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Course: Mental Health Nursing

Topic: Mood Disorder: Bipolar Disorder Part I

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Module Goals

Learners will be able to

Define bipolar disorder.
Identify the symptoms of bipolar disorder.
Identify the clinical manifestations associated with bipolar disorder.
Identify the nurse’s role in treatment of bipolar disorder.

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Bipolar Disorders

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5):

Bipolar Disorder is a group of brain disorders that cause extreme fluctuation in a person’s mood, energy, and ability to function.

Truschel, 2021

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Bipolar Disorders

Includes three conditions:

Bipolar I disorder: A manic-depressive disorder that may exist with or without psychotic episodes.

Bipolar II disorder: Consists of alternating depressive and manic episodes that are typically less severe.

Cyclothymic disorder: A cyclic disorder that causes brief alternating episodes of hypomania and depression.

Truschel, 2021

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Causes of Bipolar Disorder

Polymorphisms in genes coding for brain-derived neurotrophic factor (BDNF).
Associations with catechol-O-methyl transferase (COMT) and monoamine transporters.
Proteins involved in cell signaling such as ODZ4, and genes encoding for gamma-aminobutyric acid (GABA) receptor.
Interaction between childhood abuse and BDNF gene polymorphisms.
Past Toxoplasma gondii infection increases risk.

Rowland & Marwaha, 2018

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Environmental Risk Factors

Prenatal and perinatal factors

Maternal viral infections
Seropositivity for T. gondii infection

Causes changes in dopamine metabolism leading to increased dopamine production, similar to that suggested as a potential mechanism for manic episodes.

Extreme prematurity (less than 32 weeks gestation)

Rowland & Marwaha, 2018

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Postnatal Risk Factors

Childhood maltreatment

Emotional abuse and/or neglect.
Behavioral problems and presence of other mental illnesses.

Psychological stressors

Recent stressful life events.

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Critical Thinking Question

Which is of the following is the less severe form of Bipolar Disorder?

Bipolar I
Bipolar II
Cyclothymic
Depressive

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Risk Factors (continued)

Misuse of substances (cannabis, opioids, cocaine, sedatives, and alcohol)
Family history of psychiatric disorders
Stressors

Traumatic events
Childhood sexual or physical abuse
Child neglect
Death of parents

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Risk Factors (continued)

Gender

Affects men and women equally.
Women are three times more likely to experience rapid cycling of mood episodes.
Women are more likely to experience depressive and mixed episodes of the disorder compared to men.

Smith, 2021

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Critical Thinking Question

Which of the following is a risk for developing Bipolar Depressive Disorder? (Select all that apply)

Childhood abuse
Childhood neglect
Childhood trauma
A chronic disease

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Parts of Brain Affected by Bipolar Disorders

Gray Matter of the Brain

Reduction of gray matter in the brain

Hippocampus

Smaller and shrunken

StoneRidge Center, 2021

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Bipolar Disorder DSM-5 Diagnostic Criteria

A person must have experienced at least one episode of mania or hypomania.
To be considered mania

Elevated, expansive, or irritable mood must last for at least one week and is present most of every day.

To be considered hypomania

Mood must last at least four consecutive days and be present most of the day, almost every day.

Truschel, 2021

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Bipolar Disorder DSM-5 Diagnostic Criteria (Continued)

Three or more of the symptoms must be present to represent a significant change from usual behavior for mania

Inflated self-esteem or grandiosity
Decreased need for sleep
Increased talkativeness
Racing thoughts
Distracted easily
Increase in goal-directed activity
Engaging in risky behaviors (unrestrained buying sprees)

Truschel, 2021

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Bipolar Disorder DSM-5 Diagnostic Criteria (Continued)

Five or more of the following symptoms in two weeks with a major depressive episode.

Depressed mood most of the day
Loss of interest or pleasure
Significant weight loss
Decrease or increase in appetite
Engaging in purposeless movements
Fatigue or loss of energy
Feelings of worthlessness or guilt
Diminished ability to think/concentrate
Recurrent thoughts of death

Truschel, 2021

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What Would the Nurse Do?

The nurse is assessing the client who is diagnosed with bipolar disorder. What would the nurse expect to find in the client’s history?

A depressive episode followed by prolonged sadness.
A series of depressive episodes that recur periodically.
Symptoms of mania that may or may not be followed by depression.
Symptoms of mania that include delusional thoughts.

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Signs and Symptoms of Bipolar Disorder

The classic symptoms can be compared to a roller coaster

Moods changes from the very low to the very high (mania or hypomania)

Cagliostro, & Nelson, 2021

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Signs and Symptoms of Bipolar Disorder

Manic Episode

Racing thoughts
Abnormally talkative
Pressured speech
Wired/jumpy
Excess energy
Poor decision-making
Easily distracted
Cranky and/or impatient
Euphoric/uncontained excitement

Cagliostro & Nelson, 2021

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Signs and Symptoms of Bipolar Disorder

Manic Episode

Invincibility

Along with a surge of energy and risk-taking, get a huge boost in self-confidence.

High sex drive

Constantly thinking about and wanting sex.

Unattainable plans (Determined to book the ticket for Paris even if they know they do not have the funds).
Psychosis

A detachment from reality that may include delusions or hallucinations.

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Signs and Symptoms of Bipolar Disorder

Depressive Episode

Feeling of overwhelming sadness or urge to cry.
Experience feelings of hopelessness and worthlessness.
A negative outlook on life.
An increased need to sleep.
Not able to complete daily tasks and feeling deeply demoralized.
Suicidal ideation.

Cagliostro & Nelson, 2021

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Signs and Symptoms of Bipolar Disorder

Depressive Episode

Low energy
Low motivation
Loss of interest
Feeling sad, tearful, hopeless
Weight fluctuations
Feelings of fatigue
Indecisiveness
Inability to concentrate

Cagliostro & Nelson, 2021

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Nurse’s Role in treatment of Bipolar Disorder

Provide safe emotional environment.
Develop trusting relationship.
Be alert to signs of suicidal ideation in depressive phase.
Provide education about medication and disease process.
Maintain professional and nonjudgmental approach.
Be honest in responses to client’s excessive perceptions when mania or depression.
Provide self interventions for client to use to reduce stress.
Help client develop a plan to take medication regularly.

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Critical Thinking Question

A client is admitted to the medical center with the diagnosis of bipolar disorder, single manic episode. Which of the following behaviors would the nurse expect to assess?

Apathy, poor insight, and poverty of ideas.
Anxiety, somatic complaints, and insomnia.
Elation, hyperactivity, and impaired judgment.
Social isolation, delusional thinking, and clang associations.

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Red Flag

Be alert to signs of suicidal edeation especially during depressive phase.

Educate family and friends to be alert to the symptoms of suicide.

Be alert to client’s adherence to medication regimen (clients in manic phase may decide they no longer need their medication).

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References

Cagliostro, D. & Nelson, J. (2021). Tell Me All I Need to Know About Bipolar Disorder. Psycom. https://www.psycom.net/depression.central.bipolar.html

Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic advances in psychopharmacology, 8(9), 251–269. https://doi.org/10.1177/2045125318769235 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116765/

Smith, K. (2021). Bipolar Disorder Causes. Psycom. https://www.psycom.net/bipolar-disorder-causes

StoneRidge Center, (2021). How Does Bipolar Disorder Affect the Brain. https://pronghornpsych.com/how-does-bipolar-disorder-affect-the-brain/

Truschel, J. (2021). Bipolar Definition and DSM-5 Diagnostic Criteria. Psycom. https://www.psycom.net/bipolar-definition-dsm-5/

Contact info: info@nursesinternational.org

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