clinical practice with adults session 4 notes
clinical practice with adults session 4 notes SCWK885611
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This 3 page Class Notes was uploaded by Amber Notetaker on Wednesday February 17, 2016. The Class Notes belongs to SCWK885611 at Boston College taught by Phillip Higgins in Fall 2016. Since its upload, it has received 8 views. For similar materials see clinical practice with adults in Social Work at Boston College.
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Date Created: 02/17/16
Clinical- Adults: 2/12 Bipolar and related disorders - major affective problems - problem with moods (mood disorder) - lithium (medication often used for mood disorders) - evidence of tooth decay due to longterm use - runs in the family - strong genetic factor - Acting out behavior - Suicide risk is about 15 times higher than the general population - Bipolar disorder may account for ¼ of all completed suicides - Currently the 6th leading cause of disability among medical illnesses - Generally a lifetime condition - highly recurrent: 90% pst with single manic episode will have recurrent mood episodes - 40-70% have history of substance abuse - may co-occur with anxiety disorders such as PTSD - lifetime suicide risk 15x general population - BP depression often misdiagnosed with MDD - hypomania may go unrecognized, mistaken for normal happiness Bipolar I Manic Episode *see page 124 for full list* DURATION: 1 week abnormally and persistently elevated, expansive or irritable mood grandiose (inflated self esteem) decrease need for sleep more talkative (verbal diarrhea) increase in goal directed behaviors goals generally tend to get them into trouble marked impairment and possible hospitalization NOT A RESULT OF SUBSTANCE ABUSE OR MEDICATION Hypomanic Episode *see page 124 for full list* DURATION: 4 days form of mania that doesn’t leave the patient unable to function NOT A RESULT OF SUBSTANCE ABUSE OR MEDICATION Major Depressive Episode *see page 125 for full list* DURATION: two weeks depressed mood (not necessarily affect) feelings of sadness, emptiness, and hopelessness children may show it as being irritable or angry markedly disinterested in activities that were once pleasurable significant weight-loss or weight-gain psycho-motive agitation or retardation inability to concentrate or make decisions recurrent thoughts of death NOT A RESULT OF SUBSTANCE ABUSE OR MEDICATION *key term with all of this is nearly everyday, not looking at isolated incidents* Bipolar II Disorder criteria must be met for past or current hypomanic episodes and depressive episodes no manic episodes ever not serve enough to cause marked impairment or to necessitate hospitalization childbirth may be a specific trigger for a hypomanic episode flight of ideas distractible Distinguishing between Bipolar I and Bipolar II Bipolar II doesn’t have any manic episodes Depressive episodes are required for Bipolar II may be present in Bipolar I but not always Differentiating BP depression with MDD age of onset mean age for BP=21 MDD=29 frequency of depressive episodes number prior episodes for BP is greater than MDD responses to antidepressants treatment emergent manic/hypomanic symptoms and non-response to antidepressants shuts BP family history if family members with BP a BP diagnosis is more common history of suicide suicide risk is higher with BP *EBP for Bipolar Disorder: Therapeutic interventions* Cognitive Behavioral Therapy emphasis on routine, sleep, BPD as “diathesis-stress” illness (predispositional vulnerability + life stressors= episode) identify cognitive/behavioral influences on treatment adherence, maladaptive beliefs, triggers, coping with programs (warning signs) Family-Focused Therapy psychoeducation, communication/problem-solving skills, CG self-care particularly for high “expressed-emotion” families: criticism, hostility, emotional over-involvement during/after acute episode Interpersonal and social Rhythm Therapy (IRSRT) resolution of interpersonal problems (unresolved grief, social role, transitions, interpersonal deficits) management of affective symptom through therapy adherence, stabilizing, social rhythms (i.e. circadian rhythm instability via stressful events, disrupted routines) Psychoeducation awareness of BPD, treatment adherence, avoiding substance abuse, early detection of programs, regular habits, stress management *Common medications for BPD* Meds take up to at least six weeks to work Mood stabilizers lithium Anticonvulsants Depakote (valproic acid) Lamictal Tegretol Trileptal Atypical antipsychotic Respiradom (anti-psychotic) Ziprasidone (anti-psychotic) Antidepressants Prozac Paxil Zoloft Wellbutrin antidepressants alone may induce manic/hypomanic switch pr rapid cycling olanzapine-fluoxetine (Symbyax)
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