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Mood Disorder: Bipolar Disorders, LOW MOOD, Medication Considerations -…
Mood Disorder: Bipolar Disorders
Characterized by
:
•Manic episodes (or mania)
abnormally elevated or irritable mood;
aggressiveness; happy, euphoric, impulsive
behavior; decreased sleep; increased activity; and
grandiosity (exaggerated sense of self-importance).
Must have symptoms for at least one week.
Bipolar I disorder: classic form of manic depression. 1 full manic episode required for diagnosis - 1 week of symptoms
Bipolar II disorder: requires at least 1 hypomanic episode and at least one episode of major depression - 4 days with at least 3 or more symptoms
Cyclothymic disorder: Chronic (2+ years) fluctuating mood disturbances involving hypomanic and depressive symptoms
Phases of Treatment
Acute Therapy
treatment of acute episode
Monotherapy vs. Combination therapy
Maintenance Therapy
prevention of the relapse of episodes: continuation treatment
can be high risk for relapse upto 6 months
Symptoms
Manic episodes are an elevated or irritable mood: aggressive, happy, euphoric or grandiose
Hypomanic episodes are a milder form of manic episodes that do not interfere with an individual's daily function
Depressive episodes are feelings of sadness, decreased interest, low self-esteem, sleep disturbance, and appetite disturbance
Dental Considerations:
Causes orthostatic hypotension-
Monitor vital signs,
Pt should remain in the chair for a few minutes, sitting up right before standing up.
Decrease salivary flow-
asses for caries, periodontal disease, and oral candidiasis
Review medical history and drug log
Treatment
Lithium
Standard mood stabilizer
Prevents manic episodes
Carbmazepine
Valproic acid
Gabapentin
LOW MOOD
•Depressive episodes
feeling sad, decreased interest (low mood), low
self-esteem, sleep disturbance, and appetite
disturbance (at least two weeks with ≥ five
symptoms most of the day
•Mixed episodes are characterized by both
mania and depression (both high and low mood)
over a one-week period.
Medication Considerations
If patients are taking Lithium DO NOT recommend NSAIDs (eg. ibuprofen, naproxen sodium
If patients take Valprotate expect more bleeding for periodontal procedures
Blood values should be monitored in patients taking lithium, valproate and carbamazepine
DO NOT prescribe Metronidazole (antibiotic): it increases lithium levels