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Bipolar Disorder

Description

A mood disorder, formerly known as manic depression is characterized by recurrent episodes of depression and mania. Either phase may be predominant at any given time or elements of both phases may be present simultaneously.

Risk Factors
  1. Biochemical imbalances
  2. Family genetics – one parent, child has 25% risk; two parents, 50-75% risk.
  3. Environmental factors such as stress, losses, poverty, social isolation.
  4. Psychological influences – inadequate coping, denial of disordered behavior.

Specific Biological Factors
  1. Possible excess of norepinephrine, serotonin, and dopamine.
  2. Increased intracellular sodium and calcium
  3. Neurotransmitters supersensitive to transmission of impulses
  4. Defective feedback mechanism in limbic system.

Signs and Symptoms
  1. Risk for self or others
  2. Impaired social interactions
  3. Mania
    • Persistent elevated or irritable mood
    • Poor judgment
    • Increase in talking and activities, grandiose view of self and abilities.
    • Impulsivity such as spending money, giving away money or possessions.
    • Impairment in social and occupational functioning
    • Decreased sleep
    • Distractibility
    • Delusions, paranoia, and hallucinations
    • Dislike of interference or intolerance of criticism
    • Denial of illness
    • Agitation
    • Attention seeking behavior
    • Depression

Nursing Diagnoses
  1. High risk for violence, directed at self or others
  2. Impaired verbal communication
  3. Anxiety
  4. Individual coping, ineffective
  5. Disturbance of self-esteem
  6. Alteration in though processes
  7. Alteration in sensory perceptions
  8. Self-care deficits
  9. Sleep pattern disturbances
  10. Alteration in nutrition

Therapeutic Nursing Management
  1. Environment
  2. Psychological treatment
    • Individual Psychotherapy – may be used to identify stressors and pattern of behavior.
    • Group therapy – establishes a supportive environment and redirect inappropriate behavior.
    • Family therapy – verbalizes family frustration and establishes a treatment plan for outpatient use.
  3. Somatic and Psychopharmacologic treatments
    • electroconvulsive therapy
    • Psychopharmacology

Nursing Interventions
  1. Assess client’s suicidal feelings and intentions and escalating behavior regularly.
  2. Set consistent limits on inappropriate behavior to help the client de-escalate.
  3. Establish a calm environment for the client.
  4. Reinforce and focus on reality.
  5. Provide outlets for physical activity but prevent client for escalating.
  6. Client may be very likable during “high periods”. Staff members need to avoid participating in this behavior, at other times, client may be very irritable and staff members should approach client quietly and with limits, if necessary.
  7. If the client cannot control self and other methods are not successful, staff may need to provide client protection if a threat of a self-harm or injury to other exist.
  8. Monitor client’s nutrition, fluid intake and sleep.
  9. Discuss with the client and family the possible environment or situational causes, contributing factors and triggers for a mood disorder with recurrent episodes of depression and mania.

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