I need a total of 3 replies to these discussions' post.  Please make sure the references are APA format , within 5 years peer reviewed. 1 reply to each student. each reply around 300 words.  please don't use the same references as the ones in the students post. Thank you 

Student 1 post: 

Bipolar depression and bipolar mania are rather similar when you compare the two on paper. Both include feelings of depression, agitation, highly aggressive or regressive moods, helplessness, and much more. When experiencing depression, one is more likely to regress, one will isolate themselves from persons and things they otherwise enjoy. There is a strong shift of energy, where one may have otherwise been energetic and a go-getter, during a depressive episode, one will increase sleep and have a much lower drive of energy and emotion. On the flip side, when someone is in a manic episode, they are almost non-stop. This means that they are less likely to sleep, they are likely to do things they enjoy much more consistently, and they will become obsessively high-energy (Tondo et al., 2022)

One of the most commonly used tools to screen for bipolar disorders is the MDQ, which stands for Mood Disorder Questionnaire, and screens for bipolar and mania. The MDQ is a self-rated screening tool that is a series of 5 questions that delve into feelings, and emotions and can help bring the individual to focus on their current behaviors. There is a multitude of other tools to utilize such as the Young Mania Rating Scale (YMRS), which is used to evaluate manic symptoms versus the individuals’ baseline over a period of time. The Bech-Rafaelsen Mania Rating Scale (MAS) assesses motor and verbal activity and also gauges the necessity for fight or flight that the individual may feel. The MAS is a more concessive screening tool that overall gauges every aspect like well-being, self-esteem, sexual, sleep and work interest/activities (Cerimele et al., 2019)

Treatment for bipolar depression and bipolar mania both include therapy, but individualized treatment is required clinically. Mania would require medications such as valproate, carbamazepine, or even lithium. Depression would require medications such as quetiapine, lamotrigine, or even lithium. A combination of medications would often be required to treat both, such as lithium and valproate.

Reference

Cerimele, J. M., Goldberg, S. B., Miller, C. J., Gabrielson, S. W., & Fortney, J. C. (2019). Systematic review of symptom assessment measures for use in measurement-based care of bipolar disorders. Psychiatric Services, 70(5), 396–408. https://doi.org/10.1176/appi.ps.201800383

Tondo, L., Miola, A., Pinna, M., Contu, M., & Baldessarini, R. J. (2022). Differences between bipolar disorder types 1 and 2 support the DSM two-syndrome concept. International Journal of Bipolar Disorders, 10(1). https://doi.org/10.1186/s40345-022-00268-

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Student 2 post

Differentiate between bipolar depression and bipolar mania. 

Bipolar mania is succinctly distinguished using the mnemonic DIGFAST – Distractibility, Impulsivity, Grandiosity, Flight of ideas, Increased activity, Sleep disturbance, and Talkativeness. This acronym represents terms of the potential range of symptoms that may be expressed by the manic patient. In the context of mania, patients may be easily distracted, cannot pay attention, and are unable to complete tasks. The patient may be impulsive, making decisions that are illogical and not in the patient’s best interest. Grandiosity may present as an inflated sense of self-worth, even to the point of the patient believing they are omnipotent. A flight of ideas manifesting as rapid successive thoughts of tangential topics may occur. An increase in activity and even agitation can be seen. Patients experiencing mania tend to have sleep disturbances where there is a significantly diminished need for sleep. The person affected may feel rested after only a few hours of sleep or have no tolerance for sleep days at a time.  Finally, talkative, rapid, pressured speech may ensue. As the state of mania increases, speech may even become incomprehensible as seen in psychosis. Overall, in a manic state, a patient’s mood may range from euphoric to emotionally labile, and even shift to irritability (Sadock et al., 2022).

In bipolar depression, symptoms may be likened to major depressive disorder (MDD); however, the depression in bipolar patients is more commonly seen as melancholic, atypical, psychotic, and with a mixed feature presentation (McIntyre et al., 2022). Symptoms in a depressive phase of bipolar include anhedonia, a non-reactive mood, and psychomotor retardation mixed with agitation. It can include hypersomnia and hyperphagia, not typical of MDD. Psychotic symptoms may be concurrent with a depressive episode and can include nihilistic and somatic delusions (McIntyre et al., 2022). Mixed features seen in a depressive episode of bipolar, termed intra-episodic manic symptoms, affects up to 80% of those with bipolar depression (McIntyre et al., 2022). While those with bipolar II disorder experience some form of depression, persons with bipolar I may never have a depressive episode.

Select a screening or diagnostic tool relevant to bipolar disorders.

There are multiple scales to assist in the assessment of bipolar depressive symptoms including the Hamilton Rating Scale for Depression (HAM-D), the Montgomery Asberg Depression Rating Scale (MADRS), and the Beck Depression Inventory (BDI) to name a few. Evaluation of mania can be challenging as the clinical scenario is variable both between patients and along the continuum of an individual patient. The Young Mania Rating Scale (YMRS) is the used most frequently for mania assessment (McIntyre et al., 2022). The YMRS typically takes up to 30 minutes to complete and utilizes 11 items. Irritability, speech variance, content of thought, and aggression are measured on a scale of zero to eight. Mood, motor activity, sexual interest, sleep, language-thought, appearance, and insight are rated from 0-4. Scoring is based on the patient’s subjective report of symptoms over the course of a 48-hour period (McIntyre et al., 2022).

Indicate recommended treatment for bipolar depression or bipolar mania using clinical guidelines.

Most bipolar patients will initially seek help from a primary are provider. Collaborative care models have been shown to improve outcomes for mental illness in general (Carvalho et al., 2020). Both medical and alternative psychiatric conditions that might imply an affective disorder should be evaluated and ruled out before consideration of the diagnosis of bipolar disorder. In the case of mania and hypomania, antipsychotics or mood stabilizers remain center stage. Lithium, carbamazepine, and valproate continue to be proven, effective mood stabilizing agents approved by the FDA. When a regimen is a combined mood stabilizer along with an antipsychotic such as aripiprazole or olanzapine, a longer term, maintenance regimen may result (Carvalho et al., 2020).  Of note, treatment of bipolar depression with antidepressants carries the risk of affective switching where manic episodes may be accelerated.

References

Carvalho, A. F., Firth, J., & Eduard, V. (2020). Bipolar Disorder. The New England Journal of Medicine, 383(1), 58-66. https://doi.org/10.1056/NEJMra1906193Links to an external site.

McIntyre, R. S., Alda, M., Baldessarini, R. J., Bauer, M., Berk, M., Correll, C. U., Fagiolini, A., Fountoulakis, K., Frye, M. A., Grunze, H., Kessing, L. V., Miklowitz, D. J., Parker, G., Post, R. M., Swann, A. C., Suppes, T., Vieta, E., Young, A., & Maj, M. (2022). The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 21(3), 364–387. https://doi-org /10.1002/wps.20997

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (12th ed.). Wolters Kluwer.

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Student 3 post.

The clinical presentation of depression and mania demonstrate distinguishing characteristics of bipolar disorder. Mania presentation shows demonstrable features such as euphoric or irritable mood, talkativeness with loud and rapid speech (Russo et al., 2020; Saddock et al., 2022). Initially, the individual’s mood may present as euphoric and subsequently culminate into irritability if their grandiose plan is not met with approval. In a heightened manic state, individuals lose touch with reality and lack higher cognitive function (Russo et al., 2020). In this stage, they will have a flight of ideas and their speech is indecipherable sharing similar features to an individual with schizophrenia (Saddock et al., 20220). In comparison, depression is most notably characterized by depressed mood and thoughts originating from internal stimuli (Russo et al., 2020). Saddock et al (2022) describe depression as increased insomnia, slowing of psychomotor function and loss of interest or pleasure. These characteristics are distinguishable from major depressive disorder and follow a clinical pathway unique to bipolar depression. 

In terms of diagnostic tools relevant to bipolar disorder, depressive and manic symptoms can be measured by rating scales such as Montgomery-Asberg Depression rating scale (MADRS) as well as Young Mani Rating Scale (YMRS) (Keramatian et al., 2021). The MADRS involves a series of ten questions utilized to measure the severity of depressive episodes with mood disorders whereas the YMRS is eleven-item rating scale measuring baseline symptoms over forty-eight hours in individuals with mania. These evidence-based practice tools are useful in determining the reduction of symptoms incorporating measurable outcomes (Keramatian et al., 2021).

In respect of treatment, the first line treatment of bipolar mania is second generation antipsychotics (Keramatian et al., 2021; Preston et al., 2021; Saddock et al., 2022). Originally, first generation antipsychotics were the primary treatment for agitation and aggressive behavior. Nonetheless, with the introduction of second-generation antipsychotics, these agents surpassed the first generations in treating acute mania (Preston el., 2021). Currently, FDA approved second generation antipsychotics approved for the treatment of manic or mixed manic episodes include aripiprazole, asenapine, cariprazine, olanzapine, quietiapine, risperidone and ziprasisdone (Preston et al., 2021). In an effort to decrease non-adherence and increase compliance, long-acting injectable antipsychotics (LAIs) were developed for maintenance treatment (Yan et al., 2018). Abilify Maintena and Risperidone LAI are approved for monthly maintenance treatment of bipolar depression I (Yan et al., 2018). 

References

Keramatian, K., Chakrabarty, T., Saraf, G., & Yatham, L. N. (2021). New developments in the use of atypical antipsychotics in the treatment of bipolar disorder: A systematic review of recent randomized controlled trials. Current Psychiatry Reports, 23(7), 1–15.

Preston J., O'Neal, J., & Talaga, M. (2022). Handbook of clinical psychopharmacology for therapists. New Harbinger Publications.

Russo, D., Martino, M., Magioncalda, P., Inglese, M., Amore, M., & Northoff, G. (2020). Opposing changes in the functional architecture of large-scale networks in bipolar mania and depression. Schizophrenia Bulletin, 46(4), 971–980. doi:10.1093/schbul/sbaa004

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (12th ed.). Wolters Kluwer.

Yan, T., Greene, M., Chang, E., Hartry, A., Touya, M., & Broder, M. S. (2018). Medication adherence and discontinuation of aripiprazole once-monthly 400 mg (AOM 400) versus oral antipsychotics in patients with schizophrenia or bipolar I disorder: A real-world study using us claims data. Advances in Therapy, 35(10), 1612–1625. https://doi.org/10.1007/s12325-018-0785-y