Mood Disorders: Bipolar

Chapter 13

Called Manic Depressive Disorder Characterized by 2 opposite poles: mania-

exaggerated euphoria or irritability and depression

Defined as alternating mood episodes characterized by mania, hypomania, depression, & concurrent mania and depression (mixed episodes)

Chronic, recurrent, and life threatening that require monitoring

Bipolar disorder

Bipolar I: at least 1 episode of mania alternating with major depression. Psychosis may accompany mania

Bipolar II: Hypomania alternating with major depression. No psychosis. Hypomania in this disorder tends to be euphoric and the depression puts people at risk for suicide

Cyclothymia: Hypomanic episodes alternating with minor depressive episodes . Tend to have irritable hypomanic episodes

Rapid Cycling: 4 or more mood episodes in a 12 month period

Bipolar disorder: most to least severe

Bipolar disorder emerges between 18-30 yrs 1st episode in males most likely mania 1st episode in females most likely depression Cyclothymia usually begins in adolescence Substance abuse/use common, possibly to self-

medicate Associated with other psychiatric disorders

Prevalence and comorbidity

Bipolar disease is defined as a disorder involving complex disturbances in relationships, marked disruption in sleep patterns, linking environment, genes, neural systems, & behaviors and high rates of certain psychological and medical comorbidities

Biological Theory Genetic Factors: strong genetic component

Neurobiological Factors Neurotransmitters are link to causal factors in mania and

depression Psychological Influences

Stressful life events can trigger symptoms bipolar

Theory

Diagnosed people with bipolar disorder tend to achieve higher levels of education and occupational status.

Proportion is higher among creative writers, artists, highly educated men and women and professional persons

Cultural considerations

Individuals with bipolar disorderMisdiagnosedUnderdiagnosedOn average, spend 8 yrs seeking treatment

before receiving correct diagnosisGoal of early diagnosis- Avoid the following

Suicide (1 in 5) Substance abuse Marital or work problems Development medical comorbidity

Clinical picture

Assessment Mood Disorder Questionnaire (screening tool) pg 249 Level of Mood: euphoric or depressed Behavior: mania, indiscriminate sex, spending sprees Thought Process: flight of ideas, grandiose Cognitive function: verbal, sustained attention Assessment Guidelines

Diagnosis: Risk for Injury Outcomes Identification

Phase 1: Acute Phase (Acute Mania) Phase 2: Continuation of Treatment Phase Phase 3: Maintenance Treatment Phase

Application of nursing process

Planning Geared toward the particular phase that is occurring Acute Phase (0-2 months) Continuation Phase (2-6 months) Maintenance Phase (6 months)

Implementation Acute Phase Communication Guidelines Milieu Therapy: seclusion, safety & physical needs Pharmacology/Biological/Integrative

Mood Stabilizers: Lithium Anticonvulsive: Depakote, Tegretol, Lamictal

Evaluation Outcome criteria dictate the frequency of evaluation

Application of nursing process