Bipolar and Depression PPT

Bipolar and Depression : 

Bipolar and Depression Dr. Dawn-Elise Snipes PhD, LMHC, CRC, NCC Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

NIMH Primer : 

NIMH Primer BiPolar Disorder

Bipolar I and II : 

Bipolar I and II Bipolar I disorder: at least one episode can be characterized as mania Episodic, lifelong illness with a variable course. The first episode may be manic, hypomanic, mixed,or depressive Patients may experience several episodes of depression before a manic episode Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Differential Diagnosis : 

Differential Diagnosis Ask about a history of depression accompanied or followed by manic or hypomanic symptoms Assess for substance use disorder, other general medical conditions or medications Medical conditions associated with manic-like symptoms or secondary mania are Multiple sclerosis Lesions closely linked to the limbic system Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Medications associated with manic-like symptoms : 

Medications associated with manic-like symptoms L-Dopa Corticosteroids High-dose decongestants Antidepressants may trigger a manic episode Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Substance use : 

Substance use May cause manic-like episodes May help patient self-medicate Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Patients with bipolar : 

Patients with bipolar Seek treatment during a depressive episodes Rarely volunteer information about manic or hypomanic symptoms. Do not see the symptoms of hypomania to be that distressing Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Case Study : 

Case Study John is a 26 year old white male who has been referred for a mental health evaluation by his physician. He reports recurrent episodes of depression during which his drinking increases. Upon further discussion he reveals that in between depressive episodes, he feels really good. The doctor has him on Zoloft which seems to help some with the depression, but he just feels kind of blah all the time when he is taking it. The good periods disappear, so he often stops taking his meds until he is in a depressive episode.

Goals of Psychiatric Management : 

Goals of Psychiatric Management Establish and maintain a therapeutic alliance and monitor the patient’s psychiatric status. Assist the patient and significant others in anticipating stressors and identifying new episodes early Assist the patient in minimizing functional impairments by promoting regular patterns of activity and sleep Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Suicide : 

Suicide Completed suicide rates 10% to 15% Suicide attempts associated with depressive episodes or depressive features of mixed episodes Ask every patient about suicidal ideation Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Slide 11: 

Factors associated with increased risk Means Lethality Family history of suicide Pervasive insomnia Impulsiveness Psychiatric comorbidity Psychosis Personality disorder Lack of social support Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Hospitalization : 

Hospitalization Patients who Pose a serious threat of harm to themselves Are severely ill Lack adequate social support Demonstrate significantly impaired judgment Have complicating psychiatric or general medical conditions Have not responded adequately to outpatient treatment. Re-evaluate treatment setting regularly Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Other : 

Other Because of the risk of reckless behavior during the manic phase consider limiting access to cars, credit cards, bank Therapeutic alliance assists the clinician in helping the patient identify triggers Monitoring is especially important during both manic and depressive episodes Patients vary in their ability to understand and retain information and accept and adapt to the need for long-term treatment Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Education : 

Education Should introduce facts about the illness and its treatment Use printed, verbal and videotaped material Present in an ongoing gradual and consistent process Use psychoeducational groups Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Ambivalence : 

Ambivalence Expressed through poor treatment compliance. Causes include Lack of insight about the severity of the illness Reluctance to give up the experience of hypomania or mania Medication side effects Cost Other demands of long-term treatment Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Stressors : 

Stressors Commonly precede episodes Disrupted sleep-wake cycles may specifically trigger manic episodes. Regular patterns should be promoted Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Counselor Activities : 

Counselor Activities Preplanning Plan for impairments in functioning Assisting patient in scheduling absences from work Avoid major life changes Plan for the needs of their children while the patient is in an acute state Assist the patient who is able to work in contacting vocational rehab Assist the patient in linking with a case manager and/or services Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Medication : 

Medication Severe mania or mixed episodes: antipsychotic and valoprate or lithium. Mild to moderate mania or mixed episodes Monotherapy with an antipsychotic, valporate or lithium Short-term adjunctive treatment with a benzodiazepine may be helpful. Mixed episodes Certain drugs preferred over lithium Atypical antipsychotics preferred over typical antipsychotics Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Antidepressants : 

Antidepressants Use earlier for bipolar II depression than for bipolar I Patients with bipolar II disorder probably lower rates of antidepressant induced switching into hypomania or mania Antidepressants may increase mood cycling Recommended to combine mood stabilizer with antidepressant Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Electroconvulsive therapy (ECT) : 

Electroconvulsive therapy (ECT) May be considered for Patients who are severely ill Whose mania or depression is treatment resistant Who experience symptoms during pregnancy Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Goals of Treatment : 

Goals of Treatment Prevent relapse and recurrence Reduce cycling frequency and subthreshold symptoms. Reduce suicide risk. Improve overall functioning Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Psychosocial interventions : 

Psychosocial interventions Address Illness management Interpersonal difficulties Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Postpartum period : 

Postpartum period Associated with increased risk for relapse into mania, depression, or psychosis Rate of postpartum relapse is as high as 50% Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Prevalence in children and adolescents : 

Prevalence in children and adolescents 1% Additional 5% to 6% have mood symptoms NOS Children with bipolar disorder often have Mixed mania Rapid cycling Psychosis Often comorbid with attention deficit and conduct disorders Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Elderly : 

Elderly In patients over 65 years of age, prevalence rates of bipolar disorder range from 0.1% to 0.4% Most manic symptoms are due to a general medical condition or medication Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC

Summary : 

Summary Bipolar can be diagnosed in children, adults and elderly Wide range of medications effective in treatment Psychosocial interventions focus on minimizing stress and increasingroutines Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC