BIPOLAR DISORDER
(For B.Sc and GNM Nursing)
Introduction:
Bipolar mood or affective disorder is characterized by recurrent episodes of mania and depression in the same patient at different times.
Previously it was known as manic depressive psychosis.
Predisposing factors
1. Biological
Genetics: Twin studies have indicated that if one twin has bipolar disorder other twin is four or five times more like to develop this disorder.
Family studies: Family studies shown that if one member in the family has bipolar disorder, then the other member are 7-10 times lkely than general population to also have bipolar disorder.
Biochemical influences: Catecholamine's abnormality (norepinephrine, dopamine and serotonin) in one or more sites at brain. Acetyl choline and GABA may also play a role. The effects of antidepressants and mood stabilizers also provide additional evidence.
Physiological influence: Studies have shown that lesions in the left fronto temporal or right parieto occipital quadrants tend to be associated with depression.
Medication sideeffects: Certain medications used to treat somatic illnesses have been known to trigger a manic episode. the most common of these are steroids frequently used to treat chronic illness such as multiple sclerosis and SLE.
Types of Bipolar Disorder
Clinical features
During the period of mood disturbance:
Inflated self esteem
Decreased need for self
More Talkative than usual
Flight of Ideas
Distractibility
Increased goal directed activity but inability to complete it
Increased psychomotor activity
Pressure of speech
Delusion of grandiosity
Reduced sleep
Increased appetite
Hallucination
Management of Mania
1. Psychological treatment
Individual psychotherapy: Manic clients traditionally have been difficult candidates for psychotherapy. they have been difficult candidates for psychotherapy. they form a therapeutic relationship easily because they are eager to please and grateful for therapists interest.
2. Group therapy
3. Family therapy
4.Cognitive therapy
B. Psychopharmacology
The following mood stabilizing drugs are commonly prescriibed to regulate manic episode.
Lithium: It is one of the oldest and most frequently used drugs for the treatment of manic episode. the drug take 4-7 days to reach a therapeutic levels in the blood stream. It has high toxicity level, so while prescriing the drug periodical lithium level check up in the blood is essential. therapeutic level of blood in the lithium is 0.6-1.2 mEq/L.
Carbamazepine: It is an anticonvulsant drug usually prescribed in the conjuction with other mood stabilizers. the drug often used to treat the patient when lithium is not effective.
Valproate: It is an anticonvulsant drug prescribed alone or in combination with carbamazepine. it is usually given to the patient with mixed mania.
Clozapine is an atypical antipsychotic drug also used to treat manic episodes.
Nursing Mnagement
Nursing Diagnosis:
1. Risk for injury related to extreme hyperacrtivity evidenced by increased agotatioon and lack of control over purposeless and potentially injurous movements.
Intervention:
Use firm and calm approach.
use short and concise statement.
Remain neutral avoid power struggles.
Be consistent with approach and expectatations.
Have frequent staff meetings to plan regularly about the patient.
Firmly redirect energy into more appropriate and constructive channnels.
2. Risk for violence directed to others related to manic excitement, hallucinations
Intervention
Maintain low level stimuli in clients environmennt.
provide structured solitary activities.
Provide frequent rest periods.
Redirect violent behaviors.
When manic episode is there, use phenothiazines and seclusion to minimize phhysical harm.
Observe signs of lithium toxicity
Protect client from giving away money and possessions.
3. Imbalance nutrition less than body requirements related to refusal or inability to sit a long enough to eat evidenced by loss of weight .
Intervention
Monitor intake out put and vital signs.
Consult with the nutritionist.
Offer frequent high calorie diet.
Frequent remind client ot eat.
4. Disturbed sleeping pattern related to possible imbalanced neurochemicals as evidenced waking up at night.
Intervention
Encourage frequent rest periods.
Provide calm and quet place.
Dim light should be provided.
Arrange soothing music.
Avoid caffeine.
Administer sedativemedication as prescribed.
Medication sideeffects: Certain medications used to treat somatic illnesses have been known to trigger a manic episode. the most common of these are steroids frequently used to treat chronic illness such as multiple sclerosis and SLE.
Types of Bipolar Disorder
Clinical features
During the period of mood disturbance:
Inflated self esteem
Decreased need for self
More Talkative than usual
Flight of Ideas
Distractibility
Increased goal directed activity but inability to complete it
Increased psychomotor activity
Pressure of speech
Delusion of grandiosity
Reduced sleep
Increased appetite
Hallucination
Management of Mania
1. Psychological treatment
Individual psychotherapy: Manic clients traditionally have been difficult candidates for psychotherapy. they have been difficult candidates for psychotherapy. they form a therapeutic relationship easily because they are eager to please and grateful for therapists interest.
2. Group therapy
3. Family therapy
4.Cognitive therapy
B. Psychopharmacology
The following mood stabilizing drugs are commonly prescriibed to regulate manic episode.
Lithium: It is one of the oldest and most frequently used drugs for the treatment of manic episode. the drug take 4-7 days to reach a therapeutic levels in the blood stream. It has high toxicity level, so while prescriing the drug periodical lithium level check up in the blood is essential. therapeutic level of blood in the lithium is 0.6-1.2 mEq/L.
Carbamazepine: It is an anticonvulsant drug usually prescribed in the conjuction with other mood stabilizers. the drug often used to treat the patient when lithium is not effective.
Valproate: It is an anticonvulsant drug prescribed alone or in combination with carbamazepine. it is usually given to the patient with mixed mania.
Clozapine is an atypical antipsychotic drug also used to treat manic episodes.
Nursing Mnagement
Nursing Diagnosis:
1. Risk for injury related to extreme hyperacrtivity evidenced by increased agotatioon and lack of control over purposeless and potentially injurous movements.
Intervention:
Use firm and calm approach.
use short and concise statement.
Remain neutral avoid power struggles.
Be consistent with approach and expectatations.
Have frequent staff meetings to plan regularly about the patient.
Firmly redirect energy into more appropriate and constructive channnels.
2. Risk for violence directed to others related to manic excitement, hallucinations
Intervention
Maintain low level stimuli in clients environmennt.
provide structured solitary activities.
Provide frequent rest periods.
Redirect violent behaviors.
When manic episode is there, use phenothiazines and seclusion to minimize phhysical harm.
Observe signs of lithium toxicity
Protect client from giving away money and possessions.
3. Imbalance nutrition less than body requirements related to refusal or inability to sit a long enough to eat evidenced by loss of weight .
Intervention
Monitor intake out put and vital signs.
Consult with the nutritionist.
Offer frequent high calorie diet.
Frequent remind client ot eat.
4. Disturbed sleeping pattern related to possible imbalanced neurochemicals as evidenced waking up at night.
Intervention
Encourage frequent rest periods.
Provide calm and quet place.
Dim light should be provided.
Arrange soothing music.
Avoid caffeine.
Administer sedativemedication as prescribed.
Soumya Ranjan Parida
