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©2011, THE AMERICAN ACADEMY OF NURSE PRACTITIONERS. ALL RIGHTS RESERVED.
This publication is designed to complement the presentation titled
The Many Faces of Bipolar Disorder: Improving Diagnosis and Tailoring Treatment in Primary Care. None of the contents may be reproduced in any form without prior written permission from the publisher. The opinions expressed in this publication and related educational event are those of the speakers and do not
necessarily reflect the opinions or recommendations of their affiliated institutions, the publisher, the American Academy of Nurse Practitioners, or AstraZeneca.
This program was developed by the American Academy of Nurse Practitioners in cooperation with Medical Communications Media, Inc., Newtown, PA.
This program was planned in accordance with
AANP CE Standards and Policies and AANP Commercial Support Standards.
This program is supported through an educational grant from AstraZeneca.
The content of the slides printed in this syllabus was accurate as of the publication date. Some slides may have been updated for the live presentation. This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Further, attendees/participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this program.
RELEASE DATE: FEBRUARY 3, 2011 PROGRAM ID: 1012385
This program is approved for
1.0 contact hour of continuing education
(which includes 0.25 hours of pharmacology)
by the American Academy of Nurse Practitioners.
Dr. Adams is the Program Director for the Psychiatric-Mental Health Nurse Practitioner Program (PMHNP) at Vanderbilt University School of Nursing. She joined the Vanderbilt faculty in 1995, providing leadership in developing the PMHNP curriculum and in implementing the modified distance option for the PMHNP program. She has 30 years of experience as a therapist and advanced practice psychiatric nurse. She pioneered a model of integrated mental health care (PMHNP role) within a private OB-GYN group, where she maintains a faculty practice. Dr. Adams has extensive experience in curriculum consultation and program development assisting other universities in the implementation and evaluation of PMHNP programs. She maintains an active role in
professional organizations that impact advanced practice psychiatric nursing, addictions treatment, health policy, and access to mental health care. She has directly help educate over 300 PMHNPs and mentored nursing and psychology students by serving on dissertation committees for PhD students and chairing scholarly projects for DNP students. Dr. Adams' current research concerns are efficacy of trauma-informed interventions and sustained
recovery for women with co-occurring substance use and mental health disorders in community-based programs. Her research goal is to identify effective prevention and early intervention strategies for women with co-occurring substance use and mental health disorders and to facilitate their success in parenting their children. She is a member of the American Academy of Nurse Practitioners (Fellow), American and Tennessee Nurses Association, Association of Medical Educators and Researchers in Substance Abuse (Board), American Psychiatric Nurses Association, National Organization of Nurse Practitioner Faculty (Chair, Psych SIG), and the International Nurses Society on Addictions.
Disclosures:Dr. Adams has no conflicts of interest to disclose.
Susie Adams, PhD, RN, PMHNP, FAANP
Professor and Director • Psychiatric-Mental Health Nurse Practitioner Program
Vanderbilt University School of Nursing • Nashville, TN
Dr. Hentz is the Program Director for the Advanced Psychiatric-Mental Health Nursing Programs at the University of Pennsylvania School of Nursing. She has taught advanced psychiatric-mental health nursing for the last 10 years. Dr. Hentz has extensive experience in curriculum and program development. Her most recent research is a qualitative phenomenological study focusing on body memory as it relates to loss and trauma. Her dissertation was a grounded theory study examining ethical decision making among nurses. Dr. Hentz acts as a consultant in the area of qualitative methodology. She is an external committee member for several doctoral students. Dr. Hentz practices part-time as a psychiatric-mental health nurse practitioner (PMHNP). She has worked in a variety of settings including private practice, inpatient psychiatric hospitals, outpatient eating disorders, and correctional psychiatry. She has precepted and mentored numerous nurse practitioner and physician assistant students. Her research interest is exploring the health disparities and disease prevention of related women’s health issues among underserved populations. Her research goal is to improve the overall health outcomes and preventative practices of women in underserved population. She is a member of the American Academy of Nurse Practitioners (Fellow), Virginia Council of Nurse Practitioners, and National Organization of Nurse Practitioner Faculty.
Disclosures:Dr. Hentz has no conflicts of interest to disclose.
Patricia Hentz, EdD, PMHCNS-BC, CRNP
Practice Associate Professor
Program Director, Advanced Practice Psychiatric-Mental Health Nursing Programs
University of Pennsylvania School of Nursing • Philadelphia, PA
Bipolar disorder is the sixth leading cause of disability worldwide with a lifetime prevalence of 3.7% to 3.9%. Individuals with bipolar disorder experience episodes of mood elevation and depression, leading to significant reductions in functional status and quality of life. Along with marked functional and psychosocial impairment, bipolar disorder is also associated with a high prevalence of medical and psychiatric comorbidity, and a lifetime suicide risk of 15%.
Bipolar disorder is not easily diagnosed in many patients who present with symptoms of depression. As a result, many patients are improperly treated. Even patients appropriately diagnosed with bipolar disorder are not routinely receiving therapy that is tailored based on the severity of their disease, the presence of co-morbidities, and other individual factors.
Nurse practitioners play a vital role in improving the diagnosis and management of patients with bipolar disorder. They are uniquely positioned to fulfill the critical role of assessing and diagnosing bipolar disorder, recommending treatment plans, and educating and motivating patients to adhere to treatment regimens so they can experience the maximum benefit from their therapy.
Upon completion of this educational activity, the participant should be able to: • Outline the diagnostic criteria and categories for bipolar disorders.
• Explain how to differentiate bipolar disorder from common comorbidities and other mental health disorders. • Review recent clinical data regarding ways to individualize the management of patients with bipolar disorder. • Describe considerations for bipolar disorder management strategies based on the presence of different patient
characteristics and comorbidities.
Learning Objectives
Needs Statement
This program was developed for nurse practitioners.
This program is approved for 1.0 contact hour of continuing education (which includes 0.25 hours of pharmacology) by the American Academy of Nurse Practitioners. Program ID 1012385.
This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.
CE Credit Statement
The following abbreviations appear in the slides and the pages of this workbook.
BPD borderline personality disorder
EPS extrapyramidal symptoms
ER endoplasmic reticulum
MDD major depressive disorder
MDE major depressive event
MDQ Mood Disorders Questionnaire
NMS neuroleptic malignant syndrome
NOS not otherwise specified
OCD obsessive-compulsive disorder
PCP primary care provider
PTSD post-traumatic stress disorder
STD sexually transmitted disease
Abbreviations
The following pharmacologic agents appear within this workbook.
Generic Brand/Alternative Names
Acamprosate Campral Aripiprazole Abilify Asenapine Saphris
Bupropion Wellbutrin, Zyban Carbamazepine Equetro Chlorpromazine Thorazine Divalproex Depakote Fluoxetine Prozac Gabapentin Neurontin Lamotrigine Lamictal
Generic Brand/Alternative Names
Lithium Eskalith, Lithobid Naltrexone Revia, Depade Olanzapine Zyprexa Pregabalin Lyrica Quetiapine Seroquel Risperidone Risperdal Sertraline Zoloft Topiramate Topamax Ziprasidone Geodon
Generic/Brand Glossary
3 2 1
6 5 4
9 8 7
12 11 10
15 14 13
18 17 16
21 20 19
24 23 22
27 26 25
30 29 28
33 32 31
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
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Craddock N, Jones I. Genetics of bipolar disorder.J Med Genet..1999;36:585-594.
Fiedorowicz JG, Black DW. Borderline, bipolar, or both? Frame your diagnosis on the patient history.Curr Psychiatr.
2010;9(1):21-32.
Goldberg JF, Harrow M, Whiteside JE. Risk for bipolar illness in patients ini-tially hospitalized for unipolar depres-sion.Am J Psychiatry. 2001;58:1265-1270.
Goldberg JF. Antidepressants in bipolar disorder. 7 myths and realities.Current Psychiatry. 2010;9(5):41-49.
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Kakiuchi C, Iwamoto K, Ishiwata M, et al. Impaired feedback regulation of XBP1 as a genetic risk factor for bipolar disorder.Nat Genet. 2003;35(8):171-175.
Keller MB. Improving the course of illness and promoting continuation of treatment of bipolar disorder.J Clin Psychiatry.2004;65(Suppl 15):10-14.
Ketter TA (ed).Handbook of Diagnosis and Treatment of Bipolar Disorder. Arlington, VA: American Psychiatric Publishing, Inc.; 2009.
Krishnan KR. Psychiatric and medical comorbidities of bipolar disorder. Psycho-som Med.2005,67(1);1-8.
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Schumacher J, Abon Jamra R, Freuden-berg J, et al. Examination of G72 and D-amino-acid oxidase as genetic risk fac-tors for schizophrenia and bipolar affec-tive disorder.Mol Psychiatry.
2004;9:203-207.
Smith DJ, Harrison N, Muir W, et al. The high prevalence of bipolar spec-trum disorders in young adults with re-current depression: toward an innovative diagnostic framework.J Affective Disorder.
2005;84(2-3):167-168.
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Stahl, SM. Depression and bipolar disor-der, In:Stahl’s Essential Psychopharmacology, 3rd ed. New York, NY: Cambridge Uni-versity Press; 2008.
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