Bipolar Disorder and Mental Health Quiz

Psychiatric Health Nursing: Bipolar Disorder

• Bipolar disorder is a complex mental health condition characterized by extreme mood swings, impacting daily life.
• This disorder involves various types, including Bipolar I, II, Cyclothymic, and substance-induced bipolar disorder, each possessing unique symptoms and characteristics.
• Bipolar I disorder necessitates a manic episode, or history of one or more, and possibly depressive episodes.
• Bipolar II disorder presents with depressive or hypomanic episodes, but not full manic episodes.
• Cyclothymic disorder involves chronic mood fluctuations, with numerous periods of elevated (but not hypomanic) or depressed mood, lasting at least two years.
• Substance-induced bipolar disorder's mood disturbance stems from substance's physiological effects.
• Bipolar disorder associated with another medical condition has abnormally elevated mood and excessive activity due to the medical condition.
• Bipolar disorder affects approximately 4.4% of adults in the United States; 82.9% of cases are severe.
• The average age of onset is 25 years.

Learning Objectives

• Define bipolar disorder.
• Describe mania and depression.
• Explain types of bipolar disorder.
• Identify signs and symptoms of bipolar disorder.
• Identify nursing assessments for bipolar disorder.
• Describe nursing interventions for bipolar disorder.
• Summarize bipolar disorder.

Bipolar Disorder: Understanding the Spectrum of Mood Disorders

• Bipolar disorder is a complex mental health condition characterized by extreme mood swings which significantly impact daily life.
• This presentation covers the causes, diagnosis, and effective management strategies of bipolar disorder, to help individuals and their loved ones navigate this challenge effectively.

What is Bipolar Disorder? (Definition, Types, Prevalence)

• Bipolar disorder is a mental health condition marked by extreme mood changes ranging from manic highs to depressive lows.
• Types include Bipolar I, Bipolar II, Cyclothymic, and substance-induced.
• Bipolar disorder affects approximately 4.4% of adults in the U.S., with a significant portion (82.9%) being severe.
• Average age of onset is age 25, years.

Types of Bipolar Disorder (Bipolar I and II)

• Bipolar I: Diagnosis requires a manic episode, or history of one or more manic episodes. It may also involve depressive episodes.
• Bipolar II: Characterized by a history of depressive or hypomanic episodes but not a full manic episode.

Types of Bipolar Disorder ((continued) – Cyclothymia)

• Cyclothymic disorder: Diagnosis requires a chronic mood disturbance, lasting at least two years, characterized by numerous periods of elevated mood (not hypomanic) or depressed mood (not major depressive).

Types of Bipolar Disorder (continued) – Substance-Induced Bipolar

• Substance-induced bipolar disorder: The mood disturbance results directly from the physiological effects of a substance.

Types of Bipolar Disorder (continued_4) – Medical Condition

• Bipolar disorder associated with another medical condition has mood elevation and excessive activity directly due to the medical condition

Nursing Care for Bipolar Manic Episodes

• Caring for individuals with bipolar disorder requires a multifaceted approach, encompassing patient safety, medication management, promoting coping strategies, and collaboration with the interdisciplinary team.

Understanding Bipolar Disorder: Manic Phases

• Heightened energy, decreased need for sleep, and impaired judgment are key aspects of manic episodes.
• Risky behaviors, like excessive spending or substance abuse, can accompany these symptoms.

Assessing and Monitoring Manic Symptoms

• Vital signs: Closely monitor the patient's heart rate, blood pressure, and temperature as they can be affected by mania.
• Mental status exam: Evaluate the patient's mood, thought processes, and level of orientation to assess the severity of the episode.
• Behavior monitoring: Observe the patient's activity levels, sleep patterns, and social interactions to identify any changes in behavior.

The Mental Status Examination

• This includes detailed observations of the patient's appearance, behavior, attitude, level of consciousness, speech, mood, affect, and thought process, among other factors.

Pharmacological Interventions: Mood Stabilizers

• Lithium: Widely used mood stabilizer to prevent and regulate manic episodes.
• Anticonvulsants (e.g., valproate, lamotrigine): Medications that can also be used to stabilize mood.
• Antipsychotics: May be used in combination to manage acute manic symptoms or to augment existing medication effects.

Non-Pharmacological Interventions: Psychotherapy

• Cognitive-behavioral therapy (CBT): Helps patients identify and modify negative thoughts and behaviors associated with manic episodes.
• Interpersonal and social rhythm therapy: Focuses on stabilizing mood by improving social functioning and establishing sleep-wake cycles.
• Family-focused therapy: Involves the patient’s family in the treatment process to enhance communication and support during manic episodes.

Ensuring Patient Safety During Manic Episodes

• Restraint minimization: Prioritize de-escalation techniques to minimize the need for physical or chemical restraints.
• Environmental modifications: Create a safe and calming environment by limiting access to potential hazards.
• Close monitoring: Observe the patient continuously to prevent impulsive or dangerous behavior and intervene promptly if necessary.
• Suicide prevention: Assess the patient's suicide risk and implement appropriate interventions to maintain their safety.

Coping Strategies

• Stress management: Teach relaxation techniques such as deep breathing, meditation, or yoga.
• Sleep hygiene: Establish consistent sleep schedules and routines to help manage mood.
• Emotional regulation: Develop skills for identifying and expressing emotions in healthy ways.

Managing Disruptive Behaviors

• De-escalation: Utilize calming communication techniques to address volatile situations.
• Conflict resolution: Facilitate constructive discussions to address interpersonal issues.
• Emotional support: Offer a compassionate and non-judgmental listening ear.

Promoting Rest and Sleep

• Sleep hygiene: Establish consistent sleep schedules and bedtime routines.
• Environmental modifications: Adjust lighting, temperature, and noise levels to create a calming environment.
• Relaxation techniques: Encourage the use of relaxation techniques like meditation, deep breathing, and progressive muscle relaxation.

Interdisciplinary Collaboration

• Psychiatrist: Oversees medication management and treatment plan.
• Psychologist: Provides psychotherapy and behavioral interventions.
• Social worker: Coordinates community resources and discharge planning.
• Nurses: Implements nursing interventions and monitors patient progress.

Discharge and Ongoing Support

• Discharge planning: Develop a comprehensive discharge plan to transition patients smoothly to community-based care.
• Outpatient follow-up: Coordinate appointments with specialists to maintain continuity of care.
• Family education: Educate family members to help them understand and cope with the condition.
• Community resources: Connect patients with local support groups and resources for long-term stability.

Depressive Episode

• An affective state, characterized by sadness, guilt, and low self-esteem.
• Can be a part of another illness.
• Manifested by decreased physical activity or psychomotor agitation.

Symptoms of Depressive Episode

• Feeling sad, hopeless, lacking energy.
• Difficulty concentrating and remembering things.
• Loss of interest in activities.
• Delusions (false beliefs), hallucinations (perceiving non-existent things), and disturbed thoughts.
• Suicidal thoughts.
• Lack of appetite.
• Difficulty sleeping or waking up early.

Diagnosis (Bipolar Depression)

• Risk for suicide: Assess client's thoughts of self-harm or suicide and support them.
• Complicated grieving: Respond compassionately and non-judgmentally.
• Social isolation: Promote social activities and encourage interactions with others.

Risk for Suicide

• Ask the client directly: "Have you thought about killing yourself?" or "Have you thought about harming yourself in any way?"
• If so, what do you plan to do? Do you have the means?

Expected Outcome and Nursing Intervention (Risk for Suicide)

• Expected Outcome: The patient will remain safe and free from self-harm throughout the care period.
• Nursing Intervention:
  • Create a safe environment by removing harmful items.
  • Establish a contract with the client regarding self-harm.
  • Monitor the client frequently.
  • Consult with other specialists or medical staff.

Expected Outcome and Nursing Intervention (Grief Complications)

• Expected Outcome: The patient will express emotions appropriately and show improved ability to perform daily living activities.
• Nursing Intervention:
  • Determine the stage of grief the client is in.
  • Build a trustful relationship with the client.
  • Validate the client's feelings and offer support.
  • Encourage participation in activities to help process emotions.

Expected Outcome and Nursing Intervention (Low Self-Esteem)

• Expected Outcome: The patient will verbalize increased self-worth and participate in activities fostering self-confidence.
• Nursing Intervention:
  • Acknowledge and accept pessimism and negativism.
  • Focus on the patient's strengths and accomplishments.
  • Encourage the patient to be independent.
  • Provide praise and encouragement.

Expected Outcome and Nursing Intervention (Social Isolation)

• Expected Outcome: The patient will gradually engage in social activities and interactions.
• Nursing Intervention:
  • Help the patient identify reasons for isolation.
  • Encourage significant others to visit.
  • Encourage the patient to have phone contact with significant people.

Expected Outcome and Nursing Intervention (Imbalanced Nutrition)

• Expected Outcome: The client will not have signs or symptoms of malnutrition.
• Nursing Intervention:
  • Offer nutritious foods.
  • Have snacks and drinks available.
  • Monitor intake and output, maintain calorie counts, and assess weight.
  • Meet the client’s individual food preferences whenever possible.

Expected Outcome and Nursing Intervention (Risk for Injury - Mania)

• Expected Outcome: The client will not experience injury.
• Nursing Intervention:
  • Remove environmental stimuli (simple décor, quiet unit, low lighting and noise level).
  • Remove hazardous objects.
  • Provide physical activities.
  • Administer tranquilizing medication.

Expected Outcome and Nursing Intervention (Risk for Violence - Mania)

• Expected Outcome: The client will not harm self or others.
• Nursing Intervention:
  • Maintain low stimuli in the environment.
  • Observe client behavior frequently.
  • Remove potentially harmful objects.
  • Redirect violent behavior, if necessary, with physical activities.
  • If necessary, offer medication or restraints.

Bipolar Depression Treatment

• Fluoxetine (SSRI) is the only antidepressant effective in treating bipolar depression, often in combination with an atypical antipsychotic like olanzapine.
• Antidepressants are often considered for bipolar depression after other therapies have been tried.

Pharmacology

• Mania: Anxiolytics (e.g., clonazepam, alprazolam).
• Depression: Antidepressants and mood stabilizers (e.g., carbamazepine, valproic acid, lithium).

Summary

• This section provides a summary of bipolar disorder, including its types, symptoms, and nursing interventions for safe and effective management.

References

• Mayo Clinic
• Nclex.com
• Townsend, M. (2008). Essential of psychiatric mental health nursing: concepts of care in evidence Based Practice. (4th ed.). Philadelphia: F.A Davis