bipolar%20disorder
BIPOLAR DISORDER
Bipolar I disorder is primarily defined by manic or mixed episodes that last for at least 7 days, or very severe manic symptoms needing immediate hospital care. The patient also has depressive episodes which may last for at least 2 weeks.
Bipolar II disorder is usually misdiagnosed. It is characterized by occurence of ≥1 major depressive episodes with at least 1 hypomanic episode.
Cyclothymic disorder or cyclothymia is a mild form of bipolar disorder. Patients have  episodes of hypomania alternating with mild depression that lasts for 2 years.
Rapid-cycling bipolar disorder patients have ≥4 episodes of major depression, mania, hypomania or mixed symptoms within a year.

Patient Education

General Recommendations

Patient and Family Education

  • Treatment plan needs to be discussed with both patient and family members
    • Discuss expected results, dosing strategies, side effects and drug interactions
  • They need to understand that long-term treatment is necessary
    • Education should continue throughout treatment
  • Educate patient and family about prodromal symptoms
    • Teach them to recognize early signs and symptoms of manic and depressive episodes and how to prevent
    • Patient may keep diary of events and moods over time to assist in this process
    • Teach them about destigmatization and non-discrimination

Treatment Compliance

  • Encourage treatment compliance because noncompliance may lead to relapse
    • Must overcome patient’s ambivalence towards treatment
    • Patient may find mania/euphoric episode enjoyable hence fueling reluctance to medication

Manage Functional Impairment

  • Patients may suffer emotional, family, social, occupational, financial or academic problems during an episode
  • Full functional recovery rarely occurs within 12 weeks following the remission of mood symptoms
    • May need assistance in addressing the psychosocial consequences of their actions
    • Patient should be advised to withdraw from work or other responsibilities when needed
    • Major life decisions should not be done while in depressed, manic or hypomanic state

Psychosocial Stressors

  • Enhance coping strategy & problem solving skills in managing psychosocial stressors
  • Disruption in sleep cycles or social rhythm can trigger manic episodes
    • Disruption of sleep is usually the final common pathway trigerring manic episodes
    • Patient and family should be educated on the potential consequences and taught coping strategies
    • Patient may benefit from regular daily activity pattern, including eating, sleeping and physical activities along with emotional and social stimulation
  • Proper assessment, advice and treatment is required in managing patients who abuse substance/alcohol
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