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What is the Treatment for Bipolar Disorder?
How do we treat bipolar disorder? Specifically, how do we treat mania or depression associated with bipolar disorder? The treatment of these two clinical states is not the same.
The treatment of mania is dependent upon its severity and acuity. For mild to moderate mania, mood stabilizers such as lithium and valproic acid (Valproate) are still the standard of treatment and may be sufficient to contain the symptoms. Lithium starts to work after 10 to 14 days while valproic acid, about 7 to 10 days.
Also, recent studies have shown the effectiveness of atypical antipsychotics such as risperidone, olanzapine, and quetiapine even when used alone to treat the acute phase of bipolar disorder.
These drugs are relatively safe but they don't come without side effects. Nausea, vomiting, tremors, and dizziness during the initial phase of treatment are commonly experienced. The more serious side effects such as renal and thyroid problem from lithium, liver dysfunction and pancreatitis from valproic acid, and increased risk of diabetes and high cholesterol from atypical antipsychotics are uncommon. However, regular blood tests are required to monitor any abnormalities.
For moderate to severe cases, atypical antipsychotics such as risperidone and quetiapine should be added to the mood stabilizers during the acute phase. Once the illness has stabilized and the symptoms have subsided, then the atypical neuroleptics can be gradually tapered off. But the mood stabilizers should continue. Regardless of severity, patients usually do well on a combination of mood stabilizer and atypical antipsychotic during the acute phase.
What is the treatment for bipolar depression? In general, the mood stabilizers' dosage should be optimized or if the patient is not on any medication yet, a mood stabilizer such as lithium should be started. Physicians should make sure that the medication maintains a "therapeutic level." If not, the dosage should be adjusted. Moreover, possible precipitants such as stresses at home should be addressed.
If these measures don't help and the depression is so severe, an antidepressant with the least risk to induce mania such as bupropion should be added to the mood stabilizer. When the depression is resolved, then the antidepressant can be gradually tapered off because its prolonged use even in the presence of mood stabilizer can still induce mania.
When should the medication be discontinued? Bipolar patients have to continue taking the medication for several months even after they become normal. High relapse rate is common if medications are prematurely stopped. Also, for patients with multiple or difficult-to-treat episodes, they may need to take the medication for years or even for life to prevent recurrence.
Patients and their physicians should thoroughly discuss the risk and benefits of any treatment intervention. Knowledge about the drug's indication, side effects, and prognosis with or without treatment is a must.
Furthermore, it is crucial that bipolar patients should also receive individual psychotherapy to help them deal with the many personal and psychosocial issues they face on a daily basis. As you know, medication alone won't suffice to address financial problems, marital conflict, work issues, and prior abuse.
In summary, the combination of medication and psychotherapy is the best treatment for bipolar disorder.
Copyright © 2004. Dr. Michael G. Rayel ? author (First Aid to Mental Illness?Finalist, Reader's Preference Choice Award 2002) psychiatrist, and inventor of Oikos Game: An Emotional Intelligence Game. For info, visit http://www.oikosgame.com and http://www.soardime.com.
The Diagnosis Myth
Although I risk dissension by doing so, I must say something that I think many of us in the mental health community have acknowledged for quite some time: every single diagnosis of a mental disorder is fallible.
Are All Dementias Alzheimer?s?
I'm surprised when some patients and caregivers confuse dementia and Alzheimer's as one and the same. Each time a family member is suffering from memory loss, the conclusion is always Alzheimer's. Is it reasonable to label all dementias as Alzheimer's?
Fairies and Mental Health
Schizophrenics hallucinate alternate realities. People who claim to have been abducted by aliens are accused of having Fantasy Prone Personalities. So what about those of us who claim to be conversing with angels, fairies, and spirit guides? Are we nuts? Absolutely yes! If we weren't crazy before we started chatting with the divine, we soon will be. Just the constant questioning of one's sanity can drive a person insane. How do you know if you're really talking to spirits or if you're losing your mind?
Posttraumatic Stress Disorder: Nightmare After The Ordeal
Sarah is a 28 y/o accountant who had a traumatic past that she kept to herself. At age 15, she was grabbed by a masked man while she was jogging in a park. The man threatened to kill her with a knife and brutally raped her. She screamed but nobody seemed to have heard her.
Are Observations Objective?
On the outset all observations may seem to be objective, but in reality subjectivity tends to shape the objective observations. The observations can be categorized into three for better understanding Objective, Subjective, medley of subjective/objective observations.
Ever felt urged to steal a piece of bubblegum from the grocery store and given in? Then you are likely training to become either a kleptomaniac or an addictive compulsive thief. Do not despair ? you're not alone. Not a threat. And there is a way out.
The Myth of Mental Illness
"You can know the name of a bird in all the languages of the world, but when you're finished, you'll know absolutely nothing whatever about the bird? So let's look at the bird and see what it's doing ? that's what counts. I learned very early the difference between knowing the name of something and knowing something."
No Picnic In Sight
Upon being diagnosed with Obsessive-Compulsive Disorder, I saw the reality behind the greatest myth of mental illness, the myth that The Victim Is Unaware of His or Her Own Condition. A childhood flooded with media depictions of the mentally ill had lead me to believe that the afflicted had somehow been robbed of their objectivity, thrown into a dark hall-of-mirrors beyond the realm of rational perspective.
What is the Theory of Multiple Intelligences? Part 2: Cultural Influence
Howard Gardner's theory of multiple intelligences developed as he worked with brain injured adults and autistic children. He identified distinct portions of the brain that control specific human abilities or talents like analysis, classification, speech, self-awareness, etc. He has identified eight distinct abilities that he refers to as "intelligences": verbal-linguistic, logical-mathematical, spatial, bodily-kinesthetic, musical, interpersonal, intrapersonal, and the naturalist. In addition to the biological basis for these intelligences, Gardner also places great emphasis on cultural influences that may impact the development of each intelligence.
Countess Erszebet Bathory was a breathtakingly beautiful, unusually well-educated woman, married to a descendant of Vlad Dracula of Bram Stoker fame. In 1611, she was tried - though, being a noblewoman, not convicted - in Hungary for slaughtering 612 young girls. The true figure may have been 40-100, though the Countess recorded in her diary more than 610 girls and 50 bodies were found in her estate when it was raided.
Even though hypnosis has been around officially since the 1700s (Franz Anton Mesmer), there are still questions as to its validity and benefits. For the most part, these questions stem from fear and ignorance. Regarding this subject, it is generally assumed that what you don't know can hurt you. People's viewpoints on hypnosis vary according to what their experiences have been and what they've heard.
Randomness of Human Thought
Random thought Sequence in the Human Mind. I want to comment on an article about Random Sequence in the Mathematical Association of America Newsletter in January 2002. A lot of philosophical talk has been spent over these notions and many have tried to put a specific analytical answer to the question. Even Bill Gates loves to play cards probably due to the mathematical tendencies of probability. Within the confines of chaos, mathematicians have always tried to explain things of chance, game theory, probability, randomness, luck.
The 5 Hindrances of the Mind: Are They Blocking Your Self-Esteem?
The issue of self-esteem is perhaps one of the greatest determinates in creating a life of freedom and abundance, or feeling inhibited and "just getting by". Self-esteem is defined as "a feeling of pride in oneself". It is how you feel in relation to yourself rather than how others see you. It's between you and, well? you. Therefore, it's not necessary to be so concerned about what others think to determine your level of self -esteem, as the definition does not include any "others", just you. So where can you help yourself to better understand you? There are so many aspects of you but one that is of great importance is that of your mind.
Its Never Too Late
First of all, a bit of background: A high school dropout, stay-at-home mom until the age of 40, I wasn't too motivated to learn. Then I read the following quote:"Old Bureaucrat, my comrade, it is not you who are to blame. No one ever helped you to escape.? Nobody grasped you by the shoulder while there was still time. Now the clay of which you wereshaped has dried and hardened, and naught in you will ever awaken the sleeping musician, the poet, the astronomer that possibly inhabited you in the beginning." (Antoine de Saint Exupery)
Behavioral Manifestations of Alzheimer?s Dementia
Alzheimer's Dementia has a combination of cognitive and behavioral manifestations. Cognitive impairment is the core problem which includes memory deficits and at least one of the following: aphasia or language problem, agnosia or problems with recognition, apraxia or motor activity problem, and impairment in executive functioning (e.g. planning, abstract reasoning, and organizing).
Creating A Winning Mindset
Do you know anyone who always wins? Sure you know that person, everything just works out for them. They go into business and they are an instant success. They enter the dating scene and their phone rings off the hook. If they were in the Olympics, you just know they wouldn't settle for anything less than the gold. It seems as though they always win.
The Cyber Narcissist
To the narcissist, the Internet is an alluring and irresistible combination of playground and hunting grounds, the gathering place of numerous potential Sources of Narcissistic Supply, a world where false identities are the norm and mind games the bon ton. And it is beyond the reach of the law, the pale of social norms, the strictures of civilized conduct.
A Look at The Brain
The endless, immeasurable brain. It does seem like more we discover about it, the more mystery we create. Perhaps the most intriguing of all is the child's brain. In certain ways, children are the most brilliant people in the world. They have the ability to absorb more information than we can conceive of as adults.
The Cultural Narcissist - Lasch In An Age Of Diminishing Expectations
"The new narcissist is haunted not by guilt but by anxiety. He seeks not to inflict his own certainties on others but to find a meaning in life. Liberated from the superstitions of the past, he doubts even the reality of his own existence. Superficially relaxed and tolerant, he finds little use for dogmas of racial and ethnic purity but at the same time forfeits the security of group loyalties and regards everyone as a rival for the favors conferred by a paternalistic state. His sexual attitudes are permissive rather than puritanical, even though his emancipation from ancient taboos brings him no sexual peace. Fiercely competitive in his demand for approval and acclaim, he distrusts competition because he associates it unconsciously with an unbridled urge to destroy. Hence he repudiates the competitive ideologies that flourished at an earlier stage of capitalist development and distrusts even their limited expression in sports and games. He extols cooperation and teamwork while harboring deeply antisocial impulses. He praises respect for rules and regulations in the secret belief that they do not apply to himself. Acquisitive in the sense that his cravings have no limits, he does not accumulate goods and provisions against the future, in the manner of the acquisitive individualist of nineteenth-century political economy, but demands immediate gratification and lives in a state of restless, perpetually unsatisfied desire."
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