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Home Books Medication Therapy Management: A Comprehensive Approach, 2e

Chapter 15: Bipolar Disorder MTM Data Set

Megan J. Ehret

KEY POINTS

KEY POINTS

  • Bipolar disorder is a lifelong illness, which requires adherence to medications to prevent repeated episodes.

  • Polypharmacy is the rule in the treatment of bipolar disorder, rather than the exception.

  • Adverse effects, drug interactions, and cost of medications can lead to nonadherence. Medication therapy management (MTM) providers should be watchful of nonadherence and work with the patient to create a regimen that is both tolerable and affordable.

  • Inclusion of the patient in a therapeutic alliance can increase adherence to treatment and medications.

INTRODUCTION TO BIPOLAR DISORDER

Bipolar disorder (previously known as manic-depressive disorder) is a cyclic mood disorder characterized by recurrent fluctuations in mood, energy, and behavior.1,2 Bipolar disorder is a lifelong illness with a variable course, which requires both nonpharmacologic and pharmacologic treatment.1,2 Episodes of bipolar disorder include not only major depression but also hypomania, mania, and mixed (Table 15-1).

TABLE 15-1abEvaluation and Diagnosis of Mood Episodes
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TABLE 15-1 Evaluation and Diagnosis of Mood Episodes
Diagnosis Episode Impairment of Functioning or Need for Hospitalizationa DSM-5 Criteriab
Major depressive Yes

At least 2-week period of either depressed mood or loss of interest or pleasure in normal activities, associated with at least five of the following symptoms:

 Depressed, sad mood (adults); can be irritable mood in children

 Decreased interest and pleasure in normal activities

 Decreased or increased appetite, weight loss or weight gain

 Insomnia or hypersomnia

 Psychomotor retardation or agitation

 Decreased energy or fatigue

 Feelings of excessive guilt or worthlessness

 Impaired concentration or indecisiveness

 Recurrent thoughts of death, suicidal thoughts or attempts
Manic Yes

At least 1-week period of abnormally and persistently elevated mood (expansive or irritable) and energy, associated with at least three of the following symptoms (four if the mood is only irritable):

 Inflated self-esteem (grandiosity)

 Decreased need for sleep

 Increased talking (pressure of speech)

 Racing thoughts (flight of ideas)

 Distractibility (poor attention)

 Increased goal-directed activity (socially, at work, or sexually) or psychomotor agitation

 Excessive involvement in activities that are pleasurable but have a high risk for serious consequences (buying sprees, sexual indiscretions, poor judgment in business ventures)
Hypomanic No

At least 4 days of abnormally and persistently elevated mood (expansive or irritable) and energy, associated with at least three of the following symptoms (four if the mood is only irritable):

 Inflated self-esteem (grandiosity)

 Decreased need for sleep

 Increased talking (pressure of speech)

 Racing thoughts (flight of ideas)

 Distractibility (poor attention)

 Increased goal-directed activity (socially, at work, or sexually) or psychomotor agitation

 Excessive involvement in activities that are pleasurable but have a high risk for serious consequences (buying sprees, sexual indiscretions, poor judgment in business ventures)
a

Impairment in social or occupational functioning; may include need for hospitalization because of potential self-harm, harm to others, or psychotic symptoms.

b

The disorder is ...

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