Bipolar II Disorder: Discuss the differences between your chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria including presentation of symptoms according to DSM 5 TR criteria

Bipolar II Disorder
Bipolar disorder is a mental health problem with considerable effects on the affected populations and their significant others. Patients suffer from reduced quality of life, and productivity, and an increased risk of premature mortality. The clinical management of bipolar disorder entails the use of pharmacological and non-pharmacological interventions. All populations irrespective of their ages are at risk of different types of bipolar disorders such as bipolar I, II, cyclothymic, and substance/medication-induced bipolar disorders. Therefore, this paper investigates prevalence, neurobiology, differences, clinical guidelines and treatment, and monitoring for bipolar II disorder.

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Prevalence and Neurobiology of Bipolar II Disorder
The selected bipolar disorder type for analysis is bipolar II disorder. The experience of at least a major depressive episode and hypomanic episode characterizes bipolar II disorder. Bipolar II disorder prevalence in the United States is 0.8%. Its global prevalence is 0.3% while the combined prevalence of the different types of bipolar disorders is 1.8%. The pooled lifetime prevalence of bipolar II disorder is 1.57%. Females have an increased prevalence risk of bipolar disorder as compared to males (McIntyre et al., 2020). There is also the high risk of comorbid disorders such as substance use and anxiety disorders in patients diagnosed with bipolar II disorder.
Bipolar II disorder has a neurobiological basis. Evidence shows the existence of a link between genetics, epigenetics, and bipolar II disorder. Twin studies have revealed high heritability rates of bipolar disorders in 70-80% of the cases. There is also a high risk of bipolar disorder in first-degree relatives of patients with the disorder (Scaini et al., 2020). Epigenetic mechanisms such as histone modifications, DNA methylation, and chromatin remodeling also play a role in the disorder.
Changes in the brain’s neuroplasticity and neurotropic signaling pathways also contribute to bipolar II disorder. Neurotropic factors regulate neurosurvival processes, synaptic formation and growth, and cellular plasticity in the central nervous system. Any changes in neurotrophic factors such as brain-derived neurotrophic factor (BNDF) are associated with an elevated risk of bipolar disorders. A decrease in BNDF blood levels is associated with the development of bipolar disorder symptoms. Alterations in the neurotrophic signaling also cause bipolar disorders (Scaini et al., 2020). Factors such as brain damage alter the normal signaling pathways and neurotransmitters, hence, bipolar disorders.
Oxidative stress and mitochondrial dysfunction also contribute to the development of bipolar II disorder. Mitochondrial dysfunction affects neuronal activity, neuronal plasticity, behavioral adaptations, and cellular resilience. The dysfunction and alterations in these pathways form the basis of bipolar disorders. Any factor that raises the brain’s oxidative stress levels has also been associated with bipolar disorders (Madireddy & Madireddy, 2022). This is because oxidative stress alters the brain’s antioxidant capacity, hence, an increased risk of behavioral changes that are seen in bipolar disorders.
An injury to the hypothalamic-pituitary-adrenal axis (HPA) axis also contributes to bipolar disorders. The HPA axis regulates the physiological stress response. However, an injury to the axis increases the risk of relapse of bipolar disorders and cognitive dysfunction. In addition, structural abnormalities such as larger ventricular-to-brain ratios have been linked to bipolar disorders. Patients with bipolar disorders have also been found to have reduced bilateral cortical thickness in the temporal, frontal, and parietal regions (Abé et al., 2022). Therefore, the structural brain changes predict the risk of and development of bipolar disorders.
Differences between Bipolar II Disorder and Bipolar I Disorder
Bipolar II disorder differs from bipolar I disorder. According to DSM-5, patients diagnosed with bipolar I disorder have episodes of mania, hypomania, and depression. Patients diagnosed with bipolar II disorder have hypomania and depression episodes. During hypomania, patients experience persistently expansive, elevated, or irritable moods and increased energy or activity for at least four consecutive days, almost every day throughout the day. The additional symptoms during this stage include easy distractibility, indiscretion, grandiosity, flight of ideas, engaging in goal-directed activity, and sleep disturbances. Symptoms of major depressive episodes include a depressed mood almost every day, throughout the day, lack of energy, interest, or pleasure, sleep disturbances, difficulty concentrating and thinking, and suicidal thoughts, plans, or attempts (McIntyre et al., 2020). The symptoms of mania are similar to those of hypomania but more severe as compared to those seen in hypomania.
Special Population and Consideration
Children with bipolar disorder are the vulnerable population that has been chosen for the analysis. Children with bipolar disorder are a vulnerable population because of several reasons. Firstly, the risk of comorbid conditions among them is high. According to evidence, children with bipolar II disorder and other bipolar disorder types have a high risk of other disorders such as anxiety disorders, attention-deficit-hyperactivity disorder, and oppositional defiant disorder (Gautam et al., 2019). The existence of comorbidities affects the course of treatment in children with bipolar II disorder.
Children with bipolar II disorder and other bipolar types are also considered a vulnerable population because of the increased risk of syndromal recurrences. Up to 80% of children and adolescents diagnosed and treated for bipolar II disorder develop recurrences of depressive episodes and subsyndromal recurrences. Children have immaturely developed organs. Organs such as the liver and kidneys have not developed to perform optimal functions such as drug metabolism and clearance (Post et al., 2020). As a result, the risk of drug toxicity among them when treating bipolar II disorder is high, leading to them being considered a vulnerable population.
Special considerations should inform bipolar II treatment in children. Treatment should be initiated in low doses to reduce the risk of drug toxicities. Practitioners should monitor the patients closely for response, efficacy, and adverse reactions. Practitioners should also focus on initiating children with bipolar II disorder on monotherapy to lower the risk of harm. Dual therapy should only be considered in severely ill children. Besides, a trial of treatment might be considered in children who are more ill to reduce the risk of harm. Practitioners must also educate families about the benefits, risks, and the need for compliance for optimum outcomes (Gitlin & Malhi, 2020). These considerations will ensure beneficence, non-maleficence, and justice in the treatment of bipolar II disorder in children.
FDA and/or Clinical Practice Guidelines
Several drugs are available for use in treating bipolar II disorder in children. Antipsychotics such as risperidone, quetiapine, and olanzapine are the drugs of choice for hypomania symptoms. Fluoxetine is the primary drug of choice for children who present with bipolar depression. Fluoxetine should be used in combination with olanzapine. The first-line drugs for the acute treatment of mania in children include risperidone, lithium, asenapine, aripiprazole, and quetiapine. Second-line drugs include ziprasidone and olanzapine while divalproex is the third-line drug of choice in acute mania. The first-line drug for acute bipolar depression is lurasidone while lithium and lamotrigine are second-line drugs. Olanzapine-fluoxetine combination, escitalopram, sertraline, and quetiapine are the third-line drugs of choice (Gautam et al., 2019). The first-line drugs for maintenance treatment are varied. They include lithium, divalproex, aripiprazole, a combination of lithium/Divalproex plus risperidone, and a combination of lithium plus divalproex/carbamazepine. The FDA has approved risperidone, quetiapine, olanzapine, and aripiprazole for use in treating bipolar disorders in children (Cichoń et al., 2020).
Side Effects, FDA Approvals, and Warning
Children who are prescribed the above drugs should be monitored for side and adverse effects. Patients prescribed lithium should be monitored for polydipsia, polyuria, weight gain, interstitial fibrosis, hypothyroidism, leukocytosis, alopecia, and abdominal discomfort. Children prescribed valproate should be monitored for tremors, weight gain, abdominal discomfort, alopecia, and decreased bone density. Those prescribed lamotrigine should be monitored for headache, dizziness, meningitis, leucopenia, blurred vision, and blood dyscrasias. Children prescribed carbamazepine should be monitored for leukopenia, blurred vision, rashes, and confusion. Antidepressants such as fluoxetine have side effects such as weight gain, sedation, and sleep disturbances. Patients should be monitored for the increased risk of suicidal thoughts, plans, or attempts (Cichoń et al., 2020; Gautam et al., 2019; Yee et al., 2019). Those prescribed antipsychotics should be monitored for extrapyramidal side effects such as dyskinesia, weight gain, and sedation.
Laboratory investigations should be done to monitor the drug levels of the different treatments. For example, blood tests should be done to ensure lithium level is within 0.6-1.0 mmol/l, valproate 50-125 mg/l, and carbamazepine 6-12 mg/l. Blood tests should also be done for blood glucose levels and rule out complications such as leukocytosis (Gautam et al., 2019). Children should be weighed to rule out overweight and obesity due to treatment.
Examples of Prescriptions
Name: Q.T
Age: 12 years
Diagnosis: Bipolar II disorder
Treatment
Oral olanzapine 2.5 mg once daily
Refills: None
Prescriber’s name and signature
Name: C.D.
Age: 13 years
Diagnosis: Bipolar II disorder
Treatment
Oral fluoxetine 20 mg once daily
Refills: None
Prescriber’s name and signature
Name: E.T.
Age: 13 years
Diagnosis: Bipolar II disorder
Treatment
Oral lithium 600 mg twice daily
Refills: None
Prescriber’s name and signature
Conclusion
In summary, this paper has explored the prevalence and neuroscience of bipolar II disorder. It has also examined the differences between bipolar I and bipolar II disorder. The essay has investigated the different treatment options for bipolar II disorder and why children are considered a vulnerable population. Therefore, bipolar II treatment in children should aim at ensuring harm reduction while enhancing symptom management.
References
Abé, C., Ching, C. R. K., Liberg, B., Lebedev, A. V., Agartz, I., Akudjedu, T. N., Alda, M., Alnæs, D., Alonso-Lana, S., Benedetti, F., Berk, M., Bøen, E., Bonnin, C. del M., Breuer, F., Brosch, K., Brouwer, R. M., Canales-Rodríguez, E. J., Cannon, D. M., Chye, Y., … Landén, M. (2022). Longitudinal Structural Brain Changes in Bipolar Disorder: A Multicenter Neuroimaging Study of 1232 Individuals by the ENIGMA Bipolar Disorder Working Group. Biological Psychiatry, 91(6), 582–592. https://doi.org/10.1016/j.biopsych.2021.09.008
Cichoń, L., Janas-Kozik, M., Siwiec, A., & Rybakowski, J. (2020). Clinical picture and treatment of bipolar affective disorder in children and adolescents. Psychiatria Polska, 54(1), 35–50. https://doi.org/10.12740/PP/OnlineFirst/92740
Gautam, S., Jain, A., Gautam, M., Gautam, A., & Jagawat, T. (2019). Clinical Practice Guidelines for Bipolar Affective Disorder (BPAD) in Children and Adolescents. Indian Journal of Psychiatry, 61(Suppl 2), 294–305. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_570_18
Gitlin, M., & Malhi, G. S. (2020). The existential crisis of bipolar II disorder. International Journal of Bipolar Disorders, 8(1), 5. https://doi.org/10.1186/s40345-019-0175-7
Madireddy, S., & Madireddy, S. (2022). Therapeutic Interventions to Mitigate Mitochondrial Dysfunction and Oxidative Stress–Induced Damage in Patients with Bipolar Disorder. International Journal of Molecular Sciences, 23(3), Article 3. https://doi.org/10.3390/ijms23031844
McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., Malhi, G. S., Nierenberg, A. A., Rosenblat, J. D., Majeed, A., Vieta, E., Vinberg, M., Young, A. H., & Mansur, R. B. (2020). Bipolar disorders. The Lancet, 396(10265), 1841–1856. https://doi.org/10.1016/S0140-6736(20)31544-0
Post, R. M., Goldstein, B. I., Birmaher, B., Findling, R. L., Frey, B. N., DelBello, M. P., & Miklowitz, D. J. (2020). Toward prevention of bipolar disorder in at-risk children: Potential strategies ahead of the data. Journal of Affective Disorders, 272, 508–520. https://doi.org/10.1016/j.jad.2020.03.025
Scaini, G., Valvassori, S. S., Diaz, A. P., Lima, C. N., Benevenuto, D., Fries, G. R., & Quevedo, J. (2020). Neurobiology of bipolar disorders: A review of genetic components, signaling pathways, biochemical changes, and neuroimaging findings. Brazilian Journal of Psychiatry, 42(5), 536–551. https://doi.org/10.1590/1516-4446-2019-0732
Yee, C. S., Hawken, E. R., Baldessarini, R. J., & Vázquez, G. H. (2019). Maintenance Pharmacological Treatment of Juvenile Bipolar Disorder: Review and Meta-Analyses. International Journal of Neuropsychopharmacology, 22(8), 531–540. https://doi.org/10.1093/ijnp/pyz034

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Include at least 5 recent intext citations and references in APA formatt

For this assignment, you will write a 5–6-page paper on the topic of bipolar and bipolar and related disorders. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of your course provided resources.

In your paper, you will choose one of the following diagnoses: Bipolar I, Bipolar II, Cyclothymic Disorder, Substance/Medication-Induced Bipolar and Related Disorder, Bipolar and Related Disorder Due to Another Medical Condition. Your paper will include discussion for your chosen diagnosis of bipolar and related disorder on the following:

Prevalence and Neurobiology of your chosen disorder

Discuss the differences between your chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria including presentation of symptoms according to DSM 5 TR criteria

Discuss special populations and considerations (children, adolescents, pregnancy/post-partum, older adult, emergency care) for your chosen bipolar and related disorder; demonstrating critical thinking beyond basics of HIPPA and informed consent with discussion of at least one for EACH category: legal considerations, ethical considerations, cultural considerations, social determinants of health

Discuss FDA and/or clinical practice guidelines approved pharmacological treatment options in relation to acute and mixed episodes vs maintenance pharmacological treatment for your chosen bipolar and related disorder

Of the medication treatment options for your chosen disorder discuss side effects, FDA approvals and warnings. What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring

provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy.