Situational Overview

“There are millions of

individuals undiagnosed
suffering from Bipolar
Disorders”
 Situational Overview
• Bipolar I disorder occurs
equally in both sexes;
however, rapid-cycling
bipolar disorder (4 or
more episodes a year) is
more common in women
than in men. Incidence of
bipolar II disorder is
higher in females than in
males.
 Situational Overview
• The age range for  Most cases
both bipolar I and commence when
bipolar II is from individuals are aged
childhood to 50 years, 15-19 years.
with a mean age of  The second most
approximately 21 frequent age range of
years. onset is 20-24 years.
 Morbidity
Result of the functional impairment often experienced in areas of:

work school relationships

 Mortality
Death by:

accidental death because of the

suicide functional impairments
(e.g., car accident, illicit drug
use, poor nutrition, neglect
of health, recklessness)
What is Bipolar Disorder
 Causes of Bipolar Disorder
Genetic
Factor

Biochemical
Factor

Psychodynamic
Factor

Environmental
Factor
Causes of Bipolar Disorder

Genetic control of Genetic control of

sensitivity to Exposure to the
environment environment

Genetic &
More heritable Environmental
Factor

Genetic Factor
 Causes of Bipolar Disorder

Epinephrine Epinephrine
Norepinephrine Norepinephrine

Increased & Decreased

Glutamate Levels

Biochemical Factor
Causes of Bipolar Disorder

Manifestation of the losses: Serves as a defense

loss of self-esteem against the feelings
the sense of worthlessness of depression

Depression Mania

Psychodynamic Factor
Causes of Bipolar Disorder

External Stressors
Or External Pressures

Environmental Factor
 Signs and Symptoms of Mania
A Auditory or visual hallucinations

P Paranoia or delusional ideation

H High energy levels

E Extremely happy, euphoric, or irritable mode

E Engagement in risk – taking behaviors

R Racing thoughts or increased rate of speech

D Difficulty concentrating or high distractibility

D Decreased need for sleep

I Increased sex drive

I Inflated self – esteem or grandiose ideas

 Signs and Symptoms of Depression
Sadness or irritability

Loss of enjoyment

Loss of energy

Difficulty concentrating

Insomnia or Hypersomnia

Unexplained physical complaints

Fatigue

Decreased sex drive

Change in appetite

2H

Suicidal Thoughts
Types of Bipolar
 Summary of DSM-IV-TR
Classification of Bipolar Disorders

Bipolar Disorder
Bipolar I Bipolar II Cyclothymic NOS

One or more One or more At least 2 years Bipolar features

manic or mixed major of numerous that do not meet
episodes, depressive periods of criteria for any
usually episodes hypomanic and specific bipolar
accompanied by accompanied depressive disorders
major by at least one symptoms*
depressive hypomanic
episodes episode
MALE=FEMALE FEMALE>MALE
Diagnosing Bipolar
 Mental Status Examination:
Appearance
Depressed Hypomanic Manic
Demonstrate poor to no eye Patients are busy, active, Hyperactive and might be
contact and involved hyper vigilant
Clothes may be unkempt, Always planning and doing Restless, energized, and
unclean, holed, unironed, and things active
ill-fitting  Talk and act fast
Lost significant weight Attire reflects the mania
Poor grooming, lack of
shaving, and lack of washing
Fingernails may show
different layers of polish or
one layer partially removed
(women)
Ma exhibit dirty fingernails
and hands (men)
Move slowly and very little
(psychomotor retardation)
Talk in low tone
 Mental Status Examination:
Affect/Mood

Depressed Hypomania Manic Mixed Episode

Feel sad, depressed, Mood is up, Mood is exhibits both
lost, vacant, and expansive, and often inappropriately joyous, depression and mania
isolated irritable elated, and jubilant within a brief period (1
2Hs Demonstrate wk or less)
annoyance and
irritability
 Mental Status Examination:
Thought Content
Depressed Hypomania Manic Mixed Episode
Preoccupied with Optimistic, forward Very expansive and Oscillate dramatically
negative ideas and thinking, and have a optimistic thinking between depression
nihilistic concerns positive attitude Excessively self- and euphoria
Focus on death and confident and/or Demonstrate marked
morbid persons grandiose irritability
Highly distractible
and quickly shift from
one person to another
 Mental Status Examination:
Perception
Depressed Hypomania Manic Mixed Episode
With psychosis, the Do not experience Three fourths of Exhibit delusions and
patient experiences perceptual patients in the manic hallucinations
delusions and disturbances phase have delusions consistent with either
hallucinations  Delusions reflect depression or mania
(Congruent or perceptions of power,
Incongruent) prestige, position, self-
worth, and glory
 Mental Status Examination:
Suicidal/Self - Destruction
Depressed Hypomania Manic Mixed Episode
Attempt and succeed Incidence of suicide Incidence of suicide Depressed phases
at killing themselves is low is low put the patient at risk
More specific the for suicide
plan, the higher the
danger
 Mental Status Examination:
Homicide/Aggression/Violence
Depressed Hypomania Manic Mixed Episode
2hs are viewed to self Show evidence of Openly combative Exhibit aggression,
and to others irritability and and aggressive especially in the manic
aggressiveness No patience or phases
tolerance for others
Highly demanding,
violently assertive, and
highly irritable
Homicidal element
emerges if these
individuals have a
delusional content to
their mania
 Mental Status Examination:
Judgement
Depressed Hypomania Manic Mixed Episode
Clouds and dims Have good but Seriously impaired Major shifts in affect
these individuals' expansive judgment judgment during short lengths of
judgment and colors See themselves as Make terrible time severely impair
their insights productive and decisions in their work their judgment and
“See no tomorrow”, conscientious, not as and family interfere with their
therefore, planning for hypomanic insight
it is difficult
 Treatment:
Indication for Hospitalization
1. Danger to self
2. Danger to others
3. Total inability to function
4. Totally out of control
5. Medical conditions that warrant
medication monitoring
 Treatment:
Indication for Partial Hospitalization
1. These patients have severe symptoms
but have a level of control and a stable
living environment.
 Treatment:
Outpatient
• Four (4) Major Goals
1. Look at areas of stress and find ways to
handle them.
2. Monitor and support the medication.
3. Develop and maintain the therapeutic
alliance.
4. Recognize somatic health issues.
 Treatment:
Medications
• Lithium carbonate • Note:
(Duralith, Eskalith, – Monitoring blood levels is
Lithobid) critical with this medication.
1. Considered as first-line
agent for long-term
prophylaxis in bipolar
illness, especially for
classic bipolar disorder
with euphoric mania.
2. unlike any other mood
stabilizer, may have a
specific antisuicide
effect
 Treatment:
Medications
• Carbamazepine (Tegretol)
1. It is known to be effective in patients who have
not responded to lithium therapy.
2. can act to inhibit seizures induced through the
kindling effect, which is thought to occur by
way of repeated limbic stimulation.
3. Effective in treating patients who have rapid-
cycling bipolar disorder or those who have not
been responsive to lithium therapy.
 Treatment:
Medications
• Valproate sodium, valproic acid (Depakene,
Depakote)
1. Has proven effectiveness in treating and
preventing mania. unlike any other mood
stabilizer, may have a specific antisuicide
effect.
2. Useful in treating patients with rapid-cycling
bipolar disorders and has been used to treat
aggressive or behavioral disorders.
 Treatment:
Medications
• Lamotrigine (Lamictal)
1. An anticonvulsant that appears to be
effective in the treatment of the
depressed-phase in bipolar disorders.
Considered as first-line agent for long-
term prophylaxis in bipolar illness,
especially for classic bipolar disorder
with euphoric mania.
Electroconvulsive Shock (ECT)
1. ECT has proven to be highly effective in
the treatment of acute mania.
2. Often, the severity of the symptoms, the
lack of response to medications, or the
contradiction of certain medications
necessitates the use of ECT.
 Psychotherapy
1. Psychodynamic Therapy
2. Interpersonal Therapy
3. Cognitive Behavioral Therapy
 Complications
1. Suicide
2. Homicide
3. Addictions
 Nursing Diagnosis
• Deficient Knowledge
• Risk for Other – Directed Violence
• Imbalanced Nutrition: Less than body
requirements
• Self – care Deficit
 References
1. Kaplan & Sadocks, Synopsis of
Psychiatry, 2007, 10th Edition
2. Swearingen, P., All – in – One Care
Planning Resource, 2004, 1st Edition
3. http//:www.emedicine.com.