1. Bipolar DisorderBipolar Disorder

2. What It IsWhat It Is
• Biological origin, Psychological experiences
• Chronic, and recurrent
• Lifetime management
• Alternating mood episodes
– Mania
– Hypomania
– Depression
– Concurrent mania and depression
• Periods of normal function alternate w/ periods
of illness

3. PrevalencePrevalence
• Lifetime prevalence in US: 5.1%
• Emerge between ages 18 – 30
• Bipolar I: males ↑, Bipolar II: females ↑
• 1st Episode:
– Males: more likely manic
– Females: more likely depressed
• Episodes ↑ in # & severity with aging
• Cyclothymia:
– Usually begins in adolescence/early adulthood
– 15% - 50% risk of developing Bipolar I or II

4. ComorbidityComorbidity
• Substance abuse disorders- very high
• Personality disorders (Borderline)- poorer
outcomes
• Anxiety disorders (Panic attacks, phobias)
• Oppositional Defiant Disorder
• SAD
• Physical disorders

5. TheoryTheory
• Biological Theories
– Genetics (chromosomes 13 &15)
– Neurobiological
– Neuroendocrine
• Psychological Influences
– Triggered by an event perceived as stressful
• Environmental Factors

6. AssessmentAssessment
• Level of Mood
• Behavior
• Thought Processes & Speech Patterns
• Cognitive Function
• Self-Assessment

7. Nursing DiagnosisNursing Diagnosis
• Risk for injury
• See Table14-1, p. 289
• Remember to choose nursing diagnoses
that fit the symptoms

8. Outcome CriteriaOutcome Criteria
• Based on which phase of illness client’s in
• Acute
– Prevent injury
• Continuation of Treatment
– Relapse prevention:
• Client/family psychoeducation
• Support groups/Therapy
• Communication & Problem-solving skills
• Maintenance Treatment
– Focus on preventing relapse and limiting severity &
duration of future episodes

9. PlanningPlanning
• Acute
– Medical stabilization
– Safety
– Self-care needs
• Continuation
– Maintain medication compliance
– Prevent relapse
• Maintenance
– Prevent relapse
– Limit severity and duration of future episodes

10. InterventionsInterventions
• Acute
– Hospitalization, Firm & calm
– Short, concise, neutral, and consistent limits, remain neutral
– Re-direct to positive activities
– Medication management
– ECT
– Milieu therapy: Seclusion
• Continuation
– Health teaching: Psychoeducation
• Maintenance
– Psychotherapeutic approaches
– Support groups
• See Table 14-2 (pp. 291-292)

11. PsychopharmacologyPsychopharmacology
• Mood Stabilizers
– Lithium
– Anticonvulsants: Depakote (Divalproex, Valproic
acid), Lamictal (Lamotrigine), Tegretol
(Carbamazepine), Topamax (Topiramate), Neurontin
(Gabapentin)
• Anxiolytics
– Ativan (Lorazepam), Klonopin (Clonazepam)
• Atypical Antipsychotics
– Zyprexa (Olanzapine), Seroquel (Quetiapine),
Abilify (Aripiprazole)

12. EvaluationEvaluation
• Were outcome criteria met?
• If not, Why?
• Re-assess
• Revise the plan