Mood Disorders - Bipolar Disorder

Question 1

DSM-5 Diagnostic Criteria of BPD: Manic Episode

Answer 1

• Elevated mood (Euphoria), Extreme expression of Emotion (Expansive)
• Increased energy and agitation, irritability
• Decreased need for sleep
• Racing thoughts and distractibility
• Pressured speech
• Poor decision-making
• Marked impairment in Social, Occupational functioning
• Unusual social activities
• Unusual relationships with others
• Requires hospitalisation to prevent harm to self and others

Question 2

DSM-5 Diagnostic Criteria of BPD: Hypomaniac Episode

Answer 2

• Mood higher than normal mood
• High mood (Euphoria) with Increased energy
• Easily distracted
• Need to rule out other medical conditions (e.g. Hyperthyroidism, Diabetes)
• Check if client is in drug influence
• Interferes social and occupational function (Less severe impact than mania)
• Symptoms can be controlled
• Does not require hospitalisation

Question 3

Bipolar I VS Bipolar II

Answer 3

• Bipolar I: 1 or more manic or mixed episode, Alternating with episodes of Major Depression, Presence of Psychosis (Hallucinations, Grandiose Delusion)
• Bipolar II: 1 or more hypomanic episode (4 days or more), No full blown mania, 1 episode of major depression, Usually no psychosis

Differences: I - Mania and May have presence of Psychosis, II - Hypomania
Similarity: Major Depression

Question 4

Predisposing Factors of Bipolar Disorder

Answer 4

• Pessimistic attitude
• Social Withdrawal
• Thoughts of Death/ Suicide
• Extreme Sadness
• Irritability
• Genetics
• Neurochemical Imbalances in The Brain
• Medication Side-Effects
• Disease of The Brain (Right-sided lesions in limbic system)
• Seasonal Effects and Amount of Sunlight
• Childhood trauma
• Lack Emotional and Social Support
• Stressful Life Events

Question 5

Casual Factors leading to Destructive and Self-Destructive Behaviours

Answer 5

• Childhood Trauma
• Low Self-Esteem
• Depression
• PTSD
• Emotional Sensitivity
• Social Exclusion / Social Isolation

Question 6

Nursing Diagnosis of Bipolar Disorder

Answer 6

• Risk for Injury / Violence
• Disturbed Thought Process

1. Problem (P)
2. Etiology (E)
3. Symptoms (S)

Question 7

Treatment of Bipolar Disorder

Answer 7

1. Pharmacotherapy: Lithium (1st Line), Anti-Convulsants for Mania (Combined with Lithium), Atypical Anti-Psychotic (e.g. Olamzapine, Quetiapine)
2. Cognitive-Behavioural Therapy (CBT): Teaches ways of positive cognitive appraisals and problem-solving, Gain insight and teach constructive coping, Skills of controlling thoughts, regulating feelings, controlling impulse, Re-learn constructive coping skills, Find alternative coping techniques
3. Group Psychoeducation
4. ## Crisis Intervention: Individual feels overwhelmed by events, Usual coping mechanism fails, Becomes destructive to self or others, Standby crisis management plan
5. rTMS
6. Therapeutic Nurse Patient Relationship (TNPR)
7. Create a Safe and Structured Milieu
8. Monitor medication compliance
9. Ensure adequate sleep and calories intake: Reduce dehydration and exhaustion, Sleep deprivation affects emotion regulation
10. Management of Aggression: De-escalation Techniques (Prevent escalation to crisis state, Calm and fit approach to maintain control, Use short and simple instruction, Remain neutral and not argue), Use of Chemical & Physical Restraints (e.g. Rapid Tranquillisers IM Haloperidol), Reduce environmental stimuli (e.g. Isolation room to provide calming environment), Document behaviours and interventions
11. Organise Group Psychoeducation: Educate clients on Mental condition, Treatment adherence, Ways of maintaining psychosocial functioning, Relapse prevention

Question 8

Outcomes of Bipolar Disorder Treatment

Answer 8

• Client did not harm self of others
• Client did not exhibit signs of physical agitation
• Client eats well-balanced diet and maintain nutritional status
• Client will verbalise and exhibit socially acceptable behaviours