Bipolar Disorders

Question 1

Affective Disorders

Answer 1

• Major depressive disorder
• Dysthymic disorder
• Bipolar disorder: types I and II
• Cyclothymic disorder
• Seasonal affective disorder (SAD)
• post partum disorder

Question 2

Bipolar Disorder

Answer 2

Characterized by the occurrence of one or more manic episodes or mixed episodes (mania and major depression), that cause marked impairment in social activities, occupational functioning, and interpersonal relationships and many individuals require hospitalization to prevent self-harm. The full range of behaviours may occur across the mood range

Question 3

Manic episodes

Answer 3

• periods in which the individual experiences abnormally and persistently elevated, expansive, or irritable mood characterized by inflated self-esteem, decreased need to sleep, excessive energy of hyperactivity, racing thoughts, easy distractibility, and inability to stay focused
• other symptoms can include hyper sexuality and impulsivity

Question 4

Bipolar I Disorder

Answer 4

• Characterized by the occurrence of one or more manic episodes or mixed episodes (mania and major depression), and often one or more major depressive episodes

Question 5

Bipolar II Disorder

Answer 5

Characterized by a re-occurring major depressive episode either currently or in the past, and at least one hypomanic episode
Characterized as less severe

Question 6

Cyclothymic Disorder

Answer 6

• Defined by chronic fluctuations of mood from numerous periods of both depressive symptoms and hypomania
• Diagnosis is not made unless the patient has been free of major depression, manic, or mixed episodes for at least two years
• There is usually no sign of a normal range of mood

Question 7

Strategies for Optimal Assessment

Answer 7

• changes in sleep and eating pattern
• elated mood, irritated, agitation, grandiose thinking
• low concentration, disjointed, distorted thinking
• hallucinations, delusions
• low self-care
• high possibility of injury to self and others
• low interpersonal relations
• low occupational functioning
• hyper sexuality, risky sexual practices

Question 8

Diagnosing and Planning Appropriate Interventions

Answer 8

• rule out any medical problems
• meeting the patient’s focused needs
• nurse and patient collaboratively determine the outcomes to be achieved

Question 9

Treatment Options

Answer 9

• pharmacological therapy: mood stabilizers alone or in combination with antipsychotics or benzodiazepines if psychosis, agitation, or insomnia is present and antidepressants for unremitted depression
• family therapy or couples therapy
• cognitive behavioural therapy
• individual therpay
• patient and family education
• electroconvulsive therapy

Question 10

Implementing Effective Interventions

Answer 10

• nurse and patient collaboratively determine the outcomes to be achieved
• re-establish sleep and nutrition
• offer snacks, high energy foods, finger foods
• short 1-1 interventions
• limit setting, offer protection (physical, psychological , emotional, social)
• environment: calm, safe, soft colour, low noise
• offer routine and structure

Question 11

Evaluating

Answer 11

• objective re-assessment of interventions and self reflection
• this phase is also part of the termination of the patient-patient relationship
• many times a patient will have a setback due to their feeling of loss of this relationship

Question 12

Interventions: Depression

Answer 12

• Medication
• Hospital, outpatients, home
• protection: self-harm
• Possible suicide
• short 1-1 interaction
• offer structure
• approach: calm, warm, accept, slow pace
• patience, presence, listen, respect
• no sympathy/over identification
• groups: structured & non-structured
• environment: low stimuli
• help with physical care
• Nutrition: weight, finger foods
• Sleep: no naps, day program
• Directions; simple
• Activities: achievable, what they can do
• Goals: reachable

Question 13

Interventions: Mania

Answer 13

• Medication
• Hospital, outpatients, home
• protection: self-harm and harm to others
• Limited risk for suicide
• approach: calim, warm, accepting
• patience, presence, listen, respect
• no sympathy but empathy
• no groups
• environment: low stimuli
• help with physical care
• nutrition: weight, finger foods
• Sleep: naps
• Directions: simple
• Activities: limited
• Goals: reachable