1. Mood Disorders: Bipolar
Chapter 13
Mood Disorders: Bipolar

3. Bipolar disorder 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

4. Bipolar disorder: most to least severe
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

5. Prevalence and comorbidity
Bipolar disorder emerges between 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

6. Theory
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

7. Cultural considerations
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

8. Clinical picture Individuals with bipolar disorder Misdiagnosed
Underdiagnosed
On average, spend 8 yrs seeking treatment before receiving correct diagnosis
Goal of early diagnosis- Avoid the following
Suicide (1 in 5)
Substance abuse
Marital or work problems
Development medical comorbidity

9. Application of nursing process
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

10. 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