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Bipolar Disorder Treatment

The treatment of bipolar disorder involves 3 stages: acute, continuation, and maintenance. The acute stage aims to control symptoms affecting functioning and well-being. Continuation treatment consolidates response and avoids new episodes. Treatment choice depends on several factors and may include pharmacology, psychoeducation, cognitive behavioral therapy, family therapy, and electroconvulsive therapy. Common medications have side effects like restlessness, dry mouth, and dizziness.

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aarushi sabharwal
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149 views16 pages

Bipolar Disorder Treatment

The treatment of bipolar disorder involves 3 stages: acute, continuation, and maintenance. The acute stage aims to control symptoms affecting functioning and well-being. Continuation treatment consolidates response and avoids new episodes. Treatment choice depends on several factors and may include pharmacology, psychoeducation, cognitive behavioral therapy, family therapy, and electroconvulsive therapy. Common medications have side effects like restlessness, dry mouth, and dizziness.

Uploaded by

aarushi sabharwal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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BIPOLAR

DISORDER
TREATMENT
■ The treatment of BD has 3 stages:
(1) Acute
(2) Continuation and
(3) maintenance.
The goal of the acute stage is to control or ameliorate the acute symptoms that
are affecting the psychosocial functioning and well-being or endangering the
client’s life.
Continuation treatment is required to consolidate the response during the acute
phase and avoid new episodes or recurrences. The choice of pharmacological,
psychosocial, or combined (pharmacological and psychosocial) treatment for
each of these stages depends on the severity, phase of the illness, subtype of
BD, chronicity, comorbid disorders, age, family and patient preference and
expectations, availability of skilled psychotherapists, familyand environmental
circumstances, and family psychopathology.
Pharmacology

Psychoeducation

Types of
Cognitive Behavior Therapy

Treatment Family Focused Therapy

Interpersonal & Social Rhythm Therapy

Electro-Convulsive Therapy
■ Mood stabilizing medications are
usually the first choice to treat
bipolar disorder like Lithium,
Depakote

Pharmacolo ■ Atypical antipsychotic medications


are called "atypical" to set them
apart from earlier medications, which

gy are called "conventional" or "first-


generation" antipsychotics. Eg.
Zyprexa, Abilify, Seroquel, Risperdal,
Geodon
■ Antidepressant medications like
Prozac, Paxil, Zoloft, Wellbutrin
Restlessness

Dry mouth

What are the Bloating or indigestion

Acne

side effects
Unusual discomfort to cold temperatures

Joint or muscle pain

Brittle nails or hair.

of these
Drowsiness

Dizziness

Headache

medications Diarrhea

Heartburn

?
Mood swings

Stuffed or runny nose, or other cold-like


symptoms
Electroconvulsive therapy

■ For cases in which medication and/or psychotherapy does not work,


electroconvulsive therapy (ECT) may be useful. ECT, formerly known
as “shock therapy,” once had a bad reputation. But in recent years, it
has greatly improved and can provide relief for people with severe
bipolar disorder who have not been able to feel better with other
treatments. Before ECT is administered, a patient takes a muscle
relaxant and is put under brief anesthesia. He or she does not
consciously feel the electrical impulse administered in ECT. On
average, ECT treatments last from 30–90 seconds. People who have
ECT usually recover after 5–15 minutes and are able to go home the
same day
Psychoeducation

■ Psychoeducation and support start during the assessment stage and are
always indicated at any stage of treatment.
■ Family members and the patient should be educated about the causes,
symptoms, course, different treatments of BD, and the risks associated with
each treatment option, as opposed to no treatment at all.
■ The patient and family should be equipped for what is likely to be a recurrent
and often chronic illness with frequent fluctuations in the mood, and be aware
of the importance of good adherence to treatment.
■ Sleep hygiene and routine are important, especially in view of sleep
deprivation leading to worsening of mood symptoms. Ensuring a stable
circadian rhythm is needed to have a positive effect on physiology and daily
functioning.
Interpersonal & Social Rhythm Therapy

■ IPSRT teaches patients to regulate sleep-wake patterns, work,


exercise, meal times and other daily routines in addition to having
therapy addressing interpersonal issues. IPSRT in the acute phase
prolong remission compared to Intensive Clinical Management (ICM).
Maintain Maintain regular sleep routine: same bedtime and wake time

Avoid Avoid naps

Do not stay Do not stay in bed awake for more than 5-10 minutes; move to a chair
in in the dark

Do not Do not watch TV or read in bed

Sleep
watch

Avoid substances that interfere with sleep: caffeine, cigarettes,


Avoid

Hygiene
alcohol, over the counter medications

Exercise Exercise before 2 pm everyday, not before bed

Have Have a quiet, comfortable bedroom

Hide Hide the clock if you are a clock watcher

Have Have a comfortable pre-bedtime routine


■ Family-focused therapy (Miklowitz et
al., 2003), a psychoeducational
programme for individual families in

Family
which one member experiences
bipolar disorder. It incorporates a
strong behavioural component by

Focused
focusing on understanding disorder-
specific risks, communication and
problem-solving skills in the family.
Each of these approaches is primarily
focused on reduction of relapse and
recurrence of mania or depression.
■ The main goal of Cognitive
Behavioral Therapy (CBT) for bipolar
disorder is to maximize adherence
with pharmacotherapy and other

Cognitive forms of treatment over time.


■ This is accomplished by identification

Behavioral
and removal of factors that can
interfere with compliance.
■ To beneficially affect the course of

Therapy bipolar, there are at least six


separate targets for treatment. The
first five of these concern relapse
prevention, and the last directly
targets the treatment of bipolar
depression
THE MAIN
OBJECTIVES OF
CBT IN THE
TREATMENT OF
BIPOLAR
DISORDER.
■ This rationale is used to engage the
patient in cognitive therapy through
monitoring and linking changes in
thoughts, behaviours, feelings and the
biological symptoms of bipolar disorder.
The model also acknowledges that
sleep disturbance may be a useful
predictor of biological and/or
psychosocial disruption and may act as
an early-warning sign of shifts from
euthymic to abnormal mood states
(Wehr et al, 1987). When the
connections between the biological and
other aspects of their experience are
exposed, patients are able to
understand the reasons for using
cognitive therapy as well as medication.
This establishes the rationale for
cognitive and behavioural interventions,
and also provides a starting point to
explore attitudes towards the use of,
and adherence to, medication.
■ Outsider’s Perspective
■ Yousef is 40. He has been brought to the emergency department with
cuts to his arms, chest and face, which he received as a result of a fight
in a bar. His friend has advised that Yousef has bipolar disorder, and that
he looks like he is ‘on the way up’.
■ Staff have concluded that a psychiatric assessment of Yousef is needed
to determine whether admission for psychiatric reasons is
required. Yousef is to be kept in the emergency department until this can
be arranged, which could be several hours.
■ During this time, he finds it extremely difficult to stay in bed and is
constantly wandering around the ward into other rooms. When he is in
bed, Yousef is constantly ringing the buzzer. He is frequently found
talking to other patients, staff and visitors about his wonderful new
invention.
■ Insider’s Perspective
■ The early stages of a hypomanic/manic episode is either unknown to me as a
problem or nearly unknown, I feel good, my mind is sharp, my confidence
escalates, ideas come easily, my mood is above average and life feels great.
As the mood escalates my mind runs faster, like a car engine as you press
down on the accelerator, thoughts race, I talk more and faster and a variety of
ideas begin to cram my mind. I can become frustrated and angry with people
because they can't keep up with my thoughts or ideas, regardless of how
bizarre they might be because to me they are brilliant. I start planning
business ideas, grand holidays, contacting famous people who will surely
understand me, my sexual drive increases, I shop more, a lot more, I will talk
to anyone about anything, my inhibitions plummet, I might consider myself in
the league of great prophets like Jesus and Buddha (bizarre considering I'm a
lifelong atheist), I can fly into fits of rage, I can be as happy as anything one
second and switch to furious the next, I have little fear and can put myself into
life threatening situations, I can love like never before and hate in equal
measures. I feel free of all burden, but then I can become confused and break
down and weep, I sleep very little and need little food, I am out and about
exploring the world, meeting people and talking with them, talking at
them, getting bizarre ideas. I have taken quite a lot of drugs in my life, none,
not one comes close to the elation felt when reaching a certain level of mania.

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