Welcome, this is a unit of several psychiatric disorders that we will be covering in this class. According to the World Health Organization (WHO) in 2011, bipolar disorder ranked 12th in the world as a health condition with moderate to severe disability affecting 22.2 million people (WHO, 2012). The National Institute of Mental Health(NIMH) in 2005 estimated approximately 2.6% of the population in the United States were affected with bipolar disorder with 82.9% of them labeled as “severe” (NIMH, 2012). Today will explore this disorder and how it affects the people diagnosed with it.
This course will cover what bipolar disorder is and will allow you to distinguish the range of moods, treatment plan, and how someone can use self-help techniques to keep themselves healthy. We also will discuss how the risk of suicide is associated with this disorder and the social issues that affect many people with unmanaged bipolar disorder.
The tragedy in Arizona where six people lost their lives and U.S. Representative Gabby Giffords and 13 others were injured is an example of this stigma. The news media used the words -“psycho” and “lunatic” to describe the shooter which reinforced the stigma associated with mental illness (NAMI, 2011). Mental illness is a medical disease and should be treated like diabetes and heart disease but it is often not the case. Through the ages people with mental illness were shunned from society and called names. It is time to support people with mental illness and get them the help they need.
The learning objectives for this course are as follows:You will be able to define bipolar disorderDescribe what mania and depression are,identify their symptoms, and distinguish between themIdentify the treatment for bipolar disorder including the explanation of self-help measuresIdentify possible triggers of an episode List the warning signs of suicide and how to help a person who is suicidalDescribe the social stigma faced by those who have bipolar disorder
What is bipolar disorder, how is it defined? It is a chronic mood disorder that affects how a person thinks, feels, and behaves. Theses shifts in moods are dramatic not subtle and can vary in the time spent in each mood. The moods can change several times a day, last a week, month or more. Understanding the variability in moods, it is evident that this disorder affects the social life of the person, their family, and those who come in contact with them. The dramatic change in moods affect how they respond to everyday situations, sometimes making them stand out from a crowd.
Lets talk about how the moods alternate. Along a continuum there is a high end, middle, and low end that reflects a person with bipolar disorder and their mood. There are two opposite polls at each end reflecting very different moods, this is why it is called “bipolar disorder.” A person with this disorder can swing from one end to the other. Mania is at the extreme of one poll, with severe depression at the other poll, with normal mood being in the middle.
Mania is defined as an episode that lasts more than a week and consists of an abnormally high mood. Sometimes these are the people who are the loudest in a crowd, the most daring, and confident people. At first they can appear happy, energetic, and animated but they continue with this behavior longer than what is considered the norm. This level of high energy physically and mentally takes a toll on their body depleting them of energy when they eventually come crashing down.
Mania can be displayed in a variety of symptoms. A manic person will not necessarily have all of these symptoms but most likely a few in a variety of combinations. They can feel they are unstoppable, take risks they usually would not take while finding it difficult to sleep due to racing thoughts. Many times they find it is difficult to relax in one place due to the increased physical and mental energy. They can become overly aggressive or irritable and feel a increase in their sexual drive. Due to their impulsiveness some people feel the need to go on spending sprees buying things they want in the moment. These symptoms can lead to dangerous acts and intervention from family and friends is needed to keep the person safe and get them help. People are less likely to seek treatment when they are in the manic phase because they usually do not realize that anything is wrong and most describe it as a good feeling (NAMI, 2011).
Depression is the other end of the pole. Major depression is defined as a serious medical illness that affects 15 million American adults in a year (NAMI, 2011). It is more then the “blues” lasting much longer affecting the daily life of those experiencing it. People with depression lose interest in things they once loved to do and isolate themselves from others.
Like mania there are many symptoms of depression and one does not have to exhibit all of them to be diagnosed as depressed. They may eat too much or not feel like eating at all. Some people have difficulty sleeping and others sleep hours and hours through the night and day rarely leaving their beds. They may feel emotionally and physical tired, sometimes unable to get out of bed at all. Decision making is affected because they cannot concentrate well. Feelings of worthlessness and being a burden to others can bring thought of death and suicide. It is in this mood that people with bipolar disorder are more likely to seek help (NAMI, 2011).
Hypomania is a shorter duration of manic symptoms that are less severe lasting at least four days as is considered a mild functional impairment (Stovall, 2012). People may experience this if they are usually more on the “low” or depressed side and do not have elated manic symptoms. A mixed state is often referred to as rapid cycling because a person they have both depressive and mania simultaneously. Depressed people are more likely to seek treatment and lays the groundwork for diagnosing bipolar disorder.
Treatment of bipolar disorder in long-term as it is a chronic disease. A person may go for years without a episode or may be affected more frequently. Medication is part of treatment and some people with bipolar disorder may think they feel “fine” and think they do not need their medication and stop taking it. This can lead to severe symptoms and increase the difficulty of controlling the disorder. Psychotherapy or counseling may help a person manage their bipolar disorder offering them support and a place to vent their feelings. Lifestyle changes also are important because daily doses of medications must be adjusted to get the best results with the least side-effects. Sometimes this medication can make people tired, lack energy, and gain weight all which can be troublesome when trying to fit into society. Recognizing and avoiding the triggers of an episode are important part of the disorder this can force a lifestyle change. For example, if lack of sleep for a period of time increases the chance of an episode then their lifestyle needs to be adjusted to include time for adequate sleep. Social support is extremely important because this disorder is trying on relationships with others because of the moods swings, irritability, and other symptoms. Helping someone recognize that they are entering a manic or depressive episode can help them seek help avoiding a major episode. People with bipolar disorder many times have issues at work because their mood can be labile and others may not know they have the disorder and feel that they are trying to make trouble and fire them. People with bipolar disorder many times have co-morbidities with substance abuse. Drugs and alcohol are often used to self-medicate and present many social problems including needless incarceration.
People affected by bipolar disorder can help themselves through keeping track of their moods, making choices that support wellness and managing stress levels. A plan should be in place for support if the need should arise. Seeking education on their own or through support groups about the disorder can help them understand and manage the disorder, realizing that they are not alone.
People with bipolar disorder should recognize the triggers that can set them off into an episode of mania or depression. These will be different for each person. It also would be an advantage if the people closest to them including their support person be aware of what the triggers are and get them help or help change the situation prior to any problems.
As a group, people with bipolar disorder are at increased risk for suicide if they are not receiving treatment. A precursor to suicide is usually a major depression. According to Web MD (2012) “men commit almost 75% of suicides, even though twice as many women attempt it” There are warning signs that a person is contemplating suicide and they vary from person to person and should be taken very seriously.
Depression can lead to suicide. Steps should be taken to assure a depressed person gets the help they need. These are some of the ways that you can help someone. Make time for a depressed person or it may be too late.
People with bipolar disorder are not seeking sympathy, but empathy. In order to understand what it can be like here is a short video than can help explain it. Play video. Now what do you think? What are your thoughts and feelings? What are some ways you could help a friend or loved one with bipolar disorder?
People with bipolar disorder just want to be like everyone else. They can live a productive life if they take care of themselves, recognize triggers, seek help and continue treatment. Next time you see someone who appears to be “standing out in the crowd” will you think differently now and realize they may have a medical condition called bipolar disorder? Will you try to make others understand and treat people with mental illness respectfully and extend yourself and offer to help them if you can? Remember they just want to “fit in” and lead a healthy, happy life.
Questions anyone? What new things did you learn today? How does this change how you view people with bipolar disorder? How could you help a friend who is experiencing some of the symptoms of bipolar disorder? Next We will test your knowledge about a bipolar disorder. (A series of 8 questions would be asked, using the clicker their votes would be tabulated anonymously but they would be able to compare their answer to others in the class).
1. Bipolar Disorder Cherie Tenfel BSN RN Kaplan University May 2012
2. Unit Objectives Learners will be able to: Explain bipolar disorder Identify the range of moods that make up bipolar disorder Summarize a basic treatment plan for someone with bipolar disorder Describe how people with bipolar disorder can help themselves Discuss why people with bipolar disorder are at risk for suicide Predict social issues that may affect a person with bipolar disorder
3. “Mental illness is nothing to beashamed of, but stigma and biasshame us all.”~ Bill Clinton
4. Learning Objectives By the end of this course, learners will be able to: Define bipolar disorder Describe the difference between mania and depression Identify and distinguish between the symptoms of mania and depression Identify the course of treatment for bipolar disorder Explain measures of self-help for bipolar disorder Identify at least three possible triggers of bipolar episodes List the at least four warning signs of suicide Explain how to help someone who is suicidal Describe the social stigma of bipolar disorder
5. What is Bipolar Disorder?Mood Disorder Affecting  Thought  Energy level  Behavior
6. Moods Alternate Between “Poles” Severe mania High Hypomania Normal Mood Lows Mild depression Severe depression
8. Symptoms of Mania Inflated self-esteem/grandiosity Decreased need for sleep Racing thoughts or "flight of ideas" Spending sprees Increased physical/mental energy Irritability/aggressive behavior Impulsive/risk taking Increased sexual drive
9. Depression Feeling down Loss of interest in enjoyable things
10. Symptoms of Depression (Cont.)  Weight loss/gain  Insomnia/hypersomnia  Psychomotor agitation/slow down  Fatigue/loss of energy  Decreased ability to concentrate/make decisions  Recurrent thoughts of death/suicide
11. Between Mania and Depression  Hypomania  Mixed state
12. Treatment Medication Lifestyle Long-term Therapy Changes Social Support
13. Self-Help For Bipolar Disorder  Monitor your moods  Make healthy choices  Seek support  Keep stress in check  Get educated
14. The Warning Signs of Suicide Talking about death, self-harm, or suicide Feeling hopeless/helpless/worthless Withdraw from friends/family Acting recklessly Putting affairs in order or saying goodbye Seeking out weapons or pills
15. How to Help Someone Whois Suicidal Recognize Warning Signs Offer Support/Help/Listen Take It Seriously/Get Them Help
16. What is Like to be Bipolar?
17. Social Stigma and BipolarDisorder…….
18. Questions?Pick up your clickers and lets test what you have learnedBipolar DisorderCherie Tenfel RN BSNCherieTenfel@student.kaplan.eduKaplan University
19. ReferencesGoogle Images. (2012). Retrieved from http://www.google.com/imghp?hl=en&tab=wiHelpguide. (n.d.). Suicide prevention: Spotting : The signs and helping a suicidal person. Retrieved fromhttp://www.helpguide.org/mental/suicide_prevention.htmHelpguide. (n.d.). Understanding bipolar disorder. Retrieved fromhttp://www.helpguide.org/mental/bipolar_disorder_symptoms_treatment.htmJoskypay. (2007, December 5). How I would describe bipolar disorder [Video file]. Retrieved fromhttp://www.youtube.com/watch?v=WtVTmi1TCVI&NR=1&feature=endscreenMicrosoft Office. (2012). Search 1,000s of images. Retrieved from http://office.microsoft.com/en-us/images/?CTT=6&ver=14&app=powerpnt.exeNational Institute of Mental Health (NIMH). (2012). Bipolar disorder. Retrieved from http://www.nimh.nih.gov/statistics/pdf/NCS-R_data-Bipolar_Disorder.pdfNational Alliance on Mental Illness (NAMI). (2011). Fight stigma. Retrieved fromhttp://www.nami.org/template.cfm?section=fight_stigmaQuotable Quotes. (2012). Retrieved from http://ask.metafilter.com/68066/Quotable-QuotesStovall, J. (2012). Bipolar disorder in adults: Epidemiology and diagnosis. Retrieved from http://uptodate.comWebMD. (2012). Bipolar disorder and suicide. Retrieved fromhttp://www.nami.org/Template.cfm?Section=Depression&Template=/ContentManagement/ContentDisplay.cfm&ContentID=88858World Health Organization (WHO). (2012). World report on disability, 2011. Retrieved fromhttp://www.who.int/disabilities/world_report/2011/report.pdf