Medication
- The goal of maintenance treatment is to prevent future manic or depressive episodes.
- Because of the relapsing and remitting nature of bipolar I disorder, maintenance treatment is indicated after the first manic episode.
- The focus of maintenance treatment is long-term medication management, psychotherapy, and lifestyle changes.
Therapy
Natural remedies for treating bipolar disorder
- Lifestyle changes. Counseling, cognitive behavioral therapy (CBT), and a range of lifestyle changes can help people with bipolar disorder to manage their symptoms and improve their overall quality of life.
- Alternative remedies. ...
- Clinical support and treatment. ...
- Takeaway. ...
Which type of therapy is best for treating bipolar disorder?
After hospitalization it can be very difficult to feel like you can get well. Most individuals, with proper treatment, do go on to live full and productive lives. Find more information about general wellness in the Getting Well and Staying Well section.
How to treat bipolar disorder naturally without drugs?
Important things to know before getting treatment for bipolar disorder include:
- there are specially trained mental health professionals such as psychiatrists and psychologists who can help you with bipolar disorder
- you need a thorough check from a health professional before treatment is prescribed
- specially prescribed medication is the most effective way to treat and manage bipolar disorder
What can I expect after bipolar disorder treatment?
What should I include in my Bipolar disorder treatment plan?
What is the best treatment for bipolar disorder?
The most effective treatment for bipolar disorder is a combination of medication and psychotherapy. Most people take more than one drug, like a mood-stabilizing drug and an antipsychotic or antidepressant.
What is a common therapy for bipolar disorder?
Other types of therapy also may help, such as social rhythm therapy — establishing a consistent routine for better mood management. Substance abuse treatment. Many people with bipolar disorder also have alcohol, tobacco or drug problems.
Can bipolar disorder be completely treated?
There is no cure for bipolar disorder, but through behavior therapy and the right combination of mood stabilizers and other bipolar medicines, most people with bipolar disorder can live normal, productive lives and control the illness.
What is the best initial treatment for bipolar?
Medication is the key to stabilizing bipolar disorder. Initial treatment of mania consists of lithium or valproic acid (Depakene). If the patient is psychotic, a neuroleptic medication is also given.
What are 5 signs of bipolar?
Symptoms - Bipolar disorderfeeling sad, hopeless or irritable most of the time.lacking energy.difficulty concentrating and remembering things.loss of interest in everyday activities.feelings of emptiness or worthlessness.feelings of guilt and despair.feeling pessimistic about everything.self-doubt.More items...
What triggers bipolar disorder?
Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include: Having a first-degree relative, such as a parent or sibling, with bipolar disorder. Periods of high stress, such as the death of a loved one or other traumatic event. Drug or alcohol abuse.
Does bipolar worsen with age?
Changes in the frequency and severity of episodes are among the most evident changes in bipolar disorder at an older age. Research suggests that older adults with bipolar disorder often experience: more frequent episodes. more depressive episodes and less time spent in manic or hypomanic states.
Is bipolar a serious mental illness?
Bipolar disorder is a serious mental illness that causes unusual shifts in mood, ranging from extreme highs (mania) to lows (depression).
How are you tested for bipolar?
To diagnose bipolar disorder, a doctor performs a physical exam, asks about your symptoms, and recommends blood testing to determine if another condition, such as hypothyroidism, is causing your symptoms. If the doctor does not find an underlying cause of your symptoms, he or she performs a psychological evaluation.
What happens if bipolar disorder goes untreated?
When left untreated, the symptoms of Bipolar Disorder will often increase in severity and may lead to suicide; there is a high suicide rate for people with the disorder. When treated, it's possible to control the symptoms of Bipolar Disorder and enjoy a more stable and fulfilling life.
How long does it take to treat bipolar disorder?
Treatment options for bipolar disorder Episodes of depression tend to last longer, often 6 to 12 months. But with effective treatment, episodes usually improve within about 3 months. Most people with bipolar disorder can be treated using a combination of different treatments.
What can mimic bipolar disorder?
Some non-psychiatric illnesses, such as thyroid disease, lupus, HIV, syphilis, and other infections, may have signs and symptoms that mimic those of bipolar disorder. This can pose further challenges in making a diagnosis and determining the treatment.
How long do bipolar patients stay depressed?
Up to a third of patients with bipolar disorder do not respond to treatments in naturalistic studies;4,5,7these figures probably underestimate the proportion of treatment-resistant patients with depression in clinical practice. Even patients who receive adequate pharmacotherapy have lengthy and debilitating periods of subthreshold depressive symptoms after major episodes. Longitudinal studies estimate that patients with bipolar disorder type I spend as many as 3 weeks depressed for every 1 week (hypo)manic; the ratio in bipolar disorder type II is 37:1.5,44Subthreshold depressive symptoms are associated with social and occupational impairment,45and increased psychosocial impairment is prospectively associated with earlier recurrences.46,47
How many people have bipolar disorder?
Bipolar disorders types I and II affect about 2% of the world’s population, with subthreshold forms of the disorder affecting another 2%.1–2Even with treatment, about 37% of patients relapse into depression or mania within 1 year, and 60% within 2 years.3In the STEP-BD cohort (n=1469), 58% of patients with bipolar disorder types I and II achieved recovery, but 49% had recurrences in a 2-year interval; twice as many of these recurrences were of depressive polarity (marked by sad mood, loss of interests, or fatigue) rather than of manic polarity (marked by elevated mood, grandiosity, and decreased need of sleep).4After initial onset, patients with bipolar disorder have residual depressive symptoms for about a third of the weeks of their lives.5In 2009, the direct and indirect costs of bipolar disorder were estimated to be US$151 billion.6Patients also experience psychotic symptoms, impaired functioning, compromised quality of life, and stigma.7,8
How to treat bipolar disorder?
Treatment of bipolar disorder conventionally focuses on acute stabilisation, in which the goal is to bring a patient with mania or depression to a symptomatic recovery with euthymic (stable) mood; and on maintenance, in which the goals are relapse prevention, reduction of subthreshold symptoms, and enhanced social and occupational functioning. Treat ment of both phases of the illness can be complex, because the same treatments that alleviate depression can cause mania, hypomania, or rapid cycling (defined as four or more episodes in 12 months), and the treatments that reduce mania might cause rebound depressive episodes.
What is the best treatment for bipolar disorder?
Lithium, introduced by John Cade in 1949, remains the best established long-term treatment for bipolar disorder.49Although the metal has been in clinical use for more than 50 years, the most convincing evidence of long-term efficacy comes from randomised clinical trials in which lithium was included as an active comparator.50A meta-analysis of five placebo-controlled lithium maintenance trials (n=770) showed that lithium reduces the risk of manic relapses by 38% (RR 0·62, 95% CI 0·50–0·84) and depressive relapse by 28% (0·72, 0·40–0·95).50Lithium is the only known anti-suicidal treatment with randomised evidence of a reduction in the risk of suicide of more than 50%.51However, the benefits of lithium are restricted by adverse effects and a low therapeutic index.52Although little evidence exists of a clinically substantial reduction in renal function in most patients, the risk of end-stage renal failure remains unclear. The risk of congenital malformations in the babies of mothers who have taken lithium during pregnancy is uncertain, but probably lower than previously thought. The balance of risks should be considered before lithium is withdrawn during pregnancy. In addition to known effects of lithium on the thyroid, the risk of hyperparathyroidism is increased and calcium concentrations should be checked before and during treatment.52
Why is lithium unique?
However, lithium remains unique because its main therapeutic use is in bipolar disorder, and investigation of its mechanism of action has, and remains, crucially important in the identification of future targets . Table 1. Validation evidence of putative treatment development targets in bipolar disorder.
What is enrichment design?
Enrichment designs are standard in continuation trials sponsored by industry. Enrichment selects patients with known acute response to, or who can tolerate, the investigational agent. Patients are then randomly assigned to either continue the investigational agent during the active trial or switch to placebo or an active comparator. The enrichment design can answer questions about the continued benefits of the investigational medicine, but is not a fair test of the comparator agents that do not have the prerandomisation selection. For example, one trial protocol treated 2438 patients with quetiapine for 4–24 weeks; 1226 (50%) who responded to treatment were randomly allocated to continue quetiapine or to switch to placebo or lithium (0·6–1·2 mEq/L).40Over 104 weeks, time-to-recurrence of any mood event was significantly longer for patients given quetiapine versus placebo and for patients given lithium versus placebo.
What is efficacy shown as?
Efficacy is shown as a continuous outcome against the dropout rate. Treatments toward the red section combine the worst efficacy and tolerability profiles and treatments towards the green section combine the best profiles.
What is the best medication for mania?
Haloperidol ( Haldol Decanoate) or other newer antipsychotic medications, such as aripiprazole ( Abilify ), asenapine ( Saphris ), olanzapine ( Zyprexa, Zyprexa Relprevv, and Zyprexa Zydis ) or risperidone ( Risperdal ), are often given to patients as an alternative to lithium or divalproex. They also may be given to treat acute symptoms of mania -- particularly psychosis -- before lithium or divalproex ( Depakote) can take full effect, which may be from one to several weeks. Another antipsychotic, lurasidone (Latuda ), is approved for use in bipolar I depression as is the combination of olanzapine plus fluoxetine (called Symbyax ). The antipsychotic quetiapine ( Seroquel) is approved to treat bipolar I or II depression . Preliminary studies also suggest that the atypical antipsychotic cariprazine ( Vraylar) also may have value for treating bipolar depression
What is the most important thing to know about bipolar?
IMPORTANT! Help and Support. In the manic phase of bipolar disorder, patients may engage in risky activities, such as fast driving or certain risky sports. They should be monitored and prevented from taking chances, especially in a car.
How to help someone with bipolar disorder?
If someone you live with has bipolar disorder, maintain a calm environment, particularly when that person is in a manic phase. Keep to regular routines for daily activities -- sleeping, eating, and exercise. Adequate sleep is very important in preventing the onset of episodes. Avoid excessive stimulation.
How to help bipolar patients?
While medications are usually the cornerstone of treatment for bipolar disorder, ongoing psychotherapy is important to help patients understand and accept the personal and social disruptions of past episodes and better cope with future ones. Several specific forms of psychotherapy have been shown to help speed recovery and improve functioning in bipolar disorder, including cognitive-behavioral therapy, interpersonal/social rhythm therapy, family therapy, and group therapy. In addition, because denial is often a problem -- sticking with medications can be especially tricky in adolescence -- routine psychotherapy helps patients stay on their medications.
What is the best treatment for bipolar disorder?
Bipolar disorder is treated with three main classes of medication: mood stabilizers, antipsychotics, and, while their safety and effectiveness for the condition are sometimes controversial, antidepressants.
What are the different types of depression?
The newer types of nonpharmocological treatments of depression are: 1 VNS (Vagus or Vagal Nerve Stimulation) involves implantation of a device that sends electrical signals to the vagus nerve in order to treat depression. 2 TMS (Transcranial Magnetic Stimulation) is a procedure which involves the use of an electromagnetic coil to create electrical currents and stimulate nerve cells in the mood centers of the brain as a treatment for depression. 3 Light therapy has proved effective as an additional treatment when bipolar disorder has a connection to seasonal affective disorder. For those people who usually become depressed in winter, sitting for 20 minutes to 30 minutes a day in front of a special light box with a full-spectrum light can help treat depression.
What is the best antiepileptic drug for depression?
Lamotrigine ( Lamictal), another antiepileptic drug, has been shown to have value for preventing depression and, to a lesser degree, manias or hypomanias. Other antiepileptic drugs, such as gabapentin ( Neurontin), oxcarbazepine ( Trileptal ), or topiramate ( Topamax ), are regarded as experimental treatments that sometimes have value ...
How does IPSRT work?
How IPSRT works for the treatment of the bipolar disorder is that it helps you stabilize daily rhythms, like sleeping, waking, exercising, and mealtimes. Because these can become very erratic during a bipolar episode, many people with bipolar disorder end up abandoning their regular schedules, even when they're not having an episode. Getting back on track with these daily habits can improve their mood and prevent mood swings.
What is the best mood stabilizer for bipolar disorder?
One of the first mood stabilizer medications to be used successfully for bipolar disorder was lithium carbonate. Lithium has been shown effective in many studies. In one review of the scientific literature on lithium, researchers found that lithium did prove effective in preventing relapses. This was especially true of manic relapses, but also true of depressive relapses to a lesser degree. However, lithium is used less often now than it was in previous decades.
How does CBT help with bipolar?
Then, you can choose more positive thoughts. This technique can help you improve your behavior as well as your mood. If you have bipolar disorder, CBT can be effective for helping to identify the triggers that tend to bring on a bipolar episode for you. You can also use CBT to manage stress and deal with situations that exacerbate your bipolar disorder symptoms.
What is the best medication for manic episodes?
Antipsychotics can certainly be used to treat the delusions and hallucinations that can happen during a manic episode. Yet, they can also be beneficial for many people with bipolar disorder who don't have these symptoms. Often, when depression or mania don't go away with other medications, adding an atypical antipsychotic medication can bring some relief. Also, these antipsychotic medications can be added to an antidepressant in the medication regime as an antimanic agent to prevent mood switching. Some of the atypical antipsychotics typically used for bipolar treatment include: 1 Zyprexa 2 Risperdal 3 Seroquel 4 Abilify 5 Geodon 6 Latuda 7 Saphris
What type of therapy is used for bipolar disorder?
Many types of psychotherapy have been used for bipolar treatment. Sometimes, more than one type of talk therapy is used. For example, you may receive psychoeducation as well as cognitive behavioral therapy. Or, you might have CBT along with family-focused therapy. Expressive therapies, such as music therapy or art therapy, can also be helpful as additional therapy.
How effective is CBT for bipolar disorder?
However, a 2 010 scientific analysis found that CBT, while somewhat effective, needs to be further developed to create strategies that work better for people with bipolar disorder. Since then, changes have been made, although there is little research on the new methods at this point.
What is family focused therapy?
Family-focused therapy is a type of intervention that can help prevent relapses in bipolar disorder. This type of therapy builds support and improves communication within the family. During sessions, the family learns more about bipolar disorder and finds out how they can help the person who has it by recognizing warning signs.
How do people with BD get together?
People with BD get together (often accompanied by family members) and are led by a group facilitator (either a psychologist or a trained peer mental health counselor). Some groups are highly structured and follow an educational and skill-training agenda. Others are oriented toward telling one’s story and getting support and suggestions from people who have gone through similar situations. These groups, including those provided by NAMI and the Depression and Bipolar Support Alliance, are quite beneficial to people because they reduce feelings of isolation that often come with mental illness.#N#Over time, the specific type of therapy may not be as important as the continuity of having a therapist or a group that knows you well and makes you feel comfortable enough to disclose important issues. Along with medications, support from mental health professionals who understand your journey are key to an effective treatment plan and recovery.#N#David J. Miklowitz is the author of The Bipolar Disorder Survival Guide , 3rdEdition ( www.guilford.com/p/miklowitz2 ), which has just been published by Guilford Press. Check out his website and information about the UCLA Child and Adolescent Mood Disorders program (www.semel.ucla.edu/champ).
How many sessions does FFT therapy last?
Family-focused therapy (FFT) includes both the person with BD and their parents, spouse, or other family members. FFT typically lasts about 12 sessions (depending on the family’s needs) given by a single therapist. Early sessions focus on education about the condition: its symptoms and how they cycle over time, its causes, ...
What is IPSRT therapy?
IPSRT is an individual therapy in which the person with BD keeps daily records of their bed times, wake times, and activities, and the effects of changes in these routines on their moods. The clinician coaches the person on how to regulate their daily routines and sleep-wake cycles as a way to stabilize moods.
What is cognitive behavioral therapy?
Cognitive behavioral therapy (CBT) is an individual therapy focused on the relationship between a person's thoughts, feelings and behaviors. CBT teaches people to: Identify negative assumptions and thinking patterns, and challenge themselves to rehearse more adaptive ways of thinking.
What is BD in psychology?
By David J. Miklowitz, Ph.D. Bipolar disorder (BD) is a condition that is strongly affected by stress. Episodes of mania and depression can be triggered by significant life events, severe family conflicts, turbulent relationships and situations that disrupt sleep/wake rhythms.
What is dialectical behavior therapy?
Dialectical behavior therapy is a skill-based approach that includes both individual and group therapy. It teaches mindfulness and acceptance skills, such as the ability to experience moment-to-moment thoughts, emotions and their accompanying physical sensations from an observer’s stance, without negative judgment.
How does BD work?
Those with BD function better when they receive medication management from a psychiatrist and regular (weekly or biweekly) psychotherapy sessions. Therapy can help a person cope with the stress from these external factors, manage their symptoms and improve their relationships. Here are several different forms of therapy ...
What does it mean when you have hypomania?
During an episode of hypomania, you have an elevated or irritable mood and increased goal-oriented activity. You also have three or more of the following symptoms, or four or more if the mood is irritable.
What are the medications used for bipolar disorder?
Some of the medications used are mood stabilizers, antipsychotics, and antidepressants. Mood stabilizers help prevent mood swings and keep the mood more stable. Antipsychotics can be used if you have hallucinations or delusions, which can happen in bipolar disorder. However, antipsychotics are often used even if you don't have these psychotic symptoms to help stabilize the mood in conjunction with a mood stabilizer.
How many symptoms do you get from bipolar?
For an episode of major depression in bipolar disorder, you would have five or more of the following symptoms nearly every day for most of the day over two weeks or more.
What is the DSM-5 for bipolar disorder?
In the DSM-5, bipolar disorder is divided up into four categories: bipolar one disorder, bipolar two disorder, cyclothymia, and "other specified or unspecified bipolar and related disorders." This last type refers to someone who has symptoms of bipolar disorder that don't match up to any of the three other types.
Can you have bipolar without knowing?
Bipolar 1 disorder, bipolar two disorder, cyclothymia, and other types of bipolar disorder aren't always easy to recognize. In fact, only a psychiatrist or psychologist can make any of these diagnoses. Often, people have bipolar disorder without knowing what the problem is. Other times, people suspect they have bipolar disorder, but it turns out that the problem is something else. Even if they're right that they have bipolar disorder, they may not realize what type they have.
Is bipolar disorder worse than bipolar disorder 2?
It may seem obvious that bipolar disorder 1 is worse since manic symptoms are more severe than hypomanic symptoms. However, this isn't necessarily true. Despite the difference between bipolar 1 and 2, both can affect your life dramatically. Both conditions can cause difficulty in functioning. Also, people with bipolar two disorder often have more and longer periods of depression, which can be severe. No matter which type of bipolar disorder you have, it's imperative that you get treatment to manage the disorder.
Can bipolar affect your mood?
If you have this type of bipolar disorder, you will likely experience drastic changes in your energy level. You will be much more active during manic phases and much less active in de pressed phases . Whether you are in a manic state or a depressed state in bipolar one disorder, there probably will be times when you have trouble carrying out your daily tasks. You might need to be hospitalized.
What is the difference between bipolar and schizoaffective?
Schizoaffective disorder: When you have schizoaffective disorder, psychotic symptoms appear out of the blue and are unattached to mood changes. With bipolar disorder, psychotic symptoms only crop up during a mood episode.
How long does cyclothymia last?
However, these symptoms must be present for at least 2 years with no symptom-free period for more than 2 months.
How many types of bipolar disorder are there?
Contrary to popular belief, there is more than one type of bipolar disorder. In fact, according to the American Psychiatric Association (APA), there are four types, each defined by the presence, frequency, and intensity of your moods.
Why is bipolar disorder so difficult to diagnose?
Bipolar disorders can also be difficult to diagnose because it shares symptoms with so many other conditions. Here are a few mental health conditions that often get mistaken for bipolar disorder and how you can tell the difference.
What are mood episodes?
People with bipolar disorder experience periods of unusually intense emotion, changes in energy and activity levels, and uncharacteristic behaviors. These distinct periods are called “ mood episodes .”
What to do if you have bipolar disorder?
Your physician may want to rule out any potential physical health issues that may be contributing to your symptoms.
How long does a manic period last?
You feel like you have extra energy to burn. This period lasts at least one week.
How effective is carbamazepine?
Carbamazepine has been shown to be efficacious in the management of acute bipolar mania and prevention of relapse. Prior to starting carbamazepine, clinician needs to focus on the history of blood dyscrasias and hepatic dysfunction. When carbamazepine is considered, patients need to be informed about the signs and symptoms of hepatic dysfunction, haematological dysfunction and skin reactions and told to report to the psychiatrist if these symptoms emerge. Baseline investigation prior to starting of carbamazepine may include complete haemogram, liver function tests and renal function test (Table-5). When used in elderly serum electrolytes may also be done, in view of the risk of hyponatremia. Usual starting dose of carbamazepine is 200 mg/day given in divided doses and titrated upward slowly. Once the dose of 800-1000 mg/day is reached the increment of dose may be slower and the usual maintenance dose is about 1000 mg/day, but it can vary from patient to patient and may be 200 to 1600 mg/day. The carbamazepine therapeutic drug levels have not been established in patients with BPAD and the serum levels of 4-12 µg/ml, which is recommended for seizure disorders is commonly used. As with lithium and valproate the serum levels need to be done after 5 days of initiation of treatment or increment of dose.
What is a bipolar disorder?
Bipolar disorder (BPAD) is a serious mental disorder characterized by episodes of depression, hypomania/mania and mixed episodes, with interepisodic recovery. However, many patients with BPAD continue to exhibit residual symptoms in the interepisodic period. The illness usually starts in adolescence or early adulthood and has significant negative impact on the life of the sufferer and their caregivers. Patients with BPAD encounter educational difficulties, job related problems, interpersonal difficulties, psychosocial dysfunction, disability, marital problems, multiple suicidal attempts, completed suicide and medication side effects. Additionally patients with BPAD have high rates of physical and psychiatric comorbidity. The prevalence rates of BPAD vary from country to country. A large multinational study suggests that lifetime prevalence of BPAD-I ranges from 0-1% with a mean of 0.6 (SD-0.4). The prevalence rate of BPAD-II ranges from 0 to 1.1% with a mean of 0.4 (SD-0.3). Additionally a significant proportion of patients have been shown to have subthreshold BPAD with a range of 0.1 to 2.4% with a mean of 1.4 (SD-0.8). There is no nationwide study to evaluate the prevalence rates of BPAD in India. In a country like India, patients have limited resources, poor knowledge about the disorder and treatment; have inadequate access to the health care facilities, which makes treatment of BPAD a challenge. Indian Psychiatric Society (IPS) made first attempt to formulate Clinical Practice Guidelines (CPGs) for management of BPAD in 2005. Since then, over the last one decade there have been several developments, especially in the form of emergence of new evidence for some of the pharmacological agents. Accordingly, these new guidelines attempt to update the previous guidelines published by IPS. These guidelines should be read along with the earlier version of the CPGs, published by IPS in 2005.
What are the mainstays of BPAD management?
The mainstay of management of BPAD is mood stabilizers. The available mood stabilizers include lithium, valproate, lamotrigine, carbamazepine/oxcarbazepine and topiramate.
How much Valproate should I take daily?
Maximum daily dose which is recommended is 60 mg/day but most patients do not require such high doses. The usual therapeutic serum levels which are considered to be efficacious vary from 50 to 100µg/ml. Once the dose of valproate is stabilized, the dosing schedule need to be changed to OD or BD dosing to reduce the side effects and improve compliance. In case OD dosing is given, extended release formulation may be used. However, it is important to remember that the bioavailability of extended release formulations is about 15% less than the immediate release preparations and the dose is to be increased accordingly. Serum valproate levels are to be done after 5 days of starting or increase in the dose of valproate. The sample need to be collected after 12 hours in case patient is receiving immediate release formulation, however, if the patient is receiving extended release formulation, the sample may be collected after 21 to 24 hours (table-5). There is evidence to suggest that patients with BPAD-II, dysphoric or mixed mania, rapid cycling affective disorder, stable episode frequency, later age of onset of illness, shorter duration of illness, long and severe course of illness respond well to valproate. Other indicators for good response to valproate include presence of comorbid alcohol use disorder, mental retardation, anxiety and panic attacks, post-traumatic stress disorders, marked sleep disturbances, explosive dyscontrol and aggression and comorbid migraine.
What are the treatment options for BPAD?
Treatment options for management of BPAD can be broadly classified as mood stabilizers, antidepressants, antipsychotic medications, electroconvulsive therapy (ECT), adjunctive medications and psychosocial interventions [Table-2]. Use of various treatment options is guided by the phase of illness (mania/hypomania/depression/mixed) in which patient presents to the clinician and past treatment history.
What is a comprehensive assessment of a patient?
Assessment of patients is an ongoing process and comprehensive assessment of a patient involves the assessment of patients themselves and their caregivers. The role of taking a proper history from the patient and all the available resources cannot be over-emphasized. In addition to the history taking, proper attention must be paid to the mental status examination. Diagnosis of BPAD is to be made on the basis of current diagnostic criteria, because a diagnosis based on diagnostic criteria can be considered more reliable, facilitates communication among various clinicians and paves the way for management on the basis of evidence based recommendations. It is important to remember that especially during the initial part of the illness, the symptoms may be confusing and at times it may be difficult to distinguish symptoms of mania from other psychiatric syndromes like schizophrenia, acute and transient psychosis and other psychiatric disorders. A possibility of substance induced disorder or disorder secondary to organic causes is to be considered, when the symptoms are atypical or there is evidence of the use of substance or underlying organic causes. Occasionally establishing the definite diagnosis of BPAD may require time.
What is a thorough assessment?
A thorough assessment includes assessment of comorbid psychiatric and medical conditions. It is important to remember that many a times; comorbidity is not very evident during the acute episode of illness. The comorbid conditions become more evident when the patient has come out of the acute episode of the illness. Evaluation of comorbid substance abuse needs to consider the type and frequency of substance abuse. If the patient does not provide adequate information about the substance use pattern, but there is high index of suspicion, urine or blood screens (with prior consent) can be used to confirm the existence of comorbid substance use/dependence, wherever such facilities are available. Functional impairment in various domains of life including impact of the illness on the family functioning and psychosocial impact of the illness on the caregivers is not to be neglected. A thorough physical examination need to be done to rule out presence of any physical illness and also to rule out episodes secondary to physical illnesses. This may be supplemented by the judicious use of investigations. Depending on the feasibility, unstructured clinical assessments need to be supplemented by documentation of severity and extent of symptoms on appropriate standardized rating scales. Patients with bipolar disorders also have cognitive deficits. Accordingly, depending on the need, detailed cognitive testing may be undertaken. The use of neuroimaging may be indicated in those with atypical features, neurological signs, non-response to treatment and having first episode of illness at a later age and elderly. Caregiver's assessment may involve evaluation of their knowledge about illness, knowledge about treatment, their attitudes and beliefs regarding treatment, the impact of the illness on them and their personal and social resources in the form of burden, distress, stigma, personal and marital life etc.
What is bipolar 2?
Bipolar II: This type of bipolar disorder is diagnosed when the individual has only displayed formal hypomanic episodes. They may or may not have displayed episodes of depression, but they have never displayed a full manic episode.
What is a melancholic disorder?
Bipolar disorder with melancholic features is diagnosed when the depressive episode is primarily concerned with an inability to experience pleasure. Bipolar disorder with seasonal pattern is diagnosed when some of the symptoms of bipolar disorder can be consistently diagnosed during a specific time of year.
How long does it take for a person to experience rapid cycling?
Rapid cycling results when a person experiences four or more episodes of mania, hypomania, or depression within 12 months. Again, one of these episodes must have been mania or hypomania for an initial diagnosis of bipolar disorder to be made.
What is bipolar disorder with psychotic features?
Bipolar disorder with psychotic features is diagnosed when the individual who has bipolar disorder also presents with hallucinations (seeing or hearing things that are not really there) or delusions (fixed, irrational , and dysfunctional beliefs , such as the belief that everyone is out to harm them).
What is bipolar disorder?
Bipolar Disorder. Types of Bipolar Disorder. Bipolar disorder is a severe psychiatric/psychological disorder that involves specific fluctuations of: Mood, which is the subjective emotional content that an individual personally experiences and can describe to others (e.g., “I feel very sad.”) Affect, which are the behaviors ...
What is the DSM-5?
The DSM–5 ( Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition) presents extensive formal diagnostic criteria for bipolar disorder.
What is an atypical feature of depression?
For instance, most people with depression lose weight or have decreased appetite. An atypical feature of depression is weight gain or increased appetite. A person with bipolar disorder displaying these features could receive this specifier.
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- To determine if you have bipolar disorder, your evaluation may include: 1. Physical exam.Your doctor may do a physical exam and lab tests to identify any medical problems that could be causing your symptoms. 2. Psychiatric assessment.Your doctor may refer you to a psychiatrist, …
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