Nursing 140-Mental Health-Bipolar-Test 2-Olol

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Bipolar Disorders

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extreme mood polarity

One or more episodes of mania and depression occur

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Etiology

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A. Psychodynamic theories
 Developmental theorists: faulty family dynamics in early life are responsible for manic behavior in later life
 Manic episodes are defenses against depression
B. Neurotransmitter & structural hypotheses
 Serotonin deficiency, brain lesions more common in bilateral subcortical & periventricular gray matter

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General Considerations

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 Genetics has a role: diagnosed twin? increased chance 40 -70 %
 Family planning: counsel women with BP about
 Hereditary nature of disease
 Stress of parenthood
 Effect ill parent has on child
 Teratogenicity of lithium, carbamazepine, & valproic acid

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Co-Morbidity

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 Alcohol abuse
 Relapse rates increase
 Response to lithium decreases
 Remission is delayed
 Poor treatment compliance and outcomes

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General description

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 Manic Episodes: elevated, expansive, irritable mood
 1.2% of population over 17
 Begin suddenly, escalate rapidly, few days to months
 Early 20s
 Inflated view of importance
 Many do not seek treatment
 10 -15 % are successful suicides

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Criteria for Manic Episodes

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 ELEVATED, EXPANSIVE, OR IRRITABLE MOOD X 1 WEEK [BIPOLAR I]
3 OR MORE of the following:
■INFLATED SELF-ESTEEM
■DECREASED SLEEP
■TALKATIVE-PRESSURED
■FLIGHT OF IDEAS
■DISTRACTIBILITY
■INCREASED ACTIVITY
■EXCESSIVE PLEASURE
 Deterioration at home, work, school
 Less need for sleep
 Talkativeness
 Flight of ideas
 Distractibility
 Risky behavior
 Excess: spending indiscretions, clothing, make-up

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May need hospitalization
 r/o medical cause

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 Anoxia
 Hyperthyroidism
 Lyme disease
 Hypercalcemia
 Stroke
 Brain tumor
 MS

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Excessive energy =

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psychotic activity=
unacceptable behavior

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Hypomanic Episodes

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 Less severe level of impairment, observable by others, distinct from person’s typical behavior
 Abnormal period of persistent elevated, expansive, or irritable mood. Four days duration w/o hospitalization

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Hypomanic Episodes con't

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3 OR MORE of the following:
■INFLATED SELF-ESTEEM
■DECREASED SLEEP
■FLIGHT OF IDEAS
■DISTRACTIBILITY
■INCREASED goal related ACTIVITY
■EXCESSIVE PLEASURE

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BIPOLAR DISORDERS

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 Bipolar I- most significant--swings between mania and major depression
 Subtypes
 Bipolar I, single manic
 Bipolar I, most recent event a manic episode
 Bipolar I, most recent event a hypomanic episode
 Bipolar I disorder, most recent episode mixed
 Bipolar I disorder, most recent episode depressed
 Bipolar I disorder, most recent episode unspecified

 *mixed-”rapid cycling” is given if 4 or more or episodes of mania and depression in 1 year

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Bipolar II

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 Similar to BPI except no manic episode, only a hypomanic episode
 May be a higher incidence in women
 Over course of few years, 5 -15% will develop a full manic episode

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Cyclothymic disorder

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 A swing between a hypomanic episode and depressive symptoms
 Over 2 yrs without remission for more than 2 months
 Equally distributed among men and women

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Behavior

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 Objective
 Enthusiastic, euphoric (excessive)
 Disturbances of speech
 Disturbances of social, interpersonal, work relationships
 Common features:
 Violent behavior
 Divorce
 Domestic violence
 Job loss
 Academic failure

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Disturbed speech patterns

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 Rapid, loud, pressured, easily distracted
 Rapid fire, monopolize
 Jokes, puns, sarcasm
 Complain often & loudly
 Engage staff into defensive mode
 Dramaticsong

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Altered social, interpersonal, & work relationships

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 Failed relationships, job loss, overbearing behavior, incr. sex drive, alienation of family
 Fault finding, anger, blaming (Janowsky, Leff, Epstein, 1970)
 Manipulate self esteem of others
 Ability to find vulnerability in others
 Ability to shift responsibility
 Limit testing
Alienation of family

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Alterations in activity & appearance

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 Hyperactive & agitated
 Pacing, flamboyant gestures, colorful dress, singing, excessive make-up
 Exhaustion, malnourished

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SUBJECTIVE BEHAVIOR

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 Alterations of affect
 Elevated mood, greatness, joy
 Invincibility  social, interpersonal, work problems

Alterations of Perception
 Delusions
 Hallucinations

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Nursing Care

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N-Pt Relationship
 Matter of fact approach
 Clear, concise directions and comments
 Limit setting

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Psychopharmacology

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 Lithium

 Anticonvulsants
 Valproic acid (Depakote)
 Carbamazepine (Tegretol)

 Atypical antipsychotics
 Olanzapine (Zyprexa)

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Milieu Management

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 Safety
 Staff consistency
 Reduction in environmental stimuli
 Do not escalate patient
 Reinforce hygiene & dress
Nutrition & sleep issues