Bipolar Disorder Diagnostic Criteria

Bipolar Disorder Diagnostic Criteria

• Bipolar 1: Requires one lifetime manic episode; major depressive episode not necessary.
• Bipolar 2: Involves one hypomanic episode and one major depressive episode; no manic episodes occur.

Manic and Hypomanic Episodes

• Manic Episode: Lasts at least one week; marked by elevated or irritable mood and significant goal-directed activity. Symptoms must impair functioning and include inflated self-esteem, decreased sleep, racing thoughts, and risky behaviors.
• Hypomanic Episode: Lasts at least four days; similar symptoms to mania but does not severely impair functioning and lacks psychotic features.

Rapid Cycling and Atypical Features

• Rapid Cycling: Characterized by four or more episodes within 12 months; women are at higher risk, particularly related to menstrual cycles.
• Atypical Features: Include mood reactivity, weight changes, hypersomnia, and heightened sensitivity to interpersonal rejection.

Age of Onset and Genetic Factors

• Average onset of bipolar symptoms occurs during late adolescence to young adulthood.
• Genetic predisposition is significant; identical twins have a 70% risk, while children of affected parents face risks ranging from 15-75%.

Nursing Assessment and Management

• Assess for manic symptoms: sleep deprivation, irritability, weight loss, risky behaviors, and substance use.
• Mental status evaluations show flamboyant appearance, pressured or incomprehensible speech, and grandiose, paranoid, or psychotic thoughts.

Nursing Responsibilities

• Monitor mental status and promote healthy sleep and activity patterns.
• Identify stressors early to minimize functional impairments; address safety concerns, especially regarding risk-taking behaviors and potential suicide.

Communication Strategies

• Use a calm, firm approach with concise explanations; avoid engaging in power struggles or humor.
• Establish clear limits and redirect excessive energy.

Nursing Interventions During Acute Mania

• Reduce environmental stimuli, provide structured activities, and keep verbal interactions brief.
• Implement safety measures and monitor for medication side effects; increase fluid intake and ensure adequate rest.

Pharmacologic Treatments

• First line treatment: Lithium is primary for managing bipolar disorder.
• For acute mania, use antipsychotics (e.g., Haldol, Olanzapine), mood stabilizers (Divalproex), and long-acting benzodiazepines for sleep.

Group and Individual Therapies

• STEP-BD (Systematic Treatment Enhancement Program) includes pharmacotherapy and therapies such as interpersonal psychotherapy, social rhythm therapy, family therapy, and CBT.
• Group psychoeducation promotes mutual support and recovery skills among patients.

Sleep Hygiene Practices

• Encourage a regular sleep schedule, balanced diet, limited caffeine and alcohol intake, exercise, and relaxation techniques to promote better sleep.

Treatment of Psychotic Depression and ECT

• Treatments involve both antidepressants and antipsychotics, or ECT for severe cases; effects usually noticed within a week, with multiple sessions required.

Nursing Interventions for ECT

• Prior to ECT, complete necessary lab tests, ensure safety by removing loose objects, and prepare for sedation.
• Post-ECT care includes monitoring vital signs, ensuring the airway is maintained, and providing reassurance.

Postpartum Psychosis

• Can manifest within three weeks after delivery; characterized by severe mood disturbances, delusions regarding the baby, and potential harmful ideation.

Nursing Care for Postpartum Psychosis

• Prioritize safety for mother and child; assess for suicidal or homicidal thoughts, administer medications, and educate the family on the illness while fostering a non-judgmental environment.