Bipolar Disorder and HIV

1. BipolarDisorderand HIV Medical Case Manager Clinical Conference June 28th 2007

2. Objectives • Review Bipolar Disorder • Review the effects of bipolar disorder on adherence to HIV medications and risky behavior

3. Psychiatric disorder that causes unusual shifts in a person’s • Mood • Energy • Ability to function • Resulting in • Damaged relationships • Poor job or school performance • Suicide

4. Understanding Bipolar Disorder • Affects 5.7 million adults (2.6%) in a given year • Develops in late adolescence/early adulthood • Often not recognized • Bipolar disorder is a long-term illness • Alcohol and drug abuse are very common among people with bipolar disorder

5. Symptoms • Extreme, sometimes unpredictable moods • Range from overly "high" and/or irritable to sad and hopeless and then back again • Periods of highs and lows are called episodes of mania and depression • Severe changes in energy and behavior accompany changes in mood • Often periods of normal mood occur in between

6. Symptoms

7. Increased energy Overly good, euphoric mood Extreme irritability Racing thoughts and speech Easily Distracted Little sleep needed Unrealistic beliefs in one's abilities and powers Poor judgment Spending sprees A lasting period of unusual behavior Increased sexual drive Drug abuse (cocaine, alcohol, and sleeping medications) Provocative, intrusive, or aggressive behavior Denial that anything is wrong Symptoms of Mania

8. Hypomania • Less destructive state than mania • Experience fewer symptoms of mania • Shorter duration of symptoms • Often a very 'artistic' state of the disorder • A flight of ideas • Extremely clever thinking • Increased energy

9. Lasting sad, anxious, or empty mood Feelings of hopelessness or pessimism Feelings of guilt, worthlessness, or helplessness Loss of interest or pleasure in activities once enjoyed Difficulty concentrating, remembering, making decisions Decreased energy Restlessness or irritability Sleeping too much, or can't sleep Change in appetite Chronic pain not caused by physical illness or injury Thoughts of death or suicide, or suicide attempts Symptoms of Depression

10. Mixed State • Symptoms of mania and depression occur simultaneously • Ex. anxiety, belligerence, confusion, fatigue, insomnia, irritibility, paranoia, racing thoughts, restlessness, psychosis, and rage • Moods can easily and quickly be shifted • Suicide attempts, substance abuse, and self-mutilation may occur during this state

11. Variations of Bipolar Disorder • Rapid Cycling • Moods change >4 time a year • Slow Cycling • Ultra-rapid Cycling • Moods change several times per week or day • Rare but real • Type I vs. Type II • Type II more difficult to diagnose • Symptoms differ between patients

13. Diagnosis • Symptoms • Course of illness • Family history, when available • Type I • one or more manic or mixed episodes • Type II • at least one episode of hypomania and depression • More common

14. Causes • Inheritance • Genetics • Stressful environment or negative life events • Other possible "triggers“: • Antidepressant medication → mania • Sleep deprivation → mania • Hypothyroidism → depression

15. Children

16. Receiving timely and competent treatment can be difficult Adherence is key Recurrence still possible Treatment • Can not be cured but can be managed • Optimal treatment combines medication and psychosocial treatment

17. Medication • Mood Stabilizers • Lithium prevents and controls manic and depressive episodes • Anticonvulsant medications for difficult-to-treat bipolar episodes • valproate or carbamazepine • Thyroid supplementation • Especially those with rapid cycling • Lithium treatment may reduce thyroid levels

18. Weight gain Nausea Tremor Reduced sexual drive or performance Anxiety Hair loss Movement problems Dry mouth Side Effects • Adherence reduces the chance of having recurrent, worsening episodes

19. Psychosocial Treatments • Cognitive behavioral therapy • Changing negative thought patterns • Psychoeducation • Teaching the patient and family about the illness • Family therapy • Reduce the level of distress within the family • Interpersonal and social rhythm therapy • Improve interpersonal relationships

20. Bipolar Disorder and HIV

21. Bipolar Disorder and HIV • Mania as a presenting symptom • Mania as a result of HIV • Both occur more often in patients with an AIDS diagnosis • Failure to treat mania may result in: • Nonadherence to HIV medications • Self-destructive behavior • Unsafe sex

22. Role of Nurses and Case Managers

23. Role of Nurses and Case Managers • A good prognosis depends on: • The right medicines • Correct dosing • An informed patient • A good relationship with a competent physicain and therapist • Supportive family or significant other • A balanced lifestyle • Regulated stress level • Regular exercise • Regular sleep and wake times

24. Role of Nurses and Case Managers • Assist patients in keeping a chart • Daily mood symptoms • Treatments • Sleep patterns • Life events • Encourage client/patient in continuing their treatment • Adherence techniques • Accompanying them to mental health appointments

25. Role of Nurses and Case Managers • Providing support as patient/client “tests out” treatment plans • Supporting patient’s/client’s family as they cope with altered behavior, spending sprees, and withdrawal • Offering referrals to support groups for patient/clients and their families

26. Questions? • Mental Health Services Locator http://mentalhealth.samhsa.gov/databases/kdata.aspx?state=LA • Christina Price, MPH • cprice@lsuhsc.edu