Bipolar disorder, sometimes referred to as manic-depressive illness, may be misidentified by health care practitioners as major depression, an anxiety disorder, attention deficit hyperactivity disorder, or even schizophrenia because of the wide range of clinical presentations. 1 National screening studies estimate that the lifetime prevalence of bipolar disorder is approximately 4%, which is higher than schizophrenia at 1% 2 and lower than major depressive disorder at almost 17%.3-5
Medications used to treat bipolar illness are as wide-ranging as the symptoms. Lithium, anticonvulsants, antipsychotics, benzodiazepines, and antidepressants all have a place in the treatment of individuals with bipolar disorder.6,7 The challenge is finding the right combination of medication and psychosocial intervention for a given individual.
Lack of insight into the illness and high rates of nonadherence (40-60%) are primary barriers to the stabilization of bipolar illness.8,9 Up to 60% of those with bipolar disorder abuse drugs and alcohol.10 This greatly contributes to mood instability and nonadherence. The use of antidepressants without mood stabilizers (eg, lithium, valproate) or second-generation antipsychotics (SGA) has been shown to increase the frequency of mood episodes in bipolar illness and lead to mood destabilization.6,11
The Role of the Community Practitioner
The role of the community practitioner is threefold: 1) to recognize symptoms of bipolar disorder and encourage appropriate drug therapy; 2) to counsel patients on bipolar disorder as a highly treatable illness that requires lifelong medication and psychosocial interventions; and 3) to provide medication education and monitoring to ensure maximum therapeutic benefit, prevent drug interactions, and help patients manage medication side effects.
- Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, and Registered Nurses
CE activities for Pharmacists and Pharmacy Technicians:
This continuing education (CE) activity meets the requirements of all state boards of pharmacy for approved continuing education hours. CE credit is automatically reported to CPE Monitor.
The American Nurses Credentialing Center (ANCC) for formally approved continuing education (CE) hours, and CE hours of pharmacotherapeutics.
The American Academy of Nurse Practitioners Certification Program (AANPCP) for acceptable, accredited CE.
- The ANCC requires all advanced practice nursing certificants (CNSs and NPs) to complete 25 CE hours of pharmacotherapeutics as a portion of the required 75 continuing education hours.
- Pharmacology CE is recommended by the AANPCP and will be required for Certificants renewing certification starting January 2017.
- Most State Boards of Nursing require a minimum number of pharmacy contact hours to renew an advanced practice license.
Requirements for CE Credit
- Describe the diverse clinical presentations of bipolar disorder and explain how this impacts treatment.
- Recognize appropriate and inappropriate drug treatment for each phase of bipolar illness and recommend drug-specific monitoring parameters.
- Provide medication counseling to a patient taking lithium, an anticonvulsant, antipsychotic, antidepressant or combination of medications for bipolar illness. Provide education to promote mood stability and avoidance of drug interactions.
Julie Dopheide, Pharm.D.
Brief Bio : Julie A. Dopheide, PharmD, BCPP, FASHP is a Professor of Clinical Pharmacy, Psychiatry and the Behavioral Sciences at the University of Southern California School of Pharmacy and the Keck School of Medicine in Los Angeles, California
Disclosure : Dr Dopheide reports no financial or personal relationship with any commercial interest producing, marketing, reselling, or distributing a product or service that appears in this issue.