Prevalence and Neurobiology of Bipolar 1 Assignment

Bipolar 1 Disorder

A bipolar disorder is encompasses a mental health disorder characterized with unusual changes of an individual’s mood, activity levels, energy and concentration. These are the changes that make it difficult for one to execute their normal daily routine. Bipolar is categorized into three, where Bipolar 1 is my bipolar disorder of choice. Bipolar 1 by definition refers to the manic episodes that in most cases last for seven consecutive days. The manic symptoms at this stage are severe where the person requires medical attention with immediate effect (Xu et al., 2020). Bipolar 1 is also characterized with depressive episodes that last for about two weeks. Bipolar 1 can therefore manifest through having both depressive and manic symptoms at the same time, which makes it even more dangerous. The aim of this paper is exploring the bipolar 1 disorder. Prevalence and Neurobiology of Bipolar 1 Assignment

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Prevalence and Neurobiology of Bipolar 1

Bipolar 1 occurs as a chronic illness, where it is estimated that 1% of the global population live with the disorder. The disorder occurs in the same rate with respect to gender and mostly begins at adolescence or early adulthood. However, the disorder also begins at childhood in rare cases. It is a disorder that has been found to occur equally across all the cultures of the world regardless of the race or ethnic groups. The bipolar 1’s neurobiology is a complex one, where different research works have suggested various factors to be contributing to the disorder’s development. To start with, genetic factors is one contributing factor for development of bipolar 1 disorder. Many research studies have suggested a genetic component that makes people from a family with a history of bipolar 1 disorder to progressively develop the disorder generation wise (Tokumitsu et al., 2020). Although the gene is still under investigation, most studies have suggested genetic factors as potential risk factors. Secondly, the imbalances and dysregulations of neurotransmitters such as norepinephrine, dopamine and serotonin responsible for mood regulation contribute to development of Bipolar 1 disorder. For instance, in manic cases, increase in dopamine may trigger mood elevation. Finally, environmental factors may also be contributing factors to development of bipolar 1. For example, drug abuse, traumatic events, sleep pattern disruptions among other life stressors in a given environment may trigger bipolar 1 disorder. According to Xu et al (2020), brain damage is also attributed to the development of this disorder especially in areas such as the hippocampus, prefrontal cortex and amygdala that play an essential role in structuring the brain’s functionality. Prevalence and Neurobiology of Bipolar 1 Assignment

Difference between the Bipolar 1 disorder and Cyclothymic disorder symptoms according to DSM 5 TR criteria

There are various differences between bipolar 1 disorder and cyclothymic disorder according to the DSM 5 TR criteria. The first difference is that bipolar 1 is characterized with one manic episode that can either be extensive mood elevation or increased activity. The period of this elevated mood can last for at least seven days. In cyclothymic disorder, there are multiple periods of hypomanic symptoms, similar to those of bipolar 1, but less severe (Monahan et al., 2022). The symptoms in this case may at least go for four consecutive days but not so severe. The second difference is that in bipolar 1 disorder, the patient might experience major depressive disorder symptoms such as hopelessness, sadness and lack of interest in most activities, and can last for at least 2weeks. In cyclothymic disorder on the other hand, the patient also experience similar symptoms of major depressive disorder, but in a mild state. These symptoms however fail to meet the complete criteria for major depressive episode. Finally, in bipolar 1 disorder, the symptoms of depressive and manic episodes end up impairing the patient’s occupational and social life (Baldessarini et al., 2019). In the case of cyclothymic disorder, they also cause significant impairment of the patient’s social and occupational life, despite being less severe. Prevalence and Neurobiology of Bipolar 1 Assignment

Special populations and considerations

Children

The legal consideration for children is engaging the parents or guardians in major decision making processes such as during the choice of a treatment plan for the child, since they lack informed consent. Child abuse laws are also a consideration in such a case. In terms of ethical consideration, the child’s autonomy should well be balanced with the best interest while considering parental involvement in decision making (López-Muñoz et al., 2018). Ethical considerations also encompasses ensuring that all interventions are best addressing the wellness of the child. In the case of cultural consideration, there should be utmost respect to cultural values, beliefs and practices that in fluence the decision making of the child’s healthcare plan. Prevalence and Neurobiology of Bipolar 1 Assignment

Adolescents

The legal consideration at this age group is ensuring that there is a balance in the rights of adolescents when making their healthcare decisions. It should be done in consideration of the legal consent age and confidentiality. The ethical consideration in the adolescents is respecting their privacy, growing autonomy and rights to confidentiality while at the same time considering their decision making capacity and involved potential risks (Carvalho et al., 2020). Cultural consideration on the other hand should be considered through acknowledging the variations in cultural practices and how they transit from adolescence to adulthood with a consideration of the role of family and community in their decision making.

Pregnancy/Postpartum

The legal consideration for this population group involves confidentiality and privacy protection of information that is sensitive while at the same time complying with legal requirements such as child abusing reporting, reporting of prenatal substance exposure or any other issue concerning maternal wellbeing. The ethical consideration in this case is ensuring that a strike in balance is achieved between the mother’s wellbeing and the wellbeing of the fetus through facilitating a proper access to prenatal care and proper treatment options (Tokumitsu et al., 2020). It also involves respecting the rights of the pregnant women making their healthcare decisions as well as decision for their unborn babies.  In terms of cultural considerations, the diverse cultural beliefs of the pregnant woman that surrounds childbirth, pregnancy and postpartum care should be observed. Prevalence and Neurobiology of Bipolar 1 Assignment

Older adults

With regards to legal considerations, issues related to competency, consent and guardianship while in the process of working with elder adults who might be suffering from cognitive impairment thereby limiting their decision making should be considered. Elder abuse cases reporting is also essential in this case. With regards to ethical considerations, there should be promotion of dignity, self-determination rights and autonomy for elder adults regardless of the presence of cognitive impairment (Xu et al., 2020). Therefore, their preferences and contributions in decision making should highly be valued. With regards to cultural consideration, it is essential to understand their culture’s factors that affect healthcare decisions, aging attitudes and end of life preferences.

Emergency care

With regards to legal considerations, there should be a strike in balance for the need for immediate medical intervention and acquiring informed consent, especially in a situation where the person is not able to provide their consent as a result of incapacitation. With regards to ethical considerations, patient wellbeing, safety and life saving measures should come first in emergency cases while striving to respect the rights of patients and their autonomy. There should also be a clear communication with family members or any other decision maker if available. Finally, cultural considerations should also be observed through recognizing the beliefs, communication styles and any language barrier that might influence healthcare delivery in emergency cases. Prevalence and Neurobiology of Bipolar 1 Assignment

When it comes to social determinants of health, it is important to consider the social determinants that cut across and affect all these special populations. The factors such as education, socioeconomic status, access to healthcare, housing, social support networks as well as discrimination are among the influencers of social determinants that affect patient outcomes (Monahan et al., 2022). Therefore, all healthcare providers are mandated to strive towards addressing these factors to ensure that equity and inclusivity of all patients in their practice are achieved.

FDA approved Pharmacological treatment options for Bipolar 1

Pharmacological approaches play an essential role in treatment and management of acute and mixed episodes of bipolar 1 disorder. The various FDA approved medications for treatment of bipolar 1 disorder are as follows;

Acute and mixed episodes

• Acute stabilizers used in treatment of acute manic or mixed episodes. They are essentially used to stabilize mood and prevention of episodes recurrence. Examples include valproate and lithium. Prevalence and Neurobiology of Bipolar 1 Assignment
• The second group of medications is antidepressants such as the SSRIs or SNRIs. They can effectively be used together with mood stabilizers to manage depressive symptoms during acute episodes (Carvalho et al., 2020).
• The third group of medication for managing acute and mixed episodes include the atypical antipsychotics. They are prescribed to reduced acute mania symptoms such as aggression and agitation. Examples include aripiprazole and quetiapine.

Maintenance treatment

• Mood stabilizers is the first group of medications. They facilitate prevention of future episodes of mania as well as promoting a long term stability. An example is lithium medication.
• The second group of medications is the Atypical Antipsychotics such as olanzapine and quetiapine which help in relapse prevention as well as reduction of frequency and severity of mood episodes (Baldessarini et al., 2019).
• Electroconvulsive Therapy (ECT) is also a pharmacological maintenance treatment that is effectively used when other pharmacological interventions are poorly tolerated.
• Finally, the Anticonvulsants medications such as the carbamazepine and lamotrigine used in maintenance treatment of bipolar disorder (López-Muñoz et al., 2018). They facilitate manic and depressive episodes prevention.

Side effects, FDA approvals and warnings

The side effects associated with lithium include nausea, vomiting, diarrhea, increased urination and thirst, tremor and weight gain. Some long term side effects may include thyroid and kidney related problems. Lithium is an FDA-approved medication for treating mixed and manic symptoms (Monahan et al., 2022). Warnings with the use of lithium is close monitoring of blood levels to prevent toxicity. It can also interact with other medications to cause during pregnancy hence the need for close monitoring. Prevalence and Neurobiology of Bipolar 1 Assignment

The side effects of Atypical Antipsychotics such as Quetiapine and Aripiprazole include weight gain, glucose intolerance, dyslipidemia, symptoms of extrapyramidal and sedation (Tokumitsu et al., 2020). The medications are FDA approved for treating mixed and acute manic symptoms as well as maintenance medication in Bipolar 1 disorder. One major warning is increased mortality for elderly patients with dementia.

Valproate medication has side effects such as hair loss, tremor, weight gain and gastrointestinal symptoms. Liver function abnormalities is an extra-long term symptom. The medication is FDA approved for treating mixed and acute manic symptoms as well as maintenance medication in Bipolar 1 disorder (Carvalho et al., 2020). The warnings of the medication is that one develops a risk of developing pancreatitis and hepatotoxicity.

The first monitoring consideration is kidney and thyroid functioning for individuals prescribed lithium in treatment and management of bipolar 1 disorder. Lithium may affect kidney and thyroid function hence the need for a regular monitoring in the renal function and thyroid hormone (Baldessarini et al., 2019). The second consideration is monitoring of liver functioning since Valproate can affect the enzymes of the liver hence altering its functioning. Blood levels monitoring is also essential for patients under lithium medication to avoid toxicity of the blood. Prevalence and Neurobiology of Bipolar 1 Assignment

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Examples of proper prescription

Example 1: Mood stabilizer prescription

Patient Name: John Maxwell

Date: 24/6/2023

Prescription

Medication: Lithium

Dosage: 300mg

Instructions: One tablet orally on daily basis

Quantity: 30tabs

Refills: 3

Doctor’s Signature:

Example 2: Aripiprazole medication prescription

Patient Name: Maryann kyalo

Date: 20/6/2023

Prescription

Medication: Aripiprazole

Dosage: 10mg

Instructions: One tablet orally on daily basis after meal.

Quantity: 30tabs Prevalence and Neurobiology of Bipolar 1 Assignment

Refills: 2

Doctor’s Signature:

Example 2: Sertraline Hydrochloride (SSIR) medication prescription

Patient Name: Simon Kim

Date: 23/6/2023

Prescription

Medication: Sertraline Hydrochloride

Dosage: 50mg

Instructions: One tablet orally daily after breakfast.

Quantity: 30tabs

Refills: 1

Doctor’s Signature:

In a recap, bipolar 1 is a mental health disorder and the most severe type of bipolar that requires immediate medical intervention. It involves both depressive and manic episodes that can last seven to 14 days. Various contributors of bipolar 1 development include genetic factors, environmental factors, brain impairment among other factors. The disorder can develop at adolescent age and adulthood stage. However, the disorder rarely begins in childhood. As compared to other types of bipolar such as the cyclothymic, the bipolar 1 symptoms are manic and depressive and much more severe compared to other types. Examples of the various FDA-approved medications for this disorder include SSRIs, SNRIs, antipsychotics and mood stabilizers among others. Prevalence and Neurobiology of Bipolar 1 Assignment

References

Baldessarini, R. J., Tondo, L., & Vázquez, G. H. (2019). Pharmacological treatment of adult bipolar disorder. Molecular psychiatry, 24(2), 198-217. https://doi.org/10.1038/s41380-018-0044-2

Carvalho, A. F., Firth, J., & Vieta, E. (2020). Bipolar disorder. New England Journal of Medicine, 383(1), 58-66. DOI: 10.1056/NEJMra1906193

López-Muñoz, F., Shen, W. W., D’ocon, P., Romero, A., & Álamo, C. (2018). A history of the pharmacological treatment of bipolar disorder. International journal of molecular sciences, 19(7), 2143. https://doi.org/10.3390/ijms19072143

Monahan, C., McCoy, L., Powell, J., & Gums, J. G. (2022). Olanzapine/Samidorphan: New Drug Approved for Treating Bipolar I Disorder and Schizophrenia. Annals of Pharmacotherapy, 56(9), 1049-1057. https://doi.org/10.1177/10600280211070330

Tokumitsu, K., Yasui-Furukori, N., Adachi, N., Kubota, Y., Watanabe, Y., Miki, K., … & Watanabe, K. (2020). Real-world clinical features of and antidepressant prescribing patterns for outpatients with bipolar disorder. BMC psychiatry, 20(1), 1-11. https://doi.org/10.1186/s12888-020-02967-5

Xu, N., Huggon, B., & Saunders, K. E. (2020). Cognitive impairment in patients with bipolar disorder: impact of pharmacological treatment. CNS drugs, 34(1), 29-46. https://doi.org/10.1007/s40263-019-00688-2 Prevalence and Neurobiology of Bipolar 1 Assignment