Bipolar Disorder

Question 1

Pathophysiology

Answer 1

Unknown. Thought to arise from a combination of genetics, physiological, environmental, & psychosocial factors.

Question 2

Bipolar I

Answer 2

Consists of 1 or more manic or mixed episodes, & course of illness is usually accompanied by major depressive episodes.

Question 3

Bipolar II

Answer 3

Consists of 1 or more major depressive episodes & accompanied by at least 1 hypomanic episode.

Question 4

Risk Factors

Answer 4

• Family hx
• Drug abuse
• Periods of very high stress
• Major life-altering event

Question 5

Are women & men at equal risk?

Answer 5

Yes. Women are more likely to experience rapid cycling & depressive symptoms.

Question 6

Mania

Answer 6

Abnormal & persistently elevated, expansive, or irritable mood & increased energy (or activity) present for most of the time, nearly every day, or a week or more & accompanied by @ least 3 specific symptoms of mania.

Question 7

Symptoms of mania?

Answer 7

• Inflated self-esteem or grandiosity
• Decreased need for sleep
• Talkative, pressured speech patterns
• Flight of ideas
• Distractability
• Increase in goal-directed activity
• Psychomotor agitation
• Excessive involvement in pleasurable activities that have a high potential for painful consequences
• Severe? –> Delusions, hallucinations

Question 8

Hypomania

Answer 8

Not severe enough to markedly impair functioning or require hospitalization. Feels “on top of the world.”

Question 9

Characteristics of manic episodes?

Answer 9

• Behavior excessive, overly enthusiastic
• Increased sexual behavior often seen
• Often follows a severe disappointment, embarrassment, or other psychic stressor
• Individual rarely believes they are sick.

Question 10

Depressive episodes

Answer 10

Similar to depression. Many w/ bipolar disorder initially diagnosed w/ depression.

Question 11

Rapid cycling (dysthymic)

Answer 11

4 mood episodes occuring within a year w/ periods of partial or full remission of 2 months or more or w/ immediate alternate periods of mania/hypomania & depression.

Question 12

Mixed

Answer 12

Symptoms of both mania, depression present.

Question 13

Cyclothymic disorder

Answer 13

Chronic, fluctuating mood disturbance involving numerous periods of hypomanic symptoms & numerous periods of depressive symptoms for at least 2 yrs.

• No severe symptoms (this would cause dx of manic disorder or MDD)
• Moody, unpredictable, temperamental
• Begins in adolescence, early adulthood

Question 14

Pharmacologic Txs

Answer 14

• Lithium carbonate –> Rx of choice
• Anticonvulsants –> maintenance
• Atypical antipsychotics –> sedative & mood-stabilizing effects

Question 15

What are initial episodes like in males?

Answer 15

Manic episodes

Question 16

What are initial episodes like in females?

Answer 16

Depressive episodes

Question 17

Typical age of onset?

Answer 17

15-30 yrs

Question 18

Possible nursing dxs

Answer 18

Risk for Injury
Disturbed Thought Processes
Impaired Social Interaction
Self-Care Deficit
Sleep Deprivation
Risk for Suicide

Question 19

Goals for nursing care?

Answer 19

• Promote client safety
• Promote reality-based thinking
• Enhance socialization
• Set limits
• Promote improved self-care
• Enhance rest & sleep