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Bipolar Disorder

Bipolar Disorder. Use of therapeutic drugs in the treatment of mental health. What is Bipolar Disorder?. Also known as Manic-Depression Typifies mood swings from high and irritable (mania) to utter hopelessness outside of everyday blues (depressive). 2 million Americans suffer from it

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Bipolar Disorder

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  1. Bipolar Disorder Use of therapeutic drugs in the treatment of mental health.

  2. What is Bipolar Disorder? • Also known as Manic-Depression • Typifies mood swings from high and irritable (mania) to utter hopelessness outside of everyday blues (depressive). • 2 million Americans suffer from it • Runs in families and seen to be inherited. • Usually begins in early adulthood and remains possibly through entire life span.(American Journal of Psychiatry & www. nimh.com)

  3. MORE INFO…. • Uncommon under age of 12 but, careful diagnosis must be made due to similarity with ADD/ADHD. • People who suffer have serious behavioral problems with consequences. (Spending Sprees, Instant Gratification, etc.) • Effects Relationships with loved ones. (www.APA.com, Psychiatry, www.nimh.com, & Journal of the American Academy of Child & Adolescent Psychiatry)

  4. Mood Swings (Mania) • Restlessness, racing thoughts, and rapid talking. • Excessive high thoughts • Irritability • Decreased need for sleep • Lack of Good Judgement • Increased Sexual Drive • Aggressiveness (American Psychiatric Association: DSM-IV, 1994)

  5. Mood Swings…Depression • Sad, anxious or empty mood • Feeling of Hopelessness • Loss of interest in activities • Constant Fatigue • Lack of Concentration • Loss of appetite and change of weight • Contemplation of death or suicide (DSM-IV)

  6. Causes of Bipolar Disorder • Genetic Factors (X-Linked) • Biological Factors • Norepinephrine and Serotonin Levels (American Journal of Psychiatry & Psychiatry, 1990)

  7. Treatment • Therapeutic Drugs • ECT (Electroconvulsive Therapy) • Counseling/Psychotherapy

  8. Therapeutic Drugs • Lithium • Valproate • Carbamazepines • Neuroleptics • Benzodiazapines • Anti-depressants

  9. History of Lithium • Used in 1920’S as a sedative-hypnotic compound and anticonvulsant drug • 1940’s saw it as a salt substitute for those with heart disease • First recorded to have antimanic effects in 1949 by J. Cade’s Guinea Pig Test • Widespread use since 1960’s (A Primer of Drug Action. Julien, 1997)

  10. Use of Lithium • Most effective in Bipolar Disorder episodes and prevention (National Mental Health Association)

  11. Response to Medication

  12. Use of Lithium • Most effective in Bipolar Disorder episodes and prevention • Decreases Mood Instability Between Episodes in mania and depression • Patients have difficulty complying with Lithium-leads to reoccurrence • Lithium=Li+ (Julien, 1997 & AJOP)

  13. Pharmacokinetics • Available in Tablets or Capsules as the carbonate salt • Found in syrups as the citrate form • Peak blood levels range from (1-2 hrs. NIOMH; 3 hrs. Julien) • Crosses the blood brain barrier slowly and incompletely (Julien)

  14. Pharmacokenetics cont... • Lithium is excreted by the kidneys in two phases (Julien), vs. • Lithium is excreted entirely in one phase (NIOMH) • Phase 1 (half life)- (14 to 30 hours NIOMH & 18 to 24 hours Julien) • Phase 2-next two weeks (Julien)

  15. More Pharmacokinetics…. • Most closely monitor therapeutic dose with blood levels • Lithium has very narrow therapeutic window (toxicity and side effects) • At controlled episodes blood levels between 0.5 and 0.9 is recommended as a “target level” (Julien & American Journal of Psychiatry )

  16. Silverstone and Romans, 1996 • “ A level much below this is likely to be associated with a greater likelihood of relapse, while a higher one is frequently accompanied by more adverse effects, leading to an increased risk of noncompliance.”

  17. Pharmacodynamics • Lithium may increase presynaptic reuptake of norepinephrine and serotonin • May decrease the release of both norepinephrine • May interfere with the movements of intracellular calcium ions • Lithium interfere with second-messenger in the post-synaptic neuron

  18. Side Effects of Lithium • Weight Gain • Cognitive Problems • Tremor • Sedation or Lethargy • Impaired Coordination • Gastrointestinal distress • Hair Loss • Benign Leukocytes • Acne (DSM-V)

  19. Considerations • Checking medical background • Non-compliance • Psychological Support, Family Therapy, and other treatments (NIOMH, American Journal of Psychology & Julien)

  20. Valproate • Studied alone and in conjunction with other mood stabilizers • In manic patients improvement seen in 3 days • Also an antiepileptic drug • May lower white blood cell count of those who struggle with alcoholism and bipolar disorder (APA & American Journal of Psychiatry)

  21. Pharmacokinetics • Available in capsules and syrups • Rapidly absorbed after ingestion • Peak serum concentration is reached after 2 hours • Half-life ranges from 6-16 hours • Relationship with mood stabilizing is not fully defined • Valproate is metabolized by the liver and contain much protein (AJOP)

  22. Side Effects • Gastrointestinal Problems (upset stomach) • Sedation • Lethargy • Hand Tremor • Loss of Hair • Metabolic changes in the liver • May be risk to fetus during pregnancy (1-2% suffer adverse affects) (Julien & Canadian Family Physician)

  23. Implementing Treatment • A general medical history SHOULD be taken with a focus on hepatic, hematological, and bleeding abnormalities • Continual blood tests should be given to check liver functions throughout patients usage. (At least every 6 months) • Normal Dosage: 750 mg in 2 doses (American Psychological Association)

  24. Other Uses of Valproate • Antiepileptic • Personality Disorders • Behavioral Dyscontrol (agitation, aggression, temper outbursts) • Migraine (APA, AJOP & www.athealth.com)

  25. Carbamazepine • Studied alone and in conjunction with other mood stabilizers • Lithium more effective; Neuroleptics same (APA) Just as effective as lithium (Julien) • Those who fail to respond usually do not have the correct dosage (Julien)

  26. Pharmacokinetics • Available in a wide variety of forms: solutions, suspensions, syrups, and newly developed chewable and slow release formulations • Elimination half-life ranges from 18-55 hours • With maintenance treatment carbamazepine induces its own half-life and may decrease to 5-26 hours (APA)

  27. Side effects of carbamazepine • Gastrointestinal upset • Sedation • Visual Disturbances • Dizziness • Overdoses may be fatal (Julien)

  28. Neuroleptics • Lithium is better for long-term treatment, neuroleptics are best for quick action • Typically seen in psychotic patients • Used prior to mood stabilizers and sometimes in conjuction • Drug: Clozapine & Risperdone (American Journal of Psychiatry)

  29. Benzodiazapines • Benzodiazapines-used in conjunction with neuroleptics • Not as effective as antidepressants • Risk: further depression • Benefit: Sleep for the insomniac (APA)

  30. Antidepressants • Mainly used in conjunction with Lithium • Should have lowest dose for the shortest amount of time • Risk: May lead to further depressive states and ruin response to mood stabilizer

  31. Recent trends • Self-medicating herbal products (St. John’s Wort) • Herbal Products are dangerous when used and not effective then additional drugs used • Most effective when used in conjunction with psychotherapy (AJOP)

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