225 -Bipolar and Depression: Assessment and Addressing 10 Side Effects of Medications

Summary: Bipolar and Depression Dr. Dawn-Elise Snipes PhD, LMHC Executive Director, AllCEUs.com Objectives ~ Differentially Diagnose Bipolar Disorder and Depression ~ Recognize general medical conditions and drugs that may mimic depression or mania ~ Understand the goals of psychiatric management of bipolar disorder and depression ~ Identify bipolar patients at increased risk of suicide ~ Understand the link between bipolar disorder and substance abuse ~ Identify key areas of consideration when making a treatment placement decision ~ Learn about the areas which patients with bipolar disorder and their families may need education ~ Familiarize with the most common psychopharmacological interventions for bipolar disorder Bipolar I and II ~ Bipolar I disorder: at least one episode can be characterized as mania ~ Episodic, lifelong illness with a variable course ~ The first episode may be manic, hypomanic, mixed, or depressive ~ Patients may experience several episodes of depression before a manic episode Differential Diagnosis ~ Ask about a history of depression accompanied or followed by manic or hypomanic symptoms ~ Assess for substance use disorder, other general medical conditions or medications ~ Medical conditions associated with manic-like symptoms include: ~ Multiple sclerosis ~ Lesions closely linked to the limbic system ~ Hyper or hypothyroid ~ Head injuries ~ Encephalitis Medications Associated with Manic-like Symptoms ~ L-Dopa ~ Corticosteroids ~ High-dose decongestants ~ Stimulants (weight loss, ADHD) ~ Antidepressants may trigger a manic episode Substance Use ~ May cause manic-like episodes ~ May help patient self-medicate ~ Stimulants (manic like symptoms) ~ Cocaine ~ Methamphetamines/Amphetamines ~ Ephedrine ~ Ecstasy/MDMA ~ Caffeine Patients with Bipolar ~ Seek treatment during depressive episodes ~ Rarely volunteer information about manic or hypomanic symptoms ~ Do not see the symptoms of hypomania to be distressing Suicide ~ Completed suicide rates 10% to 15% ~ Suicide attempts associated with depressive episodes or depressive features of mixed episodes ~ Ask every patient about suicidal ideation Increased Risk Factors ~ Factors associated with increased risk: ~ Means ~ Lethality ~ Family history of suicide ~ Pervasive insomnia ~ Impulsiveness ~ Psychiatric comorbidity ~ Psychosis ~ Personality disorder ~ Lack of social support Hospitalization ~ Patients who: ~ Pose a serious threat of harm to themselves ~ Are severely ill ~ Lack adequate social support ~ Demonstrate significantly impaired judgment ~ Have complicating psychiatric or general medical conditions ~ Have not responded adequately to outpatient treatment. ~ Re-evaluate treatment setting regularly Education ~ Should introduce facts about the illness and its treatment ~ Use printed, verbal and videotaped material ~ Present in an ongoing gradual and consistent process ~ Use psychoeducational groups Stressors ~ Commonly precede episodes ~ Disrupted sleep-wake cycles may specifically trigger manic episodes ~ Physical illnesses that cause changes in eating and/or dehydration ~ Alter blood plasma levels ~ May require dose adjustment ~ Regular patterns should be promoted Counselor Activities ~ Preplanning ~ Plan for impairments in functioning ~ Assisting patient in scheduling absences from work ~ Avoid major life changes ~ Plan for the needs of their children while the patient is in an acute state ~ Assist the patient who is able to work in contacting

225 -Bipolar and Depression: Assessment and Addressing 10 Side Effects of Medications

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