Multidimensional Care For Screening And Treatment For Bipolar Disorder

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Abstract: Treatment for the Bipolar Disorder patient is one of the complex to accomplish. They have an increased risk for cardiovascular disease, obesity and diabetes. This is not only due to their manic and depressive behaviors but the pharmacological treatment they receive. Studies have shown that they receive less screening and treatment for these conditions (2). There seems to be a gap between the mental and physical health care that leads to these comorbidities which can result to premature death for Bipolar patients. Importance of a multidimensional care model for the treatment of a Bipolar Disorder patient especially with any or increased risk for cardiovascular disease, obesity and diabetes. Proper screening, medication reconciliation, and help from many health professionals can help increase their physical health as well as their quality of life. Bipolar Disorder (BD) patients have an increased risk for cardiovascular disease, obesity and diabetes. Cardiovascular disease is also the leading cause of premature mortality among individuals with bipolar disorder. These conditions can be worsened by psychiatric symptoms and unhealthy behaviors such as inactivity, overeating and tobacco use (3). Diabetes and CVD are closely linked to one another, therefore a patient would be at risk for one just by having another. BD patients are 30% less likely to receive care for CVD and diabetes and tests for blood glucose and lipid (2). It may be easier to tell if someone is obese but CVD and diabetes do not show symptoms until they have progressed and are commonly known as silent killers. Therefore, detailed screening is important before these diseases cause permanent damage such as a myocardial infarction, kidney damage or even worse death. Individuals with Bipolar Disorder receive fewer prevention interventions and have difficulty implementing lifestyle interventions that can modify risk factors (7). Obesity can be linked to the characteristics of bipolar disorder, such as binge eating, sedentary behavior, and treatment non-adherence which stems from the shifting symptoms of mania and depression (1). Bipolar patients are less likely to seek help from their general practitioner because of decreased awareness of cardiovascular risk factors and symptoms (7). In nursing, it is key to educate patients and to never assume what they have been taught before. BD patients are not properly screened or educated just because they have a mental illness. “Poor quality of medical care for persons with bipolar disorder has also been attributed to the organizational and professional separation of mental and physical health care and to lack of effective self-management strategies that target cardiovascular disease-related risk factors” (1). Bipolar Disorder medications lead to an increased risk for cardiovascular disease and patients lack proper screening and treatment for these conditions. CVD and diabetes are twice as prevalent in SMI and are related to unhealthy lifestyle behaviors and the use of antipsychotic medications (2). Antipsychotic medications also have adverse effects that contribute to these conditions. These medications can lead to elevated glucose and lipid tests but BD patients are lacking the proper screening to determine these findings (2). “Atypical antipsychotics, lithium, and other mood stabilizers is postulated as one important determinant of weight gain” (4). As mentioned before, weight gain will lead to obesity which will increase a patient's risk for diabetes and CVD. BD patients are also less likely to be prescribed blood pressure management or cardiovascular medications (7). The effect of not being prescribed these medications could lead to many severe life-threatening conditions, the most serious being death. Lithium is one of the most common drugs prescribed for Bipolar Disorder patients and it has a small therapeutic index which increases the risk of toxicity. When lithium is given with angiotensin converting
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