Bipolar Type II Diagnosis and Treatment

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The article examines the clinical differences between bipolar disorder type I (BDI) and bipolar disorder type II (BDII) since the difficulty in choosing a correct diagnosis often leads to poorly treated patients. The study focuses explicitly on critical differentiating factors such as an illness course and developmental antecedents. The study’s findings prove to be credible as the authors thoroughly analyze the symptoms and possible treatments based on reliable statistical evidence.

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Pharmacological treatment of the adult bipolar disorder

The article focuses on the pharmacological aspect of treating different phases of bipolar disorder. The study finds antipsychotics useful for treating mania but unsatisfactory for depression. The problem of underdeveloped treatment for the depressive phase and suicidal thoughts in bipolar disorder is addressed. The source is especially relevant to the research paper since it underlines the key pharmacological treatment options, their benefits, and limitations in the long-term treatment.

Pharmacotherapeutic interventions for bipolar disorder type II: Addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

The article covers the pharmacotherapeutic treatment and its effect on patients with BDII. The authors consider the choice of medicine, patient management, and therapy in the successful treatment of BDII. The study specifically focuses on the correlation of ethical standards and consideration of cultural and personal beliefs in treating BDII. The article’s intended audience is medical specialists, as the authors provide guidelines for treating BDII and improving the conditions of the patients.

Characteristics of bipolar I and II disorder: A study of 8766 individuals

The research provides an in-depth analysis of phenotypic differences in bipolar disorder types I and II. The study is credible and large-scale due to the consideration of a number of clinical features, comorbid conditions, and socioeconomic factors that affect the treatment. The results provide clear and evidence-based findings in the illness course, pharmacology, and hospitalization to improve the current state of bipolar disorder treatment.

Bipolar disorders. Nature Reviews Disease Primers

The article covers the issue of bipolar disorders as a whole, including the statistics, symptoms, heritability, comorbidities, and clinical practices. The following study combines the features of previously mentioned articles about symptoms and pharmacology and gives a thorough overview of the illness. It is especially relevant to the study since it structures the prominent features of BDII to increase the ability to provide an accurate diagnosis and treatment.

Bipolar Type ll Diagnosis and Treatment

Bipolar disorders present a common yet rather life-disrupting group of mental disorders. Bipolar disorders are typically characterized by alternating periods of mania and depression with various degrees. Such conditions present a considerable difficulty in diagnosis and proper pharmaceutical and psychological treatment for many doctors due to difficulties in psychosocial functioning, outstanding mood symptoms, and greater suicide risk in patients. The disorder also needs to be continually evaluated throughout one’s life to adjust the long-term treatment. Thus, it is critical to determine the symptoms, diagnosis, and probable treatment for a specific type of the condition – bipolar disorder type II.

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Bipolar disorder type II is the variation of bipolar disorder characterized by severe mood swings and psychological effects. BDII usually has familial aggregation, significant functional impairment, and longitudinal diagnostic stability (Vieta et al., 2018). It is typically diagnosed by the presence of at least one hypomanic and one major depressive episode. Various causes can trigger the appearance of bipolar disorder type II. It typically has high heritability where individuals who have a relative with bipolar disorder will most likely develop it as well. However, the disease is also defined by many environmental factors (Vieta et al., 2018). Various life events such as adverse childhood or drug misuse can also be considered the determinants for developing the disorder. Stress and trauma also largely contribute to triggering the condition for the person genetically predisposed for it. BDII clinically dominates in females and statistically starts in one’s teens or early 20s. Several studies suggest that BDII is a stable diagnosis that the person handles throughout their lifetime. The symptoms commonly occur with various intensities systematically even after the course of treatment.

Symptoms

Bipolar disorder II appears to be highly similar to bipolar disorder type I, but still has a few differences in mood swings flow. In both BDI and BDII, the mood changes from mania to depression, but BDII never reaches a full-blown mania (Karanti et al., 2020). The moods in BDII swing from hypomania that is a less-elevated state than mania to depression. BDII characterizes by the presence of two distinct episodes of hypomania and depression (Bayes et al., 2019). The symptoms do not develop solely due to medication or substance use or other conditions. Individuals with BDII can be depressed with higher mood instability for more extended periods of time and less excited during hypomania episodes than patients with BDI (Karanti et al., 2020).

The overall course of illness is often marked by prolonged periods of depression and periods of hypomanic symptoms. Bigger amounts of depressive episodes in BDII lead to a higher prevalence of psychiatric comorbidity and more often suicide attempts requiring more frequent psychotherapy and receiving medication such as lamotrigine and antidepressants (Karanti et al., 2020). BDI, on the other hand, has higher rates of hospitalization and metabolic diseases, for which they take mood stabilizers, antipsychotic drugs, electroconvulsive therapy, and receive psychoeducation (Karanti et al., 2020). The burden of depression for BDII makes the overall degree of social and functional impairment almost the same for patients with BDII as for those with BDI.

Hypomania usually lasts a few days and involves having more energy, creativity, quicker actions, and being more sociable, distracted, or irritable. An individual at this stage is more susceptible to engaging in risky behaviors, alcohol, and drugs. A person with BDII can feel good and function well, but the behavior may appear strange. After a period of hypomania, depression occurs in bipolar disorder type II. The symptoms include feeling empty or sad, having low motivation and energy levels, trouble focusing, and feeling worthless. An individual can also lose interest in activities, sleep too much or too little, gain or lose weight. All of these behaviors can disrupt one’s life, especially in BDII, as the person remains mainly depressed.

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Diagnosis

The detection of BDII presents significant difficulty in clinical practice. The intricacy primarily lies in the detection of hypomanic episodes that the patient may often dismiss as they are not as apparent as in mania. Despite the significant morbidity, hypomania can be characterized by high productivity and slight disturbances that appear not severe enough to require a clinical diagnosis. The predominance of depressive symptoms often leads to the doctor misdiagnosing BDII as anxiety or depression. The hypomania stage may also be overlooked and qualified as a substance use or personality disorder. Thus, it is crucial to ensure differential diagnosis to pose proper treatment and psychotherapy.

Treatment

Correct diagnosis and adequate treatment can help manage the disorder. Proper management of the disorder requires both pharmacotherapy and psychological interventions in the specific phases of the disorder. The treatment should be provided and tailored to each illness phase as the mood may switch or the response is incomplete, especially in the depressive phase. Combined pharmacological and non-pharmacological interventions for acute phases of hypomania and depressive episodes allow the patients to prevent the disorder’s recurrences in the long-term perspective. The screening instruments used with detailed questioning of the patient are needed to determine and aid the diagnosis. Questioning and psychotherapy prove to be especially useful in enhancing the diagnosis of BD.

The treatment for bipolar disorder is mainly composed of the medicine for the appearing symptoms. Since BDII usually presents depressive episodes, treatment includes the medicine for depression with antidepressants. However, the treatment with antidepressants might as well unmask bipolar disorder. The hypomanic episodes treatment with mood stabilizers is not as standard. The other possible treatments for BDII are the medical components dealing with mood switches such as androgens, corticosteroids, isoniazid, chloroquine, and electroconvulsive therapy (ECT) (Godman et al., 2019). An atypical antipsychotic combined with a mood stabilizer is commonly used to treat BDII (Godman et al., 2019). The patients with BDII are more likely to have lamotrigine and antidepressants combined with psychotherapy compared to patients with BDI who commonly receive electroconvulsive therapy and antipsychotics (Baldessarini et al., 2019). Treatment with quetiapine and benzodiazepines can be assigned to both types of bipolar disorder. Generally, the two numbers of medicines are used for both BDI and BDII and do not differ from the disorder’s subtype.

Pharmacology often appears essential for managing acute episodes of hypomania and depression. For treating hypomania or mania that is not as severe in BDII as in BDI, mood stabilizers such as valproate and lithium are typically used combined with antipsychotics such as aripiprazole, quetiapine, or olanzapine (Karanti et al., 2020). They are typically prescribed for severe hypomania in patients with BDII (Karanti et al., 2020). The aforementioned medications’ effects should also be taken into account because of the potential weight gain. The other conditions closely related to bipolar disorder or triggered by it may also arise during treatment. They are endocrine disorders, stroke, subthreshold hypothyroidism, or systemic lupus erythematosus that may require additional medical interventions. Moreover, specific implications may appear with the light exposure and the change of season, particularly from summer to autumn and winter to spring and be the triggers for the disorder.

Antipsychotics such as quetiapine are typically used to treat depression in BDII. However, the number of approved antipsychotics for bipolar depression is relatively low: quetiapine, lurasidone, and olanzapine combined with fluoxetine. The risks of using antidepressants for bipolar depression include elevated mood cycling, only worsening the condition (Baldessarini et al., 2019). However, the risk of switching from depression to hypomania can be reduced by prescribing an antimanic medication such as valproate or lithium combined with an antidepressant (Baldessarini et al., 2019). The risk of cycling can also be reduced with selective serotonin reuptake inhibitors instead of antidepressants. Electroconvulsive treatment can also be used for patients with BDII in a depressive phase who has not responded well to other treatments or have resistant depression. Severe bipolar depressive episodes are recommended to be treated in ambulatory care unless there is an impending suicide risk (Baldessarini et al., 2019). General treatment implies lower starting doses and titration in treating BDII as the patients with depression are less tolerant and more sensitive to treatment (Baldessarini et al., 2019). Olanzapine is also commonly combined with lithium in BD treatment.

Preventative strategies are also typically prescribed in recurring cases of BDII to reduce acute episodes of depression and hypomania. It typically includes a combination of an antipsychotic such as quetiapine and mood stabilizers such as valproate or lithium (Godman et al., 2019). Patients usually have positive results with antipsychotics for disorder maintenance. Antidepressants may be used with extra caution instead of antipsychotics in patients’ mixed recurrent symptoms to avoid poor outcomes. The type of treatment should also be tailored to BD type, specifically as the symptoms may vary. Patients with BDII should primarily address the predominant depressive symptoms. The receptiveness of medical treatment depends mainly on the condition of BDII. A prescribed antidepressant may have a worse effect than an anticonvulsant such as lamotrigine in a patient with BDII (Baldessarini et al., 2019). However, individual reactions may also vary; therefore, monitoring the patient is essential. The condition’s assessment should include the quality of prescribed ambulatory care and medication in individual psychotherapy sessions.

The treatment of the BDI and BDII also differs both medically and psychotherapeutically. The treatment with antidepressants is typically received by more than half of patients with BDII compared to one-third of patients with BDI (Baldessarini et al., 2019). Such a division is usually explained by a more significant number of depressive episodes in BDI patients (Baldessarini et al., 2019). Thus, lamotrigine is twice as common in treating BDII than BDI. On the other hand, mood stabilizers and antipsychotic drugs are more common in patients with BDI (Karanti et al., 2020). Quetiapine and benzodiazepines do not appear to provide a different effect for both types of bipolar disorder, despite the prevalence of anxiety disorders in patients with BDII (Karanti et al., 2020). Psychotherapy is statistically more common in treating BDII due to higher psychiatric comorbidity and other underlying personality disorders in BDII.

Altogether, bipolar disorder type II presents a complex disorder that should be treated with extreme consideration. The specific phase of hypomania or depression needs specially tailored treatment. It requires the symptomatic analysis to determine the diagnosis first and then manage the psychotherapeutic and pharmaceutic treatment. These steps predetermine the manageability of the disorder and the person’s ability to function in society and decrease the adverse effects of the disorder and medication. The adequately managed BDII can become a manageable condition that does not prevent a person’s functioning.

References

Bayes, A., Parker, G., & Paris, J. (2019). Differential diagnosis of bipolar II disorder and borderline personality disorder. Current Psychiatry Reports, 21(12), 125. Web.

Baldessarini, R. J., Tondo, L., & Vázquez, G. H. (2019). Pharmacological treatment of the adult bipolar disorder. Molecular Psychiatry, 24(2), 198-217. Web.

Godman, B., Grobler, C., Van-De-Lisle, M., Wale, J., Barbosa, W. B., Massele, A., Opondo, P., Petrova, G., Tachkov, K., Sefah, I., Alrasheedy, A. A., Unnikrishnan, M. K., Garuoliene, K., Bamitale, K., Kibuule, D., Kalemeera, F., Fadare, J., Khan, T. A., Hussain, S.,… Abdulsalim, S. (2019). Pharmacotherapeutic interventions for bipolar disorder type II: Addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries. Expert Opinion on Pharmacotherapy, 20(18), 2237-2255. Web.

Karanti, A., Kardell, M., Joas, E., Runeson, B., Pålsson, E., & Landén, M. (2020). Characteristics of bipolar I and II disorder: A study of 8766 individuals. Bipolar Disorders, 22(4), 392-400. Web.

Vieta, E., Berk, M., Schulze, T. G., Carvalho, A. F., Suppes, T., Calabrese, J. R., Gao, K., Miskowiak, W. K., Grande, I. (2018). Bipolar disorders. Nature Reviews Disease Primers, 4(1), 1-16. Web.

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PsychologyWriting. 2022. "Bipolar Type II Diagnosis and Treatment." February 6, 2022. https://psychologywriting.com/bipolar-type-ii-diagnosis-and-treatment/.

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