Bipolar disorder

Symptoms of Manic State Are

Describes in three stages: Stage I- Hypomania Stage II- Hypomania (Acute mania) Stage III-Delirious mania

Children And Adolescence

Diagnosis is made using the FIND: Frequency: Symptoms occur most days in a week. Intensity: Symptoms are severe enough to cause extreme disturbance in one domain or moderate disturbance in two or more domains. Number: Symptoms occur three or four times a day. Duration: Symptoms occur 4 or more hours a day.

Side Effects of Lithium Include

Drowsiness, dizziness, headache Dry mouth; thirst; GI upset; nausea/vomiting Fine hand tremors Hypo-tension; arrhythmia, pulse irregularities Polyuria; dehydration Weight gain Potential for toxicity

Characteristic of a manic episode

During a manic episode, the mood is elevated, expansive, or irritable. Disturbances are severe to cause marked impairment in occupational functioning or in usual social activities.

Childhood And Adolescence Symptoms

Euphoric/expansive mood: extremely happy, silly, or giddy Irritable mood: hostility and rage, often over trivial matters Grandiosity: believes abilities to be better than everyone else Decreased need for sleep: may only sleep 4 or 5 hours per night and wake up feeling rested Pressured speech: loud, intrusive, difficult to interrupt Racing thoughts: rapid change of topics Distractibility: unable to focus on school lessons Increase in goal-directed activity/psychomotor agitation: activities become obsessive; increased psychomotor agitation Excessive involvement in pleasurable or risky activities: exhibits behavior that has an erotic, pleasure-seeking quality about it Psychosis: may experience hallucinations and delusions Suicidality: may exhibit suicidal behavior during a depressed or mixed episode or when psychotic

Biological Theories

Genetic, Biochemical influences and Physiological influences.

Hypomania

Is a mild degree of mania, which is not severe enough to cause marked impairment in social or occupational functioning or to required hospitalization, and it does not have psychotic features.

Cyclothymic Disorder

Is a milder form of bipolar disorder characterized by several hypomanic episodes and less severe episodes of depression that alternate for at least two years. The severity of this illness may change over time.

Bipolar disorder

Is characterized by mood swings from profound depression to extreme euphoria(mania), with intervening periods of normalcy.

Psychopharmacology For mania

Lithium carbonate Anticonvulsants Verapamil Atypical antipsychotics

Substance/Medication Induced Bipolar Disorder

Mood disturbances associated with this disorder is considered to be a direct result of physiological effect of a substance (e.g., ingestion of or withdrawal from a drug or a medication).

What Should a Client Taking Lithium do If He/She Develops Nausea, Vomiting or Diarrhea?

Notify the physician, these symptoms can result in loss of sodium which can increase the risk for lithium toxicity.

Treatment of Bipolar Disorder

Psychopharmacology and Family interventions

Bipolar II Disorder

Characterized by one or more major depressive episodes and at least one episode of hypomania, with possible periods of level mood between episodes.

Stage III- Delirious Mania

A grave form of the disorder, characterized by severe clouding of consciousness and representing an intensification of the symptoms associated with acute mania Has become relatively rare since the availability of antipsychotic medication

Lithium Therapeutic Range is:

1.0 to 1.5 mEq/L (acute mania) 0.6 to 1.2 mEq/L (maintenance)

Mania

An alteration in mood that is expressed by feeling of elation , inflated self-esteem, grandiosity, hyperactivity,agitation, and accelerated thinking and speaking.

Which Patient Teaching Should be Included for a Patient Starting on Lithium?

-Lithium takes 1-3 to start working -The client should have serum Lithium levels every 1-2 months. -Client should drink between 2500-3000ml of fluids daily. -The client should not skimp on dietary sodium intake. -Client should wear an identification card or bracelet, stating that they are taking lithium. -Client should learn to recognize symptoms of toxicity and what to report to HCP. -Client should be advised not to D/C lithium abruptly. -Client should not drive or operate dangerous machinery until reaction is established. -Client should wear sunblock lotion and protective clothing; the skin is more susceptible to sunburn. -Advise client to rise slowly from a sitting or lying position to prevent orthostatic hypotension.

Bipolar I Disorder

Bipolar I is characterized by one or more manic episodes or mixed episodes (which is when the person experience symptoms of both a mania and a depression). Typically a person will experience periods of depression as well. Bipolar I disorder is marked by extreme manic episodes.

symptoms if Lithium Toxicity Includes

Blurred vision, ataxia, tinnitus, persistent nausea and vomiting, and severe diarrhea Ensure that client consumes adequate sodium and fluid in diet

Treatment Modalities For Bipolar Disorder

Individual psychotherapy Group therapy Family therapy Cognitive therapy

Stage II- Acute Mania

Intensification of hypomanic symptoms; requires hospitalization Mood: euphoria and elation Cognition and perception: fragmented, disjointed thinking; pressured speech; flight of ideas; hallucinations and delusions Activity and behavior: excessive psychomotor behavior; increased sexual interest; inexhaustible energy; goes without sleep; bizarre dress and make-up

Biochemical Influences

Studies shows that symptoms of depression are associated with deficiency in the biogenic amines nor-epinephrine and dopamine. They also suggest that mania is cause by an excess of these amines.

Stage I Hypomania

Symptoms not sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalization Mood: cheerful and expansive Cognition and perception: self- exultation; easily distracted Activity and behavior: increased motor activity; extroverted; superficial

What is the difference between Bipolar I and Bipolar II?

The main difference between the two types of bipolar disorder is that a person with bipolar I has manic episodes, while someone with bipolar II has hypomanic episodes. So, in other words, it's the severity of the mania that distinguishes these two types.

Predisposing Factors

There are two theories: 1)Biological Theories 2)Psycho social Theories

Bipolar Disorder Due to Another Medical condition.

This disorder is characterized by an abnormally and persistently elevated, expansive , or irritable mood and excessive activity or energy that is judged to be the result of direct physiological consequence of another medical condition.

For depressive phase

Use antidepressants with care (may trigger mania)