Disease Focus

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Description of bipolar disorder and explained its pathology

Bipolar disorder can be described as chronic, impairing disorder that is typified by significant disturbance in mood and grandiosity or unstable self esteem, hypersexual behavior, a decreased need for sleep, poor judgment, racing thoughts in addition to pressured speech. It is linked to substantial impairments, economic distress chronic and debilitating medical conditions and increased rate of suicide in the frequency of ten to twenty. It is the leading cause of disability in adults. The severe psychopathology may better be indicated by elevated mania (MIllan et al., 2012; Price & Marzani-Nissen, 2012).

Different agents used in the treatment of bipolar disorder

The typical and atypical antipsychotics have been used extensively to treat bipolar mania. Haloperidol agents are also used in the treatment of acute mania. It has faster onset of action as compared to either lithium or atypical antipsychotics. Other agents are the anticonvulsant which was used initially in seizure control applications. They were later accepted as substitutes for lithium for individuals diagnosed with bipolar disorders that do not respond to lithium treatment or experienced severe side effects (Edwards et al., 2013).

Monitoring and follow–up necessary during treatment of bipolar disorder

You should find out whether the current medications might be causing manic to the patient or causing hypomanic or mixed manic episode. If that is the case, then discontinue antidepressants or other mania inducing agents. You should also examine and closely monitor patients with bipolar depression for the risk of mood destabilization. Initiate an antipsychotic agent in patients with bipolar depressions with psychotic features in addition to considering psychosocial interventions such as psycheducation and psychotherapy strategies. In case the patient is in short term inpatient care unit but has not made any improvement, then evaluate again the management strategy. Then consider even transferring to long term inpatient care unit. A patient who is in a depressed or maniac phase while at the same time does not respond to medications can be transferred to a facility where elecroconvulsive therapy can be administered. Moreover, consultation with the psychiatric colleague or a psychopharmacologist is at all times suitable in case the patient does not respond to conventional treatment and medication. The individuals also need education concerning their condition with regular schedule and with great flexibility if they require additional sessions (MIllan et al., 2012; Price & Marzani-Nissen, 2012).

You also need to re-examine patients who start treatment for acute bipolar mania, hypomania, or mixed episodes every one to two weeks for at least six weeks. Patients with severe mania who are not hospitalized should be re-evaluated every two to five days until symptoms get better. An absence of any significant symptoms of mania or depression for two months ought to be considered to be full remission and examination of symptoms should then be continued occasionally to check for relapse. Examine the patient’s reaction to treatment with the similar standardized tool at follow-up visits, after changes in treatment, and with periodic examinations until total remission has been reached (MIllan et al., 2012; Price & Marzani-Nissen, 2012).

Treatment of bipolar depression and acceptable pharmacologic agents.

The three categories of pharmacologic interventions namely lithium, antiepileptics and second generation antipsychotics are reviewed for treatment with the algorithm for medication also reviewed. The existing psychosocial treatments together with the proofs of those treatments are also reviewed. Antipsychotics are usually used together with mood stabilizers like lithium/valproate as a first line treatment for manic and mixed incident linked to bipolar disorder. A number of atypical antipsychotics have some benefits when used with other treatments like fluoxectine in major depressive disorders (MIllan et al., 2012; Price & Marzani-Nissen, 2012).

Mechanisms and toxicities of drug therapy, including antipsychotics, neuroleptics, and atypicals.

Lithium treatment acts upon the stimulatory neurotransmitter of glutamate, offering a bi-directional force that eventually brings about relative stasis in mood. Although the exact mechanism of action of the antipsychotics such as neuroleptics appears to be unknown, it has been suggested that neuroleptics operate on specific neuroreceptors inside the central nervous system, using a dissimilar mode of attack in comparison with the other medications. Just like the antipsychotic agents, the exact mechanism of action for anticonvulsants is not known. However, it had been proposed that carbamazapine operates by blocking the reuptake of norepinepherine which stops the sodium channel impulses from constantly firing and slows down the enzymes responsible for breaking down gama aminobutyric acid, hence creating more of the neurotransmitters accessible during the manic and depressive episodes(Edwards et al., 2013; McElroy, 2014).

Whether SSRIs an appropriate treatment for bipolar depression

SSRIs is not appropriate for the treatment of bipolar depression. This is because; SSRIs are traditional antidepressants which are considered experimental in treating bipolar depression. None of the traditional antidepressants are FDA approved for the purpose of such treatment. In addition, there is no research showing that they have any greater benefit than taking a mood stabilizer like lithium or Depakote alone (McElroy, 2014).

References

Millan, M. J., Agid, Y., Brüne, M., Bullmore, E. T., Carter, C. S., Clayton, N. S., … & Young, L. J. (2012). Cognitive dysfunction in psychiatric disorders: characteristics, causes and the quest for improved therapy. Nature reviews Drug discovery, 11(2), 141-168.

Edwards, S. J., Hamilton, V., Nherera, L., & Trevor, N. (2013). Lithium or an atypical antipsychotic drug in the management of treatment-resistant depression: a systematic review and economic evaluation. Health technology assessment (Winchester, England), 17(54), 1.

Price, A. L., & Marzani-Nissen, G. R. (2012). Bipolar disorders: a review. Am Fam Physician, 85(5), 483-93.

McElroy, S. L. (2014). Prescribing antidepressants for bipolar depression: what does the evidence say?. The Journal of clinical psychiatry, 75(9), e24-e24.