2. The dominance of substance abuse disorders is higher in bi-polar disorders than any other psychiatric illness (Ostacher, Perlis, Nierenberg, Calabrese, Stange, Salloum, Weiss, & Sachs, 2010). Bipolar disorder patients often use alcohol and/or other substances in order to help control their symptoms such as anxiety and sleep disorders (Jennings, 2002). Individuals self-medicate with the use of substances to lower their anxiety and help them fall asleep or sleep for a longer period of time. Individuals with bipolar disorder that abuse substances are prone to a 7-fold increase of risk for developing antidepressant-induced mania or causing them to be vulnerable to mood instabilities (Goldberg, Ostacher, & Perlis, 2010). These patients are more likely to suffer from rapid mood swings, such as, depression to mania, hypomania, or mixed episodes than those who do not have a substance abuse disorder (Ostacher et al, 2010). If the patient has an anxiety disorder and a substance abuse disorder the severity of their bipolar disorder will intensify increasing the frequency and duration of hospitalization (Ghoreishizadeh, et al, 2009). Abstact
3. Individuals do not always disclose to their doctor they are using substances The interaction of prescription drugs with illegal substances has not been tested This could cause compromising situations, heightening their risk of mood instabilities, and life threatening events Substances could lead to more symptoms and/or hospitalziations
4. Also known as manic-depressive disorder Classified as a mental illness Affects individual’s emotions, causing a clustering of anxiety & depression, aggression & irritability, and at times psychosis. Bipolar is categorized by the DSM-IV with 3 types Type I those with severe mood swings Type II those with milder mood swings Mixed type those with combination of symptoms presenting at the same time What is bipolar?
5. 3 types of episodes- depressive, manic and mixed Depressive episodes one may be sad, show little to no interest in usual activities, have trouble sleeping low energy, no appetite and concentration problems Manic episodes one can be overly happy or irritable, have racing thoughts, little or no need for sleep, high activity levels and grandiose thinking When one experiences both depressive and manic symptoms this would be considered a mixed episode Bipolar I patients experience full-blown episodes Bipolar II patients experience hypomanic episodes Symptoms
6. There are 5 clinical stages of bipolar disorder Stage 0: Known risk factors but no symptoms Stage 1: On-set of initial symptom “mild, non-specific and identifiable disorder-specific symptoms” Stage 2: Onset of the first episode Stage 3: Reoccurring episodes Stage 4: Resistance in treatment brought on by a persistence unremitting course of presenting symptoms or occurrences Progressive Nature
7. Children with 1 bipolar parent are 10.6% at risk of having bipolar disorder Children with 2 bipolar parents are at 29% risk Among bipolar children 32% have substance use disorder Bipolar symptoms tend to start in adolescents , who want immediate gratification Prescription medications used to treat bipolar can take up to 6 weeks to see results Adolescents tend to turn to substances to coop with symptoms Offspring of Bipolar Patients
8. Dominance of substance use disorders are high in bipolar patients than any other psychiatric patients Substances help control symptoms such as anxiety and sleep disorder for some bipolar patients These substances help to lower anxiety or help them fall asleep or stay sleeping for a longer period of time Due to exclusion from clinical trials there is very little information about bipolar disorder patients that have a substance use problem Substance Use Disorder
9. 57% of bipolar I patients abuse at least 1 substance compared to the 39% of bipolar II patients Substance use can complicate the clinical symptoms and decrease treatment response Bipolar patients with a substance use disorder are prone to a 7-fold increase of risk for developing antidepressant-induced mania or causing them to be vulnerable to mood instabilities A mix of anxiety disorder and substance use disorder can intensify the severity of the disorder and increase duration of hospitalization Substance Use Disorder Cont.
10. Psychiatric hospitalization usually happens when a patient is in a manic, depressed or psychosis episode Patients with substance use disorder are more at risk of having higher prevalence of work-related disability Marijuana users with bipolar disorder spend an increased amount of time in an episode Low number of patients receive psychiatric hospitalization Psychiatric Hospitalization
11. Bipolar disorder is uncurable Many patients use substances to self-medicate We do not know how substances interact with prescription medicines Future studies on how these substances interact with bipolar disorder and prescription medicines is needed
12. Berk, M. (2009). Neuroprogression:pathways to progressive brain changes in bipolar disorder. The International Journal of Neuropsychopharmacology, 12(4), 441-5. Retrieved on July 9, 2010, from ProQuest Health and Medical Complete. Bipolar Disorder; Findings in bipolar disorder reported from University of Manitoba, Department of Psychiatry. (2010). Pediatrics Week, 304. Retrieved on July 9, 2010, from ProQuest Health and Medical Complete. Bipolar Disorder Prevention; Research from School of Medcine yields new data on bipolar disorder prevention. (2010). Clinical Trials Week, 270. Retrieved on July 9, 2010, from ProQuest Health and Medical Complete. References:
13. Ghoreishizadeh, M., Amiri, S., Bakhshi, S., Golmirzaei, J., & Shafiee-Kandjani. A. (2009). Comorbidity of Anxiety Disorders and Substance Abuse with Bipolar Mood Disorders and Relationship with Clinical Course. Iranian Journal of Psychiatry, 4(3), 120-125. Retrieved on July 9, 2010, from ProQuest Health and Medical Complete. Goldberg, J., Ostacher, M., & Perlis, R. (2010). Substance Abuse and Switch from Depression to Mania in Bipolar Disorder/Reply to Goldberg Letter. The American Journal of Psychiatry, 167(7), 868-9. Retrieved on July 9, 2010, from Research Library Core. Goodwin, F. K. & Jamison, K. R. (1990). Manic-Depressive Illness: Bipolar disorders and recurrent depression. (2nd ed.). NY: Oxford University Press. References cont.:
14. Hoblyn, J., Balt, S., Woodard, S., & Brooks, J. (2009). Substance Use Disorders as Risk Factors for Psychiatric Hospitalization in Bipolar Disorder. Psychiatric Services, 60(1), 50-5. Retrieved on July 9, 2010, from Psychology Module. Jennings, C. (2002). Bipolar disorder, substance abuse often go hand-in-hand. Standard, p. E2. Retreieved on July 9, 2010, from Canadian Newsstand Complete. Ostacher, M., Perlis, R., Nierenberg, A., Calabrese, J., Stange, J., Salloum, I., Weiss, R. & Sachs, G. (2010). Impact of Substance Use Disorders on Recovery From Episodes of Depression in Bipolar Disorder Patients: Prospective Data From the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). The American Journal of Psychiatry, 167(3), 289-97. Retrieved on July 9, 2010, from Research Library Core. Wagner, K. (2010). Offspring of Parents with Bipolar Disorder. Psychiatric Times, 27(2), 56-57. Retrieved on July 9, 2010, from ProQuest Nursing & Allied Health Source. References cont.:
Editor's Notes
DSM-IV is the standard criteria published by the American Psychiatric Association for the classification of mental illnesses. There are 9 diagnosis utilized for bipolar disorder with a total of 33 codes due to the severity of symptoms.
How bipolar affects an individual can vary depending on which stage they are in.
How fast the disorder progressive depends on each individual.
These patients should not use substances while under going treatment or after treatment in order to fully treat the bipolar disorder. However, substance use disorder does not change or predict time of recovery from a depressive, manic, hypomanic or mixed episode.
Low number of hospitalizations could because the suicide rates triple in those who are bipolar and have substance use disorder. There are no clinical profiles that can be used to determine the patient’s risk of needing psychiatric hospitalization or the importance of different risk factors.
