This is characterized by recurrent episodes of mania and depression in the same patient. Bipolar mood disorder is further classified into two according to DSM IV. Bipolar I disorder Bipolar II disorder

1. Bipolar disorder
MEDNOTEZ.

2. Bipolar Mood Disorders.
 This is characterized by recurrent episodes of
mania and depression in the same patient.
 Bipolar mood disorder is further classified into
two according to DSM IV.
 Bipolar I disorder
 Bipolar II disorder
 Bipolar I: episodes of severe mania and severe
depression
 Bipolar II : episodes of hypomania and severe
depression.

3. Manic Episode
 Mania refers to a syndrome in which
the central features are:
 Over activity
 Mood change (elation or irritability)
 Self important ideas.
 This disorder occurs in episodes lasting
usually 3 to 4 months, followed by
complete recovery.

4. Classification of Mania
 Hypomania
 Mania without psychotic episodes
 Mania with psychotic episodes
 Manic episode unspecified.

5. Clinical features
 An acute manic episode is characterized by the following
features which should last for at least one week:
1. Elevated, expansive or irritable mood:
 Elevated mood in mania has four stages depending on the
severity of manic episodes:
 Euphoria (stage I): increased sense of psychological well being
and happiness not in keeping with ongoing events.
 Elation (stage II) :moderate elevation of mood with increased
psychomotor activity
 Exaltation (stage III): intense elevation of mood with delusions of
grandeur.
 Ectstasy (stage IV): severe elevation of mood, intense sense of a
rapture or blissfulness seen in delirious or stuporous mania.


6. Clinical features contd’
 Expansive mood is unceasing and unselective
enthusiasm for interacting with people and
surrounding environment.
 Sometimes irritable mood may be predominant,
especially when the person is stopped from doing
what he wants.
2. Psychomotor activity
 There is an increased psychomotor activity ranging
from over activeness and restleness to manic
excitement.
 The person involves in ceaseless activity.
 The activities are goal oriented and based on
external environment cues.

7. Clinical features contd’
3. Speech and thought
 Flight of ideas: thoughts racing in mind,
rapid shifts from one topic to another
 Pressure speech: speech is forceful,
strong and difficult to interrupt. can use
playful language with jokes, and teasing
and speaks loudly.
 Delusions of grandeur
 Delusions of persecution
 Distractibility

8. Other features
 Increased sociabilities
 Impulsive behavior
 Hypersexual and promiscuous behavior
 Dressed up in gaudy and flamboyant clothes .
 Decreased need for sleep (less than 3 hours)
 Decreased food intake due to hyperactivity
 Poor judgment
 Absent insight
 Decreased attention and concentration
 Disinhibition

9. Hypomania
 It is a lesser degree of mania.
 There is a persistent mild elevation of mood
and increased sense of psychological well
being and happiness not in keeping with the
ongoing events.
 The ability to function becomes better in
hypomania, and there is marked increase in
productivity and creativity.
 The features of hypomania may be specified
as follows:
1) A distinct period of persistently elevated,
expansive, irritable mood, lasting throughout 4
days, that is clearly different from the usual
non-depressed mood.

10. Clinical features of hypomania contd’
2) During the period of mood disturbance, 3 or more of the
following symptoms are persistent, (4 if the mood is only irritable)
and present to a significant degree:
a. Inflated self esteem or grandiosity
b. Decreased need for sleep
c. More talkative than usual
d. Flight of ideas or subjective experience that thoughts are racing
e. Distractibility (attention too easily drawn to unimportant or
irrelevant external stimuli)
f. Increase in goal directed activity
g. Excessive involvement in pleasurable activities that have a high
potential for painful consequences (unrestrained buying sprees,
foolish business investments or sexual indiscretions)

11. Clinical features of hypomania contd’
3) The disturbance in mood and the
change in functioning are
observable by others.
4) The episode is not severe enough to
cause marked impairment in social or
occupational functioning, or to
necessitate hospitalization and there
are no psychotic features.

12. Treatment
 Pharmacotherapy
 Lithium: 900-2100 mg/day
 Carbamazepine: 600-1800mg/day
 Sodium valproate: 600-2600mg/day
 Other drugs: clonazepam/calcium channel blockers
 Electroconvulsive Therapy (ECT)
 Can be used for acute manic episodes if not adequately
responding to antipsychotics and lithium.
 Psychosocial treatment
 Family and marital therapy to decrease interfamilial and
interpersonal difficulties and to reduce or modify stressors with a
aim of ensuring continuity of treatment and adequate drug
compliance.

13. Nursing Management for Mania
 Diagnosis :risk for injury related to extreme hyperactivity
and impulsive behaviuor,evidenced by lack of control
over purposeless and potentially injurious movements.
 Objective: patient will not injure self.
 Intervention: keep environmental stimuli to a minimum;
keep lighting and noise level low, limit interactions with
others
 Rationale :patient is extremely distractible and
responds to even the slightest stimuli.
 Intervention: remove hazardous objects and
substances.
 Rationale: rationality is impaired and patient may harm
self inadvertently.

14. Nursing Management for Mania contd’
 Intervention: assist patient to engage in
activities such as writing, drawing and other
physical exercise.
 Rationale: to bring relief from pent-up tension
and dissipate energy.
 Intervention: stay with the patient as
hyperactivity increases
 Rationale: to offer support and provide feeling
of security.
 Intervention: administer medication as
prescribed by physician
 Rationale: for providing rapid relief from
symptoms of hyperactivity

15. Nursing Management for Mania contd’
 Diagnosis: risk for violence; self directed or
directed at others related to manic excitement,
delusional thinking and hallucinations.
 Objective: patient will not harm self or others
 Intewrvention:maintain low level of stimuli in
patient’s environment
 Rationale: to minimize anxiety and suspiciousness
 Intervention: ensure that all sharp objects, glass or
mirror items, belts ties have been removed from
patient’s environment.
 Rationale: these may be used to harm self or
others.

16. Nursing Management for Mania contd’
 Intervention: have sufficient staff to
indicate a show of strength to the patient
if necessary. State limitations and
expectations.
 Rationale: this conveys control over the
situation and provides physical security for
the staff.
 Intervention: administer tranquillizing
medication
 Rationale: for rapid relief from symptoms of
violent behavior.

17. Nursing Management for Mania contd’
 Altered nutrition, less than the body
requirements related to refusal or inability to sit
still long enough to eat, evidenced by weight
loss, amenorrhea.
 Objective: patient will not exhibit signs and
symptoms of malnutrition.
 Intervention: provide high protein, high caloric,
nutritious finger foods and drinks that can be
consumed on the run.
 Rationale: patient has difficulty sitting long
enough to eat a meal.
 Intervention: Find out patient’s likes and dislikes
and provide favorite foods.

18. Nursing Management for Mania contd’
 Intervention: walk or sit with the patient while he
eats
 Rationale: to offer support and to encourage
patient to eat.
 Intervention: Supplement diet with vitamins and
minerals
 Rationale: to improve nutritional status.
 Intervention: maintain accurate record of intake,
output and calorie count. Weigh the patient
regularly.
 Rationale: these are useful data to assess
patient’s nutritional status

19. Nursing Management for Mania contd’
 Altered family process related to euphoric mood and
grandiose ideas, manipulative behavior, refusal to
accept responsibility for own actions
 Objective: the family members will demonstrate coping
ability in dealing with the patient
 Intervention: provide information about behavior
patterns and expected course of illness
 Rationale: assists family to understand the various
aspects of bipolar illness
 Intervention: assess the role of the patient in the family
and how the illness affects the roles of other members.
 Rationale: when the role of the ill person is not filled,
family disintegration may occur.