Bipolar Affective Disorder

By
M. Zubair Khan
Lecturer Kmu
 DEFINITION

 Bipolar disorder is a chronic mood

syndrome that manifests as alternating
and recurring mood episodes
throughout a person’s life.
 Alternating mood episodes are
characterized by mania, hypomania,
depression, and concurrent mania and
depression (mixed episodes) alternating
with periods of normal functioning.
 BIPOLAR DISORDERS
Types

 Bipolar, manic
 Bipolar, depressed
 Bipolar, mixed
 Cyclothymia
 BIPOLAR DISORDERS
Types (cont)
 Bipolar I- Mania alternating with
depression.

 Bipolar II- Hypomanic episodes

alternating with depression.

 Cyclothymia- Hypomanic episodes

alternating with dysthemia.
Prevalence and Comorbidity
• 1.2% to 3%
• Substance abuse
• Personality disorders
• Anxiety disorders
 Biological Theories

 Genetics-
 Neurobiological Factors- Neurotransmitter
alteration: NE, DA and 5-HT
 Neuroendocrine Factors- Hypotalamic-
pituitary-thyroid-adrenal axis
 Neuroanatomical Factors- Dysregulation in
neurological circuits
 Sociological Findings
– Education
– Occupation
– Economic status
– Creativity

Psychological Influences
– Highly expressed emotions
– Childhood experiences
 Assessment- Hypomania
 Talks and jokes incessantly, “life of the party”
demands constant attention.
 Treats everyone with familiarity; often crude.
 Sexual talk often inappropriate and, proposes to
strangers.
 Talk is fresh; flits from topic to topic.
 Full of pep and humor; euphoria and sociability.
 Inflated self-confidence and enthusiasm. Many
plans to become rich and famous.
 Poor judgment; involved with schemes in which
job, financial, or marriage is destroyed.
 High degree of involvement with the rich and
famous; world-wide phone calls.
 Assessment- Hypomania (cont.)
 Decreased attention span, overactive.
 Busily preoccupied with grandiose plans (not
delusions) goes from one action to the next.
 Increase sexual appetite; sexually irresponsible
and indiscreet, illegitimate pregnancies, increased
incidences of venereal disease. Sex used for
escape not for relating.
 Voracious appetite, gobbles food, eats on the run.
 May go without sleeping, unaware of fatigue.
 Financially extravagant, buying sprees, gives
money and gifts freely. Goes into debt easily.
 Wears extravagant often inappropriate clothes
and jewelry.
 Assessment- Mania
 Labile moods
 Inappropriate and intrusive behavior.
 Speech profane and crude sexual remarks.
 Flight of ideas; may have clang associations.
 Good humor turns into rage and hostility specially
when not getting his way, or controls are set. Quick
shifts in moods, hostile to docility.
 Grandiose delusions.
 Judgment extremely poor.
 Decreased attention span and distractibility
intensify.
 Assessment- Mania (cont.)
 Restless, disorganized and chaotic. Behavior
difficult to control, frequent outbursts and briefly
assaultive when crossed.
 Too busy for sex.
 No time to eat or sleep. Too distracted and
disorganized.
 Severe hyperactive and restless. Can result in
exhaustion and death.
 Same as hypomanic with finances but extreme.
 Assessment- Depressed

Symptoms for the depressed cycle of

the Bipolar Disorder- Depressed are the
same as the symptoms of Major
Depression. The difference is that the
bipolar patient has the history of at least
one manic episode.
 Nursing Diagnosis
Risk for other-directed violence
Risk for self-directed violence
 Risk for injury
Disturbed thought process
Imbalanced nutrition, less than…
Disturbed sleep pattern
Self care deficit
Impaired social interaction
 Goals
The client
– Exhibits no evidence of physical injury
– Has not harmed self or others
– Is no longer exhibiting signs of
physical agitation
– Eats a well-balanced diet with snacks to
prevent weight loss and maintain
nutritional status
 Goals (cont.)
 The client (cont)
– Verbalizes an accurate interpretation of
the environment
– Accepts responsibility for own
behaviors
– Does not manipulate others for
gratification of own needs
– Interacts appropriately with others
 BIPOLAR DISORDERS
NURSING INTERVENTION

 Firm and calm approach.

 Short and concise explanations.
 Remain neutral, avoid power struggles.
 Be consistent in approach.
 Have frequent staff meetings to plan consistent
approach.
 Set limits and tell in concrete terms
consequences of inappropriate behavior.
 BIPOLAR DISORDERS
NURSING INTERVENTION (cont.)

 Firmly redirect energy into appropriate

channels. Redirect violent behavior
 Hear and act on legitimate complaints.
 Low level of stimulation in environment.
 Structured solitary activities with staff.
 High- calorie protein “finger foods” snacks and
drinks. Avoid caffeine.
 Provide frequent rest periods.
 Make sure patient takes prescribed meds.
 BIPOLAR DISORDERS
NURSING INTERVENTION (cont.)
 When violent or extreme agitation use
antipsychotics and seclusion.
 Protect client from giving away money and
possessions.
 Monitor lithium levels and observe for signs of
toxicity.
 Supervise hygiene and choice of clothing.
 Give simple step-by-step directions.
 When able to learn teach about disorder,
medication and community agencies.
 PSYCHOPHARMACOLOGY
 ANTIPSYCHOTICS
 BENZODIAZEPINES
 MOOD STABILIZERS
– LITHIUM CARBONATE
 Eskalith
 Lithane
– Lithobid
– ANTICONVULSANTS
 Carbamazepine (Tegretol)
 Valproic acid (Depakote)
 Lamotrigine (Lamictal)
 Gabapentin (Neurontin)
 Oxcarbazepine (Trileptal)
 Tiagabine (Gabitril)
 Topiramate (Topomax)
 LITHIUM

 NOT METABOLIZED IN BODY

 80% REABSORBED IN BODY AND
EXCRETED BY KIDNEYS
 LEVELS OUT
NEUROTRANSMITTERS
 LITHIUM
 SIDE EFFECTS
– METALLIC TASTE
– FINE HAND TREMORS
– WEIGHT GAIN
– NAUSEA
– POLYDIPSIA; POLYURIA
– EDEMA
 TOXICITY
– DROWSINESS
– SLURRED SPEECH
– ATAXIA, MUSCLE SPASMS
– DIZZINESS, STUPOR
– CONVULSIONS & DEATH
 NURSING IMPLICATIONS OF
LITHIUM
 ADMINISTER WITH MEALS
 SERUM LITHIUM LEVELS AT LEAST
TWICE WEEKLY – THEN MONTHLY
 THERAPEUTIC LEVELS - 0.5 – 1.5 mEq/L
 TEACH PATIENT TO
– MAINTAIN A NORMAL SALT INTAKE
– DRINK 8 GLASSES OF FLUIDS/DAY
 Client/Family Education

Nature of illness
– Causes of bipolar disorder
– Cyclic nature of the illness
– Symptoms of depression
– Symptoms of mania
 Client/Family Education
(cont.)
Support services
– Crisis hotline
– Support groups
– Individual psychotherapy
– Legal/financial assistance