Bipolar Disorder is diagnosed with increasing frequency in children and adolescents. Approximately 20% of all Bipolar patients experience their first episode during adolescence. Challenges in diagnosis include differentiation from ADD and other child behavioral disorders. The intensity and severity of mood swings and unprovoked behavioral outbursts create undue suffering for both the children and thier families.
Treatment includes both medications and therapy. Mood stabilizers and a newer class of medication, atypical antipsychotics, are used with increasing frequency. While meds are more of a last resort clinically, the option becomes higher priority when a youngster's outbursts become a risk to hurt self or others, even accidentally.
Caution with medication is always indicated, due to risk of side effects and the lack of research on many of these medications in children.
The study examined the potential benefits of glyconutritional supplements for a period of 5 months.
The results of this study were promising. Of 15 children who completed the study, 14 exhibited considerable improvement after 20 weeks on glyconutritional supplements. One child exhibited mild improvement on glyconutritional supplements.
Children who experienced side effects from the medications for Bipolar Disorder displayed considerable improvement in their tolerability to medication.
Examples included: near elimination in sedation from Risperdal and elimination of migraines while on Seroquel and Trileptal. One youngster who had been very fatigued from his medication regimen, which included Trileptal, Lexapro, Ambien, Abilify and Seroquel, experienced elimination of daytime fatigue by week 12.
It was also clear to the researchers and study volunteers that the children looked happier, healthier, calmer and more stable as the study progressed.
At the onset of this study, all parents expressed interest in the potential benefits of the supplements, particularly in offsetting side effects; however, all parents were clear that it had take quite along time for their children to become stable on their medications and they wished not to make changes in their medications prematurely. Many of the children had been hospitalized at least once. All families were highly invested in their childrens' well-being and each felt their child's condition was the single largest stressor in the family, including for the child who suffered from the condition.
Our initial study results speak to the need for larger clinical trials over longer periods of time.
Along with use of psychotropic medications in children, augmentation strategies with natural supplements warrant further consideration, to improve childrens' overall health, augment mood stablizing effects of medications and improve tolerability of medications. Longer term studies may determine if medications could be successfully weaned, at least in part, over a longer period of time.
Diagnosis Bipolar Disorder: "Bipolar disorder is a severe biologic illness characterized by recurrent fluctuations in mood. Typically, patients experience alternating episodes in which mood is abnormally elevated or abnormally depressed-separated by periods in which mood is relatively normal." (Lehne, 2004, p. 321)
The following is a short synopsis according to the DSM-IV-TR, "Criteria for Bipolar Disorder" includes a distinct period of abnormality and persistently elevated, expansive, or irritable mood for at least: - 4 days for hypomania - week for mania
During the period of mood disturbance, at least three or more of the following symptoms have persisted and have been present to a significant degree: - Inflated self-esteem or grandiosity - Decreased need for sleep - More talkative than usual or pressure to keep talking - Excessive involvement in pleasurable activities that have a high potential for painful consequences. (American Psychiatric Association [APA], 2000).
Psychodynamics of the Disease The onset of the disease usually occurs during late adolescence or in the mid twenties. However, the disease has been known to occur up into the fifth decade of life. The mood swings that accompany this disorder are of several types. They are as follows: the Pure Manic Episode, evidenced by hyperactivity, excessive enthusiasm, and flight of ideas, constant wakefulness without sleep,
Impairment in normal social functioning usually requiring hospitalization; Hypomanic Episode, evidenced by a milder form of the Pure Mania, without the loss of normal functioning that would require hospitalization; Major Depressive Episode, characterized by depressed mood consisting of symptoms such as anhedonia, avolition, alogia, affective flattening and thoughts of suicide and death; the last episode associated with Bipolar disorders is the Mixed Episode in which, patients experience symptoms of mania and depression simultaneously. The combination of high energy and depression puts them at significant risk of suicide. (Lehne, 2004, p. 321)
Case Presentation A Caucasian woman in her mid twenties presented signs and symptoms of self mutilation with a straight edge razor inflicted gash across her lower abdomen approximately six inches below the umbilicus. The depth of the gash just stopped at the abdominal fascia. The patient was sent from the emergency room to the psychiatric floor. Upon meeting the patient one day after her admission to E.R., she appeared dressed in pajama bottoms and a t-shirt, shuffling down the hall in her socks. She was holding her abdomen with one hand and appeared in some discomfort. Her black hair was short and disheveled. When the patient arrived at her room she sat down on her bed.
She acknowledged with blunted affect that she cannot stop self mutilation, and described how she cut herself through the muscles in her abdomen almost down to the fascia. Her voice was tremulous and fast paced. This could be due to the fact that she had just been given her first dose of Clozaril. She stated that her mouth was dry and that she needed to drink some water. She then went on to say that she was getting very sleepy. The client felt comfortable with the interview.
She shared personal information in regards to being sexually abused by her bother beginning at the age of seven until the age of fifteen. Her brother was two years older than her and died in an automobile accident at the age of eighteen. She went on to say that her mother never knew or acknowledged the sexual abuse and that she could not tell her because the mother idolized the son. The client was receptive to cognitive reframing; however she was very critical of herself and stated that she felt worthless and ashamed. She appeared very tired and stated that she wanted to sleep.
Table 1 Textbook characteristics of Bipolar disorder versus client characteristics observed
Textbook Characteristics: Pure Manic Episode Hypomanic Episode Major Depressive Episode- Affective Flattening Alogia Avolition-apathy Anhedonia Mixed Episode Rapid-Cycling Bipolar Disorder- Patients experience four or Client
Characteristics Observed: No current symptoms Rapid breathing, rapid speech, however due to medication a client was concurrently exhibiting lethargy Client acknowledged sadness/ worthlessness Facial expression flat Thoughts of dying, hard to focus Hair/clothes unkempt Expressed no interest in children or own
Client's Symptoms 1. Hypomania 2. Depression a.) Affective Flattening b.) Alogia c.) Avolition & Apathy d.) Anhedonia 3. Mixed Episode 4. Rapid Cycling (Varcarolis, 2004, p. 485)
Nursing Interventions 1. Observe the client every 15 minutes while suicidal, remove all dangerous, sharp objects from room. 2. Reinforce that she is worth while, a.) Assist the client in evaluating the positive as well as the negative aspects of her life b.) Encourage the appropriate expression of angry feelings. c.) Schedule regular periods of time throughout the day for recreational/occupational therapy, encourage client to groom self, offer praise for completing grooming. d.) Ensure client's participation in taking mood stabilizing medications. Watch client swallow medication. 3. Engage client in interpersonal therapies, cognitive-behavioral therapy, 4. Encourage client to attend group therapy, and journal episodes.
Table 2 Medical Interventions, Bipolar Disorder Drug therapy using Mood stabilizer Antidepressants Antipsychotics Education and Psychotherapy ECT (Varcarolis, 2002, p. 483)
Clients Medical Interventions Drug therapy includes Lithium 300mg every h.s. Not taking any Clozaril Client is receiving psychotherapy, family counseling, group therapy while in hospital, and cognitive restructuring. None
References Lehne, R. (2004). Pharmacology for Nursing Care. Missouri: Saunders Varcarolis, E. (2002). Foundations of Psychiatric Mental Health Nursing: A Clinical Approach. Pennsylvania: Saunders
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Mary F. Zesiewicz, Md has sinced written about articles on various topics from Parenting, Addictions and Cure Anxiety. Mary F. Zesiewicz,MD, served as the Chief Clinical Investigator of this study; she serves as the Chief Medical Officer of INTEGRITY HEALTH SOLUTIONS, a 501 C3 not-for-profit corporation dedicated to research, relief and education in the transformation of. Mary F. Zesiewicz, Md's top article generates over 1600 views. to your Favourites.
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