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Cycles of mania and depression
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Affects 2.6% of US population
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Affects men and women equally
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Occurs more frequently in people of higher socio-economic status
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Delusions and hallucinations may occur
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Psychosis may be present
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Hypomania
Milder degree of symptoms Not as severe; no hospitalization No psychotic features |
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Well: 53% of time
Depressed: 32% of time Manic: 9% of time Cycling: 6% of time |
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Twin Studies
60-80% monozygotic, 10-20% dizygotic |
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Family Studies
1 Parent with BPD, 28% risk of child developing BPD both parents with BPD 2-3x greater risk of child |
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Biochemical factors
Norepinephrine and dopamine high during mania, low during depression Serotonin remains low in both states |
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Neuroanatomical Factors
MRI reveal large third ventricles and subcortical white matter and periventricular hyperintensities |
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Client Teaching
Increase fluid intake - up to 2L/day May be swelling in extremities Metallic taste in mouth is normal Monitor blood levels regularly Signs and symptoms decrease longer client is on drug Always report side effects |
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Recurrent disorder where person has 1+ manic episodes with depressive episodes
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More manic than depressive episodes
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Mania is usually time-limited
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Recurrent major depressive disorders with hypomania
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More depressive episodes than hypomanic episodes
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Client never experiences full manic episode
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More common in women than men
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Mood disturbance of at least 2 years
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Numerous episodes of elevated mood
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Do not meet criteria of hypomanic episode
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Depressed mood not severe enough to meet MDD
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Medication, education, support
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Antimanic Agents
ie. Lithium |
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Anticonvulsant Agents
Carbamazepine Clonazepam Valporic acid Lamotrigine Effective for clients who are cycling Manage mania/hypomania |
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Antidepressant augmented with antipsychotics
Risperidone Olanzapine |
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Psychotherapy
Individual/group/family therapy 6-8 sessions reduce rate of relapse by 50% |
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ECT
Used with lithium to treat mania |
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Mood disturbance r/t physiological effects of substance
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Elevated, expansive or irritable mood
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Inflated self esteem
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Decreased need for sleep and distractibility
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Alcohol, opioids, inhalants, hypnotics, anesthetic, analgesics, anti-convulsants, cardiac medications, anti-parkinsonian agents, anti-ulcer agents, oral contraceptives, muscle relaxants, steroids, sulfonamides
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Antimanic agents
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Lithium Carbonate
Affects neurotransmitters Maintained by serum levels Must remain between 0.9-1.4mEq/L Toxic if above therapeutic range |
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Side Effects
Fluid retention, weight gain, metallic taste, fine tremors, thirst Slurred speech, abdominal pain, convulsions, incontinence, coma |
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Signs of Toxicity
Vomiting, slurred speech, blurred vision, weakness, tinnitus, poor coordination, diarrhea, poor coordination |
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