Treatment for Bipolar I
Treatment for Bipolar I
Current paper examines DSM-IV-TR Bipolar I disorder and methods of its treatment. DSM-IV-TR Bipolar I disorder is defined by periodic change of mild (depression) and serious (mania) mood. Occurrences can be mainly depressive or manic, with normal and stable temper between occurrences. Temper changes can follow one another in a short term, in few days, or can happen with long breaks in months or years. The serious and mild can alter in severity and intensity and may cohabit in mixed forms.
When patients are in a manic phase, they can be overly communicative, have a lot of energy, hyperactive, and have less time for sleep and for rest than usually. They can quickly change the topic of conversation because it is hard for them to express their thoughts clearly and quickly. Their span of attention is short, and it is easy to distract them. Mania, in untreated state can transform into a psychotic condition (Manic depression / Bipolar disorder, 2013).
In a depressive state, the patient can have a mild temper with difficulties in concentration; demerit of energy, with slow movements and thinking; alterations in sleeping and eating habits; feelings of sadness, guilt, helplessness, hopelessness, worthlessness or even ideas of suicide.
Nowadays, DSM-IV-TR Bipolar I disorder may be treated in several ways, with using of medication (pharmacological treatment), electroconvulsant therapy or by psychotherapy.
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Lithium is one the medications that is often used to cure Bipolar I disorder. Lithium aligned temper changes in both cases from depression to mania, and from mania to depression, thus, it is applied not only to manic episodes or exacerbation of the affection, and as a long-standing maintenance therapy for Bipolar I disorder.
Moreover, lithium can reduce strong symptoms of manic in term from 5 to 14 days; it can take weeks or even months to control the condition. Antipsychotic medicines sometimes are applied in the prime period of treatment to regulate manic indicants before the lithium starts to take effect. Antidepressants also can be taken with lithium in term of the depressive condition of Bipolar I disorder. In case, if given in the lack of lithium or another stabilizer of temper, antidepressants can cause a transformation into mania among patients with Bipolar I disorder.
An individual can have one occurrence of Bipolar I disorder and never have regression, or he may be free of disorder for some years. However, for those who have few manic happenings, doctors often give essential examination to maintenance therapy with lithium.
Some patients react well to the therapy continuation and have no episodes in the future. Others can have reserved temper changes that diminish as pharmacological therapy lasts, or have less strong or less frequent occurrences. Nevertheless, some individuals with Bipolar I disorder cannot be treated at all by the use of lithium. Reaction to therapy with lithium is different, and it cannot be known in advance who will or will not react to treatment (Introduction: Bipolar disorder, 2008).
Permanent blood examinations are a significant part of therapy with lithium. In a small dose application, lithium will not be efficient, and in big dose it may cause different side effects. The range of application between an efficient dose and a critic one is little. The level of lithium in blood is checked at the beginning of therapy to identify the correct lithium dosage. When a patient is stable and on a certain dosage, the level of lithium must be examined every two months. The quantity of lithium that individuals have to take can vary over some period; it depends on the stage of disorder of patients, their physical condition, and their body chemistry.
Side Effects of Lithium
When individuals take lithium for the first time, they can have such side effects as weakness, hand tremor, drowsiness, fatigue, nausea, or urination and increased thirst. Some can decrease or vanish quickly, however, hand tremor can remain. Rapid gain of weight also can occur. Dieting can be effective, however, extreme diets must be evaded as they can lower or raise the level of lithium. Taking no-calorie or low-calorie beverages, will aid in reducing weight. During treatment, some kidney disorders, like increased urination or enuresis may develop. These disorders are usually controllable and are diminished by decreasing the dosage. The treatment with lithium can produce the hypothyroidism of thyroid body or in some cases goiter that is why, the monitoring of thyroid function is a part of the treatment. To restore normal thyroid function, thyroid hormone may be given along with lithium.
By virtue of probable ravelments, doctors cannot prescribe lithium or can recommend it with warning when a patient has kidney, heart, or thyroid disorders, brain damage, or epilepsy. Women of reproductive years must be warned that lithium augments the possibility of congenital defects in babies. Special warnings must be taken in period of pregnancy during the first 3 months (Smith, Robinson, Segal, & Ramsey, 2013).
Anything that decreases the sodium level in the body a passage on a low-salt diet, low consumption of table salt, vomiting, fever, or diarrhea advance sweating from physical activities or a hot climate, can be a reason of a lithium cumulation and turn to toxicity. It is substantial to be warned of state that decreases sodium or occurrence of dehydration and to contact the doctor if these states are present so the dosage is changed.
With proper controlling, lithium is a reliable and effective medication that permits many individuals with disabling changes of mood, to have normal lives.
Anticonvulsants (Valproic Acid) Therapy
Some individuals with evidence of mania who have clinical holds or prefer to evade lithium have been found to react to anticonvulsant drugs usually prescribed to cure seizures.
Valproic acid (divalproex sodium, depakote) is the anticonvulsant, and it is the basic alternative treatment for Bipolar I disorder. It is efficient in both Bipolar I disorder non rapid-cycling and with lithium in Bipolar I disorder rapid-cycling. Whereas valproic acid can be the reason of gastrointestinal disorders, the frequency is low. Other side effects intermittently happened are double vision, dizziness, headache, confusion, or anxiety. However, in some episodes valproic acid has caused liver malfunction, liver examinations must be effected before treatment and with short intervals after therapy, notably during the first several months of treatment.
Researches made in Finland among individuals with epilepsy demonstrated that valproic acid can enhance the level of testosterone among girls and generate Stein-Leventhal syndrome among females that start taking the treatment under the age of 20. Stein-Leventhal syndrome can produce amenorrhea, hirsutism and obesity. Hence, young women patients must be supervised observantly by a specialist (Bipolar disorder, 2013).
Other anticonvulsant substances applied for Bipolar I disorder are lamotrigine (Lamictal), carbamazepine (Tegretol), topiramate (Topamax), and gabapentin (Neurontin). The averment for anticonvulsant efficacy is more intense for mania than for long-term Bipolar I disorder. Some researchers offer exception effectiveness of Lamictal for depression. Nowadays, the incomplete of formal FDA confirmation of anticonvulsants difference from the use of valproic acid for Bipolar I disorder and can limit insurance deposit for these medicines.
Most patients with Bipolar I disorder use more than one medicine. Together with the temper stabilizers like anticonvulsants and lithium, they can use a medication for companion anxiety, agitation, depression, or insomnia. It is essential to hold on taking the temper stabilizer when using an antidepressant. The study has demonstrated that therapy with antidepressants augment the risk that the individual will pass to hypomania, or mania. Occasionally, when a Bipolar I patient is not reacting to other medicines, a doctor can prescribe an atypical antipsychotic therapy.
Instructions of the American Psychiatric Association offer that electroconvulsant therapy is an admissible optional treatment for those people who can have suicidal squint or psychosis. Moreover, electroconvulsant therapy may be effective for pregnant females who suffer intense Bipolar I mania or depression.
Together with pharmacological treatment for Bipolar I depression, individuals can have a positive result from long-term psychotherapy. This individual therapy blends behavioral techniques with interpersonal psychotherapy to assist people in finding out how to decrease interpersonal issues, regulate their life pattern and remain on their medicines (Suppes, & Dennehy, 2012).
DSM-IV-TR Bipolar I disorder is a common psychiatric condition, nevertheless, it is possible to overcome it if to keep to a special therapy mode. At the mean, a patient is free of indication for about four-five years between the occurrences. With the course of time, a period between occurrences can shorten, particularly in episodes when therapy is discontinued rapidly. It is proposed that an individual with Bipolar I disorder has at the mean of seven to nine temper cases in term of his or her lifespan.
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- NIMH » Bipolar Disorder
- The Ohio State University Wexner Medical Center