BIPOLAR MOOD
DISORDER
MENTAL HEALTH
NURSING
RNB30803
INTRODUCTION
The term mood disorder
denotes a group of
disorder in which
disturbance of mood is
the prominent features
LEARNING OUTCOME
At the end of the session the students should be able to
describe the symptoms of:
• Depressive
• Manic depressive psychosis
• Dysthymic disorder
• Hypomania
• Cyclothymic disorder
BIOLAR MOOD DISORDER DESCRIPTION
• Bipolar disorder is also known as manic depression.
• It is a treatable illness marked by extreme changes in mood, thought, energy
and behavior.
• It has symptoms of Mania: The "Highs" of Bipolar Disorder and Depression:
The "Lows" of Bipolar Disorder.
• These changes in mood, or "mood swings" are intense and can last for hours,
days, weeks or even months.
• People with this disorder typically seek help when they are in the depressive
phase and are often initially diagnosed with unipolar depression.
• Some people suffer for years before they are properly diagnosed and treated.
• 7 of every 10 people with bipolar disorder are misdiagnosed at least once.
• The average length of time to correct diagnosis and treatment is 10 years.
• Bipolar disorder is the sixth leading cause of disability in the world.
Contrary to popular belief, as many men have this disorder as women.
• As many as one in five patients with bipolar disorder complete suicide.
• Although a specific
genetic link to
bipolar disorder has not
been pin pointed,
research shows that
bipolar disorder tends to
run in families.
• About 6 million adult
Americans are affected
by bipolar
disorder.
• That is approximately
2.5%
of the adult population.
ETIOLOGY
• Biological factor
• Psychological factor
• Cognitive theory
• Social and environmental
factor
ETIOLOGY
• Biological factor
Mood disorder runs in families
Neurobiological studies of mood disorders
show abnormalities in various
neurotransmitters
Decrease norephinephrine causes
depression
Low level of serotonin also cause depression
ETIOLOGY
• Psychological factor
Psychological mechanism by various
life experiences can cause mood
disorders
Loss of self-esteem was also
considered critical for the onset of
depression
Mania, on the other hand serves as a
defense against depression
ETIOLOGY
• Cognitive theories
Negative and gloomy thoughts of
depressed patient are considered
secondary to low mood
Depressive cognition are the cause of
depressed mood or are powerful factor in
aggravating and maintaining the disturbed
mood
A person with negative and distorted mood
more likely to become depressed when
faced minor problem
ETIOLOGY
• Social and environmental factors
Adverse childhood experiences such as maternal
deprivation, lack of parental care, sexual abuse,
alcoholism and antisocial personality disorders in
parents predispose a person to depressive disorder
Death or separation from a loved one increase the
risk of depression
BIPOLAR DEPRESION DISORDER
• The "lows" of this disorder are much
like that of unipolar depression and are
sometimes referred to as "bipolar
depression.
• " People with BD experience bipolar
depression more often than mania or
hypomania.
• Bipolar depression is also more likely to
be accompanied by disability and
suicidal thinking and behavior.
Symptoms of Depression:
Prolonged sadness or unexplained crying spells
Loss of appetite and changes in sleep patterns
with sleeping far too much
Irritability, anger, worry, agitation, anxiety
Pessimism, indifference, defeat, feelings of
impending doom
Loss of energy, lethargic
Feelings of guilt, worthlessness
Having problems focusing, remembering, and
making decisions
Unable to enjoy things anymore, social
withdrawal and isolation
Unexplained aches and pains
Suicidal thoughts or attempting suicide.
NURSING ASSESSMENT
• History
• General appearance and motor behavior
• Mood and affect
• Thought process and content
• Sensory and intellectual process
• Judgement and insight
• Roles and relationship
• Physiologic and self care concern
OTHER NURSING ASSESSMENT
• Risk of suicide
• Self-neglect – inadequate nutritional intake,
poor personal hygiene
• Hopelessness
• Negative self – regard and low self worth
• Fatigue
• Difficulty in sleeping
• Agitation
• Financial and relationship problems, guilt and
anxiety
NURSING INTERVENTION
1. Therapeutic use of self
Model interpersonal relationship skill
Teach patient to value herself (self-worth)
2. Patient safety
Ensure safe environment – both physical
and psychological
Physical – prevent self harm or exploitation
by others
Psychological – freedom to express views,
and emotions without being censured or
judged
NURSING INTERVENTION
Problems related to be attended to according to
its priority
3. Identify suicidal idea
Identify suicidal idea – talk of suicide,
threat of self-harm and behavior that are
secretive e.g hoarding of medication, hide
razor blade etc
Need to communicate with the doctors and
nursing team to prevent from patient’s
suicidal action
NURSING INTERVENTION
Problems related to be attended to according to
its priority
3. Identify suicidal idea
Some patient can become more actively
suicidal when they are recovering
Risk of suicide is also high in the first few
weeks following discharge (Rihmer, 2007)
NURSING INTERVENTION
Problems related to be attended to according to
its priority
4. Self-care
Identify self care deficits
Assess the level of intervention required –
to ensure basic care are met
NURSING INTERVENTION
Occupational therapy
To focus patient’s thought on things other
than her personal problems
Activities such as art and craft, cooking
and playing games will give information
about patient’s mental and emotional state
and level of skill
The "highs" of this disorder come less frequently, but can be
very intense and last for a long period of time.
Symptoms of Mania:
Excessive energy, racing thoughts and rapid talking
Denial that anything is wrong
Extreme “high” or euphoric feelings
Easily irritated or distracted
Decreased need for sleep – possibly days with little or no
sleep without feeling tired
Unrealistic beliefs in one’s ability and powers
Unusually poor judgment
Sustained, unusual behavior
Unusual sexual drive
Abuse of drugs and alcohol
Provocative, intrusive, or aggressive behavior
There are different levels of this disorder.
Bipolar I Disorder — defined by manic or mixed episodes
that last at least seven days, or by manic symptoms that
are so severe that the person needs immediate hospital
care. Usually, depressive episodes occur as well, typically
lasting at least 2 weeks.
Bipolar II Disorder — defined by a pattern of depressive
episodes and hypomanic episodes, but no full-blown manic
or mixed episodes.
Bipolar Disorder Not Otherwise Specified (BP-NOS) —
diagnosed when symptoms of the illness exist but do not
meet diagnostic criteria for either bipolar I or II. However,
the symptoms are clearly out of the person's normal range
of behavior.
There are different levels of this disorder.
• Cyclothymic Disorder, or Cyclothymia — a mild form of bipolar
disorder. People with cyclothymia have episodes of hypomania as
well as mild depression for at least 2 years. However, the symptoms
do not meet the diagnostic requirements for any other type of
bipolar disorder.
• Rapid-cycling Bipolar Disorder — An extremely severe form of the
disorder. Rapid cycling occurs when a person has four or more
episodes of major depression, mania, hypomania, or mixed states,
all within a year. Rapid cycling seems to be more common in people
who have their first bipolar episode at a younger age. Rapid cycling
affects more women than men. Rapid cycling can come and go.
• Although bipolar disorder is equally common in women and men,
research indicates that approximately three times as many women
as men experience rapid cycling.
• Everyone is different and will experience their own combination of
symptoms.
NURSING INTERVENTION
Nursing intervention
• The nursing intervention depend on the severity of the illness
• During the depressive episode, patient is given the care as in major
depression
• During the manic state – the patient will be elated and will be with full od
idea
• Need to take history and other information for assessment from family
members
NURSING INTERVENTION
Common problem form the assessment that need to be attended
• Risk of violence – any restriction imposed will be an irritant to the patient
• Nutritional status – will not realize he is hungry or tired
• Disrupts and interferes with another patients
• Compliance problem
• Difficulty in sleeping
• Unable to recognize and meet self care needs
NURSING INTERVENTION
1. Administer regular medication to reduce symptoms of the disease
2. Provide diversional therapy such as occupational and recreational
therapy to divert the attention of patient
3. Advise patient to participate in group therapy (problem-focused
group) for interpersonal learning (learn form others), self-
understanding (gain personal insight) and guidance
NURSING INTERVENTION
LITHIUM CARBONATE
1. Advice patient to take medication with meals to minimize
gastrointestinal upset, nausea and vomiting
2. Ask patient to reduce calorie diet and ensure adequate exercise
to maintain oral hygiene
3. Advise patient to avoid participating in activities that require
alertness e.g. driving, as he may feel drowsy, headache or
dizziness after taking the medication
NURSING INTERVENTION
LITHIUM CARBONATE
4. Encourage patient to take frequent sips of water, ice, sugarless
candy to maintain oral hygiene
5. Advise patient to see doctor if experience tremors which is one of
the side effects of lithium carbonate
6. Instruct patient to see doctor if he feels very drowsy after taking
the medication. Doctor may decrease the dose of the medication
to prevent from going into hypotension or pulse irregularities
NURSING INTERVENTION
LITHIUM CARBONATE
7. Encourage patient to maintain daily intake and output and also
monitor his weight and skin turgor because he may experience
polyuria and dehydration which may subside after 2-3 weeks after
taking medication
BIPOLAR DISORDER IS TREATABLE, AND RECOVERY IS POSSIBLE.
ONE WAY TO TREAT IT IS WITH VARIOUS FORMS OF PSYCHOTHERAPY.
Cognitive Behavioral Therapy (CBT) - Helps people with
bipolar disorder learn to change harmful or negative thought
patterns and behaviors.
Family-Focused Therapy - Helps enhance family coping
strategies, such as recognizing new episodes early and helping
their loved one.
Interpersonal and Social Rhythm Therapy - Helps people with
bipolar disorder improve their relationships with others and
manage their daily routines.
Psychoeducation - Usually done in a group, teaches people
about the illness and its treatment. Can help to recognize signs
of an impending mood swing so treatment can be sought early,
before a full-blown episode occurs. It may also be helpful for
family members and caregivers.
THERE IS NO ONE MEDICATION FOR BIPOLAR DISORDER. DEPENDING ON
THE PERSON, VARIOUS COMBINATIONS OF THESE OR SIMILAR DRUGS
MIGHT BE PRESCRIBED.
Mood stabilizers: Lithium (helps with mania
and depression), LATUDA (as adjunctive therapy
with lithium), Benzodiazepines (primarily for
mania and related anxiety disorders)
Anticonvulsants Used as Mood Stabilizers:
Depakote (valproic acid), Lamictal, Neurontin,
Topamax, Trileptal Antipsychotics: Olanzapine
(Zyprexa), Aripiprazole (Abilify), Quetiapine
(Seroquel)
Antidepressants: Fluoxetine (Prozac),
Paroxetine (Paxil), Sertraline (Zoloft),
Bupropion (Wellbutrin), and there are others
DIFFERENCES BETWEEN MANIA AND DEPRESSION
Living with bipolar disorder can be like living on a rollercoaster of emotions and life events. At its
highest point there can be intense mania and at its lowest, severe depression. Either state can last
for days or weeks and the transition from one to the other can be slow. Typically, depression steals
away much more time than mania. Both can be extremely damaging to someone’s life.
With mania, thoughts and feelings come and go quickly. You can feel elated and enthusiastic with
intensity and power even invincible. Euphoria and sensuality can pervade. The universe has
meaning and the world is a wonderful place. You are in tune with life and it seems there is
nothing you can’t do but, unfortunately, it does not stop there. Your perceptions about yourself
and the world become unrealistic. Making poor decisions, you act on impulse. The money goes
easily, excessive use of alcohol and drugs can ensue, you might go in for gambling, or engage in
risky sexual behavior. The loss of control can be frightening. Instead of a wonderful experience,
you might become irritable, angry, and aggressive. Ignoring the consequences, your actions can
become very destructive. In the extreme, mania can become psychosis complete with paranoia
and hallucinations.
There might be long periods of being simply normal but severe depression can come. It can
be paralyzing and debilitating, painful emotionally and physically. Energy and optimism go
away and it could become impossible to function. This too can last for weeks or months and
will occur more than mania.
The good news is that it can all be treated such that most people with bipolar disorder can live
normal, happy, and fulfilling lives.
Fictional characters that appear to have
bipolar tendencies.
