- Bipolar I - characterised by manic episodes - most people will experience depressive periods as well but not all do.
- Bipolar II - characterised by severe depressive episodes alternating with episodes of hypo mania.
- Cyclothymiacs disorder - short periods of mild depression and short periods of hypo mania.
- Rapid cycling - four or more episodes a year. These can be manic, hypo manic, depressive or mixed episodes.
- Mixed states - periods of depression and elation at the same time.
Investigations to diagnosis
Specialist assessment
At the appointment you will be assessed. The psychiatrist will ask you a number of questions to determine whether or not you have bipolar disorder and, if you have, what treatments will be most suitable for you.
During the assessment, you will be asked about your symptoms and when you first experienced them. The psychiatrist will also ask you about how you usually feel leading up to and during an episode of mania or depression, and whether you have had thoughts about harming yourself.
The psychiatrist will also want to find out about your medical background and your family history, to determine whether any of your relatives have had bipolar disorder. If someone else in your family has the condition, the psychiatrist may wish to talk to them. However, they will ask for your agreement before doing so.
Other tests
Depending on your symptoms, you may also require tests to see whether you have a physical problem, such as thyroid disease. If you have bipolar disorder, you will need to visit your GP on a regular basis for a physical health check. As well as having bipolar disorder, you may have other health problems, and any medication prescribed for you may have side effects. For example, putting on weight is a common side effect of medication that is used to treat bipolar disorder.
Child and adolescent
If you are a child or an adolescent (0-17 years of age) your GP will make a referral for you to CAMHS (The child adolescent mental health service) where you will have the same assessment but with a psychiatrist and the people there will be friendlier towards you as you are a child. The assessment will be able to tell you and other people if you have bipolar disorder.
Common difficulties in diagnosis
Bipolar and an overactive thyroid
An overactive thyroid gland can mimic the symptoms of bipolar disorder and it is very important that this is excluded by a blood test. The similar symptoms are:
- Depressive episodes
- High blood pressure
- Manic episodes
A psychiatrist would have to look through the different symptoms and determine whether the person has an overactive thyroid or bipolar. Bipolar has many more symptoms but the main ones match that of an overactive thyroid.
Bipolar and ADHD
Because there are many shared characteristics, there is a substantial risk of either a misdiagnosis or a missed diagnosis. Nonetheless, ADHD and BMD can be distinguished from each other on the basis of these six factors:
1. Age of onset: ADHD is a lifelong condition, with symptoms apparent (although not necessarily impairing) by age seven. While we now recognize that children can develop bipolar, this is still considered rare. The majority of people who develop bipolar have their first episode of affective illness after age 18, with a mean age of 26 years at diagnosis.
2. Consistency of impairment: ADHD is chronic and always present. Bipolar mood disorder comes in episodes that alternate with more or less normal mood levels.
3. Mood triggers: People with ADHD are passionate, and have strong emotional reactions to events, or triggers, in their lives. Happy events result in intensely happy, excited moods. Unhappy events especially the experience of being rejected, criticized, or teased intensely sad feelings. With BMD, mood shifts come and go without any connection to life events.
4. Rapidity of mood shift: Because ADHD mood shifts are almost always triggered by life events, the shifts feel instantaneous. They are normal moods in every way, except in their intensity. They’re often called “crashes” or “snaps,” because of the sudden onset. By contrast, the UN triggered mood shifts of BMD take hours or days to move from one state to another.
5. Duration of moods: Although responses to severe losses and rejections may last weeks, ADHD mood shifts are usually measured in hours. The mood shifts of bipolar mood disorder must be sustained for at least two weeks. For instance, to present “rapid-cycling” bipolar disorder, a person needs to experience only four shifts of mood, from high to low or low to high, in a 12-month period. Many people with ADHD experience that many mood shifts in a single day.
6. Family history: Both disorders run in families, but individuals with ADHD almost always have a family tree with multiple cases of ADHD. Those with bipolar mood disorder are likely to have fewer genetic connections.
Bipolar disorder can be confused with other disorders, including a variety of anxiety disorders and psychotic disorders (such as schizophrenia and schizoaffective disorder). This is because anxiety and psychotic symptoms often occur during the course of bipolar disorder. Individuals with bipolar disorder also frequently suffer from psychiatric disorders that are "co morbid" with (are present in addition to) the bipolar illness. The most common of these co morbid conditions are substance abuse disorders, obsessive compulsive disorder, and panic disorder.
An example of a care pathway put in place for an individual with bipolar disorder
The care plan explained.
In this care plan it goes through the diagnosis of a person who may be suffering with bipolar mood disorder. It starts by assessing the age of the patient to know who to refer them to weather they need CAMHS or a psychiatrist.
They then go on to determine what type of bipolar the person is suffering with in order to start the correct treatment. This can take time because of all the assessments that have to be taken. They then go on to determine if medication or therapy or a mixture of the two is necessary or even hospital admission through voluntary or section. The main psychiatrist involved will then have to get the correct balance of the medications and therapies to sustain the illness.
Care plan for bipolar disorder
A care pathway is a complex intervention for the mutual decision making and organisation of care processes for a well-defined group of patients during a well-defined period.
- A statement of the goals and key elements of care based on evidence, best practice, and patients’ expectations and their characteristics.
- The facilitation of the communication among the team members and with patients and families.
- Coordination of the care process by coordinating the roles and sequencing the activities of the multidisciplinary care team, patients and their relatives.
- The documentation, monitoring, and evaluation of variances and outcomes.
The three main practitioners involved in the care of a patient with bipolar disorder
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A child psychiatrist is the practitioner involved with a young person with the diagnosis of bipolar. They are there to assess the extent of the illness prescribe medication and drugs. And organise the young person’s therapy. After the person has had a mental health assessment if they believe there may be something wrong with the patient they may need the help of the patients family doctor also known as the GP they both work together to see whether the patients past needs for doctors appointments fit in with the persons believed illness.
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GP also known as a family doctor. A GP can make a referral to a psychiatrist for an adult or CAMHS for a young person. They can also be involved in the joint care of a patient when prescribing medications. The GP the individuals family doctor and will know the patient and there background from a young age this can help the child psychiatrist to understand know what the patient was like as a child and help within diagnosis.
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A councillor is a person who talks to an individual gets them to trust them to let them understand the way they are feeling through different types of therapy and helps a person overcome and understand what has happened to them and allow them to get over the problem. They can help the psychiatrist understand what the person’s problems are or if they don’t have anything in the past to contribute to the believed illness. If there is a problem that happened in the past they can help the person overcome it without the need for the psychiatrist.
How the practitioners involved can work well together
Overall the patient will be benefitted because he or she will have all the help and support to understand and get over what may have happened and get to grips with their diagnosis. All practitioners are needed in the care of the patient because when they all work together they make a very effective team.
The practitioners getting on with each other and listening to what one another has to say can have a big impact in how the team work together. Communication is especially important because everything must be written down in the file about the patient so none of the practitioners miss anything out whilst trying to diagnose this is especially important with bipolar disorder because anything that is missed can be vital in the diagnosis and prescribing medication, all practitioners must use the same care plan so that the patient gets the best effective treatment this must be done whilst empowering individuals to make their own choices on their treatment and to try different treatments to see what works the best for them. Some treatment may have side effects on the particular patient so they might want to try a wide range of treatments before agreeing that this will be there regular treatment.
Another important subject is that all practitioners know their place in the care for the individual and don’t try and do each other’s jobs or try to take over a person’s care. The practitioners cannot try and does another person’s job, like a councillor cannot try and diagnose a patient because the councillor doesn’t have the qualifications. The psychiatrist or psychologist must with another psychiatrist make the diagnosis with a second opinion.
Communication at this stage is vital as it can help the many practitioners understand and get into the patients head and feelings as to why the person is feeling a certain way and how they can help.
The care strategies used to help a patient with bipolar disorder
Staying active and eating well
Eating well and keeping fit are important for everyone. Exercise can also help reduce the symptoms (particularly depressive symptoms) of bipolar disorder. It may also give you something to focus on and provide a routine, which is important for many people.
A healthy diet combined with exercise may also help limit weight gain, which is a common side effect of medical treatments for bipolar disorder.
Some treatments also increase the risk of developing diabetes or that diabetes gets worse. Maintaining a healthy weight and exercising is an important way of limiting that risk.
You should have a check-up at least once a year to monitor your risk of developing cardiovascular disease or . This will include recording your weight, checking your blood pressure and having any appropriate blood tests
Many people with do this as well as using another treatment such a therapy and medication when they all work together it can be very effective in helping the person take control of their illness
Medication
Almost all people with bipolar disorder, even those with the most severe forms, can obtain substantial stabilization of their mood swings. The 3 most important types of medication used to control the symptoms of bipolar disorder are mood stabilizers, antidepressants, and antipsychotics. The doctor may also prescribe other medications to help with insomnia, anxiety, or restlessness. Medication can be a very effective way of taking control of the illness there are many different types of medications available for people suffering with bipolar disorder such as:
Mood stabilisers
Medications are considered mood stabilizers if they have two properties.
- they provide relief from acute episodes of mania and depression, or prevent them from occurring
- They do not worsen depression or mania or lead to increased cycling.
Examples of this medication are:
- Lithium, divalproex and carbamazepine meet this definition. The first 2 are the most widely used.
- Divalproex
- Lithium
- Carbamazepine
Anti depressants
Antidepressants treat the symptoms of depression. In bipolar disorder, antidepressants must be used together with a mood stabilizing medication. If used without a mood stabilizer, an antidepressant can push a person with bipolar disorder into a manic state. Many types of antidepressants are available with different chemical mechanisms of action and side effect profiles.
Examples of this medication are:
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Bupropin (Wellbutrin)
- fluoxetine (Prozac)
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Venlafaxine (Effexor)
Anti psychotics
Antipsychotic medications are used to control psychotic symptoms, such as hallucinations or delusions that sometimes occur in very severe depressive or manic episodes.
Antipsychotics can be used in 2 additional ways in bipolar disorder, even if no psychotic symptoms are present. They may be used as sedatives, especially during early stages of treatment, for insomnia, anxiety, and agitation. Researchers also believe that the newer antipsychotic medications have mood stabilizing properties, and may help control depression and mania. Antipsychotic medications are therefore often added to mood stabilizers to improve the response in patients who have never had psychotic symptoms.
Examples of this medication are:
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Olanzapine (Zyprexa)
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Quetiapine (Seroqeul/Seroquel)
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Risperidone (Risperdal)
- Clozapine (Clozaril)
Sleeping tablets
Sleeping tablets help when a person is in a high mood and prevents them from sleeping because of all the racing thoughts.
Some people suffering with the illness may not need all these different types of medication but may only need one type to keep their symptoms in control.
Hospital administration or being sectioned
Many patients with bipolar disorder are hospitalized at some point in the course of the illness. Because acute mania affects insight and judgment, individuals with mania are often hospitalized over their objections, which can be upsetting for both patients and their loved ones. However, most individuals with mania are grateful for the help they received during the acute episode, even if it was given against their will at the time. Hospitalization should be considered under the following circumstances:
- When safety is a question due to suicidal, homicidal, or aggressive impulses or actions
- When severe distress or dysfunction requires round-the-clock care and support(which is difficult, if not impossible, for any family to sustain for a long period of time)
- Where there is ongoing substance abuse, to prevent access to drugs
- When the patient has an unstable medical condition
- When close observation of the patient's reaction to medications is required
Cognitive behavioural therapy
Cognitive therapy focuses on identifying and changing the pessimistic thoughts and beliefs that can lead to depression it also focuses on behaviours that can increase or decrease stress and ways to increase pleasurable experiences that may help improve depressive symptoms.
Conclusion
In this assignment I have understood more about the condition and the different types of medications and therapies available to a person who is suffering with bipolar mood disorder.
Reference
by
mistyblue95 (student)
