Assessing and Treating Patients with Bipolar Disorder

Assessing and Treating Patients with Bipolar Disorder

There are several mood disorders that patients experience with varying degrees of manifestations. Bipolar disorder is among the common mental illnesses that can either be chronic in that it persistently or constantly reoccurs or episodic in that it can occur with seasons. The symptoms of bipolar disorder are mostly observed during late adolescence or early adulthood but may also manifest in children. Bipolar disorder can be diagnosed across three distinct mental issues based on the frequency and severity of symptoms manifested. The basic types of bipolar disorder include bipolar I disorder, bipolar II disorder, and cyclothymic disorder (American Psychiatric Association, 2021). Bipolar disorders differ in the severity and recurrence rate of the episodes of depression and hypomania. Patients might also experience bipolar symptoms unrelated to the three types of bipolar disorders with mental conditions known as other specified and unspecified bipolar and related disorders. Bipolar II disorder is a major mental illness along the bipolar disorder spectrum that affects a significant number of people. This guide is developed to define and improve the understanding of Bipolar II disorder for mental health practitioners. It provides the prevalence and neurobiology of bipolar II disorder, its diagnostic criteria, population-specific considerations, approved pharmacological treatment options, side effects of the treatment options, FDA approvals, and warnings and examples of how to prescribe medications for Bipolar II disorder. Our assignment writing services will allow you to attend to more important tasks as our experts handle your task.

Prevalence and Neurobiology of Bipolar II Disorder

Bipolar II disorder is among the most common mental health illnesses. Bipolar disorders, in general, are estimated to affect about 1 percent to 2.5 percent of the world population (Marzani & Neff, 2021). Evidence shows bipolar II disorder has the highest seasonal prevalence, majorly during the onset of mood disorders (Yeom et al., 2021). The condition affects an estimated 2 percent of the U.S. population. Notably, most of the world’s population is at risk of developing bipolar II disorder. Although an estimated 4.4. percent of the adult U.S. population has had or is expected to develop bipolar II disorder, the mental illness is noted to be more prevalent among adolescents and people in their middle ages (National Institute of Mental Health, n.d.). The symptoms set up early during adolescence, while the mental disorders can be fully experienced during the early 50s. Notably, there seem to be no significant gender differences in the development of bipolar II disorder as it proportionately affects men and women at the rate of 2.9 percent and 2.8 percent of the population, respectively (National Institute of Mental Health, n.d.).

The exact etiology of bipolar disorders is not well understood. However, recent empirical evidence from analyses of bipolar disorder subtypes shows a strong but imperfect genetic correlation between the development of the disorders (Mullins et al., 2021). The genetic component affects the production and regulation of neurochemicals, especially serotonin and dopamine neurotransmitters, which affect mood regulation and lead to dysregulation. Environmental factors such as stressful life and childhood maltreatment increase the predisposition to bipolar disorders (McIntyre et al., 2020).

Differences between Bipolar II Disorder and Bipolar I Disorder per DSM 5-TR

Bipolar disorders are closely related in terms of symptom presentation and diagnostic criteria. However, there are notable symptomatic differences and specific diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5 TR) for bipolar I disorder and bipolar II disorder. For instance, the diagnostic criteria for bipolar II disorder as per the DSM-5 TR, an individual must have experienced at least one major depressive episode and one hypomanic episode in which the major depressive episode lasts at least two weeks while the hypomanic episodes are experienced for at least four consecutive days (American Psychiatric Association, 2021). On the other hand, bipolar I disorder is diagnosed based on the presence of at least one single manic episode without any symptoms of a major depressive episode. Regardless, major depressive disorder symptoms may be present in a patient with bipolar I disorder, but the episodes are not necessary for the diagnosis of the condition as it is with bipolar II disorder (American Psychiatric Association, 2021).

Besides the differences noted in the diagnostic criteria for bipolar I disorder and bipolar II disorder, there are some clearly outlined differences in both bipolar disorders as per the DSM-5 TR. Bipolar I disorder and bipolar II disorder differ majorly in the severity of the symptoms presented by a patient and how long the symptoms last. According to the DSM-5 TR, bipolar I disorder is characterized by severe symptoms such as full manic episodes lasting for over a week resulting in functional impairments and the need for hospitalization. On the other hand, bipolar II disorder is characterized by mild and shorter episodes and symptoms such as hypomanic episodes that may last up to four days (American Psychiatric Association, 2021).

Special Populations and Considerations for Bipolar II Disorder

The impact of bipolar II disorder as well as the severity of the symptoms varies across the population. This means that the strategies applied towards the management of bipolar II disorder will differ in children, adolescents, pregnancy/post-partum, older adults, and emergency care. This requires special considerations across these population groups. For children and adolescents, considerations need to focus on the diagnosis of the disorders as the symptoms tend to overlap with other related mental health issues in this population group. Children and adolescents have rapid mood changes and experience episodes of mixed feelings, majorly characterized by maniac and depressive symptoms (Abrams, 2020). The impact of bipolar II disorder in children and adolescents differs from other population groups as they are in their major developmental stages. The disorder can impact the physical and cognitive development of children and adolescents. Additionally, due to the lack of clinical trials on children, there is a need to consider the legality and ethics of available treatments as well as their effects on this population.

Pregnant and post-partum patients are considered special populations requiring special considerations for the management of bipolar II disorder. The condition in pregnant and postpartum patients is a challenge as the medications and psychotherapeutic approaches applied in managing the condition can significantly impact pregnancy and milk production. Considerations need to be made when dealing with pregnant and post-partum patients; the care approaches employed for bipolar II disorder need first to determine the potential risks associated with pharmacological and nonpharmacological approaches to care. There is also a need to consider the cultural views of mental illnesses during pregnancy and postpartum period.

Elderly patients are more affected by bipolar II disorder than other populations. Although the condition can develop during the early days, it becomes prominent later, especially during the patient’s 50s. Managing bipolar II disorder in older adults can be challenging due to the presence of other conflicting illnesses related to old age. Considerations when treating bipolar disorders in older patients need to consider the manifested symptoms in relation to age-related cognitive changes as well as the age-related changes in pharmacokinetics and pharmacodynamics of available modalities (Ljubic et al., 2021). Considerations also need to be made on the ability of elderly patients to access available care options as well as the ability of the patient to make sound care decisions.

Regardless of the population group, managing bipolar II disorder emergencies needs to consider several individual patient factors, such as the underlying factors of the condition, including age, health status, current medication regimen, and presenting symptoms. Despite the need for emergency care, the care providers need to consider the legality and ethics of the care delivered as well as the cultural background of the patient. These considerations are essential to ensure the care intervention is appropriate for the emergency situation and meets the patient’s preferences.

FDA and/or Clinical Practice Guidelines Approved Pharmacological Treatment Options for Bipolar II Disorder

There are multiple FDA-approved pharmacological treatment options for bipolar II disorder for children, adults, and special patient grounds, such as pregnant and post-partum women for acute and mixed treatments as well as for maintenance treatment. FDA-approved medications for acute and mixed episodes include mood stabilizers, anticonvulsants, and atypical antipsychotics. For children and adolescents aged between 10 and 17, FDA-approved medications include lithium for those above 12 years and aripiprazole, quetiapine, risperidone, and olanzapine for those above 13 years old. Several medication options for adult populations have also been approved for maintenance treatment, including mood stabilizers such as lithium, antipsychotics such as olanzapine and risperidone, and antidepressants and antidepressant-antipsychotic medications. Psychotherapy and psychosocial support are also approved treatment options for bipolar II disorder by clinical practice guidelines for major mental illnesses (Marzani & Neff, 2021).

Side Effects, FDA Approvals, and Warnings of Medication Treatment Options

The major side effects and warnings of the FDA-approved treatment options for treating bipolar II disorder vary across specific medications. However, major side effects may include sedation, GI issues, increased weight gain, instances of tremors, and mood and metabolic changes. Monitoring is recommended as the side effects may vary from patient to patient, while certain medications such as lithium and other atypical antipsychotics have warnings as they may increase the risk of suicide and suicidal behaviors (Nabi et al., 2022).

How to Write a Proper Prescription for Bipolar II Disorder

Sample Prescriptions

Patient Name: T. K.

Gender: Male

D.O.B.: 12/4/1967

Medication: Lithium Carbonate 300 mg

Quantity: 60 tablets

Instructions: One tablet taken orally twice daily. Drink plenty of water up to 12 a day.

Patient Name: H. M.

Gender: Male

D.O.B: 7/8/2008

Medication: Aripiprazole (oral)

Dosage forms: Oral tablet, disintegrating (15 mg)

Instructions: 15 mg taken orally once daily. Do not split the tablet. You can take it with or without food.

Patient Name: S. L.

Gender: Female

D.O.B.: 11/12/1991

Medication: Lamotrigine (Oral)

Dosage: Oral disintegrating tablet (100 mg)

Instructions: One tablet is taken orally once a day. Take the medication in the morning.

Conclusion

Bipolar II illness is a common mental disorder. This practice guideline has provided a comprehensive discussion of the disorder’s prevalence rate across various population groups, neurobiology, diagnostic and symptom differences with bipolar II disorder, and special populations and unique considerations for care. It has also provided available FDA- and practice guidelines-approved pharmacological treatment options and various methods of writing prescriptions for medications for treating bipolar II disorder. In conclusion, diagnosing and managing bipolar II disorder requires a personalized approach with consideration for the legality, ethics, and a patient’s culture when selecting treatment options.

 References

Abrams, Z. (2020). Treating bipolar disorder in kids and teens. In APA (Vol. 57, Issue 7, p. 40).

American Psychiatric Association. (2021). Diagnostic and Statistical Manu – Diagnostic Fifth Edition Text Revision (DSM-5-TR). American Psychiatric Association Publishing. https://drive.google.com/file/d/1K9nOTLZLKWaaVz231Xylxy_KJtEpsZnM/view

Ljubic, N., Ueberberg, B., Grunze, H., & Assion, H. J. (2021). Treatment of bipolar disorders in older adults: a review. Annals of General Psychiatry, 20(1), 1–11. https://doi.org/10.1186/S12991-021-00367-X/TABLES/3

Marzani, G., & Neff, A. P. (2021). Bipolar Disorders: Evaluation and Treatment. American Family Physician, 103(4), 227–239. https://www.aafp.org/pubs/afp/issues/2021/0215/p227.html

McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., Malhi, G. S., Nierenberg, A. A., Rosenblat, J. D., Majeed, A., Vieta, E., Vinberg, M., Young, A. H., & Mansur, R. B. (2020). Bipolar disorders. The Lancet, 396(10265), 1841–1856. https://doi.org/10.1016/S0140-6736(20)31544-0

Mullins, N., Forstner, A. J., O’Connell, K. S., Coombes, B., Coleman, J. R. I., Qiao, Z., Als, T. D., Bigdeli, T. B., Børte, S., Bryois, J., Charney, A. W., Drange, O. K., Gandal, M. J., Hagenaars, S. P., Ikeda, M., Kamitaki, N., Kim, M., Krebs, K., Panagiotaropoulou, G., … Andreassen, O. A. (2021). A genome-wide association study of more than 40,000 bipolar disorder cases provides new insights into the underlying biology. Nature Genetics 2021 53:6, 53(6), 817–829. https://doi.org/10.1038/s41588-021-00857-4

Nabi, Z., Stansfeld, J., Plöderl, M., Wood, L., & Moncrieff, J. (2022). Effects of lithium on suicide and suicidal behavior: a systematic review and meta-analysis of randomized trials. Epidemiology and Psychiatric Sciences, 31. https://doi.org/10.1017/S204579602200049X

National Institute of Mental Health. (n.d.). Bipolar Disorder. Retrieved June 29, 2023, from https://www.nimh.nih.gov/health/statistics/bipolar-disorder

Yeom, J. W., Cho, C. H., Jeon, S., Seo, J. Y., Son, S., Ahn, Y. M., Kim, S. J., Ha, T. H., Cha, B., Moon, E., Park, D. Y., Baek, J. H., Kang, H. J., An, H., & Lee, H. J. (2021). Bipolar II disorder has the highest prevalence of seasonal affective disorder in early-onset mood disorders: Results from a prospective observational cohort study. Depression and Anxiety, 38(6), 661–670. https://doi.org/10.1002/DA.23153

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For this assignment, you will write a 5–6-page paper on the topic of bipolar and bipolar and related disorders. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of the resources provided by your course.

In your paper, you will choose one of the following diagnoses: Bipolar I, Bipolar II, Cyclothymic Disorder, Substance/Medication-Induced Bipolar and Related Disorder, Bipolar and Related Disorder Due to Another Medical Condition. Your paper will include a discussion of your chosen diagnosis of bipolar and related disorders on the following:

Prevalence and Neurobiology of your chosen disorder

Discuss the differences between your chosen disorder and one other bipolar and related disorder in relation to the diagnostic criteria including the presentation of symptoms according to DSM 5 TR criteria

Discuss special populations and considerations (children, adolescents, pregnancy/post-partum, older adult, emergency care) for your chosen bipolar and related disorder; demonstrating critical thinking beyond the basics of HIPPA and informed consent with a discussion of at least one for EACH category:  legal considerations, ethical considerations, cultural considerations, social determinants of health

Discuss FDA and/or clinical practice guidelines approved pharmacological treatment options in relation to acute and mixed episodes vs maintenance pharmacological treatment for your chosen bipolar and related disorder

Discuss the medication treatment options for your chosen disorder, as well as side effects, FDA approvals, and warnings.  What is important to monitor in terms of labs, comorbid medical issues, and why is it important for monitoring

Provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy.