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Nurse to Nurse Bipolar Disorder DHS: SENIORS AND PEOPLE WITH DISABILITIES DIVISION Nurse to Nurse Oregon’s community-based care nursing newsletter Vol. 5 No. 2. 2008 Summer 2008 In this issue Bipolar Bipolar disorder .................1 disorder Bipolar disorder is a Nine strategies for brain fi tness ......................4 category of mood disorders characterized by episodes of Megacolon and mania. Formerly referred to megarectum .....................7 as manic-depression, bipolar disorder or Continuing education bipolar affective disorder includes bipolar for community-based I, bipolar II, cyclothymia and bipolar NOS. nurses ...............................9 According to the American Psychiatric Restraint review ..............10 Association, bipolar disorder affects 1.2 percent of the general population. It can typically be well managed with Attention all nurses .........13 appropriate treatment. Home health care and community We need your feedback! .13 nurses can make a signifi cant contribution toward the success of such treatment. Bipolar I Mania According to the DSM IV-R, one or more episodes of mania or mixed episode is required for a diagnosis of bipolar I disorder. Mania is characterized by an elevated, expansive or irritable mood over a distinct period of time. Individuals in a manic state often display increased energy and less need for sleep. They may be irritable and easily distracted. Independent. Healthy. Safe. Bipolar disorder — continued Some people become overconfi dent or Depression often leads to changes in an grandiose. If severe, individuals can develop individual’s eating or sleeping patterns. delusions or suffer from other forms of Many individuals report ongoing psychosis. Judgment and inhibition are restlessness. Others report a lack of energy often impaired. despite an increase in sleep. Some people experience suicidal ideation. If severe, a Individuals experiencing mania may engage person can become psychotic. in self-destructive behavior, such as going on shopping sprees Mixed affective with disregard episodes or a for fi nances. mixed state is an Others experience episode in which increased sex-drive an individual and may engage experiences both in risky sexual symptoms of mania behavior. Those and depression with psychosis, simultaneously. extreme anxiety An example of this or irritability would be someone may become who reports feeling combative. hopeless and sad yet displays To meet the DSM-IV-R criteria for mania, increased energy. an individual must exhibit symptoms of mania for at least one week, or with such severity to require hospitalization. Bipolar II Hypomania Depression Bipolar II disorder is characterized by There is no requirement for the presence hypomanic episodes and at least one major of depression for a diagnosis of bipolar depressive episode. I disorder. That said, many people with Bipolar I disorder do experience major Hypomania shares some characteristics depressive episodes. Symptoms of major with mania but to a lesser degree. depression include persistent feelings of Individuals experiencing hypomania also hopelessness and helplessness. Individuals experience fewer symptoms than those in a depressive phase of bipolar disorder in a full-blown manic state. People in often express feeling empty and apathetic. hypomanic states report an increase in Others report anxiety, anger, or guilt. energy and confi dence. The negative social and functional effects of mania are typically absent in hypomanic episodes. Hypomania 2 Oregon Department of Human Services — Seniors and People with Disabilities Vol. 5 No. 2 2008 Bipolar disorder — continued should be monitored, however, as it can Common comorbid conditions for children become worse leading to full-blown mania. such as depression or ADHD, can be Another concern is the risk of a major misdiagnosed as bipolar disorder. Also, depressive episode. developmental factors, such as hormonal changes, should always be considered. Cyclothymia Such factors can produce signs that look like symptoms of bipolar disorder. Cyclothymia is characterized by both episodes of hypomania and periods of depression. For this diagnsosis, however, Treatment the depression is not characterized as The emphasis of treatment for these major in severity. This is a low-grade cycle disorders is typically on the management of moods which can impact functioning and prevention of acute episodes. but to a lesser extent than what might Lithium has been the best known and occur with Bipolar I and II disorders. An most commonly used mood stabilizing individual with cyclothymia may experience medications for years. The therapeutic some diffi culties with relationships or work, range for lithium is narrow, with adverse but would generally be able to maintain effects if exceeded. Lithium levels, social supports and employment despite therefore, require monitoring. High plasma experiencing symptoms. lithium levels can cause gastrointestinal problems and fatigue. Lithium toxicity can Etiology lead to cardiac arrhythmia, seizures and even coma. Long-term use of lithium can As with most major psychiatric disorders, lead to kidney changes or renal failure. For the cause of bipolar disorder is unknown. this reason, kidney functions should also be Current research, however, attributes the monitored. disorder to various potential factors. There is an established genetic factor to the Anticonvulsants, such as carbamazepine condition. There is also good evidence to are also used to stabilize moods. link environmental stressors to the disorder. Antipsychotics can be helpful in managing Most mental health practitioners agree agitation during acute episodes of mania. that there is likely a genetic predisposition Likewise, antidepressants are used to treat to the disorder that may be triggered by episodes of depression. Their use, however, external factors. has been debated, as some researchers have associated antidepressant use with The onset of bipolar disorder typically the onset of manic or mixed state episodes. occurs in adolescence or young adulthood. Children and young adolescents are Research indicates that specifi c factors increasingly being diagnosed with bipolar increase the likelihood of recurrent disorder. This has been somewhat symptoms. Decreased sleep, caffeine controversial, particularly for children. consumption, and other kinds of substance 3 Oregon Department of Human Services — Seniors and People with Disabilities Vol. 5 No. 2 2008 Bipolar disorder — continued use have been linked to increased and you can help to protect your patient by more severe manic episodes. Other monitoring for risk, offering support, and substances, increased stress, and abrupt with your patient’s consent, communicating changes in medication may trigger episodes with other service providers. This is of both mania and depression. particularly true if your patient has a history of suicidal ideation or attempts. Considerations Some individuals have developed a crisis plan with their psychiatrist or other mental There is a high rate of substance abuse health care provider. As a nurse, you associated with these disorders. Substances should be informed of any plan for crisis are often used as a way to self-medicate that has been developed. If your patient or to quell the symptoms related to bipolar expresses suicidal thoughts or a plan to disorder. Unfortunately, many substances hurt herself, take it seriously. If necessary, can have adverse reactions when paired she should be assessed by a psychiatrist or with medications that your patient may a designated mental health professional for have been prescribed. Commonly used hospitalization. substances, such as alcohol, can also increase the severity of symptoms as well Individuals with bipolar disorder can live full as risk of dangerous or impulsive behaviors. and independent lives. As a nurse, you may As a nurse, you can educate your patient play an important role in supporting the about the risks of substance abuse. ongoing symptom management necessary to do so. This can entail ensuring good The risk of suicide for people diagnosed communication and collaboration between with bipolar disorder is also of concern. other service providers in your patient’s The American Psychiatric Association life. It may include providing ongoing reports that 10-15 percent of individuals education to both your patient and to with bipolar I disorders complete suicide. her family about symptoms, treatment, The suicide rate for people diagnosed with adverse side effects of medications, and bipolar is 10-20 percent greater than that their precautions. Monitoring symptoms of the general population. as well as changes in diet, sleep, and other Individuals are at the greatest risk for behaviors, will allow you to work with your suicide when fi rst emerging from a major patient to intervene prior to the onset of an depressive episode. During this time, your acute episode. patient may continue to express suicidal feelings and may have an increase in energy to act on such feelings. As a nurse, 4 Oregon Department of Human Services — Seniors and People with Disabilities Vol. 5 No. 2 2008 Nine strategies for brain fi tness by Roger Anunsen While everyone hopes that cures for Alzheimer’s disease and other dementia will be announced in the near future, it is now very clear that we can (and should) do much more than just worry and wait. Find a variety of challenges that you enjoy Roger Anunsen, neuroscience researcher and regularly engage your brain. numbers 8 and 9). from and host of the new Brain Wellness Series,
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