Bipolar disorder - Acute
Definition
Mental illness characteristically involving cycles of depressive and manic, hypomanic, or mixed-symptom episodes , previously known as manic-depressive disorder
Medical History
* Genetic predisposition
* Environmental Stressors
* Residual Mood Symptoms
* Cyclothymia
* Recurrent major depression
* Seafood Consumption
Findings
* Suicidal intent
* Mania
* Depression
* Disability
* Loss of appetite
* Weight loss
* Insomnia
* Euphoria
* Hyperirritability
* Decreased sleep
* Violent behavior - Acute
* Aggressive behavior
* Pressure of speech
* Psychomotor agitation
* Motor retardation
* Does not adhere to rules and boundaries
* Hypersexuality state
* Self-neglect
Differential Diagnosis
* Other mental disorders
Treatment
Drug Therapy
Acute management of bipolar disorder with mania or mixed episode
LITHIUM CARBONATE
Adults: 1800 mg/day orally in 2 to 3 divided doses; desired serum lithium level ranging between 1 to 1.5 mEq/L
VALPROATE SODIUM
Adults: In hospitalized patients, start initial dosage of 20 to 30 mg/kg IV per day; after obtaining a valproate level, adjust the dose to achieve a serum level between 50 and 125 mcg/mL ; maximum 60 mg/kg/day
CARBAMAZEPINE
Adults: Start initial dosage of 200 to 600 mg orally in 3 to 4 divided doses daily; in hospitalized patients, increase in increments of 200 mg/day up to 800 to 1000 mg/day unless side effects develop, with slower increases thereafter as indicated ; maximum 1600 mg/day
OLANZAPINE
Adults (monotherapy): 10 to 15 mg orally once daily; may increase/decrease dosage by 5 mg/day at intervals of at least 1 day; usual effective dosage range is 5 to 20 mg/day; maximum 20 mg/day
Adults (in combination with lithium or valproate): 10 mg orally once daily; may increase/decrease dosage by 5 mg/day at intervals of at least 1 day; usual effective dosage range is 5 to 20 mg/day; maximum 20 mg/day
RISPERIDONE
Adults (monotherapy or in combination with lithium or valproate): Initial dose 2 to 3 mg orally once daily, increase or decrease in increments of 1 mg/day with intervals of not less than 24 hours; maximum 6 mg/day)
Pediatrics (10 to 17 years; monotherapy only): Initial dose 0.5 mg orally once daily, increase in increments of 0.5 or 1 mg/day at intervals not less than 24 hours, to a target dose of 2.5 mg/day; maximum 6 mg/day
Outpatient management and maintenance of bipolar disorder with mania or mixed episode
LITHIUM CARBONATE
Adults: Begin in low divided doses, such as 300 mg orally 3 times daily, and titrate upward to serum concentrations of 0.5 to 1.2 mEq/L ; typical daily dosage is 900 to 1200 mg/day
VALPROATE SODIUM
Adults: Start at 250 mg orally 3 times daily; titrate the dose upward by 250 to 500 mg/day every few days, depending on clinical response and side effects, generally to a serum concentration of 50 to 125 mcg/mL; once patient is stable, simplify to once- or twice-daily dosing; maximum 60 mg/kg per day
Note: Bioavailability of the extended-release preparation, Divalproex ER®, is about 15% less than that of the immediate-release preparation; doses of Divalproex ER® will need to be increased proportionately
LAMOTRIGINE
Adults (patients not taking enzyme-inducing drugs or valproic acid): 25 mg/day orally for 2 weeks, then 50 mg/day for 2 weeks, then 100 mg/day for 1 week, then 200 mg/day; usual maintenance dose of lamotrigine in patients not taking enzyme-inducing drugs or valproic acid is 200 mg/day
Adults (added to valproic acid regimen): 25 mg/day orally every other day for 2 weeks, then 25 mg/day for 2 weeks, then 50 mg/day for 1 week, then 100 mg/day; usual maintenance dose of lamotrigine in patients taking valproic acid is 100 mg/day
Adults (added to enzyme-inducing antiepileptic drug regimen without valproic acid): 50 mg/day orally for 2 weeks, then 100 mg/day for 2 weeks in divided doses, then 200 mg/day for 1 week in divided doses, then 300 mg/day for 1 week in divided doses, then may increase up to the usual maintenance dose of 400 mg/day in divided doses
CARBAMAZEPINE
Adults: Start initial dosage of 200 to 600 mg orally in 3 to 4 divided doses daily; increase slowly up to maintenance dose of approximately 1000 mg/day; typical range is 200 to 1600 mg/day ; extended release preparation is dosed twice daily rather than 3 to 4 divided doses daily
OLANZAPINE
Adults (monotherapy): 5 to 20 mg orally once daily after achieving a responder status for an average duration of 2 weeks
RISPERIDONE
Adults (monotherapy or in combination with lithium or valproate): Start initial dosage of 2 to 3 mg orally once daily; for maintenance, dosage adjustments should be made in increments of 1 mg/day at intervals of at least 24 hours; maximum 6 mg/day
Bipolar I disorder with mania and agitation
OLANZAPINE
Adults: Initial, 10 mg IM; lower dose of 5 mg or 7.5 mg may be used if indicated; usual effective dosage range is 2.5 mg to 10 mg. Subsequent doses are up to 10 mg IM; maximum of three 10 mg doses given 2 to 4 hours apart; monitor for orthostatic hypotension prior to the administration of repeated doses
Treatment of depressive episodes associated with bipolar disorder
QUETIAPINE FUMARATE
Adults: 50 mg orally once a day on day 1, then 100 mg once daily on day 2, then 200 mg once daily on day 3, then 300 mg once daily on day 4, all doses given at bedtime, then maintenance dose 300 mg/day ; patients requiring higher doses should receive 400 mg on day 5, increased to 600 mg on day 8
Treatment of acute manic episodes associated with bipolar I disorder as either monotherapy or adjunct therapy to lithium or divalproex
QUETIAPINE FUMARATE
Adults: Initiate in twice daily oral doses totaling 100 mg/day on Day 1, increased to 400 mg/day on Day 4 in increments of up to 100 mg/day in twice daily divided doses; further dosage adjustments up to 800 mg/day by Day 6 should be in increments of no greater than 200 mg/day; usual effective dosage range is 400 to 800 mg/day; maximum 800 mg/day
Procedural Therapy
In addition to pharmacotherapy for patients with bipolar disorder
* Psychotherapy: Evidence supports the efficacy of psychotherapy for patients with bipolar disorder when combined with pharmacotherapy .
Alternative therapy for patients with bipolar disorder
* Electroconvulsive therapy: ECT is a potential treatment for patients with severe or treatment-resistant mania, mixed episodes, and depressive episodes, especially with pregnancy, psychotic features, or catatonic features .
All thanks to this great herbal doctor who cured me from (LUPUS DISEASE) his name is dr imoloa. I suffered lupus disease for over 8 years with pains like: joints, Skin rash, Pain in the chest, swollen joints and many more. The anti-inflammatory drugs couldn’t cure me, until I read about his recommendation. 2 months ago, I contacted him through his email address. drimolaherbalmademedicine@gmail.com . and he sent me the herbal treatment through DHL courier service and he instructed me on how to drink it for good two weeks. after then, And I was confirmed cured and free at the hospital after taken his powerful herbal medications You too can be cured with it if interested, he also uses his powerful herbal healing medicine to cure disease like: parkison disease, vaginal cancer, epilepsy, Anxiety Disorders, Autoimmune Disease, Back Pain, Back Sprain, Bipolar Disorder, Brain Tumour, Malignant, Bruxism, Bulimia, Cervical Disk Disease, cardiovascular disease, Neoplasms, chronic respiratory disease, mental and behavioural disorder, Cystic Fibrosis, Hypertension, Diabetes, asthma, Inflammatory autoimmune-mediated arthritis. chronic kidney disease, inflammatory joint disease, back pain, impotence, feta alcohol spectrum, Dysthymic Disorder, Eczema, skin cancer, tuberculosis, Chronic Fatigue Syndrome, constipation, inflammatory bowel disease, bone cancer, lungs cancer, mouth ulcer, mouth cancer, body pain, fever, hepatitis A.B.C., syphilis, diarrhea, HIV/AIDS, Huntington's Disease, back acne, Chronic renal failure, addison disease, Chronic Pain, Crohn's Disease, Cystic Fibrosis, Fibromyalgia, Inflammatory Bowel Disease, fungal nail disease, Lyme Disease, Celia disease, Lymphoma, Major Depression, Malignant Melanoma, Mania, Melorheostosis, Meniere's Disease, Mucopolysaccharidosis , Multiple Sclerosis, Muscular Dystrophy, Rheumatoid Arthritis, Alzheimer's Disease, bring back relationship spell. Contact him today and get a permanent cure. contact him via... email- drimolaherbalmademedicine@gmail.com /whatssapp-+2347081986098.
ReplyDeletewebsite-www.drimolaherbalmademedicine.wordpress.com
I'm here to give my testimony how I was cured from HIV, I contacted my HIV via blade. A friend of my use blade to peel of her finger nails and drop it where she use it, so after she has left i did know what came unto me i looked at my nails, my nails were very long and I took the blade which she just used on her own nails to cut of my finger nails, as i was maintaining my names, i mistakenly injured myself. I did even bother about it, so when I got to the hospital the next week when i was ill the doctor told me that I am HIV positive, i wondered where did i got it from so i remembered how I use my friend blade to cut off my hand so i feel so sad in my heart to the extent that i don’t even know what to do, so one day i was passing through the internet i met a testimony of a lady that all talk about how she was cured by a doctor called DR Imoloa so i quickly emailed the doctor and he also replied to me and told me the requirements which i will provide and I do according to his command, he prepare a herbal medicine for me which I took. He message me the following week that i should go for a test which i did to my own surprise i found that i was HIV negative. He also have cured for all kinds of incurable diseases like: Huntington's disease, back acne, chronic kidney failure, Addison's disease, Chronic Disease, Crohn's Disease, Cystic Fibrosis, Fibromyalgia, Inflammatory Bowel Disease, Fungal Nail Disease, Paralysis, Celia Disease , Lymphoma, Major Depression, Malignant Melanoma, Mania, Melorheostosis, Meniere's Disease, Mucopolysaccharidosis, Multiple Sclerosis, Muscle Dystrophy, Rheumatoid Arthritis, Alzheimer Disease and so many. Thanks to him once more the great doctor that cured me dr. Imoloa so you can also email him via drimolaherbalmademedicine@gmail.com or whatsapp him on +2347081986098. / website- www.drimolaherbalmademedicine.wordpress.com. God Bless you Sir.
ReplyDeleteI'm here to give my testimony how I was cured from HIV, I contacted my HIV via blade. A friend of my use blade to peel of her finger nails and drop it where she use it, so after she has left i did know what came unto me i looked at my nails, my nails were very long and I took the blade which she just used on her own nails to cut of my finger nails, as i was maintaining my names, i mistakenly injured myself. I did even bother about it, so when I got to the hospital the next week when i was ill the doctor told me that I am HIV positive, i wondered where did i got it from so i remembered how I use my friend blade to cut off my hand so i feel so sad in my heart to the extent that i don’t even know what to do, so one day i was passing through the internet i met a testimony of a lady that all talk about how she was cured by a doctor called DR Imoloa so i quickly emailed the doctor and he also replied to me and told me the requirements which i will provide and I do according to his command, he prepare a herbal medicine for me which I took. He message me the following week that i should go for a test which i did to my own surprise i found that i was HIV negative. He also have cured for all kinds of incurable diseases like: Huntington's disease, back acne, chronic kidney failure, Addison's disease, Chronic Disease, Crohn's Disease, Cystic Fibrosis, Fibromyalgia, Inflammatory Bowel Disease, Fungal Nail Disease, Paralysis, Celia Disease , Lymphoma, Major Depression, Malignant Melanoma, Mania, Melorheostosis, Meniere's Disease, Mucopolysaccharidosis, Multiple Sclerosis, Muscle Dystrophy, Rheumatoid Arthritis, Alzheimer Disease and so many. Thanks to him once more the great doctor that cured me dr. Imoloa so you can also email him via drimolaherbalmademedicine@gmail.com or whatsapp him on +2347081986098. / website- www.drimolaherbalmademedicine.wordpress.com. God Bless you Sir.
ReplyDeleteI''m Charlotte Johnson,65 years old, Here in Edmonton, Canada. With the new herbal mix medicine I purchased from Dr James herbal mix medicine West Africa was my only way to get rid of my Alzheimer's, the herbal mix medicine effectively reversed my condition and alleviate all symptoms. I was initially very hesitant to discuss my Alzheimer but I just hope it can still help someone. I feel this will be very important information for all Alzheimer patients, because the most violent element in society today is ignorance. Be it any condition, a healthy diet and natural herbs and roots medicine from Dr. James is the road to fast recovery. I had suffered Alzheimer for many years, I fought for proper medical recommendation, care and all form of humane treatment with little improvement I went through many sleepless nights and periods of intense grief, as do most families. I was recommended by a friend to use Dr. James herbal mix medicine for my Alzheimer with high hope and assurance. I never doubted my friend but to contact Dr. James. And purchased His herbal mix medicine which was effective and I finally feel my Alzheimer is gone with no more symptoms. He also told me that he cures diseases such as Lungs diseases, kidney diseases, Warts, Bipolar disorder, Shingles, HPV, ALS, CANCER, NEPHROTIC SYNDROME, HIV / AIDS, Herpes virus, Ovarian Cancer, Pancreatic cancers, bladder cancer, prostate cancer, Glaucoma., Cataracts, Macular degeneration, Cardiovascular disease, Autism. Enlarged prostate, Osteoporosis. Alzheimer's disease, psoriasis, Tach Diseases, Lupus, Backache, dementia, skin cancer,.testicular Cancer, Leukemia, HEPATITIS A, B, C, Contact the great one on his email greatcureman@gmail.com
ReplyDeleteInfo @ drjamesherbalmix@gmail.com