Bipolar Disorder

Mood

Emotion that influences perception

joy, depression, elation, anger, anxiety

Affect

EXTERNAL, observable REACTION

Mania think…

EUPHORIA

Bipolar disorder

Cycles of mania and depressio

Mania s/s

elation

inflated self-esteem

grandiosity

hyperactive

agitation

accelerated thinking/speech

What % of people respond to lithium threatment?

33%

Bipolar disorder is characterized by

mood swings

• profound depression (MDD)

• EUPHORIA (mania)

periods of normalcy

Hypomania

symptoms less intense and not severe enough to cause impairment in function

no psychotic feature

DOES NOT REQUIRE HOSPITALIZATION

The depression associated with bipolar disorder is similar to

MDD

Bipolar 1

Experiencing MANIC episode

Hx of or more more manic episodes

may have episodes of depression

Changes in behavior noted during mania

• Grandiosity

• Decreased need for sleep

• Talkative (pressured)

• Flight of idea (racing thoughts)

• Distractibility

• Goal-directed activity

• Risky behavior

Bipolar 2

Bouts of MDD

episodic HYPOMANIA

never experienced full manic episode

Cyclothymic disorder required length

2 years

Cyclothymic disorder

Chronic mood disturbance

• hypomania

  • depression not severe enough for MDD

Essentially cyclothymic disorder is…

less severe bipolar 2

Medical conditions that can be associated with bipolar symptoms

Thyroid

Stroke

TBI

MS

Lupus

AIDS

A connection is thought to exist between _____ and the development of bipolar disorder in youth

ADHD

Medications for Acute mania

Lithium

Risperidone (2nd gen antipsych)

Aripiprazole (2nd gen antipsych)

Quetiapine (2nd gen antipsych)

Asenapine (2nd gen antipsych)

2 meds approved for tx of bipolar depression

olanzapine/fluoxetine (combo)

Lurasidon

Stage 1

Hypomania

S/S hypomania

Cheerful/expansive (underlying irritability)

Rapid flow of ideas

Increased Perception → distracted by stimuli

Increased motor

Extroverted

NO EUPHORIA

NO HOSPITAL

Stage 2

Acute ManiaA

Acute mania s/s

REQUIRES HOSPITAL

• EUPHORIA - “high”

• Libale

• Flight of ideas

• Pressured speech

• Distractible

• Hallucination/delusions (paranoid/grandiose)

• Excess motor

• Increase libido

• Poor impulse control

• Little need for sleep

Stage 3

Delirious Mania

Do we often see delirious mania?

NO; because of antipsychotic medication

Delirious Mania

Clouding of consciousness

• labile → Panic anxiety

• Disoriented

SAFETY

• Frenzied motor → agitated purposeless movement

• Exhaustion → DEATH

Interventions for dx: RISK FOR INJURY r/t hyperactivity

• Reduce stimuli

  • private room, simple decor, quiet, low light/noise

• Remove hazardous objects

• Stay with pt

• Structured schedule

• Limit group activity

• Physical activity

Why do we want to reduce environmental stimuli?

Extremely distractible → Exaggerated response to stimuli

Interventions: RISK FOR VIOLENCE r/t manic, delusions, hallucination

• Low stimuli

• Observe behavior while carrying out routine activity (suspiciousness)

• Remove dangerous objects

• Intervene at first sign of escalation - “you seem anxious” “how can I help”

• CALM attitude

• SUFFICIENT STAFF available

• Remove restraints gradually

Interventions for Nutrition

• High-protein, high-calorie finger foods - “on the run”

• Juice/snacks

• Record INO

  • Walk/sit with pt

Interventions for impaired social interaction

• SET LIMITS on manipulative behavior

• Don’t argue, bargain, or try to reason

  • state limit and expectation

• Positive reinforcement

Interpersonal and social rhythm therapy (IPSRT)

Designed for bipolar disorder

regulate social rhythms/daily activities

• Sleep wake

• exercise

When to do group therapy

once acute phase has passed

Distorted automatic thoughts in BPD

• Personalizing: “I’m the only reason my husband is a successful businessman.”

• All or nothing: “Everything i do is great”

• Mind reading: “She thinks I’m wonderful”

• Discounting Positive: “None of those mistakes are really important”

Recovery Model

Learn how to life safe, dignified, full, and self-determined life in face of enduring disability

EMPOWERMENT

• Prevent, minimize symptoms, cope with effects