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  • Image not available. Bipolar disorder is a cyclic mental illness with recurrent mood episodes that occur over a person's lifetime. The symptoms, course, severity, and response to treatment differ among individuals.
  • Image not available. Bipolar disorder is likely caused by genetic factors, environmental triggers, and the dysregulation of neurotransmitters, neurohormones, and second messenger systems in the brain.
  • Image not available. The goal of therapy for bipolar disorder should be to improve functioning of the patient by reducing mood episodes. This is accomplished by maximizing the adherence to therapy and limiting adverse effects.
  • Image not available. Patients and family members should be educated about bipolar disorder and treatments. Long-term monitoring and adherence to treatment are major factors in obtaining stabilization of the disorder.
  • Image not available.Lithium and valproate are the mainstays of treatment for both acute mania and prophylaxis for recurrent manic and depressive episodes. Anticonvulsants, such as lamotrigine, carbamazepine, and oxcarbazepine, and second-generation antipsychotics, such as aripiprazole, olanzapine, risperidone, quetiapine, and ziprasidone are alternative or adjunctive treatments for bipolar disorder. Anticonvulsants may be more effective than lithium in several mood subtypes (e.g., mixed states and rapid cycling). The use of lithium, valproate, or quetiapine for acute bipolar depression should be considered as first-line treatment options.
  • Image not available. Baseline and follow-up laboratory tests are required for some medications to monitor for adverse effects.
  • Image not available. Some patients can be stabilized on one mood stabilizer, but others may require combination therapies or adjunctive agents during an acute mood episode. If possible, adjunctive agents should be tapered and discontinued when the acute mood episode remits and the patient is stabilized. Adjunctive agents may include benzodiazepines, additional mood stabilizers or antipsychotics, and/or antidepressants.

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Upon completion of the chapter, the reader will be able to:

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  • 1. Define the incidence, etiology, pathophysiology of bipolar disorder.
  • 2. List the DSM-IV-TR criteria for diagnosing bipolar disorder.
  • 3. Compare and contrast the antiepileptic medications used in the treatment of bipolar disorder.
  • 4. List baseline and routine laboratory test and monitoring when prescribing antipsychotics and mood stabilizers.
  • 5. State the various roles antipsychotics have in the treatment of bipolar disorder.
  • 6. Describe the literature supporting the use of antipsychotics as mood stabilizers.
  • 7. Describe how benzodiazepines can aid in the treatment of acute mania.
  • 8. Describe how to appropriately treat acute mania in a patient with bipolar disorder.
  • 9. Describe how to appropriately treat acute depression in a patient with bipolar disorder.
  • 10. Detect the appropriateness of using antidepressants in bipolar disorder.
  • 11. Formulate a general treatment plan for a patient with bipolar disorder.
  • 12. Design a treatment plan for a patient with bipolar disorder whose illness is currently stable.
  • 13. State nonpharmacologic treatment strategies associated with bipolar disorder.

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Image not available. Bipolar disorder (previously known as manic-depressive illness) is one of the most common of the severe chronic psychiatric disorders. The cyclic mood disorder is characterized by recurrent fluctuations in mood, energy, and behavior encompassing the extremes of human experiences.13 Bipolar disorder differs from recurrent major depression (or unipolar depression) in that a manic, hypomanic, ...

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