Bipolar Disorder Lecture Notes PDF

Presented by/ Dr/ Mahmoud Abd Almagied Lecturer of Psychiatric Nursing FON – SCU  OUTLINES Introduction. Definition of Bipolar Disorder, Types of Bipolar Disorder Symptoms of Bipolar Disorder Etiological Factors of Bipolar Disorder Treatment of Bipolar Disorder. Nursing man...

Presented by/ Dr/ Mahmoud Abd Almagied Lecturer of Psychiatric Nursing FON – SCU  OUTLINES Introduction. Definition of Bipolar Disorder, Types of Bipolar Disorder Symptoms of Bipolar Disorder Etiological Factors of Bipolar Disorder Treatment of Bipolar Disorder. Nursing management for caring of patient with bipolar Disorder. Bipolar Spectrum Disorder The term formerly used for these disorders: manic depressive illness. Bipolar disorders are chronic, recurrent, and life- threatening illnesses that require lifetime monitoring.  Bipolar disorders are characterized by two opposite poles. One pole is mania (or hypomania), which constitutes an elevated, expansive, or irritable mood, accompanied by a persistent increase in activity and/ or energy. The other pole is depression. Symptoms of manic episode 1. An elevated, expansive, or irritable mood 2. Increased self-esteem or grandiosity 3. Less need for sleep (2–3 hours) 4. Very talkative 5. Racing thoughts 6. Easily distracted and unable to focus 7. Excessive spending and engaging in pleasurable activities 8. Severe impairment in occupational and social functioning Symptoms of hypomanic episode The same as Manic episode BUT:  The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization.  The episode is not accompanied by psychotic features.  The distinct period of hypomanic episode lasting at least 4 days.  The distinct Manic episode lasting at least for one week Types of Bipolar disorder 1- Bipolar I disorder: At least one episode of mania, most often alternating with major depressive episodes. Psychosis may accompany the manic episode, and hospitalization may be warranted. 2- Bipolar II disorder: Hypomanic episode(s) alternating with at least one major depressive episode. Psychosis is not present in bipolar II. 3- Cyclothymia: Hypomanic episodes alternating with minor depressive episodes (at least 2 years in duration). Etiological Factors Genetic Factors Twin, family, and adoption studies provide significant evidence to support the view that bipolar disorders have a strong genetic component. Identical twins have greater risk (33% to 90%) than non identical twins (18% to 35%). First-degree relatives are seven times more likely to develop bipolar disorder than people in the general population. Neurobiological Factors Neurotransmitters During a manic episode, patients demonstrate significantly higher levels of norepinephrine, epinephrine and dopamine  Psychosocial Factors 1. Psychoanalytic. Mania and elation are viewed as defense against underlying depression. 2. Psychodynamics Feelings of inadequacy and worthlessness are converted by means of denial, reaction formation, and projection to grandiose delusions. 3. Stressful life events Family atmosphere suggests an association between high expressed emotion and relapse.  Treatment During the acute phase, medications are vital to bring the patient to a safe physical and psychological level of functioning. Also, for many patients medication is a lifelong protection against relapse.  A- Psychopharmacology Lithium carbonate (LiCO3) LiCO3 is effective in the acute treatment of acute mania and the prevention of its recurrent. Lithium aborts 60% to 80% of acute manic and hypomanic episodes within 10 to 21 days.  (2)Anticonvulsant Anticonvulsants are medications used to treat seizures, and in addition, some are also used in bipolar disorder as mood stabilizers. These medications work in bipolar disorder by Enhancing the effect GABA  B- Electroconvulsive Therapy Indicated for P.T with BPD in the following cases Treatment resistant mania Rapid cycling features. Paranoid destructive features (who often respond poorly to lithium therapy) Suicidal attempt.  C- Psychotherapy CBT a. Cognitive. Has been studied in relation to increasing compliance with lithium therapy among patients with bipolar disorder. b. Behavioral. Helps to set limits on impulsive or inappropriate behavior through such techniques as positive and negative reinforcement.  Family-focused therapy. Family therapy, is effective to help families stay together lower rates of hospitalization improve family functioning. Family-focused therapy (FFT) including: Psychoeducation Relapse prevention  Group Therapy. Can be helpful in challenging denial and defensive grandiosity.  Useful in addressing such common issues among manic patients as (inadequacy, fear of mental illness, and loss of control). Helpful I reintegrating patients socially.  Nursing care of patients with mania Assessment Assess degree of mania (mild, acute, excitement) Assessing mood and affect, thought process and physical behavior.  Nursing care of patients with mania Nursing intervention 1. Providing for safe environment: A primary nursing responsibility is to provide a safe environment for clients and others. The nurse assesses clients directly for plans or thoughts of hurting others. Reduce external stimuli (noise, motion, people), and allow proper outlet for energy through short useful activities.  Nursing care of patients with mania Nursing intervention Remove hazardous objects and substance from the environment. Encourage the patient to verbalize his feeling of anxiety, anger or fear. Maintain and convey a calm attitude to patient. Set realistic limits on behavior through explain scope of limits, be firm and consistent, anticipate destructive behavior.  Nursing care of patients with mania Nursing intervention Clients with mania may get very little rest or sleep. The nurse provides a quiet environment without noise, television, or other distractions. Establishing a bedtime routine, such as a (warm) bath at bed time, may help clients to calm down enough to rest, decrease coffee and tea, and use sleeping medication if prescribed. Observe the patient closely for sign of fatigue. Be alert for patient nutrition as it very important for manic patient.