HAL MH 4.3 (bipolar disorder)

bipolar disorder

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

hypomania

characterized by a persistent elevated, expansive, or irritable mood with increased activity & energy that is not sufficiently severe enough to cause marked impairment in social or occupational functioning or to require hospitalization

mania

expressed by feelings of elation, inflated self esteem, grandiosity, hyperactivity, agitation, racing thoughts & accelerated speech

- also sleep deprivation

bipolar 1

experiencing a manic episode or who has a history of one or more manic episodes

- may have episodes of depression

bipolar 1 diagnosis

- single manic episode

- current episode manic, hypomanic, mixed, or depressed

- psychotic or catatonic features may also be noted

- 4 manic & depressive episodes in a year (rapid cycling bipolar disorder)

bipolar 2 diagnostic specifier

characterized by recurrent bouts of major depression with episodic occurrence of hypomania

- never experienced a full manic episode

- diagnostic specifier

hospitalization

hypomanic episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate ________________

bipolar II diagnostic specificer

current or most recent episode is hypomanic, depressed, or with mixed features

- diagnostic specifier

euthymic

if a patient is in the therapeutic range/goal for their mood stabilizer, they should be _____________

- patient typically don't like being this

BPD mood instability

elevated, expansive, or irritable mood

BPD behavior

pressured speech, decreased need for sleep, increased goal directed activity

- risk taking behavior

physical findings

nutrition/fluid status, risk taking injuries, sleep disruption

- history of prior episodes & med adherence

- family observations of behavior change & functional decline

assess

________ for mania severity using tools ex: Young Mania Rating Scale

evaluate

_________ impact on functioning & safety

distinguish

____________ manic vs hypomanic vs mixed episodes

consider

_________ differential diagnoses (ex: ADHD, substance induced symptoms)

- collaborate w/ mental health team for diagnosis confirmation

immediate concerns

1. risk for injury

2. sleep deprivation

3. med nonadherance

4. impaired social or family relationships

5. ineffective coping or support systems

injury

risk for __________ due to impulsivity or poor judgement

deprivation

sleep __________ exacerbating mood instability

mood stabilizers

lithiu, valproate, & carbamazepine

atypical antipsychotics

olanzapine & risperidone

- meds for acute mania

milieu

structured ________ therapy for safety & limit setting

psychoeducation

______________ for patient and family about mood tracking

structured

routine & ___________ sleep/wake & activity schedule

nursing management

1. implement safety protocols for impulsive behaviors

2. provide calm environment w/ clear boundaries

3. monitor critical lab values

4. administer meds as prescribed & monitor SEs

5. promote adequate nutrition, hydration & rest

6. engage in therapeutic communication build trust

criteria for stabilization

- patient sleeps 6-8 hrs w/o interruption

- reduction in manic symptoms

- adherence to prescribed med regimen

- demonstrates insight into illness & identifies early warning signs

- reengagement with structured daily routines & support systems

BPD nursing priorities

1. ensure patient safety, reduce stimuli & assess risk of harm

2. notify providers and coordinate psychiatric evaluation

3. include parents/caregivers in safety planning & education

depressive

___________ episode in BPD is characterized by feelings of worthlessness, hopelessness & low energy

BP1

what is more commonly associated with rapid cycling where individuals experience 4 or more mood episodes in a year?

- BP1 or BP2

trigger

sleep deprivation is a common __________ for manic episodes in BP1

BP2 is often misdiagonsed as depression because hypomanic episodes can be less noticeable

mixed

BP1 is more likely to involve ________ episodes