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Bipolar Disorder

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by

Jaime Crucil

on 3 February 2014

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Transcript of Bipolar Disorder

Bipolar Disorder
Access?
Referral from Psychiatrist only

Psychiatrist available through Access & Crisis Service at Brooks Landing

Services Offered
Service Coordination
Crisis Intervention
Psychiatric/Psychological Treatments
Medication Prescription and Management
Service/Supports for concurrent substance use disorder
Psychosocial Rehab
Work-Related Services
Activities of Daily living
Peer Support
Support Services
Family Centered Services
Admission Criteria
Severe and persistent mental illness

1. That impairs their functioning in the community AND

2. With significant functional impairment AND

3. With frequent admissions to the hospital AND

4. One of more of the following problems
Persistent severe major symptoms
Coexisting substance abuse
Involvement with criminal justice
Coexisting developmental disability
Inability to consistently meet basic survival needs
Residing in an in-patient unit (hospital)
Difficulty effectively utilizing traditional office-based
out-patient services
Assertive Community Treatment (ACT) Team
Team Coordinator (Can be an RN)
Psychiatrist
Registered Nurses and Registered Psychiatric Nurses
Social Worker
Occupational Therapist
Substance Abuse Specialist*
Vocational Specialist*
Peer Support
*Not offered in Nanaimo
Treatment Modalities
Electroconvulsive Therapy
Weekly Concepts
Relational practice, suffering, and the vulnerability of the client.
Manifestations of Dx
Relational Practice & Bipolar Disorder
Suffering Related to Bipolar Disorder
Vulnerability Related to Bipolar Disorder
Relevance to Nursing Practice
Pediatrics
Adult Medicine
Geriatrics
Emergency & Community
It is important to use person centered care with patients with bipolar disorder, and to look at them as more than their diagnosis.

When working with a patient experiencing an episode of mania it is important to move and talk slowly and calmly, and avoid sudden movements (Arnold & Boggs, 2011, p. 425).

Due to the high risk of suicide in patients with Bipolar Disorder it is important for nurses to be able to pick up on these ques and be able to intervene when necessary (Arnold & Boggs, 2011, p. 427).


Many people with Bipolar Disorder suffer many years of misdiagnosis before discovering that they have Bipolar Disorder.

Even after diagnosis, there is constant episodes of suffering due to a lack of control.
"Although their defensive behaviour may seem threatening, they normally feel vulnerable" (Arnold & Boggs, 2011, p. 425).

People with Bipolar Disorder are considered to be part of a vulnerable population as they are at a higher risk to be homeless, marginally housed and unable to work or provide self care (Potter & Perry, 2012, p. 47).
In Canada it is estimated that 0.2-0.6% of people suffer from Bipolar Disorder.

Nurses may find the intensity of the relationships with patients with Bipolar Disorder difficult to tolerate, and therefore must be prepared.

Bipolar disoder may be seen in all areas of nursing, and therefore nurses should be familiar with the treatments and medications. It is important to recognize that anticonvulsants can be used for Bipolar treatment, and that Lithium toxicity levels are 1.5 mmol/L!
Bipolar Disorder usually first presents itself in early adolescence.

However, the symptoms of irritability, increased sexual activity, and an increase in energy can be misdiagnosed as expected teenage behaviours.

If the nurse can recognize these symptoms, the patient may be able to be diagnosed and avoid serious consequences like suicide.
A patient may present with chaotic distress behaviours that they are not able to control; they are likely having a mental health emergency.

Common types of mental health emergencies related to bipolar disorder include violence or suicide during periods of mania or depression (Austin & Boyd, p. 427).
If a patient has had a mental health emergency that has lead to injury, it is possible that they will end up on a medical ward. It is important that nurses are familiar with the signs and symptoms of mania and depression, and familiar with the medications and treatments previously discussed to provide adequate care.
Late onset of bipolar symptoms in patients age 50 or over can be due to medical illness such as systemic lupus erythematous or an endocrine disorder, or from substance abuse.

It is important to recognize this and not confuse the signs and symptoms with those of typical aging or dementia.

MANIA
heightened energy,creativity
euphoria
disturbed sleeping patterns
irritability
weight loss
fluid imbalances
inability to concentrate
heightened aggression
rapid, disjointed thinking
delusions or hallucinations
unrealistic or grandiose beliefs of
own abilities.
HYPOMANIA
euphoric, energetic and productive
feeling unusually 'high' or irritable
easily distracted
impaired judgement
impulsive or reckless behavior
rapid speech

*often escalates to full blown
mania followed by depressive
episode.
Bipolar Depression
irritability, guilt, restlessness
feelings of hopelessness
inability to experience pleasure
fatigue or loss of energy
physical or mental sluggishness
appetite or weight changes
sleep issues
concentration and memory issues
feelings of worthlessness, guilt
suicidal ideation

Mixed Episode
Symptoms of Mania/Hypomania/Depression
depression
agitation
irritability
anxiety
insomnia
distractability
racing thoughts

*High risk of suicide during
mixed episodes.
Medication
Mood Stabilizers
Lithium
Carbamazepine (Tegretol)
Valproic Acid (Depakote/Depakene
Pros
Weight gain
lethargy
low therapeutic index
convulsions/tremors
can affect kidney, cardiac, liver, and thyroid function
Cons
Naturally occuring element (salt)
Reduces the severity and frequency of manic episodes
reduces suicide risk

Lithium
Anitepileptics
Pros
Cons
used as a second choice medicine for patients who can't take lithium
treat mania and stabilizes mood
orthostatic hypotension (Tegretol)
dry mouth
blurred vision
tremors
sedation
weight gain
Anti-depressants
(SSRIs)
Paroxetine
Fluoxetine
Sertraline
Buproprion
Pros
Cons
SSRIs
treat moderate to severe symptoms of depression in bipolar disorder
boosts levels of serotonin in the brain
Escitalopram
Nausea
Insomnia
Diarrhea
Rash
Agitation/anxiety
Erectile dysfunction
Loss of libido
Weight gain or loss
may cause breakthrough mania!
Anti-psychotics
risperidone
olanzapine
quetiapine
A-typical Anti-psychotics
Pros
Cons
reduce delusions, hallucinations, and sleep deprivation associated with bipolar disorder
sedation
weight gain
orthostatic hypotension
Anti-anxiety
Benzodiazepines
Pros
Cons
provide a calming effect during manic and hypomanic episodes
can be taken prn
physical dependance and quick tolerance
sedation
clouded senses/memory
Valium
Xanax
Ativan
Rivotril
Pros
Cons
used when medications have been ineffective or have caused mainc episodes
can provide rapid, significant improvements in severe symptoms of bipolar disorder
can be used during pregnancy
great with older adults who can't cope with the physical drug side effects
confusion
memory loss
head/muslce aches

One of the most effective treatments for severe depression
brief electrical current lasting 25-150 seconds
no pain or memory of procedure
hypo/hypertension; brady/tachycardia
Psychotherapy
provide support, education, and guidance to people with bipolar disorder and their families/friends.
Cognitive
-identifying negative thought patterns &
interrupting these patterns with positive
ones.
eg: "I am worthless" --> "I have value".

Behavioral
- a recovering alcoholic identifying high risk
situations that trigger impulses to drink - client practices coping skills and rehearses ways to avoid these situations.
eg: mental distractions, substituting drinking for another, less harmful behavior.
Cognitive Behavioral Therapy
Family-Focused Therapy
integrating the experiences associated with mood episodes in bipolar disorder
Accepting the notion of a vulnerability to future episodes
Distinguishing between the patient’s personality and his/her bipolar disorder
Recognizing and learning to cope with stressful life events that trigger recurrences of bipolar disorder
Reestablishing functional relationships after a mood episode
Interpersonal and social rhythm therapy
Regulating sleeping patterns
Regulating eating patterns
Identifying good moods/bad moods and associated activities
Building interpersonal relationships and skills
Maintaining healthy routines
Hospitalization
may be required:
during a full manic episode
when the risk of suicide is high
to protect against the imparied judgement (spending, sexual activity, etc.)

Pros
Cons
Interventions
What motivates you?
What interests you?
What would you do more if you could?
What do you want?
What do you care about, or what did you care about before your illness?
Where do you want your life to go?
What brings you joy?
What are your dreams and hopes?

-Establish relationship
-Protection
-Health (nutrition, exercise, balance)
-Progression towards resolutions
-Improvement in interactions
-Sleep routine
-Client teaching
-Family teaching
-Encouragement
-Talking about concerns
-Goal setting

Goal Setting
protects
Diagnosis
Bipolar disorders are separated into three main categories using the Diagnostic and Statistic Manual of Mental Disorders (DSM)
Bipolar I: Major depressive, manic, or mixed episodes. Has also been described as "raging bipolar."
Bipolar II: Major depression and hypomania. Also described as "swinging bipolar."
Cyclothymic: Hypomanic episodes and periods of depression that do not meet the criteria for a major depressive episode. Often described as a milder form of bipolar disorder.
DSM Diagnosis of
Mood Episodes
Major Depressive Episode
Manic Episode
Hypomanic Episode
Mixed Episode
Who Can Get Bipolar Disorder?
The presence of bipolar disorder is related to genetic, biological, and environmental factors.
feelings of being institutionalized
Full transcript