Bipolar Disorder 1 What is a Bipolar Disorder

Bipolar Disorder 1

What is a Bipolar Disorder? A Bipolar Disorder can be defined as “a mental disorder marked by altering periods of elation and depression. ” 2

What Causes Bipolar Disorder? The exact cause of bipolar disorder is unknown, but several factors may be involved, such as: • Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain. • Neurotransmitters. An imbalance in neurotransmitters • Inherited traits. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition 3

Types of Bipolar Disorders • Bipolar I disorder o at least one manic episode o episode may be preceded by or followed by hypomanic or major depressive episodes o Mania symptoms cause significant impairment in your life and may require hospitalization or trigger a break from reality (psychosis). • Bipolar II disorder. o at least one major depressive episode lasting at least two weeks o at least one hypomanic episode lasting at least four days o No manic episodes o unpredictable changes in mood and behavior can cause distress or difficulty What is the difference between type I and type II? While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment. 4

Types of Bipolar Disorders conitnued… • Cyclothymic disorder o at least two years — or one year in children and teenagers — of numerous periods of hypomania symptoms (less severe than a hypomanic episode) and periods of depressive symptoms (less severe than a major depressive episode) o During that time, symptoms occur at least half the time and never go away for more than two months o Symptoms cause significant distress • Other types o These include, for example, bipolar and related disorder due to another medical condition, such as Cushing's disease, multiple sclerosis or stroke o Substance and medication-induced bipolar and related disorder 5

Signs & Symptoms There are several types of bipolar and related disorders. For each type, the exact symptoms of bipolar disorder can vary from person to person. Some include: • impulsive • Euphoric • full of energy. • unpredictable mood swings • irritability • restlessness • less need for sleep • racing thoughts • high sex drive • tendency to make grand unattainable plans 6

Risk Factors • Having a first-degree relative, such as a parent or sibling, with bipolar disorder • Periods of high stress • Drug or alcohol abuse • Major life changes, such as the death of a loved one or other traumatic experiences 7

Other illnesses that occur with Bipolar Disorder • Anxiety disorders. Examples include social anxiety disorder and generalized anxiety disorder. • Post-traumatic stress disorder (PTSD). Some people with PTSD, a trauma- and stressor-related disorder, also have bipolar disorder. • Attention-deficit/hyperactivity disorder (ADHD). ADHD has symptoms that overlap with bipolar disorder. For this reason, bipolar disorder can be difficult to differentiate from ADHD. Sometimes one is mistaken for the other. In some cases, a person may be diagnosed with both conditions. • Addiction or substance abuse. Many people with bipolar disorder also have alcohol, tobacco or drug problems. Drugs or alcohol may seem to ease symptoms, but they can actually trigger, prolong or worsen depression or mania. • Physical health problems. People diagnosed with bipolar disorder are more likely to have certain other health problems, such as heart disease, thyroid problems or obesity. 8

Complications • • Problems related to drug and alcohol use Suicide or suicide attempts Legal problems Financial problems Relationship troubles Isolation and loneliness Poor work or school performance Frequent absences from work or school 9

Tests & Diagnosis • Physical exam • Psychological evaluation • Mood charting • Signs and symptoms 10

Treatment • Life-long treatment • Programs provide the support and counseling you need while you get symptoms under control • Substance abuse treatment. If you have problems with alcohol or drugs, you'll also need substance abuse treatment • Possibly Hospitalization • Cognitive behavioural therapy • Psychoeducation • Interpersonal and social rhythm Therapy (IPSRT) • Electroconvulsive Therapy (ECT) • Transcranial Magnetic Stimulation (TMS) 11

Medications Mood stabilizers • Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal). Antipsychotics. • such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help Antidepressants Antidepressant-antipsychotic. • Example: Symbyax (combines the antidepressant fluoxetine and the antipsychotic olanzapine) Anti-anxiety medications • Example: Benzodiazepines 12

Nursing Intervntions 1. Goal Setting 2. Planning 3. Implementation 4. Evaluation 13

Goal Setting and Planning Setting goals and planning with the patient will: • demonstrate a stable mood and practice self-care activities • control thought processes • demonstrate a normal sleep pattern • interact adequately with others • not harm himself 14

Nursing Implementation During manic phase; • decrease environmental stimuli, to promote relaxation and enable to sleep • monitor drug level, especially lithium • ensure safe environment to protect the client • define and explain acceptable behaviors and then set limits • if a mood swing to depression, implement suicide precaution for client • channel the client's energy in one direction and pace activities, to decrease client's energy expenditure, prevent overstimulation and have soothing effect During depressive phase; • assess the risk of suicide and formulate a safety contract with client • assess the level and intensity if client's depression to obtain baseline information • ensure a safe environment to client to protect from self-inflicted harm • encourage the client to identify current problems and stressors, so that can begin with therapeutic treatment • select activities that ensure success and accomplishment to increase self esteem • spend time with the client, evens if he's too depressed to talk, in order to enhance therapeutic relationship • help the client to modify negative expectations and think more positively • promote opportunities for increased involvement in activities through a structures and daily program • observe the client for medication compliance and adverse 15 effect

Evaluation • • doesn't harm himself or others maintains adequate on medication and nutrition sleeps throught the night expresses understanding of the illness and states how to obtain assistance or support from others • engages in goal-directed activity and no longer exhibits disturbed thinking 16

La Fin 17