Clinical Practice Guidelines Approved Pharmacological Treatment Essay

NURS 6630 Week 5

Introduction

Bipolar II disorder is a mental illness characterized by moods cycling between low and high over time. The difference between Bipolar I and II is that the high moods in Bipolar II do not reach full-blown mania. The elevated moods in this disorder are regarded as hypomania or hypomanic episodes (Belteczki et al, 2021). Mostly, an individual with bipolar II disorder, hav e undergone an episode of hypomanic episodes in their lives. The most prominent feelings are episodes of depression hence the term manic depression term. People with bipolar II disorder tend to lead normal lives when they are experiencing hypomania. Clinical Practice Guidelines Approved Pharmacological Treatment Essay

Prevalence and Neurobiology of Bipolar II

Presently, bipolar mood disorder has become a leading cause of disability. However, its biological basis has not yet been established and its treatment is not satisfactory. It is important to note that Bipolar II mood disorder can be inherited and can be attributed to common variants of small effects (Belteczki et al, 2021). There are gene networks and risk genes that could potentially lead to Bipolar mood disorder. The disorder involves episodes of mood disturbance, immunological and physiological changes, neuropsychological, and disturbances in functioning (Belteczki et al, 2021). Ideally, it is associated with high rates of premature mortality emanating from medical comorbidities and suicide.  Epidemiological studies have revealed that 0.4% of the general population suffers from bipolar II disorder. However, it is important to note that the reasons for international differences in the prevalence of bipolar ii mood disorder are not entirely known and several factors such as ethnicity, and cultural factors could impact it.

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Studies show that there are different rates of bipolar II disorders in various ethnicities with some showing higher rates of the disorder among the Caucasians and non-white populations (Besag et al, 2021). Research shows that the black community has experienced higher rates of misdiagnosis of schizophrenia instead of bipolar II disorder. When it comes to sex, studies show that there is equal distribution in bipolar while others show that bipolar II disorder is more prevalent among females as compared to Bipolar I which is common among men. The mean age when bipolar appears is in the early twenties of an individual although research varies between 20 – 30 years (Besag et al, 2021) . It is important to note that sometimes, it is difficult to estimate the onset of the illness due to the long periods of the illness being untreated. Sometimes, the symptoms are not apparent as individuals do not assess services and may not understand the symptoms. Also, the presentation, as well as the clinical course of bipolar II disorder, appears to be different with higher rates of medical and psychiatric comorbidities such as vascular disease and suicidality.

With regards to the socio-economic status of people, studies reveal that higher rates of bipolar II disorder are experienced in low-income, unmarried and unemployed groups (Besag et al, 2021). Conversely, another finding indicates that higher occupational level and socioeconomic status may increase the risk of bipolar which is contrary to findings that creativity and high socioeconomic status could lead to a high risk of schizophrenia and depression. Clinical Practice Guidelines Approved Pharmacological Treatment Essay

Difference between Bipolar II and Cyclothymic disorder

Cyclothymic disorder is a bipolar-related disorder that is a milder version of bipolar II disorder. It is important to distinguish between the various types of bipolar so that doctors may know the best treatment options. Essentially, when a person gets access to cyclothymic treatment, it can help the illness from progressing to a severe type of bipolar disorder (Besag et al, 2021).  A person who has Cyclothymic tends to experience patterns of depressive and hypomanic symptoms for about two years but the episodes are brief and as severe as those in bipolar II disorder. Some of the symptoms of this disorder include significant changes in energy levels, shifts in mood, a tendency to overreact, and behavioral symptoms. Trouble maintaining personal relationships and increased sensitivity to stimuli.  Unlike bipolar II disorders, cyclothymic usually causes symptoms on more days than not and few periods of neutral mood in between (Besag et al, 2021). Unlike Bipolar II disorder which may have alarming symptoms such as suicidal thoughts and delusional thinking, cyclothymic is subtle and affects mostly interpersonal problems. Since its symptoms are not as severe as those of bipolar II disorder, the condition can be mistaken for a personality disorder or general moodiness.

Special Populations and Considerations for Bipolar II and Cyclothymic disorder

Under the DSM-5, cyclothymic is subsumed under the category of bipolar mood disorders and it is associated with a lifetime prevalence of about 1% with a ratio of male to female of 1:1. Studies show that the prevalence may increase especially in clinics while some reports reporting rising rates of 5% (Belteczki et al, 2021).  The pathophysiology of both disorders is that the people suffering from them have difficulties modulating their effect, which leads to hype-reactivity as well as regulatory deficits linked with functional abnormalities of the brain. Clinical Practice Guidelines Approved Pharmacological Treatment Essay

Legal, Ethical, Cultural, and Social determinants Considerations of Bipolar II and Cyclothymic disorder

Since these bipolar mood disorders are highly heritable, it is crucial to define some of the ethical considerations that may pose risks to individuals suffering from the illness. Once these factors are understood, it becomes easier to intervene early and prevent the illness. However, it is important to note that some interventions may carry risks, and may raise ethical concerns about when the treatment ought to begin and under what circumstances should it be administered (Belteczki et al, 2021). Research shows that people suffering from bipolar disorders report having low and inadequate social support between episodes of their illnesses. Further, studies show that social support can predict an increase in depression over time. Several family relationship dynamics are directly related to bipolar disorders. Family function plays a significant role in determining the severity of a person’s illness.

FDA and/or clinical practice guidelines approved pharmacological treatment options for FDA and/or clinical practice guidelines approved pharmacological treatment options.

The treatment and medication for bipolar disorders have been mainly studied in adults. However, there is a growing wave of research that is looking into the treatment of adolescents and children with bipolar disorder There are several medications approved by the FDA that are effective in treating pediatric bipolar disorder such as quetiapine, lithium, aripiprazole, olanzapine, and risperidone (Pisano et al, 2022). Also, several second-generation antipsychotic medications as well as anticonvulsants that have not been approved by FDA have been researched in children and adolescents having bipolar disorders. Further, there is empirical evidence for their use, the potential side effects, and dosing guidelines.

Another important component of managing bipolar disorders is understanding and managing risk factors, recognizing early symptoms, and seeking the required help such as psychoeducation, counseling, and pharmacotherapy.  Psychoeducation plays a crucial role as its emphasizes the importance of medication and compliance with it. Also, it instills confidence in the doctor, helps one to accept the illness, and acknowledges the impact of the maladaptive behavior patterns (Pisano et al, 2022).  Use of first-line psychotropic treatment is effective and sometimes the patients may benefit from dual therapy where they combine lamotrigine and lithium. Other times, an antipsychotic can be applied as a monotherapy alongside a mood stabilizer. Further, cognitive behavior therapy has proven to be effective in the treatment of bipolar disorders. Patients are recommended to work closely with their doctors to ensure that the treatment plans are adjusted as necessary. Clinical Practice Guidelines Approved Pharmacological Treatment Essay

What To Monitor In Terms Of Labs, And Comorbid Medical Issues.

Research shows that cardiovascular diseases, endocrine disorders, and types 2 diabetes mellitus tend to occur more often in patients diagnosed with both bipolar mood disorder and Cyclothymic disorder as compared to the general population. According to studies, cardiovascular mortality is reported to be twice as high in patients with bipolar II mood disorder and Cyclothymic disorder which may lead to higher rates of obesity. Some of the hypothesized mechanisms to explain such findings include unrecognized risk factors, smoking, and sedentary lifestyle (Pisano et al, 2022). Comorbid neurological such as migraine headaches have been reported to be more prevalent among patients with bipolar II mood disorder and Cyclothymic disorder. Although clinical guidelines for Bipolar II mood disorder support that treating the disease is complex most of them have limited recommendations specific to the patient with the mentioned comorbidities. That is a reflection of the limited nature of clinical research in the field. There is a need for medical practitioners to refine their view of the comorbid interface. Clinical Practice Guidelines Approved Pharmacological Treatment Essay

References

Belteczki, Z., Rihmer, Z., Rozsa, S., Ujvari, J., Pompili, M., Gonda, X., & Dome, P. (2021). Affective Temperaments, Panic Disorder and Their Bipolar Connections. Medicina, 57(3), 289. doi: 10.3390/medicina57030289

Besag, F. M., Vasey, M. J., Sharma, A. N., & Lam, I. C. (2021). Efficacy and safety of lamotrigine in the treatment of bipolar disorder across the lifespan: a systematic review. Therapeutic Advances in Psychopharmacology, 11, 20451253211045870. https://doi.org/10.1177/20451253211045870

Pisano, S., Sesso, G., Senese, V. P., Catone, G., Milone, A., & Masi, G. (2022). The assessment of cyclothymic-hypersensitive temperament in youth with mood disorders and attention deficit hyperactivity disorder. Journal of Affective Disorders, 298, 322-328. https://doi.org/10.1016/j.jad.2021.11.013

The Assignment: 5 pages
For this assignment, you will write a 5–6-page paper on the topic of bipolar and bipolar and related disorders. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of your course provided resources.

In your paper, you will choose one of the following diagnoses: Bipolar I, Bipolar II, Cyclothymic Disorder, Substance/Medication-Induced Bipolar and Related Disorder, Bipolar and Related Disorder Due to Another Medical Condition. Your paper will include discussion for your chosen diagnosis of bipolar and related disorder on the following: Clinical Practice Guidelines Approved Pharmacological Treatment Essay

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Prevalence and Neurobiology of your chosen disorder
Discuss the differences between your chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria including presentation of symptoms according to DSM 5 TR criteria
Discuss special populations and considerations (children, adolescents, pregnancy/post-partum, older adult, emergency care) for your chosen bipolar and related disorder; demonstrating critical thinking beyond basics of HIPPA and informed consent with discussion of at least one for EACH category: legal considerations, ethical considerations, cultural considerations, social determinants of health
Discuss FDA and/or clinical practice guidelines approved pharmacological treatment options in relation to acute and mixed episodes vs maintenance pharmacological treatment for your chosen bipolar and related disorder
Of the medication treatment options for your chosen disorder discuss side effects, FDA approvals and warnings. What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring
Provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy. Clinical Practice Guidelines Approved Pharmacological Treatment Essay