On the last track, we discussed the role childhood and upbringing
play in a
bipolar client’s life: characteristics of functions and dysfunctional
families; types of dysfunctional families; and family communication.
Depending on your home state, you may or may not be licensed to prescribe
medications for your bipolar disorder clients. Whether or not you are
certified to do so, I find that it is helpful to understand the basics of
bipolar medications to help those clients who are indeed prescribed
On this track, we will examine the three types of treatments
that clients may take in addition to therapy: psychotropic medications;
non-medicinal treatments; and hospitalization.
3 Types of Treatment in Addition to Therapy
1. Psychotropic Medications
The first topic we will discuss are the psychotropic medications and their
effect on bipolar clients. The first are, of course, mood-stabilizers such
as lithium. Lithium has been the only pure mood stabilizer available
with other mood stabilizers such as anticonvulsants and calcium channel
blockers also being used. I have found in some cases, bipolar clients find
that they only
need to take one mood stabilizer to control their disorder.
of the time, I have found that many bipolar clients take more than two or
three psychotropic drugs to stabilize their mood. Much of these
combinations include antipsychotics or neuroleptics to control psychotic episodes, antianxiety agents, hypnotics, and antidepressants.
know, to prevent
the mood swings of bipolar disorders, many doctors and psychiatrists
generally prescribe anti-depressants with a mood stabilizer. However,
as you are aware, there
is a danger if a client is diagnosed with unipolar disorder and is in fact
bipolar. Without a mood stabilizer, an antidepressant can induce a manic
or hypomanic episode.
Other considerations to take into account when prescribing medications or
treating a client on medications include the following. You are familiar
but I felt a review of these four points would be helpful to make sure we are
all on the same page.
a. MAOIs require many dietary restrictions, and some other medications do as
well. Check with your client regularly to be sure that they are not on
diet that conflicts with their medication.
b. Mood-stabilizing agents often require monitoring to ensure that they’re
not damaging the client’s thyroid, kidneys, or liver. I ask my
are currently taking mood stabilizers such as lithium and valproic acid to
get blood tests regularly.
c. Many psychotropic medications can cause birth defects or pass chemicals
through breast milk. If a client is pregnant or wants to become pregnant,
this is a serious issue to discuss with her before taking such a step.
d. Many clients during a manic or hypomanic episode doubt their need for
medications because they experience such a euphoria. I find it helpful
explain to them the risks of stopping certain medications "cold turkey".
Gradually reducing dosage should be discussed thoroughly between you and the
client or the client and the prescribing doctor.
Are you certified to prescribe psychotropic medications in your state, but
you are not certain which medications to prescribe? I have found that
client has a history of bipolar disorder in the family and the other member
has taken medication that the same medication might also work for the client due to genetic parallels.
2. Non-Medicinal Treatments
The second topic we will discuss are non-medicinal treatments that have
proved successful when treating bipolar clients in the past. The first is
the controversial electroconvulsive therapy, otherwise infamously known as electroshock
therapy (ECT). There is a certain stigma surrounding this type of treatment
in some cases does not apply today. Due to movies and literature portraying
the ECT of the past as cruel and debilitating, many clients are resistant.
However, it might be noted there have been some improvements in anesthesia,
dosage levels, and equipment that reduce the risk of side effects.
there is a risk of short-term memory loss around the time of treatment and in some cases will remain with the client
long after the treatment is finished. Dr. Martha Manning found ECT an
efficient substitute when her depression medications would not suffice.
A second treatment is vagal nerve stimulation which was originally created to
treat epilepsy. This is a small, pacemaker-like device that is placed under
the left-side of
the client’s collarbone and sends electrical pulses to the brain. Every
five minutes, the VNS device stimulates the vagus nerve for thirty seconds.
About one-third of mood disorder clients reported an improvement in their symptoms,
with a slight side effect of hoarseness when the device is on.
In addition to psychotropic medication and non-medicinal treatments,
hospitalization may be a third course of action when treating clients under
the influence of medications. Many times, bipolar clients do not require
hospitalization when being treated with medications properly and when they keep up with their prescriptions. Even when hospitalization is necessary,
often emphasize to my clients that their stay is not permanent, but merely a
means to get stabilized and back on their feet.
Louis was a bipolar client
of mine who, in the past, had required some hospitalization when he refused
to take his medications. Clients like Louis are extremely resistant to
a measure as hospitalization because they do not understand the reasoning
behind this decision.
7 Circumstances under which Hospitalization is Necessary
To help Louis, I gave him a "List of Circumstances"
under which hospitalization would most definitely be necessary. These
included the following:
1. When suicidal, homicidal, or aggressive impulses or actions threaten
yours or others’ safety.
2. When you’re severely and dangerously agitated or psychotic.
3. When you have another dangerous medical condition such as diabetes, and
are no longer managing it properly.
4. When your distress or dysfunction is so severe that it requires
round-the-clock care your loved ones can’t provide.
5. When you’re so apathetic or depressed that you won’t eat.
6. When you have an ongoing substance abuse problem.
7. When doctors need to closely observe your reactions to medications.
By giving Louis a list of circumstances he can refer to, he was less suspicious of being hospitalized.
On this track, we discussed the three types of treatments that clients may
take in addition to therapy: psychotropic medications; non-medicinal
treatments; and hospitalization.
On the next track, we will examine how stress affects those with bipolar
disorder and how clients can monitor their stress: kindling; short-term
chronic stress; and stress symptoms.
Peer-Reviewed Journal Article Reference:
Swartz, H. A., Levenson, J. C., & Frank, E. (2012). Psychotherapy for bipolar II disorder: The role of interpersonal and social rhythm therapy. Professional Psychology: Research and Practice, 43(2), 145–153.
Online Continuing Education QUESTION
What are three types of treatments that clients may take in addition to
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