanic symptoms, most commonly in patients diagnosed with BPD
  11. 11. • It assess differences in "normal" or baseline levels in 5 subjective and behavioral areas: 1 positive mood 2 self-confidence 3 sleep patterns 4 speech patterns and amount 5 motor activity
  12. 12. Young Mania Rating Scale • is an eleven-item, multiple-choice diagnostic questionnaire which psychiatrists use to measure the severity of manic episodes in pts. • The scale was originally developed for use in the evaluation of adult pts - BPD, but has since been modified for use in pediatric pts. • A similar scale was then developed to allow clinicians to interview parents about their children's symptoms, in order to ascertain a better diagnosis of mania in children. Clinical studies have demonstrated the effectiveness of the parent version of the scale.
  13. 13. Mood stabilizers To prevent both manic and depressive phases of bipolar disorder 1. Lithium 2. Anticonvulsants: Carbamazepine, Valproate, lamotrigine, 3. Risperidone, Olanzapine, ziprasidone, aripiprazole, quetiapine
  14. 14. Lithium • BPD–also along with antidepressants in depression :900-1800 mg/day • ? Second messenger modification-Phosphatidyl-InositolBiphosphate [PIP2] / Membrane stabilization/5HT/regulates circadian rhythms • Toxic = Monitor blood levels= (0.8-1.2mEq/L) OW/OM • Renal dysfunction polydipsia, polyuria, Cardiac conduction abnormalities, GI, tremor, cognitive impairment, Thyroid dysfunction – hypothyroidism, precipitation of acne • BUN, creatinine: 3 months • WBC, THYROID, urine output: 3-6 months C/I:- PREGNANCY • COMMON A/E: H, dryness, GI, PPP, hand tremor, dizziness, fatigue, sedation • Ataxia, slurring, coarse tremors, confusion, convulsion
  15. 15. MOA
  16. 16. Lithium - uses • Prevention of both manic and depressive episodes • Aggressive behavior • Borderline personality disorder • Bulimia nervosa • Cluster headaches
  17. 17. Anorexia nervosa • Refusal to maintain body • Wt above a minimal normal • Very less eating Bulimia nervosa • Irresistable craving for food with episodes of over eating in less time • Attempts to counter act the effects of over eating 1. Self induced vomiting 2. Purgative abuse 3. Appetite suppressants 4. Periods of starvation
  18. 18. Anticonvulsants as mood stabilizers – facilitate GABA- rapid cycling, mixed episode, alcohol and BZD withdrawal • Intolerance/resistance to Lithium • Carbamazepine -Drug of choice for Trigeminal neuralgia. A/E:- Aplastic, agranulocytosis, sedation, dizziness, ataxia, Steven-Johnson syndrome, C/I:- Pregnancy- neural tube defects • Oxcarbamazepine: Less blood dyscrasias • Valproic acid: (psychotic, cognitive, substance abuse) C/I:- Pregnancy- neural tube defects
  19. 19. • VALPROATE, CARBAMAZEPINE 1 Along with lithium to help the action 2 not responding or resistant to lithium 3 not tolerating lithium
  20. 20. Remember – Acute phase of mania – antipsychotic Long term treatment – mood stabilizer ACUTE PHASE OF MANIA: Immediate treatment: ANTIPSYCHOTICS – eg. Haloperidol to acutely control psychotic symptoms and/or diazepam/lorazepam Then LONG TERM treatment with – MOOD STABILIZERS
  21. 21. CARBAMAZEPINE • 400 – 1000 mg/day • Most effective for mixed states, rapid cycling • S/E– sedation, ataxia, aplastic anemia, agranulocytosis • Check CBC
  22. 22. VALPROATE • 500 – 2000 mg/day; Highest blood level for effect. Highest dose is 60 mg/kg/day S/E – GI upset, weight gain, alopecia, teratogenicity, liver problems • Best for mixed states, rapid cycling, secondary mania. Ineffective for depression • Selenium for hair loss
  23. 23. ATYPICAL ANTIPSYCHOTICS • Olanzepine – 2.5-20 mg/day; very effective; significant wt gain and lipid problems in some • Risperidone - 5-4 mg/day; more EPS and increased prolactin in some • Clozapine - For truly refractory patient, but can be remarkably effective. Slow response, serious SE profile and significant wt gain
  24. 24. GABAPENTIN • • • • Anticonvulsant, least effective new drug Most helpful with anxiety, insomnia, pain May cause persistent sedation Excreted by kidneys only, no drug interaction • 1200 to 4000 mg/day.
  25. 25. LAMOTRIGINE • Anticonvulsant, best for Bipolar depression • Improved cognition, excellent tolerance, serious autoimmune rash • Valproate interaction • 75 - 300mg/day.
  26. 26. TOPYRAMATE • Significant cognitive ill effect and paresthesiae • WEIGHT LOSS • 50 mg qhs, increase by 50 mg/wk. in divided doses to maximum of 200 mg bid
  27. 27. NEVER GIVE UP It will help patient to be inspired by us, rather than the other way around
  28. 28. THE END!!! Thank you for your time. Hope you enjoyed the presentation!