Literature Review Of Stevens-Johnson Syndrome ( SJS )

Bipolar I is identified by the length and severity of the manic and depressive episodes. The manic episodes must last for at least seven days or they must be so severe that a person requires immediate hospitalization. The depressive episodes last around two weeks. These episodes, both manic and depressive, must be an extreme, major alteration from the person’s normal behavior. An effective treatment plan for bipolar I includes medication and psychotherapy. The medication helps with stabilizing a person’s mood and the psychotherapy is for the prevention of relapse and the reduction of symptom severity. Many people with bipolar I take combination medicine treatment. The treatment includes a mood stabilizer; sometimes an anticonvulsant other times a non anticonvulsant, and an antidepressant, to help reduce depression episodes. Doctors prescribe both an anticonvulsant and an

Bipolar disorder is a mood disorder known for severe persistent mood instabilities between mania and depression, . It causes unusual changes in mood, energy, and activity levels which makes ability to perform daily tasks very hard. (Concepts Advisory Panel [CAP], 2015). BPD affects more than 2.3 million adult Americans, or 1% of the population. (Guo, Patel, Li, & Keck 2010). There are four basic types of bipolar spectrum; All of them involve clear change in the mood energy, and activity levels (CAP,2015). These mood incidences’ ranges from periods of extremely high and energized behavior known as Manic episodes to very sad, or hopeless periods known as depressive episodes. Bipolar I disorder, the client has at least one episode of manic followed by major depression. Bipolar II disorder, the client has one or more hypomanic and major depressive episodes, the other not so severe and less diagnoses type of Bipolar is chronic mood disorder that lasts more two years with combination of hypomania and dysthymia. (CAP,2015). This paper will go into, Bipolar I, Manic episodes, the pathophysiology, Sign and symptoms, treatments, comorbidity, nursing intervention and nursing and patient therapeutic relationship.

Before the pharmacotherapy era, bipolar disorder was not a very common disorder until the use of legal and illegal drugs. According to Whitaker, “… 60 percent of those with a bipolar diagnosis said they had initially fallen ill with major depression and had turned bipolar after exposure to an antidepressant” (181). Antidepressants are used to treat bipolar disorder, but it seems that instead of treating it, it makes it worse.

Bipolar disorder, also known as, "manic-depressive illness," is a brain disorder that results in unusual shifts in a person's mood, energy, and ability to function. More than two million American adults (or, about one per cent of the population aged eighteen and older in any given year) are afflicted by this affective disorder (1). Yet, because it cannot be revealed by a blood test or other physiological means, patients may suffer for years before it is properly diagnosed and treated. Fortunately, once one is diagnosed with bipolar disorder, the acute symptoms of the disease can be effectively mitigated by lithium and certain anticonvulsant drugs, the most popular being Depakote (also known as

Jacobs past medical history is significant for bipolar II disorder. In addition, she has a history of alcohol and marijuana use. Ms. Jacobs in under the stress of living in a new city and attending a graduate level program away from home and the support of her family. Her current episode of symptom onset coincidences with these events.

Jann States that sufferers of BPD are three times more likely to suffer a depressive episode than a manic or hypomanic episode. (Jann, 2014) The Joanna Briggs institute Identified that the suicide rate for bipolar suffers are 15 times higher than that of non-affected individuals of the same age and sex. Eighty percent of these suicides occur during a depressive episode. (Hung Chu, 2016). Therefore appropriate pharmacological therapy not only during the maintenance period to reduce reoccurrence but also during these acute episodes is highly important. Pharmaceutical treatment includes the use of medication such as mood stabilizers, anti-psychotics and anti-depressants. The Joanna Briggs institute recommends that combination therapy involving both mood stabilizers such as Sodium valproate or lithium valproate and antipsychotics risperidone, olanzapine, quetiapine and haloperidol is best to treat acute mania associated with Bipolar. As it increases adherence to medication regime. (Tufanaru, 2016) The same institute encourages the use Olanzapine as a monotherapy or in combination with fluoxetine in the treatment of Depression associated with Bipolar disorder. (Hung chu, 2016) Lithium continues to be the first line mood stabilizer under current guidelines but may be used in conjunction with Carbamazepine where depression is evident. (Hung chu, 2016) The Australian and New Zealand Journal of Psychiatry 2015 also shows preference for combination therapy

Though the symptoms of bipolar disorder are serious and it lacks a cure, there are many treatment options that can drastically include the quality of life of patients. There are numerous medications that can be prescribed to limit the severity of manic and depressive episodes. These medications help regulate the moods of patients, and they can even prevent severe mood episodes altogether. However, the side effects that come with these medications can be difficult to manage. Sometimes, these side effects are as minor as excessive drooling, but they can also cause weight gain, sexual dysfunction, sleepiness, and insomnia. In the most severe cases, however, some medications can cause organ failure and death. That is why it is important for patients

Psychiatric mood disorders of such as Bipolar are often complex to diagnosis. Bipolar I is differentiated from Bipolar II by a history of at least one manic episode in a person’s life, with Bipolar II being diagnosed and characterized by a history of major depression with at least one episode of hypomania (Sadock, Sadock, and Ruiz, 2015). Bipolar is often misdiagnosed as major depression, especially in the presence of a dual diagnosis of substance use disorders. Individuals with Bipolar often have a history of self-medicating their mood symptoms of mania and

Mood stabilizers are usually the first line of defense. Lithium treats both manic and depressive episodes. It usually takes about 7 to 14 days for therapeutic levels to be reached. The nurse should monitor for lithium toxicity which would include signs such as slurred speech, muscle weakness, gastrointestinal upset, sedation, and mental confusion. Anticonvulsants such as valproic acid and divalproex sodium are now commonly used as mood stabilizers as well. Atypical antipsychotics and antidepressants may be used in treatment as well. Antidepressants should be used cautiously as they increase the risk of mania or hypomania occurring (Halter, 2014, p.240). A concern associated with antidepressants and anticonvulsants is the increase in occurrences of suicidal thoughts, and the presence of unusual behaviors (National Institute of Mental Health, 2012). In recent pharmacological studies the anticonvulsant valproic acid and atypical antipsychotic quetiapine showed that, in patients with this particular dual diagnosis, alcohol consumption was significantly reduced while on these medications (Farren, Hill, & Weiss,

Conferring to the textbook Abnormal Psychology bipolar disorder is a tendency of manic episodes relating to brain disorder that centers on mood shifting and the ability to conduct a daily life tasks (Barlow & Duran, 2015). The symptoms of bipolar are severe and changes in energy. Bipolar disorder is known to be different from the normal ups and downs that everyone goes thorough from time to time. There are few subtypes of bipolar disorder: bipolar I, bipolar II and cyclothymic disorder. (Akiskal, 2009; Parker, McCraw & Fletcher, 2012) stated that cyclothymic disorder is a more chronic version where it is related in many ways to tenacious depressive disorder. The common form of this disorder involves recurrent episodes of mania

Anticonvulsants have an edge with rapid-cycling and mixed mood states (e.g. depression with racing thoughts). Except for gabapentin (Neurontin) and lamotrigine (Lamictal), they require blood tests. Carbamazepine (Tegretol) is monitored with blood levels; also CBC, platelets and liver function tests. Valproate (Depakote) requires CBC, platelet count and liver function tests; blood levels may be helpful. Lamotrigine (Lamictal) requires caution because of its association with a rare but dangerous skin rash (exfoliative dermatitis); risk can be minimized by starting with low doses and increasing gradually. Use lower doses with medications that slow lamotrigine metabolism (e.g. valproate). Gabapentin is generally safe and does not require blood tests.