Treating Patients with Bipolar Disorder I

Bipolar disorder is a spectrum disorder that causes unusual shifts in mood, energy, activity level, concentration, and the ability to carry out day-to-day tasks. Individuals with bipolar disorder have mood disorders which are extreme and intense emotional states that occur at distinct times. Bipolar disorder is unique to psychiatric illnesses in that patients fluctuate between mania and depression. (Muneer, 2016). Mania and hypomania have the same symptoms, but mania is more severe than hypomania and causes more problems and breaks from reality. It also triggers psychosis and can then require hospitalization.

To be diagnosed with bipolar 1 disorder, you must meet the DSM criteria for a manic episode which is defined as a distinct period of abnormality and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least one week and present most of the day nearly every day. Manic symptoms include irritability, racing thoughts, flight of ideas, distractibility, increased n goal-oriented activity, grandiosity, and involvement in activities with a high potential for painful consequences (David et al., 2019). Mania can be caused by medical issues such as thyroid disorder, traumatic brain injury, or temporal lobe seizures, medicines such as corticosteroids, and Illicit drugs such as cocaine. To be diagnosed with bipolar 2, according to criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), someone must experience a hypomanic and a major depressive episode. These can occur at any point over a lifetime (Tondo et al., 2022).

Epidemiological studies have suggested a lifetime prevalence of around 1% for bipolar type I in the general population. A large cross-sectional survey of 11 countries found the overall lifetime prevalence of bipolar spectrum disorders was 2.4%, with a prevalence of 0.6% for bipolar type I and 0.4% for bipolar type II (Muneer, 2016). Bipolar is found mostly in the early twenties, although symptoms vary between 20-30 years (Rowland & Marwaha, 2018). The presentation and clinical course of bipolar depend on the age of onset, with higher rates of psychiatric and medical comorbidities such as suicidality and vascular disease in later-onset mania. First-episode bipolar mania has an annual incidence of around 5 per 100,000, and peak incidence occurs between 21–25 years (Muneer, 2016). Although the incidence of first-episode mania is equal between males and females, studies have found that the onset is around 5 years earlier for men.

Neuropathological studies suggest decreased density or morphology of oligodendrocytes in bipolar patients. Some brain imaging studies have also identified differences in brain structures of bipolar patients, especially in cortical and sub-cortical areas in limbic circuitry. Patients with BD have a hyperactive HPA axis, high levels of systemic cortisol, and neurosuppression of its circulating levels in the dexamethasone suppression test or the dexamethasone/corticotrophin-releasing hormone (DEX/CRF) test (Rowland & Marwaha, 2018). The unrelenting secretion of stress hormones leads to a constant low-grade inflammatory milieu in the body that is liable for the neuroprogression of the bipolar diathesis and predisposes to cardiovascular and metabolic abnormalities often encountered in these patients.

Bipolar disorders thus occur equally in men and women, and the average age of onset is usually 25 years. Nevertheless, it also occurs in adolescents and sometimes in children. In children and adolescents, the diagnosis is often challenging and has even generated considerable controversy. As a rule, young patients with bipolar affective disorder very quickly move from a phase of painfully elevated mood, mania or hypomania, to a pronounced decrease in the overall emotional background of depression. Moreover, the differences contribute to the formation of general irritability during periods of normal state between these episodes. Parents usually note the unpredictability of their children, but often attribute it to character traits and teenage behavior. The risk of developing bipolar disorder is increased in children suffering from hyperactivity, anxiety disorders and attention deficit. A child or adolescent with cyclothymia has the right to treatment (Hede et al., 2019). Like other psychological patients, such a person has a constitutional right to receive individualized treatment that will give a realistic opportunity for improving the mental condition.

People who are first diagnosed with bipolar disorder late in life may well have undiagnosed bipolar disorder for decades, with symptoms that simply become more noticeable and problematic with age. Studies have shown that bipolar disorder affects 0.5% to 1.0% of older adults (Dols & Beekman, 2020). Care of older people with illness often falls on the shoulders of family members such as spouses and adult children. Here is what family members should know about bipolar disorder in the elderly. There are special considerations when treating older adults for bipolar disorder. Elderly patients may tolerate or metabolize drugs at different rates than younger adults, so they may need different doses. Older people may have other medical conditions and take other medications. Care is much more difficult for this age group because doctors must take into account pills, as well as the fact that drugs can be tolerated in different ways.

The legal and social aspects of health are determined by the fact that a person has the right to medical care and this right is protected by the law of the country. The social aspect determines the types, forms of participation and responsibility of various parts of social structures in the formation, preservation and strengthening of the health of their members, the formation of such work and the provision of regulatory conditions for professional activities. The disease can affect people in different age categories and proceed in completely different ways. Ethically, the principle of confidentiality applies the person, just like medical patients, has the right to talk to the therapist in complete confidence, and the information should only be revealed to parents under a few circumstances where necessary (Stoll, Müller & Trachsel, 2020). Culturally, it has been established that minorities in the US are less likely to go for mental health treatment or wait until the symptoms are severe. This behavior is common among racial and ethnic minorities such as black people, non-white Hispanics, and Asians (Hede et al., 2019). In addition, it is common among children and young people, as they fear revealing their experiences for fear of discrimination or stigmatization. Bipolar disorder can affect any ethnic or age group. It can manifest itself, in particular during pregnancy. Pregnancy can affect the course of bipolar disorder in different ways. The condition of some women is stabilizing, others, on the contrary, develop severe depression. In some cases, the first depressive episode in women is observed during pregnancy or after childbirth. A serious problem is the need to take lithium during the period of bearing a child. On the one hand, at this time, it is desirable to refuse to take any medications. On the other hand, the abolition of mood stabilizers can adversely affect the mental state of the mother, on which both the normal intrauterine development of the fetus depends and the observance of the regimen necessary for the baby after birth. In addition, women with bipolar disorder have a significantly increased risk of developing postpartum depression.

The Federal Drug Agency (FDA) has approved certain pharmacological treatment options for BD. Specifically, the main types of FDA-approved medications are mood stabilizers such as lithium and anti-seizure medications such as valproic acid, lamotrigine, and divalproex sodium in acute and mixed episodes. In addition, atypical antipsychotic medications such as risperidone, quetiapine, and olanzapine have been approved as the mainstay maintenance pharmacological treatment for bipolar disorder. However, these medications have side effects (Hede et al., 2019). For instance, mood stabilizers such as lithium produce diarrhea, nausea, dry mouth, metallic taste, thirstiness, weight gain, sleepiness, and mild tremor.

Anti-seizure medications such as valproic acid have several side effects. For example, they may produce dizziness, tremor, depression in adults, weight gain, reduced attention, irritability in children, nausea and vomiting, and reduced thinking speed (Szabo et al., 2022). The FDA warns physicians to monitor certain lab metrics, such as dosage, rate of uptake, and body weight. Such comorbid issues as depression in adults, learning problems in children, and ADHD need to be monitored because they might escalate when the patient is treated with these drugs. From a laboratory and comorbidity point of view, it is important to monitor and focus on psychotic mania as the person may harm themselves. However, it is also crucial to remember that the diagnosis of bipolar affective disorder is extremely difficult, due to the polymorphism of the category of bipolarity, the high level of comorbidity characteristic of this pathology, as well as the specifics of diagnostic approaches that are displayed in the classification.

The main goal of BR therapy is to achieve remission and maintain a euthymic period. In this case, preference should be given to drugs with a balanced efficacy, taking into account tolerability, efficacy and safety profile. In this regard, among all the medicines on the pharmaceutical market, therapy should be started with those that have the best tolerance. It should be taken into account that the most common side effects are weight gain, neurocognitive impairment and sedation. The most effective drug in the treatment of bipolar depression is lamotrigine. It has a minimal spectrum of side effects and can be successfully used in the treatment of patients with bipolar depression who also complain of hypersomnia and overweight. Lamotrigine is FDA-approved for the long-term treatment of manic, mixed, and depressive episodes, with superior efficacy over the latter.

Examples of how to write prescriptions include the patient’s name, date of birth, drug strength and quantity, and route. For example, John, S., 04/03/1994, enalapril, take 1 tablet once a day after meals. Secondly, instead of the name, you can write the identifier, the amount issued by the pharmacy, and the number of refills (Hede et al. , 2019). Third, you can write the patient’s name, hospital name, current conditions, medication name, and doctor’s signature.


Dols, A., & Beekman, A. (2020). Older age bipolar disorder. Clinics in Geriatric Medicine, 36(2), 281-296.

Hede, V., Favre, S., Aubry, J. M., & Richard-Lepouriel, H. (2019). Bipolar spectrum disorder: What evidence for pharmacological treatment? A systematic review. Psychiatry Research, 282, 112627.

Muneer, A. (2016). The neurobiology of Bipolar Disorder: An Integrated Approach. Chonnam Medical Journal, 52(1), 18-37.

Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic Advances in Psychopharmacology, 8(9), 251-269.

Stoll, J., Müller, J. A., & Trachsel, M. (2020). Ethical issues in online psychotherapy: A narrative review. Frontiers in Psychiatry, 10, 993.

Szabo, G., Fornaro, M., Dome, P., Varbiro, S., & Gonda, X. (2022). A bitter pill to swallow? Impact of affective temperaments on treatment adherence: A systematic review and meta-analysis. Translational Psychiatry, 12(1), 1-10.

Tondo, L., Miola, A., Pinna, M., Contu, M., & Baldessarini, R. J. (2022). Differences between bipolar disorder types 1 and 2 support the DSM two-syndrome concept. International Journal of Bipolar Disorders, 10(1), 1-11.

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