Bipolar Disorder is characterized by moderate or severe depression that alternates with very high levels of happiness and physical activity most of the time. Mania that is sometimes severe enough to compromise functioning is required for Bipolar I Disorder. Approximately 90% of patients have periods of depression. A manic episode usually develops over several days, and 20% of individuals in a manic state have hallucinations and/or delusions. Severe mania may be indistinguishable from organic delirium. A person with this disorder usually has a difficult time concentrating, needs very little sleep, and may have inflated self-esteem. Often people with this disorder have also had at least one major depressive episode.
The first manic episode usually occurs before age 30. It usually occurs quickly and resolves in two to four months. One or more periods of depression have usually already occurred. Suicide is a major risk during depressive episodes. Legal difficulties or substance use are major risks during manic episodes.
Bipolar II Disorder occurs when a patient has a major depressive episode and also experiences a hypomanic episode (usually around the time of the depression) but never develops a full manic episode.
Approximately 5 to 10% of first degree relatives with Bipolar Disorder develop the illness. Bipolar Disorder is considered a genetic disorder due to 70% concordance for identical twins. There is some evidence to suggest an abnormality on chromosome 11, but this is not clear at this time.
Theoretical approaches used with this disorder are psychoeducation and cognitive-behavioral therapy. The treatment of Bipolar Disorder deals with the acute manic and acute depressive episodes as well as the prevention of manic and depressive recurrence. It seems that discussing the diagnosis and including the patient in his/or her own treatment is effective. The patient should keep a chart of sleeping patterns and mood patterns.
You will need to conduct an assessment, including a thorough clinical history and psychosocial, as well as address any safety issues. A psychiatrist should be involved in the client's treatment and may prescribe Lithium to relieve his/or her immediate symptoms. If mania is present, then the patient may need to be hospitalized to ensure personal safety. A referral to a physician is a good idea to rule out any possible general medical condition that may pre-exist (obtain a release). Neuroleptic medication in small doses may help hypomanic episodes. Larger doses may be needed to treat mania. Meet the patient in a quite place with minimal stimulation. Firm limits may be needed to prevent acting out or self-destructive behaviors.
Finally, explain the diagnosis and treatment suggestions to the patient. Make sure you are supportive yet firm regarding dangerous behaviors. You may be able to reduce some of the patient's immediate symptoms by acting in a non-judgmental and genuine manner. Find out what type of support the patient has and elicit community resources. Family therapy may be helpful to educate and allay the fears of family members. They are an important resource and should be utilized if possible.