Bipolar

Mania: Described as the emotional reaction associated with an experience, characterized by an alteration in mood, represented by:
- feelings of elation
- inflated self-esteem
- grandiosity
- hyperactivity
- agitation
- accelerated thinking
- sleepiness
Example: A condition such as delirium in a patient with a urinary tract infection (UTI) can mimic mania.

Symptoms of bipolar disorder (formerly known as manic-depressive illness) have been documented since the second century in Greece.
Early writings referred to patients experiencing forms of severe madness.
The modern concept of manic-depressive illness began to evolve in the 19th century using terms like dual form insanity and circular insanity.
The term manic depressive was first used in 1913, and in 1980 the American Psychiatric Association adopted the term bipolar disorder.

Prevalence: Approximately 4.4% of adults in the United States are affected by bipolar disorder. It is likely that the actual number is higher due to undiagnosed cases.
Gender incidence: Roughly equal prevalence among men and women.
Average age of onset: 25 years old.
Socioeconomic status: More prevalent in higher socioeconomic classes.
Disability: Considered the sixth leading cause of disability among the middle-aged population.
Mood swings: Bipolar disorder is characterized by severe mood swings from profound depression to extreme mania.

The onset of symptoms may exhibit a seasonal pattern, particularly with depressive episodes occurring during less sunlight periods, leading to seasonal affective disorder (SAD).
Example: In regions like Alaska, where winter brings prolonged darkness, there is a high rate of depression.
Hypomania: A milder form of mania that might not be diagnosed as bipolar disorder because it may be perceived as someone's quirky personality.

Bipolar I Disorder: Characterized by the experience of full manic or mixed episodes and may include episodes of depression.
Bipolar II Disorder: Characterized by major depressive episodes with episodic occurrences of hypomania, never meeting the criteria for a full manic episode.
Cyclothymic Disorder: Chronic mood disorder requiring at least two years of numerous episodes of hypomania and depressive moods that do not meet criteria for bipolar I or II.
Substance-Induced Bipolar Disorder: Mood disturbances (depression or mania) are directly caused by substance use or withdrawal.
Bipolar Disorder Due to Another Medical Condition: Mood disturbances result from another medical condition rather than being attributable to bipolar disorder itself.

Predisposing Factors: Research on biological causes has not firmly established links. Twin and family studies indicate possible genetic factors.
Biochemical Influences: Potential excess of neurotransmitters, specifically norepinephrine and dopamine.
Physiological Influences: Brain lesions and enlarged ventricles have been noted in some patients with bipolar disorder.
Psychosocial Theories: The credibility of these theories has declined; bipolar disorder is increasingly viewed as a disease of the brain.

Childhood and Adolescence: Prevalence of pediatric and adolescent bipolar disorder is estimated at about 1%. Diagnosis is challenging because children may not articulate feelings or symptoms effectively.
Assessment: Nurses need to be astute in observing symptoms as children often cannot express their pain or distress.

Lithium: Mainstay treatment, requires thorough understanding for effective administration and patient education.
Other medications may include anticonvulsants, verapamil, and antipsychotics.
Comorbidities: ADHD is the most common comorbid condition in children with bipolar disorder; care requires caution as ADHD medications may exacerbate mania.

Education: Families need guidance on bipolar disorder, communication training, and problem-solving skills.
Importance of non-confrontational communication with manic patients to avoid escalation.

Symptoms categorized by severity:
- Stage 1: Hypomania: Symptoms not severe enough to cause marked impairment.
- Stage 2: Acute Mania: Symptoms cause marked impairment requiring hospitalization.

Cheerful mood, rapid flow of ideas, heightened perception, increased motor activity, reduced need for sleep.

Continuous high, marked by flight of ideas, accelerated pressured speech, hallucinations (potentially), excessive motor activity, social and sexual disinhibition.
Symptoms can lead to exhaustion and even death without intervention.

Risk for Injury: Related to hyperactivity and agitation.
Risk of Violence: Due to manic excitement or delusions.
Impaired Social Interaction: Resulting from egocentric behavior.
Insomnia: Related to excessive activity.
Disturbed Sensory Perception: Linked to biochemical changes and possible sleep deprivation.
Imbalanced Nutrition: Less than body requirements due to inability to eat.

Ensure clients eat a balanced diet, stabilize weight, demonstrate an understanding of their behaviors, manage sleep patterns, verbalize the cessation or decrease of hallucinations, and maintain personal safety.
Focus on engaging clients in activities, establishing routines to aid sleep onset, and using comfort measures like warm drinks or quiet environments before bedtime.

Teach about illness causes, cyclic nature, symptom recognition, management strategies, and the importance of medication adherence (especially lithium).
Encourage assertiveness, anger management techniques, and connection to support groups.

Measured effectiveness includes avoidance of personal injury, prevention of violence, stabilization of agitation, stabilization of nutritional status, reduction or cessation of hallucinations, ability to make self-care decisions, and sound social behavior.
Assess client understanding of maintenance medication significance as bipolar disorder is a lifelong condition requiring ongoing treatment.

Psychotherapy: Cognitive therapy for awareness of problems, family therapy if necessary.
Electroconvulsive Therapy (ECT): Effective for patients who cannot tolerate medication or have not responded to medication.
Pharmacological Options: Use of lithium for mania, with caution noted in depression phases as antidepressants may trigger manic episodes.

Instructions include adherence to medication regimens, importance of hydration, possible side effects, and appropriate responses to adverse reactions or other medical needs while on medications like lithium, anticonvulsants, and antipsychotics.

Discharge Medication Information: A client prescribed lithium carbonate should be informed to not skimp on dietary sodium.
Priority Nursing Diagnosis: Establish that risk for injury is paramount during acute manic episodes for safety reasons.

Establish safety as the foremost concern in nursing care for bipolar patients, with a strong emphasis on the importance of medication adherence and ongoing support throughout treatment.