Clarkson College summary of bipolar disorder subtypes, diagnostic criteria,
Rebustes, Initial Post Bipolar I disorder is characterized by manic episodes that may alternate with major depressive episodes, while Bipolar II disorder involves recurrent major depressive episodes with hypomanic episodes rather than full-blown manic episodes (Parker et al., 2021). Bipolar affective disorder is an umbrella term encompassing both Bipolar I and Bipolar II disorders, reflecting the fluctuation between depressive and manic states. Cyclothymia, on the other hand, is a milder form of bipolar disorder marked by numerous periods of hypomanic symptoms and depressive symptoms that do not meet the criteria for major depressive episodes (Parker et al., 2021). Manic depression, often used interchangeably with bipolar disorder, refers specifically to the mood disorder characterized by periods of depression and mania or hypomania. Kaplan and Sadock’s Synopsis of Psychiatry and the Canadian Network for Mood and Anxiety Treatments (CANMAT) provide distinct perspectives on the treatment of bipolar disorder, each emphasizing different aspects of care and management. Kaplan and Sadock’s Synopsis of Psychiatry offers a comprehensive overview of treatment modalities for bipolar disorder, encompassing both pharmacological and psychotherapeutic interventions (Kaplan et al., 2021). It emphasizes the importance of a multimodal approach, incorporating medication management with mood stabilizers, antipsychotics, and adjunctive therapies like antidepressants, alongside psychotherapy. Kaplan and Sadock’s approach emphasizes a thorough understanding of the patient’s history, psychosocial factors, and individual response to treatment. In contrast, the Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines provide a more structured and evidence-based framework for the treatment of bipolar disorder (Yatham et al., 2021). It outlines specific algorithms for the management of bipolar disorder across different phases, including acute episodes, maintenance treatment, and special populations like children and adolescents. Overall, CANMAT guidelines prioritize the use of evidence-based pharmacological treatments, with clear recommendations for first-line agents, as well as the cautious use of antidepressants in conjunction with mood stabilizers. CANMAT guidelines are notable for their focus on evidence-based practices and include specific recommendations for different phases of bipolar disorder (Yatham et al., 2021). Kaplan and Sadock’s Synopsis provides a comprehensive overview of treatment modalities with a focus on understanding underlying mechanisms and psychodynamic approaches (Kaplan et al., 2021). References Kaplan, H. I., Sadock, B. J., Boland, R., Verduin, M., & Ruiz, P. (2021). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Parker, G., Spoelma, M. J., Tavella, G., Alda, M., Hajek, T., Dunner, D. L., O’Donovan, C., Rybakowski, J. K., Goldberg, J. F., Bayes, A., Sharma, V., Boyce, P., & Manicavasagar, V. (2021). Categorical differentiation of the unipolar and bipolar disorders. Psychiatry Research, 297, 113719. https://doi.org/10.1016/j.psychres.2021.113719 Yatham, L. N., Chakrabarty, T., Bond, D. J., Schaffer, A., Beaulieu, S., Parikh, S. V., McIntyre, R. S., Milev, R. V., Alda, M., Vazquez, G., Ravindran, A. V., Frey, B. N., Sharma, V., Goldstein, B. I., Rej, S., O’Donovan, C., Tourjman, V., Kozicky, J., Kauer, S. M., & Malhi, G. (2021). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) recommendations for the management of patients with bipolar disorder with mixed presentations. Bipolar Disorders, 23(8), 767–788. https://doi.org/10.1111/bdi.13135 Noonan IP: Module 4 Discussion Bipolar I can also be called manic depression, and for a diagnosis to be made, there must be at least one manic episode and an irritable mood above normal (Boland et. al, 2022). In contrast, Bipolar II patients have hypomania as opposed to mania (Boland et. al, 2022). For a diagnosis to be made for bipolar II, patients must have at least one depressive and one hypomanic episode (Boland et. al, 2022). The third category of bipolar disorders is Cyclothymic Disorder, characterized by hypomania and depression symptoms but less severe and not quite meeting the full criteria for diagnosis of Bipolar I or II (Boland et. al, 2022). There’s also unipolar mania which is categorized as at least one manic episode with no depressive symptoms or episodes (Change et. Al, 2023). According to CANMAT, the age of onset of bipolar disorder is around late adolescence or early adulthood with an average age of diagnosis around 25 years old with an estimated prevalence of 2.4% (Yatham et. al, 2018). The similarity is the burden of diagnosis, at least 30% are unable to maintain work and quality of life is reduced compared to healthy counterparts (Yatham et. al, 2018). There is a strong familial connectivity, and most antidepressants can potentially induce hypomania or mania (Boland et. al, 2022). Treatments differ based on presenting symptoms. For instance, the most common firstline monotherapies of acute mania include Lithium, Divalproex, Olanzapine, Abilify, and Risperidone (Boland et. al, 2022). There’s also the possibility of an adjunctive therapy to add Lithium or Divalproex which include Olanzapine, Aripiprazole, and Quetiapine (Boland et. al, 2022). The treatment for bipolar depression includes the same agents Lithium or antipsychotics such as Quetiapine and Olanzapine (Boland et. al, 2022). However, Lamotrigine is not recommended for acute mania but has shown efficacy for bipolar depression (Boland et. al, 2022). Antidepressants remain controversial for use in bipolar depression due to the question of safety, inducing a manic or hypomanic episode, and the efficacy (Yatham et. al, 2018). References Boland, R., Verdiun, M. & Ruiz, P. (2022). Kaplan & Sadock’s Synopsis of Psychiatry: Vol.Twelfth edition. Wolters Kluwer Health. Chang, C.-E., Wang, J., Lin, Y.-T., Chiu, C.-C., Hsieh, M.-H., Huang, M.-C., Lu, M.-L., Chen, H.C., Chen, W. J., & Kuo, P.-H. (2023). Characterization of clinical features and comorbidities between bipolar affective disorder with and without depressive episodes. Psychological Medicine, 53(9), 4103–4113. https://doi.org/10.1017/S0033291722000782Links to an external site.. Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., Sharma, V., Goldstein, B. I., Rej, S., Beaulieu, S., Alda, M., MacQueen, G., Milev, R. V., Ravindran, A., O’Donovan, C., McIntosh, D., Lam, R. W., Vazquez, G., Kapczinski, F., & McIntyre, R. S. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20(2), 97– 170. https://doi.org/10.1111/bdi.12609Links to an external site..
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