🧠 Bipolar and Related Disorders (Ch. 13)
Overview
● Chronic, recurrent, and potentially life-threatening disorders.
● Marked by abnormal shifts in mood, energy, and activity.
● The range includes mania, hypomania, depression, and mixed states.
● Two main concerns, cardiac collapse and risk for suicide.
Prevalence
● Affects ~4.4% of the population.
● Average onset: ~18 years.
● Gender ratio:
○ Bipolar I → M:F = 1:1
○ Bipolar II → M:F = 1:2
Etiology
● Genetics: Strong familial link.
● Neurobiological: Dysregulation of dopamine, serotonin, norepinephrine.
● Neuroendocrine: HPA axis dysfunction.
● Neuroanatomical: Abnormalities in prefrontal cortex, amygdala.
● Environmental/Psychological: Stress, trauma, substance use.
● Cultural: Expression varies with cultural norms.
,Types of Bipolar Spectrum Disorders
Bipolar I Disorder
● At least one manic episode (≥1 week), may need for hospitalization.
● Possible psychosis during mania.
● Symptoms of Mania:
○ Mood: Euphoria → irritability/anger.
○ Energy: Increased energy, decreased need for sleep.
○ Thought process: Flight of ideas, pressured speech (rapid speech)
○ Psychosis: Delusions of grandeur, paranoia.
Bipolar II Disorder
● At least one hypomanic episode (4 days minimum).
● One or more major depressive episodes (more severe and longer than
bipolar).
○ Depressive Characteristics
■ Hopelessness/sadness
■ Altered sleep
■ Appetite and weight changes
■ Inability to concentrate
■ Inability to make decisions
■ Suicidal thoughts
● No psychosis.
● Hypomania → increased productivity, sociability, creativity (friends with
everyone), often borders on crude (rude, bad mannered).
○ May have a voracious appetite, eat on the run, or gobble food during brief
periods.
● Mania → Becomes inappropriately demanding of people’s attention, and repels
others from them. Does not understand personal space.
, ○ No time to eat – too distracted and disorganized; finger food diet is given.
○ Reduce stimuli
Delirious Mania
● Disoriented, psychotic, and may develop catatonia; a medical emergency.
(happens out of nowhere). Treated with Benzodiazepines.
Nursing Assessment
● Physical: Energy depletion, poor food/water intake, lack of sleep (check every
15 mins), cardiac strain (vitals every hour).
● Safety: Impulsivity → self-harm or harm to others.
● Behavioral: Hyperactivity, flight of ideas, mood lability.
● Cognitive: Poor judgment, inflated self-esteem, distractibility.
Outcomes
● Adequate hydration and nutrition.
● Stable vital signs.
● 4–6 hours of sleep/night.
● Demonstrates self-control (no harm to self/others).
● Verbalizes understanding of illness and treatment.
● No groups for actively manic patients until it’s controlled.
Implementation
● Set clear limits.
Overview
● Chronic, recurrent, and potentially life-threatening disorders.
● Marked by abnormal shifts in mood, energy, and activity.
● The range includes mania, hypomania, depression, and mixed states.
● Two main concerns, cardiac collapse and risk for suicide.
Prevalence
● Affects ~4.4% of the population.
● Average onset: ~18 years.
● Gender ratio:
○ Bipolar I → M:F = 1:1
○ Bipolar II → M:F = 1:2
Etiology
● Genetics: Strong familial link.
● Neurobiological: Dysregulation of dopamine, serotonin, norepinephrine.
● Neuroendocrine: HPA axis dysfunction.
● Neuroanatomical: Abnormalities in prefrontal cortex, amygdala.
● Environmental/Psychological: Stress, trauma, substance use.
● Cultural: Expression varies with cultural norms.
,Types of Bipolar Spectrum Disorders
Bipolar I Disorder
● At least one manic episode (≥1 week), may need for hospitalization.
● Possible psychosis during mania.
● Symptoms of Mania:
○ Mood: Euphoria → irritability/anger.
○ Energy: Increased energy, decreased need for sleep.
○ Thought process: Flight of ideas, pressured speech (rapid speech)
○ Psychosis: Delusions of grandeur, paranoia.
Bipolar II Disorder
● At least one hypomanic episode (4 days minimum).
● One or more major depressive episodes (more severe and longer than
bipolar).
○ Depressive Characteristics
■ Hopelessness/sadness
■ Altered sleep
■ Appetite and weight changes
■ Inability to concentrate
■ Inability to make decisions
■ Suicidal thoughts
● No psychosis.
● Hypomania → increased productivity, sociability, creativity (friends with
everyone), often borders on crude (rude, bad mannered).
○ May have a voracious appetite, eat on the run, or gobble food during brief
periods.
● Mania → Becomes inappropriately demanding of people’s attention, and repels
others from them. Does not understand personal space.
, ○ No time to eat – too distracted and disorganized; finger food diet is given.
○ Reduce stimuli
Delirious Mania
● Disoriented, psychotic, and may develop catatonia; a medical emergency.
(happens out of nowhere). Treated with Benzodiazepines.
Nursing Assessment
● Physical: Energy depletion, poor food/water intake, lack of sleep (check every
15 mins), cardiac strain (vitals every hour).
● Safety: Impulsivity → self-harm or harm to others.
● Behavioral: Hyperactivity, flight of ideas, mood lability.
● Cognitive: Poor judgment, inflated self-esteem, distractibility.
Outcomes
● Adequate hydration and nutrition.
● Stable vital signs.
● 4–6 hours of sleep/night.
● Demonstrates self-control (no harm to self/others).
● Verbalizes understanding of illness and treatment.
● No groups for actively manic patients until it’s controlled.
Implementation
● Set clear limits.
