Bipolar and Related Disorders Overview

Bipolar I Disorder

Most severe form, at least 1 manic episode, highest mortality rate of the three types.

Bipolar II Disorder

At least 1 hypomanic episode and 1 major depressive episode.

Cyclothymic Disorder

Alternates with symptoms of mild to moderate depression for >=2 years (adults); rapid cycling possible.

Hypomania

Low-level, less dramatic mania; increased functioning, excessive activity and energy.

Substance/Medication-Induced Bipolar Disorder

Mood disturbances due to substance use or medication.

Bipolar Disorder Due to Another Medical Condition

Mood symptoms caused by a physical illness.

Lifetime Bipolar Risk

Nearly 4%; men and women equally affected.

Risk After Severe Postpartum Psychosis

4× greater for bipolar disorder.

Cyclothymic Onset

Often begins in adolescence or early adulthood.

Biological Risk Factors

Genetic, neurobiological, neuroendocrine, peripheral inflammation.

Environmental Risk Factors

Stressful life events, family dynamics.

Cognitive Risk Factors

Negative thought patterns, impaired insight.

Mood Assessment Tool

Altman's Self-Rating Mania Scale.

Behavioral Signs

Manipulative, demanding, splitting (staff division).

Thought Processes

Pressured, circumstantial, tangential speech; flight of ideas, clang associations.

Thought Content

Grandiose and persecutory delusions.

Cognitive Dysfunction

Impairs function; worsens with psychosis, chronicity.

Common Nursing Diagnoses

Risk for injury/violence, sleep deprivation, impaired cognition/concentration, self-care deficit, impaired socialization.

Acute Phase Goals

Prevent injury, maintain hydration, sleep, cardiac stability, and reality orientation.

Maintenance Phase Goals

Knowledge of disorder, medication adherence, coping skill development, community resources.

Planning: Acute Phase

Safety, medication, possible seclusion or ECT.

Planning: Maintenance Phase

Relapse prevention, long-term medication, life restoration.

Effective Communication Strategies

Firm, calm, concise, redirect energy, structure, act on legitimate concerns.

Most Effective for Mania

Distraction is the key tool.

Manic Episode Hospitalization

For safety, control of behavior, and medication stabilization.

Seclusion/Restraint Criteria

Clear risk of harm, loss of self-control, failure of other methods.

Lithium Carbonate

Mood stabilizer; monitor levels (therapeutic vs. toxic); lifetime therapy often needed.

Lithium Toxicity Signs

Early: GI upset, tremor. Severe: confusion, seizures.

Anticonvulsants

Valproate (Depakote), Carbamazepine (Equetro), Lamotrigine (Lamictal).

Second-Generation Antipsychotics

Olanzapine, Risperidone, Quetiapine, Ziprasidone, Aripiprazole, Asenapine, Cariprazine.

Brain Stimulation Therapies

ECT (for severe bipolar depression), rTMS (not yet FDA-approved for bipolar).

Psychological Therapies

CBT, Interpersonal & Social Rhythm Therapy, Family-Focused Therapy.

Integrative Therapy

Omega-3s help with depressive symptoms but not mania.

Support Organizations

DBSA, NAMI, Mental Health America.

Patient Teaching for Lithium

Importance of hydration, signs of toxicity, regular blood tests, medication adherence, avoid NSAIDs.