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Bipolar Disease My client this week I will refer to him as Mr Smith has returned to jail for the fifth time in 2 years Diagnosed with bipolar disorder Mr Smith had recently decided to stop taking his medication because he stated that his medications were making him fat and nervous Mr Smith has been treated with novel antipsychotic drugs Within five weeks of the cessation of his medications he was arrested and jailed Bipolar disorder is characterized by extreme mood swings the unmistakable poles of a cycle are inconsolable misery depression and uncontrollable elation mania During the low periods people lose all interest in life and capacity for pleasure They find it difficult to concentrate make decisions or take initiative Suicidal thoughts are common During the manic phase people are energetic cheerful talkative and sleep little They have unrealistic visions of wealth power and love They can be intrusive and domineering may make indiscriminate sexual advances and suddenly become irritable and turn to rage Their thoughts may degenerate into confused fragments and incoherent agitation They may become delusional What situations would prompt an individual diagnosed with bipolar disorder to suddenly stop taking their medications which have clearly helped them to function normally within society and which have helped to stabilize their extreme mood swings Patients often pay a high price in side effects for the relief provided by conventional antipsychotics Weight gain may be the most serious drawback of the novel drugslike the extrapyramidal symptoms caused by older drugs weight gain is a serious side effect that portends even more serious long-term consequences it can make people stop using the drug and relapse Harvard Mental Health Letter September 2002 pg2 I feel that Mr Smith needs to be counseled on the other options in medication available to him prescribed an alternative drug that can relieve his symptoms and then be evaluated at regular intervals to see if the
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