The patho of bipolar is manic-depressive illness has not been deterimed as there are no biologic markers that correspond definitively. However there is a genic component, an epigenetic component, neurochemical, and environmental factors all play a role. There has been noted a DNA marker on a short arm chromosome 11 may play a part. AS well as 30 other genes for an increased risk.This supports brain-derived neurotrophic factor (TNF), nerver growth factor (NGF) and neutotrophin-3 (NT-3) as well as a few other play a role in the signaling molecule mechinsim within the the brain and a decrease in neuroplasticity. Other mechanism such as mitochrondrial dysfuntion, oxidative stress, immune-inflammatory imbalance play a roll in hypothalamid-pituitary - adreanl axis. Imagining also show a change in connectivity, neuronal activity and dendritic spien loss in the dorsolateral prefrontal cortex of patient with BD (that was done postt-mortem). There is also imbalances of neurotransmitters dopamine and serotonin but no pariticular neurotransmitter has been identified.

Apperance

Affectmood

Thought content

Perception

Suicide/self-destruction

Homicide/violence/aggression

Judgement/insight

Cognition

Physical health

Characterized by periods of deep prolonged and profound depression that alternate with periods of an excessively elevated or irritable mood. The manic episodes are featured at least 1 week of profound mood disturbance characterized by elation, irritability, or expansiveness

Grandisity

dimished need for sleep

Excessive talking or pressured speech

racing thoguhts or flight of ideas

clear evidence of distractibility

increased level of goal-focused activity at home, at work or sexually

excessive pleasurable activities

Depends on the stage either mainic or depressive, but a combination of pyschotherapy and medication is involved.

First-gen (loapine, haloperidol) and Second generation antipsychotics (clozapine, fluoxetine quetiapine, risperidone) Serotonin-dopamine activity modulators (SDAM) lumateperone, olanzapine/samidorphan, Penothiazine antipyschotics chlopromazine, and Lithium carbonate is wdiely used.

Depends on the phase for Acute maintain physcial health and therapeutic milieu, by providing a safe environment. Ask regularly for suicidal thougths and ideations. Decrease stiumlation without isolation, Provide outlets. Monitor for sleep, fluid intake, and nutrition. Provide portable nutritious food becasue the they may not be eating. Supervise the clothing choice. Communicate in matter of fact specfic approach, give concise explanation, provide consistency with expectations and limit set. Act on legitamint grievances. Reinforce nonmanipulative behaviours. Use Therapeutic communication techaniques.

Case mangament follow along with group, familty, and indiidual psychotherapy. Teach chronic disorder requireing long term pharmacological and psychological support. Teach about the beneifits of psychotherapy and support groups. TEach to watch for indications of impending relapse and ways to manage the crisis. Importance of sleep and medication administration and adherance.

Evaluate effectiveness of Milleu, watch fro durg interactions and medication therapeutic effects . Long term evaluate triggors and relpase of drug use and episodes of mania. Evaluate effectivieness of psychotherapy.