Bipolar Disorder assessing

Recommend monitoring methods for assessment of therapeutic and adverse effects of drugs used in the treatment of bipolar disorder. 

O Patients presenting with depressive or elevated mood features and a history of abnormal or unusual mood swings should be assessed for bipolar disorder. 

Based on all information presented, create a care plan for this patient s bipolar disorder. Your plan should include (1) a statement of the drug-related needs and/or problems, (2) the goals of therapy, (3) a patient-specific therapeutic plan, and (4) a plan for follow-up to assess therapeutic response and adverse effects. 

Lochhead,R. A., Oquendo, M. A, Mann, J. J. and Parsey,R.V. Regional brain gray matter volume differences in bipolar disorder patients as assessed by optimized voxel-based morphometry. Biol. Psych. 55 1154-1162, 2004. 

Another way that professionals assess for psychiatric disorders is to use an inventory that assesses for personality characteristics. The most famous of these inventories is the Minnesota Multiphasic Personality Inventory (MMPI), which is now in its second edition as an instrument. Although the MMPI is actually a personality inventory, as it names suggests, many professionals will use it to spot suspected psychiatric disorders, such as depression, Bipolar Disorder, Schizophrenia, and Anxiety Disorder. The MMPI has several scales to assess common personality traits, such as depression, mania, psychopathic deviance, and even alcohol and drug use (Weed, Butcher, McKenna, Ben-Porath, 1992). 

Aripiprazole has been approved for treatment of schizophrenia and acute manic or mixed episodes in bipolar disorder. This medication is also indicated for maintenance treatment in bipolar I disorder. The recommended starting and target dose for aripiprazole in patients with schizophrenia is 10 or 15 mg/day. This is a once-daily dose, and patients can take the medication with or without food. Although this medication has been shown to be effective in doses ranging from 10 to 30 mg/day, doses higher than 10-15 mg have not been shown to be more effective than 10- to 15-mg doses in patients with schizophrenia. The recommended starting dose for treatment of an acute manic or mixed episode is 30 mg the recommended dose for maintenance treatment in stable patients is 15 mg/day. The elimination half-life is 75 hours, and steady-state concentrations are reached within 2 weeks. Therefore, dose adjustments are recommended every 2 weeks, to allow time for clinical assessments of the medication s effects to be observed at steady-state concentration. Peak plasma concentrations occur within 3-5 hours. At equivalent doses, the plasma concentrations of aripiprazole from the solution were higher compared with plasma concentrations associated with the tablet form. 

Combination strategies to assess the benefits and risks of treatment with a new drug if added on to an established administration regimen (e.g. in treatment-resistant patients, bipolar disorder, etc.). 

Finally, the physician must assess whether the patient has a unipolar or bipolar disorder, because patients with the latter disorder are often first seen with a depressive episode. 

Nonpsychotic persons also experience impaired performance as judged by a number of psychomotor and psychometric tests. Psychotic individuals, however, may actually show improvement in their performance as the psychosis is alleviated. The ability of the atypical antipsychotic drugs to improve some domains of cognition in patients with schizophrenia and bipolar disorder is controversial. Some individuals experience marked improvement and for that reason, cognition should be assessed in all patients with schizophrenia and a trial of an atypical agent considered, even if positive symptoms are well controlled by typical agents. 

Glueck et al. assessed hypocholesterolemia in 203 patients hospitalized with affective disorders (depression, bipolar disorder, and schizoaffective disorder), 1595 self-referred subjects in an urban supermarket screening, and 11,864 subjects in the National Health and Nutrition Examination Survey II (a national probability sample) [34], Low plasma cholesterol concentration (<160 mg/dL) was much more common in patients with affective disorders than in those found in urban supermarket screening subjects or in the National Health and Nutrition Examination Survey II subjects. When paired with supermarket screening subjects by age and sex, patients with affective disorders had much lower TC, LDL, HDL, and higher TG concentrations. However, there was no evidence that low plasma cholesterol could cause or worsen affective disorders [34]. 

Chana G, Landau S, Beasley C, Everall IP, Cotter D. 2003. Two-dimensional assessment of cytoarchitecture in the anterior cingulate cortex in major depressive disorder, bipolar disorder, and schizophrenia Evidence for decreased neuronal somal size and increased neuronal density Biol Psychiatry 53(12) 1086-1098. 

The aim of another study was to evaluate the long-term efficacy of clozapine in patients with treatment-resistant schizophrenia (n = 34), schizoaffective disorder, bipolar type (n = 30), or bipolar disorder with psychotic features (n = 37), who were treated with clozapine in flexible doses over 48 months (16). After this time, Global Assessment of Functioning scores were improved in all three groups, with significantly greater improvement in the bipolar disorder group compared with the others ... 

The response to olanzapine in 150 consecutive patients has been assessed by reviewing their records (21). Patients with a moderate-to-marked response to olanzapine were more likely to be younger, to be female, and to have a diagnosis of bipolar disorder. No information on adverse effects was provided. 

In utilizing the collaborative model in the management of bipolar disorder, as well as depression, the psychotherapist supports the inherent coping skills of the patient, assesses progress and resistance, and tracks medication compliance. The psychotherapist can then inform the psychiatrist of any changes that have occurred and/or are required, and vice versa, thereby resulting in a more comprehensive and quality-driven level of care. 

---