Will Boney
Wingate PA program
DEC 12, 2014
OVERVIEW FOR BIPOLAR DISORDER, AND TREATMENT QUALITY INDICATORS
QI: Use of group and family based education and therapy as part of psychosocial education in maintenance therapy for Bipolar patients.
I. DEFINITION OF THE DISEASE
A. Bipolar Disorder- Episodes of major depression, hypomania, and/or mania.
Bipolar disorder is the name given to a spectrum of psychological maladies characterized by cyclical episodes of mood disorder in the form of mania and depression, interspersed with periods of relative normalcy. Manic and hypomanic episodes are the hallmark symptoms bipolar disorders, and accurate differentiation between the two is necessary to properly diagnose bipolar types I and II, and to exclude
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The major criteria are consistently elevated or irritated mood for the majority of 4 days, and, as in manic episodes, the individuals may experience a wide range of symptoms related to increased energy, self-confidence, impulsivity, and risk-taking. Besides a slightly shorter duration of symptoms, the main differentiating factor between hypomania and mania is the degree of impairment. In both states, the level of functioning must be uncharacteristic, and evident to others, but social and work functioning is not markedly impaired in a hypomanic episode. The presence of psychotic symptoms automatically excludes the definition of hypomania, as does an attributable medication or …show more content…
History taking should focus on the presence of mood disturbing episodes, which were described previously. Careful attention must be paid to the duration of symptoms and degree of impairment in order to distinguish between mania and hypomania. The diagnosis of hypomanic episodes in particular is a challenge, since it by definition does not cause impairment, and may be difficult to differentiate from euthymia in a depressed patient. Although the diagnosis of bipolar disorder requires the presence of manic or hypomanic episodes, the majority of patients present with symptoms of depressed, not elevated mood. Thus, the possibility of bipolar disorders must be considered with all patients presenting with depressive episodes. In addition to symptoms, determining family history of psychiatric diagnoses is important, especially in first-degree relatives. Substance abuse is a common comorbidity with bipolar disorder, and patients with bipolar disorder have higher rates of substance abuse than the general population. (Conceptualizing impulsivity and risk taking in bipolar disorder: importance of history of alcohol abuse) Additionally, substance abuse may be a clue to the impulsive, risk taking behavior that is a manifestation of the manic episodes. It is important to note that manic or hypomanic episodes may not be the direct result of medications or substance abuse. Sexual history may
Thankfully, there are various treatments and therapies, which can help manage bipolar disorder in an individual. Since all patents are different, experimenting with multiple treatments is always a good idea, to help figure out what will work best for them. Medication is a main and most popular route, including mood stabilizers, antipsychotics, and antidepressants (“National Institute of Mental Health”). Unfortunately, medications can have their downsides and often getting the patient to regularly take their medication is one of the biggest challenges. Another option for the patient to consider is psychotherapy. This includes different kinds of verbal therapy such as cognitive and behavioral therapy (“Bipolar Disorder”). Therapy is not only helpful for the affected person but also can help the family cope. Lifestyle changes such as healthier lifestyle, organized schedule, and the limitation of alcohol and drug consumption, can contribute to managing this disorder. Overall though, this disorder affects everyone differently, and the patent needs to consult a doctor and psychiatrist to figure out what will help them handle their symptoms the most
Despite the similarities, there are more common symptoms in bipolar depression than it is in regular depression. For example, bipolar depression has individuals feeling guilty, hopeless, sad, empty, unpredictable mood swings, and feelings of restlessness. People with bipolar depression also tend to move very slow, gain weight, and sleep a lot (Hatchett). On the other hand the hypomania state has led observers to feel that bipolar patients are "addicted" to their mania. Paranoia or irritable characteristics begin to manifest in this stage. Hyperactive behavior can sometimes lead to violence and speech becomes very rapid (Hirschfeld, 1995). A mixed episode is when you have both manic and depressive symptoms at the same time. According to Hirschfield, “Those afflicted are a special risk because there is a combination of hopelessness, agitation, and anxiety that makes them feel like they,” “could jump out of their skin” (Hirschfeld, 1995). Up to 50% of all patients with mania have a mixture of depressed moods. This episode is considered very dangerous because individuals feel as if they could commit suicide.
The stigma associated with bipolar disorder is unacceptable. The purpose of this paper is to improve the readers ability to understand what bipolar disorder is and how being diagnosed with this disorder affects all facets of daily living. Family, friends and associates of individuals with bipolar disorder are often affected as well. As a result of the stigma associated with the disorder, the effects remain: often multiplied by individuals that have a limited understanding of the disorder. There are numerous myths related to individuals diagnosed with bipolar disorder. Hopefully a few of these myths will be put to rest after learning more about the disorder.
Bipolar disorder is a mental illness which causes extreme mood swings in which the person would have times of emotional highs (manic or hypomania) and lows (depression), with periods of normal mood in between. Bipolar can affect relationships and the ability to carry out day to day tasks.
When their mood elevates they have that high feeling. These people seem like the people that are the life of the party. You don’t realize that they have this disorder. Sometimes are not in control in what happens. They feel more depressed than having hypomanic symptoms. For every patient it is different some experience depression for a longer period of time others can be a short period of time.
The two major types of Bipolar Disorder (BPD) set out in this paper are Bipolar 1 and 2. Bipolar 1 is diagnosed as guide lined by the DSM5. As the occurrence of a least one maniac episode preceding or post an episode of hypomania and/or Major depression. The DSM 5 highlights that Bipolar 2 is diagnosed by one major depressive episode in occurrence with one hypomanic episode with an absence of Mania. (Association:, 2013) Mania as defined by DSM5: “A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day.” Hypomania being: “A distinct period of abnormally and
When a patient is in a manic episode they are very excited, energetic, and hyper. A manic episode can cause a patient to make impulsive, irrational decisions such as, partaking in high risk behaviors, spending large amounts of money they cannot afford, having sexual indiscretions even when they’re in a committed relationship or driving at dangerous speeds. There is a lesser state of mania called hypomania, it is in very close relation to a manic episode, the patient is not as hyper but it is still considered a abnormal state of high emotion. When a patient is in a depression episode it consists of sadness and hopelessness. The patient can become more tired, irritable, or have a change in their eating habits. In this episode thoughts of suicide can occur, losing interest in things they have previously enjoyed. These are just a few examples of the actions a patient makes when in a manic or depressed episode. There are multiple bipolar disorders, bipolar I and bipolar II are better known. The reader has been diagnosed with bipolar two at the age of twenty two. This disorder has been a problem since the age of ten, after learning more about the disorder over the years it’s been a process learning how to cope and continue everyday life. The lives of patients who have been diagnosed with this disorder are affected
Bipolar Disorder or manic-depressive disorder is a disorder characterized by highs, manias, and lows, depressions, and can therefore be easily distinguished from unipolar depression, a major depressive disorder in DSM-5, by the presence of manic or hypomanic episodes (Miklowitz & Gitlin, 2014). Bipolar disorder is generally an episodic, lifelong illness with a variable course (American Psychiatric Association, 2010). There are two classifications of bipolar disorder; bipolar I disorder and bipolar II disorder. If the episodes are primarily manic but there has been at least one depressive episode, the diagnosis is bipolar I disorder (Early, 2009). If the episodes are primarily depressed but there has been at least one episode of hypomania, increased mood that is more euphoric than normal but not quite manic, the diagnosis is bipolar II disorder (Early, 2009).
Famous celebrities such as Demi Lovato, Catherine Zeta-Jones, Mel Gibson and Jim Carrey are proof that bipolar I disorder can be treated and still have a full and productive life. Like any other diseases such as heart disease or diabetes, bipolar I disorder is a long-term disorder that must be carefully managed throughout one’s life. Some psychotherapies can help with the treatment of bipolar I disorder with manic psychotic features such as cognitive-behavioral therapy (CBT), interpersonal and family therapies, and psycho-education. The CBT is used to identify negative thoughts and behaviors and learn to modify them to create a positive change. Interpersonal and family therapies help to manage the patient’s symptoms and needs that improve relationships and communications. Lastly, psycho-education which can be used to educate people with bipolar disorder as well as their family members to help identify the signs of mood swings before they happen. Since bipolar I disorder with manic psychotic feature is essentially a long-term condition, it is recommended that the client remains in family session therapy for as long as the client is receiving medications. Therefore, since there is no cure for bipolar I disorder, a thorough investigation of the client’s symptoms and family history along with the combination of medication and psychotherapy can lead to successful treatment and management of the
The patient is a 42 year old female who presented to the ED with bizarre behaviors. Per documentation the patient has been not eating, nor drinking, and lying in bed the bed most of the day for the past few week. The patient presents with confusion.
Bipolar II entails having recurrent major depressive episodes with hypomanic episodes. Means that most of the time the person will be depressed and not as likely to have manic episode even though they tend to happen. When manic episodes happen with depressive disorders, more often or stronger, then it is a bipolar I diagnosis. In bipolar II the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (DSM-IV TR). Severe episodes of depression, but episodes of mania are milder and are known as hypomania. Hypomania is the same symptoms as in mania, except not as severe.
Bipolar disorder is receiving much attention in the media and is more frequently diagnosed today by many mental health specialists than ever before. It has in fact almost become as commonplace as the flu or common cold. Toddlers who do not sleep well are Bipolar, young children with temper tantrums are Bipolar, husbands who get angry are Bipolar, wives with incredible stress in their lives are Bipolar and the individual who spends too much money is also Bipolar. That pretty much covers 70% of the human race. Is it possible that this number of the population can be chronically mentally ill? Prior to this increase in Bipolar diagnosis over the past 10 or 15 years, the National Institute of Mental Health reported Bipolar to exist in approximately
They chose this topic because it has not been researched much. The qualitative study examined how a sense of self and or an identity develops for those with the disorder. Psychosocial development is a challenge in itself for most teens. In this study the researchers described finding that bipolar disorder made this developmental process more challenging. According to, Inder et al. (2008), “Bipolar disorder created experiences of confusion, contradiction, and self-doubt which made it difficult for these participants to establish continuity in their sense of self.” They continued to describe how living with the disorder can be disruptive and prevent one from looking at themselves as separate from their condition. Their results showed the importance of viewing bipolar disorder within a psychosocial developmental framework. By doing so, one can consider the impact of the disorder on the developing self-identity. This study discovered that there is a need to utilize interventions that would help individuals not focus on themselves related to their illness but instead to foster increased self-acceptance and integration which would then develop a stronger self and identity. During the course of this study the researcher used an interview and interpretation process which allowed them to garner common themes from their interview responses. They found that the disorder has a profound impact in a variety of areas. Themes emerged that included
Bipolar disorders affect approximately 2.6% of the adult population in America. With nearly 6 million men and women affected by the disorder in both a medical and clinical capacity, it is essential that we understand and eliminate any barriers to self-reporting or adherence to treatment plans. Specifically, studies have reported that gender identity plays a role in the self-reporting measures in order to make a diagnosis. While women have a high frequency of self-reporting their symptoms as well as seeking treatment, men consistently demonstrate much lower rates of self-reporting as well as adherence to treatment. Because gender and gender identity impact the effectiveness of clinical treatment for those with bipolar disorders, we are interested