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Bipolar Disorder and HIV. Medical Case Manager Clinical Conference June 28 th 2007. Objectives. Review Bipolar Disorder Review the effects of bipolar disorder on adherence to HIV medications and risky behavior. Psychiatric disorder that causes unusual shifts in a person’s Mood Energy

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bipolar disorder and hiv

BipolarDisorderand HIV

Medical Case Manager Clinical Conference

June 28th 2007

  • Review Bipolar Disorder
  • Review the effects of bipolar disorder on adherence to HIV medications and risky behavior

Psychiatric disorder that causes unusual shifts in a person’s

    • Mood
    • Energy
    • Ability to function
  • Resulting in
    • Damaged relationships
    • Poor job or school performance
    • Suicide
understanding bipolar disorder
Understanding Bipolar Disorder
  • Affects 5.7 million adults (2.6%) in a given year
  • Develops in late adolescence/early adulthood
  • Often not recognized
  • Bipolar disorder is a long-term illness
  • Alcohol and drug abuse are very common among people with bipolar disorder
  • Extreme, sometimes unpredictable moods
    • Range from overly "high" and/or irritable to sad and hopeless and then back again
  • Periods of highs and lows are called episodes of mania and depression
  • Severe changes in energy and behavior accompany changes in mood
  • Often periods of normal mood occur in between
symptoms of mania
Increased energy

Overly good, euphoric mood

Extreme irritability

Racing thoughts and speech

Easily Distracted

Little sleep needed

Unrealistic beliefs in one's abilities and powers

Poor judgment

Spending sprees

A lasting period of unusual behavior

Increased sexual drive

Drug abuse (cocaine, alcohol, and sleeping medications)

Provocative, intrusive, or aggressive behavior

Denial that anything is wrong

Symptoms of Mania
  • Less destructive state than mania
  • Experience fewer symptoms of mania
  • Shorter duration of symptoms
  • Often a very 'artistic' state of the disorder
    • A flight of ideas
    • Extremely clever thinking
    • Increased energy
symptoms of depression
Lasting sad, anxious, or empty mood

Feelings of hopelessness or pessimism

Feelings of guilt, worthlessness, or helplessness

Loss of interest or pleasure in activities once enjoyed

Difficulty concentrating, remembering, making decisions

Decreased energy

Restlessness or irritability

Sleeping too much, or can't sleep

Change in appetite

Chronic pain not caused by physical illness or injury

Thoughts of death or suicide, or suicide attempts

Symptoms of Depression
mixed state
Mixed State
  • Symptoms of mania and depression occur simultaneously
    • Ex. anxiety, belligerence, confusion, fatigue, insomnia, irritibility, paranoia, racing thoughts, restlessness, psychosis, and rage
  • Moods can easily and quickly be shifted
  • Suicide attempts, substance abuse, and self-mutilation may occur during this state
variations of bipolar disorder
Variations of Bipolar Disorder
  • Rapid Cycling
    • Moods change >4 time a year
  • Slow Cycling
  • Ultra-rapid Cycling
    • Moods change several times per week or day
      • Rare but real
  • Type I vs. Type II
    • Type II more difficult to diagnose
    • Symptoms differ between patients
  • Symptoms
  • Course of illness
  • Family history, when available
  • Type I
    • one or more manic or mixed episodes
  • Type II
    • at least one episode of hypomania and depression
      • More common
  • Inheritance
  • Genetics
  • Stressful environment or negative life events
  • Other possible "triggers“:
    • Antidepressant medication → mania
    • Sleep deprivation → mania
    • Hypothyroidism → depression
Receiving timely and competent treatment can be difficult

Adherence is key

Recurrence still possible

  • Can not be cured but can be managed
  • Optimal treatment combines medication and psychosocial treatment
  • Mood Stabilizers
    • Lithium prevents and controls manic and depressive episodes
    • Anticonvulsant medications for difficult-to-treat bipolar episodes
      • valproate or carbamazepine
  • Thyroid supplementation
    • Especially those with rapid cycling
    • Lithium treatment may reduce thyroid levels
side effects
Weight gain



Reduced sexual drive or performance


Hair loss

Movement problems

Dry mouth

Side Effects
  • Adherence reduces the chance of having recurrent, worsening episodes
psychosocial treatments
Psychosocial Treatments
  • Cognitive behavioral therapy
    • Changing negative thought patterns
  • Psychoeducation
    • Teaching the patient and family about the illness
  • Family therapy
    • Reduce the level of distress within the family
  • Interpersonal and social rhythm therapy
    • Improve interpersonal relationships
bipolar disorder and hiv21
Bipolar Disorder and HIV
  • Mania as a presenting symptom
  • Mania as a result of HIV
  • Both occur more often in patients with an AIDS diagnosis
  • Failure to treat mania may result in:
    • Nonadherence to HIV medications
    • Self-destructive behavior
    • Unsafe sex
role of nurses and case managers23
Role of Nurses and Case Managers
  • A good prognosis depends on:
    • The right medicines
    • Correct dosing
    • An informed patient
    • A good relationship with a competent physicain and therapist
    • Supportive family or significant other
    • A balanced lifestyle
      • Regulated stress level
      • Regular exercise
      • Regular sleep and wake times
role of nurses and case managers24
Role of Nurses and Case Managers
  • Assist patients in keeping a chart
    • Daily mood symptoms
    • Treatments
    • Sleep patterns
    • Life events
  • Encourage client/patient in continuing their treatment
    • Adherence techniques
    • Accompanying them to mental health appointments
role of nurses and case managers25
Role of Nurses and Case Managers
  • Providing support as patient/client “tests out” treatment plans
  • Supporting patient’s/client’s family as they cope with altered behavior, spending sprees, and withdrawal
  • Offering referrals to support groups for patient/clients and their families
  • Mental Health Services Locator

  • Christina Price, MPH