Caring for a Patient with Bipolar Disorder

“Bipolar disorder, also commonly known as manic depression, is defined as a serious mental illness in which common emotions become intensely and often unpredictably magnified. Individuals with bipolar disorder can quickly alternate from extremes of happiness, energy and clarity to sadness, fatigue and confusion. All people with bipolar disorder have manic episodes abnormally elevated or irritable moods that last at least a week and impair functioning. But not all become depressed ” (American Psychological Association, 2015). Bipolar disorder can vary in each individual. The symptoms fluctuate in pattern, severity and rate of recurrence. Some people are more susceptible to either mania or depression, while others change proportionately between the two types of episodes. Some have frequent mood disruptions, while others live through a few throughout their lifetime.

Bipolar disorder is a mood disorder known for severe persistent mood instabilities between mania and depression, . It causes unusual changes in mood, energy, and activity levels which makes ability to perform daily tasks very hard. (Concepts Advisory Panel [CAP], 2015). BPD affects more than 2.3 million adult Americans, or 1% of the population. (Guo, Patel, Li, & Keck 2010). There are four basic types of bipolar spectrum; All of them involve clear change in the mood energy, and activity levels (CAP,2015). These mood incidences’ ranges from periods of extremely high and energized behavior known as Manic episodes to very sad, or hopeless periods known as depressive episodes. Bipolar I disorder, the client has at least one episode of manic followed by major depression. Bipolar II disorder, the client has one or more hypomanic and major depressive episodes, the other not so severe and less diagnoses type of Bipolar is chronic mood disorder that lasts more two years with combination of hypomania and dysthymia. (CAP,2015). This paper will go into, Bipolar I, Manic episodes, the pathophysiology, Sign and symptoms, treatments, comorbidity, nursing intervention and nursing and patient therapeutic relationship.

Some signs and symptoms of a manic episode are: increased energy, activity, and restlessness; excessively high, overly good, euphoric mood; racing thoughts and talking fast, jumping from one idea to another; distractibility or lack of concentration; spending sprees; poor judgment; increased sex drive; and denial that anything is wrong (Nevid, Rathus, & Greene, 2006). A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for one week or longer (Psychology Today, 2011). If the mood is irritable, four additional symptoms must be present.

Bipolar Disorder is a brain disorder that is characterized by abnormal changes in mood, energy and activity levels (“National Institute of Mental Health”). Manic-depressive illness is also another name that bipolar disorder is commonly referred to as (“National Institute of Mental Health”). This disorder has four basic types including, bipolar I, bipolar II, cyclothymic, and any other which do not perfectly fit the first three. All four of the types have episodes of extreme highs, manic periods, and extreme lows, depressive periods. Symptoms can range greatly and depend on what type of episode the affected is having. Manic episodes can include, but are not limited to: having extraordinarily high amounts of energy, activity,

While having a manic phase people with bipolar disorder cannot control themselves, their behaviors, they do not feel sleepy or tired, they are very involved in activities, and they can be very hyper , they can have very elevated mood.

During this period there must also be three or more of the following symptoms present: (1) inflated self-esteem or grandiosity; (2) decreased need for sleep; (3) more talkative than usual or pressure to keep talking; (4) flight of ideas or subjective experience that thoughts are racing; (5) distractibility; (6) increase in goal-directed activity; (7) excessive involvement in activities that have a high potential for painful consequences. In addition to the presence of at least three of these seven symptoms, the criteria for bipolar 1 disorder require that the mood disturbance is severe enough to cause marked social or occupational dysfunction or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. Lastly, the manic episode cannot be attributable to the effects of a substance of abuse, medication, or another medical condition (American Psychiatric Association, 2013, p. 124).

Bipolar disorder has been gaining more and more attention over the last few years. With shootings on the rise, or at least the publicity of them, people are often pointing their fingers at mental diseases including bipolar disorder. An ongoing issue regarding mental illnesses, however, is the population has failed to fully understand what they truly are, the symptoms, and how to treat them.

The symptoms presented by the client are characteristic of Bipolar I disorder with single manic episode. The defining features of this diagnosis are a single manic episode with no history of major depressive episodes. The manic episode is characterized by a distinct and persistent period of abnormal mood that is elevated and expansive that lasts for at least one week. The most prominent features of the manic episode presented by the client include a sense of grandiosity, decreased need for sleep, increased talkativeness, and an increase in behavior that is goal directed. This manic episode has caused disruption in the client's professional life, and the symptoms are not a result of physiological effects from any

For an episode to be categorized as manic, the patients’ mood has been irritable or abnormally elevated for at least 1 week. A person must also exhibit at least 3 of the following symptoms (4 if the mood is only irritable): extreme feelings of personal greatness; a decreased need for sleep, marked talkativeness; distractibility; extreme focus on a goal-directed activity; reports of ‘racing’ thoughts or a flight of ideas; or excessive involvement in pleasurable activities that have a high potential for painful consequences (i.e. sexual indiscretions or unintelligent business investments). As in the criteria for a depressed episode, the DSM-IV specifies that these symptoms should not be better explained as being a side effect of a drug or illness to qualify as a manic episode. These symptoms must interfere with the person’s normal functioning and must not meet the criteria for a mixed episode. As with adults, childhood-onset bipolar disorder has many faces. Children with Bipolar I Disorder have episodes of mania and episodes of depression, sometimes there are long periods of normal moods between episodes. Adults usually tend to have more depressed episodes than manic episodes. However, some children will have chronic mania (symptoms of mania lasting for long periods of time or marked by frequent recurrence) and seldom experience a depressed episode.

A manic episode is characterized by an abnormality of mood that is euphoric, expansive, and elevated or irritable with increased energy, along with signs and symptoms such as inflated self-esteem or grandiosity, decreased need for sleep. Pressure of speech or being extremely talkative, racing thoughts or flight of ideas, distractibility, an increase in goal-directed behavior, agitation, poor judgment and impulsive decision making are more signs and symptoms of a manic episode. A manic episode can result in unwise and potentially dangerous behavior. Destructive behaviors can often occur with spending money, sexual

Bipolar 1 disorder is when an individual has manic episodes that last at least 7 days with manic symptoms that are so severe that the person sometimes needs immediate hospital care. Depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features, having depression and manic symptoms at the same time, are also possible. Individuals with this form of bipolar experience the most dramatic transitions from mania to depression, and mood swings can be sudden and severe. The level of functional impairment is high with this form of the disorder, and many of these individuals must be hospitalized in order to protect their safety.

(2000) explained that the prevalence of bipolar spectrum disorder is between 2.6% and 6.5%, which can be compared to the prevalence of drug abuse which is 4.4%. Bipolar can be classified as a spectrum disorder because it forms an umbrella for bipolar I disorder, bipolar II disorder, cyclothymia, and bipolar disorder not otherwise specified. Unfortunately, bipolar spectrum disorders often go undiagnosed and therefore untreated. With that, Hirschfelt et all (2000), emphasizes the importance of recognizing this disorder. With recognition, these individuals can seek intervention for this disorder and decrease its symptoms and its progression. One way to diagnose this disorder is to screen for it by performing a mood disorder questionnaire. The researchers created a one-page, self-report, paper-and-pencil inventory that can be easily evaluated and administered. The questions were derived from the DSM-IV criteria at the time, but have been updated to the newest version’s clinical

Bipolar disorder has a lifetime prevalence in the United States of nearly 4% (CDC, 2013, October 4). Healthcare can be provided in various settings and consist of various interventions. It is important for nurses to have a general knowledge of how to care for patients with both bipolar disorder and alcohol abuse. This is because we can come across these patients in various nursing specialties, in outpatient clinics, or in private practices.