BIPOLAR DISORDER

A mood disorder, formerly known as manic depression is characterized by recurrent episodes of depression and mania. It involves extreme mood swings from episodes of mania to episodes of depression.
During manic phases, clients are euphoric, grandiose, energetic, and sleepless. They have poor judgment and rapid thoughts, actions and speech.
During depressed phases, mood behavior and thoughts are the same as in people diagnoses with major depression.
Either phase may be predominant at anti given time or elements of both phases may be present simultaneously.
Bipolar disorder ranks second only to major depression as a cause of worldwide disability. The lifetime risk of bipolar disorder is at least 1.2 % with a least of completed suicide of 15%. Young men early in the course of their illness are at highest risk for suicides so these patients are usually undergo Electro Convulsive Therapy (ECT).
Bipolar disorder occurs almost equally among men and women. It is common in highly educated people. The mean age for a first manic episode is the early 20’s, but some people experience onset in adolescence.

Risk Factors:
Biochemical Imbalances: Increase in norepinephrine in the brain.
Family Genetics: one parent, child has 25% risk, two parents, and 50-75% risk. Children diagnosed with attention deficit hyperactivity disorder (ADHD) are possible for having a very onset of bipolar disorder.
Environmental Factors: stress, losses, poverty, and social isolation.
Psychological Influences: inadequate coping, denial of disordered behavior.
Biochemical Factor: electrolyte imbalances. An error in metabolism results in the transportation of sodium and potassium within the neuron, low levels of norepinephrine, dopamine and serotonin.
Specific Biological Factor:
Neurotransmitters supersensitive to transmission of impulses.
Defective feedback mechanism in limbic system.

CLIENT & FAMILY EDUCATION

Discuss with the client and family the possible environment or situational causes,
Contributing factors, and triggers for a mood disorder with recurrent episodes of
Depression and mania.
Help the client and family to identify the internal and external indicators of bipolar disorders.
Educate the client and family about the following issues.
Teach:
Self-monitoring
Medication therapy and importance of blood levels and other laboratory monitoring.
Self-care, including adequate nutrition, hygiene, and sleep.
How to decrease stimuli and use other methods to control symptoms and decrease anxiety.
No harm to self or others.
Use of self-help groups.

THRAPEUTIC NURSING MANAGEMENT
Environment:
Clients who experience mania require a safe, supportive environment, which may be a hospital at home for mild mania or some other treatment setting. Hospitalization may be required if the client is a danger to self or others.

Psychological Treatment:
Individual Psychotherapy: may be used to identify stressors and patterns of behavior, also may be helpful as a client learns to cope with the illness and for medication monitoring.
Group Therapy: Establish a supportive environment and redirect inappropriate behavior.
Family Therapy: Verbalize family frustration and establish a treatment plan for outpatient use.
Somatic & psychopharmacologic Treatments:
(ECT) Electro Convulsive Therapy
Depression: Therapeutic effects may take two to six weeks to be noted during which time the side effects may be pronounced.
Mania: Drug therapy includes mood stabilizers or anticonvulsants. Lithium carbonate is the drug of choice. Lab studies must be routinely monitored since the therapeutic drug is narrow.

Nursing Intervention:

• Assess client’s suicidal feelings and intentions and escalating behavior regularly.
• Sets consistent limits or inappropriate behavior to help the client de-escalate.
• Establish a calm environment for the client.
• Reinforce and focus on reality.
• Provide outlets for physical activity but prevent the client from escalating.
• Client may be likeable during “high periods”. Staff members need to avoid participating in this behavior at other times, client may be very irritable and staff members should approach client quietly and with limits, if necessary.
• Provide client a safe environment and observe client most of the time.
• Monitor client’s nutrition, fluid intake and sleep. This is critical, as the client may not be able to do this for self. Provide nutritious portable food.