Bipolar and Depression
Dr. Dawn-Elise Snipes PhD, LMHC
Executive Director, AllCEUs.com
Objectives
~ Differentially Diagnose Bipolar Disorder and Depression
~ Recognize general medical conditions and drugs that may mimic depression or mania
~ Understand the goals of psychiatric management of bipolar disorder and depression
~ Identify bipolar patients at increased risk of suicide
~ Understand the link between bipolar disorder and substance abuse
~ Identify key areas of consideration when making a treatment placement decision
~ Learn about the areas which patients with bipolar disorder and their families may need education
~ Familiarize with the most common psychopharmacological interventions for bipolar disorder
Bipolar I and II
~ Bipolar I disorder: at least one episode can be characterized as mania
~ Episodic, lifelong illness with a variable course
~ The first episode may be manic, hypomanic, mixed, or depressive
~ Patients may experience several episodes of depression before a manic episode
Differential Diagnosis
~ Ask about a history of depression accompanied or followed by manic or hypomanic symptoms
~ Assess for substance use disorder, other general medical conditions or medications
~ Medical conditions associated with manic-like symptoms include:
~ Multiple sclerosis
~ Lesions closely linked to the limbic system
~ Hyper or hypothyroid
~ Head injuries
~ Encephalitis
Medications Associated with Manic-like Symptoms
~ L-Dopa
~ Corticosteroids
~ High-dose decongestants
~ Stimulants (weight loss, ADHD)
~ Antidepressants may trigger a manic episode
Substance Use
~ May cause manic-like episodes
~ May help patient self-medicate
~ Stimulants (manic like symptoms)
~ Cocaine
~ Methamphetamines/Amphetamines
~ Ephedrine
~ Ecstasy/MDMA
~ Caffeine
Patients with Bipolar
~ Seek treatment during depressive episodes
~ Rarely volunteer information about manic or hypomanic symptoms
~ Do not see the symptoms of hypomania to be distressing
Suicide
~ Completed suicide rates 10% to 15%
~ Suicide attempts associated with depressive episodes or depressive features of mixed episodes
~ Ask every patient about suicidal ideation
Increased Risk Factors
~ Factors associated with increased risk:
~ Means
~ Lethality
~ Family history of suicide
~ Pervasive insomnia
~ Impulsiveness
~ Psychiatric comorbidity
~ Psychosis
~ Personality disorder
~ Lack of social support
Hospitalization
~ Patients who:
~ Pose a serious threat of harm to themselves
~ Are severely ill
~ Lack adequate social support
~ Demonstrate significantly impaired judgment
~ Have complicating psychiatric or general medical conditions
~ Have not responded adequately to outpatient treatment.
~ Re-evaluate treatment setting regularly
Education
~ Should introduce facts about the illness and its treatment
~ Use printed, verbal and videotaped material
~ Present in an ongoing gradual and consistent process
~ Use psychoeducational groups
Stressors
~ Commonly precede episodes
~ Disrupted sleep-wake cycles may specifically trigger manic episodes
~ Physical illnesses that cause changes in eating and/or dehydration
~ Alter blood plasma levels
~ May require dose adjustment
~ Regular patterns should be promoted
Counselor Activities
~ Preplanning
~ Plan for impairments in functioning
~ Assisting patient in scheduling absences from work
~ Avoid major life changes
~ Plan for the needs of their children while the patient is in an acute state
~ Assist the patient who is able to work in contacting