Bipolar Disorder: (Manic Depression)

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BIPOLAR

DISORDER
(MANIC DEPRESSION)

Monsalud, Janielle Christine


BSN 3H
TABLE OF CONTENTS

01 DEFINITION 02 INCIDENCE

03 TYPES 04 FACTORS/RISKS

05 ASSESSMENT 06 MANAGEMENT/THERAPIES

07 REACTION 08 BIBLIOGRAPHY
DEFINITION

Bipolar disorder, formerly called manic depression, involves extreme mood


swings from episodes of mania to episodes of depression. During manic phases,
clients are euphoric, grandiose, energetic, and sleepless. They have poor
judgment and rapid thoughts, actions, and speech. During depressed phases,
mood, behavior, and thoughts are the same as in people diagnosed with major
depression.
INCIDENCE
Bipolar disorder ranks second
only to major depression as a
cause of worldwide disability.
The lifetime risk for bipolar
disorder is at least 1.2%, with a
risk of completed suicide for
15%.

Young men early in the course


of the illness are at the highest
risk for suicide, especially those
with a history of suicide
attempts or alcohol abuse as
well as those recently
discharged from the hospital
(Akiskal, 2017).
INCIDENCE
An estimated 2.8% of U.S.
adults had bipolar disorder in
the past year. Past year
prevalence of bipolar disorder
among adults was similar for
males (2.9%) and females
(2.8%).

Bipolar disorder affects


approximately 5.7 million adult
Americans, or about 2.6% of
the U.S. population age 18 and
older every year. (National
Institute of Mental Health).
INCIDENCE

The study conducted by the


Global Burden of Disease in
2015 reported that 3.3. million
Filipinos suffer from depressive
disorders, with suicide rates in
2.5 males and 1.7 females per
100,000.
TYPES OF BIPOLAR DISORDER

1. BIPOLAR I DISORDER

2. BIPOLAR II DISORDER

3. CYCLOTHYMIC DISORDER
Bipolar I Disorder

Bipolar I disorder is the most severe bipolar disorder. It is marked by shifts in


mood, energy, and ability to function. Periods of normal functioning may alternate
with periods of illness (highs, lows, or a combination of both).

Individuals with bipolar I disorder have experienced at least one manic episode.
Mania is a period of intense mood disturbance with persistent elevation,
expansiveness, irritability, and extreme goal-directed activity or energy. These
periods last at least 1 week for most of the day, every day.
Bipolar II Disorder

Individuals with bipolar II disorder have experienced at least one hypomanic


episode and at least one major depressive episode. Hypomania refers to a low-
level and less dramatic mania. The hypomania of bipolar II disorder tends to be
euphoric and often increases functioning. Like mania, hypomania is accompanied
by excessive activity and energy for at least 4 days and involves at least three of
the behaviors listed under Criterion B in the DSM-5. Unlike mania, psychosis is
never present with hypomania. Psychotic symptoms may, however, accompany
the depressive side of the disorder.
Cyclothymic Disorder

In cyclothymic disorder symptoms of hypomania alternate with symptoms of mild


to moderate depression for at least 2 years in adults and 1 year in children.
Hypomanic and depressive symptoms do not meet the criteria for either bipolar II
or major depression, yet the symptoms are disturbing enough to cause social and
occupational impairment.
Several other bipolar and
related disorders are included
in the DSM-5. They include:

 Substance/Medication-Induced Bipolar and Related Disorder


 Bipolar and Related Disorder Due to Another Medical Condition
 Other Specified Bipolar and Related Disorder
 Unspecified Bipolar and Related Disorder
FACTORS/RISK

ENVIRONMENTAL BIOLOGICAL PSYCHOLOGICA


FACTORS FACTORS LFACTORS
 Genetics
 Neurotransmitters
 Brain Structure and
Function
 Neuroendocrine
FACTORS/RISK

Children who have a genetic and biological risk of


developing bipolar disorder are most vulnerable in bad
environments. Stressful family life and adverse life
events may result in a more severe course of illness in
these individuals. Stress is also a common trigger for
mania and depression in adults.
ENVIRONMENTAL
FACTORS
FACTORS/RISK

 Genetics
 Neurotransmitters
 Brain Structure and Function
 Neuroendocrine

BIOLOGICAL
FACTORS
FACTORS/RISK

Psychodynamic theorists believed that a faulty ego


uses mania when it is overwhelmed by pleasurable
impulses such as sex or feared impulses such as
aggression. An overactive and critical superego is
replaced with the euphoria of mania and has also been
suggested as the cause. PSYCHOLOGICA
LFACTORS
ASSESSMENT

01 HISTORY

GENERAL
02 APPEARANCE AND
MOTOR BEHAVIOR

MOOD AND
03
AFFECT
ASSESSMENT
THOUGHT
04 PROCESS AND
CONTENT

SENSORIUM AND
05 INTELLECTUAL
PROCESSES

JUDGEMENT AND
06
INSIGHT
ASSESSMENT

07 SELF-CONCEPT

08 ROLES AND
RELATIONSHIPS
ASSESSMENT

HISTORY

 Taking a history with a client in the manic phase


often proves difficult. The client may jump from
subject to subject, which makes it difficult for the
nurse to follow.
ASSESSMENT
GENERAL APPEARANCE AND
MOTOR BEHAVIOR

 Clients with mania experience psychomotor


agitation and seem to be in perpetual motion;
sitting still is difficult. This continual movement
has many ramifications; clients can become
exhausted or injure themselves.
ASSESSMENT

MOOD & AFFECT

 Mania is reflected in periods of euphoria,


exuberant activity, grandiosity, and false sense of
well-being. Projection of an all-knowing and all
powerful image may be an unconscious defense
against underlying low self-esteem.
ASSESSMENT

THROUGH PROCESS AND


CONTENT

 Cognitive ability or thinking is confused and


jumbled with thoughts racing one after another,
which is often referred to as flight of ideas.
Clients cannot connect concepts, and they jump
from one subject to another. Circumstantiality
and tangentiality also characterize thinking.
ASSESSMENT

SENSORIUM AND
INTELLECTUAL PROCESS
 Clients may be oriented to person and place but
rarely to time. Intellectual functioning, such as
fund of knowledge, is difficult to assess during
the manic phase. Clients may claim to have many
abilities they do not possess. The ability to
concentrate or to pay attention is grossly
impaired. Again, if a client is psychotic, he or she
may experience hallucinations.
ASSESSMENT

JUDGEMENT AND INSIGHT

 People in the manic phase are easily angered and


irritated and strike back at what they perceive as
censorship by others because they impose no
restrictions on themselves. They are impulsive
and rarely think before acting or speaking, which
makes their judgment poor. Insight is limited
because they believe they are “fine” and have no
problems. They blame any difficulties on others.
ASSESSMENT

SELF-CONCEPT

 Clients with mania often have exaggerated self-


esteem; they believe they can accomplish
anything. They rarely discuss their self-concept
realistically. Nevertheless, a false sense of well-
being masks difficulties with chronic low self-
esteem.
ASSESSMENT

ROLES AND RELATIONSHIPS

 Clients in the manic phase can rarely fulfill role


responsibilities. They have trouble at work or
school (if they are even attending) and are too
distracted and hyperactive to pay attention to
children or activities of daily living. Although
they may begin many tasks or projects, they
complete few.
MANAGEMENT/THERAPIES
MANAGEMENT

MOOD
ANTIPSYCHOTICS ANTIDEPRESSANT ANTI-ANXIETY
STABILIZERS -ANTIPSYCHOTIC
 Benzodiazepine
 Lithium  Olanzapine  Symbyax
 Carbamazepine (Fluoxetine and
(Zyprexa)
(Tegretol)  Risperidone Olanzapine)
 Lamotrigine
(Risperdal)
(Lamictal)
THERAPIES
INTERPERSONAL AND SOCIAL
RHYTHM THERAPY (IPSRT) PSYCHOTHERAPY
IPSRT focuses on the stabilization of Psychotherapy can be useful in the
daily rhythms, such as sleeping, waking mildly depressive or normal portion of
and mealtimes. the bipolar cycle.
THERAPIES

COGNITIVE FAMILY
BEHAVIORAL FOCUSED
THERAPY (CBT) THERAPY
Family support and
The focus is identifying
communication can help
unhealthy, negative beliefs
you stick with your
and behaviors and
treatment plan and help
replacing them with
you and your loved ones
healthy, positive ones.
recognize and manage
warning signs of mood
swings.
REACTION
“Novel Tool May Predict Bipolar
Disorder Long Before Onset.”
BIBLIOGRAPHY

● Videbeck, S. (2020)., Psychiatric-Mental Health Nursing. 8th ed.,New


York: Wolters Kluwer.
● Halter, M. J. (2018)., Foundations of Psychiatric Mental Health Nursing: A
Clinical Approach. 8th ed., St. Louis, Missouri : Elsevier.
● Mayoclinic. (2018, January 31). Bipolar disorder. Retrieved February 08,
2021, from
https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/diagnosis
-treatment/drc-20355961
● Bipolar disorder statistics. (2019, July 12). Retrieved February 08, 2021,
from https://www.dbsalliance.org/education/bipolar-disorder/bipolar-
disorder-statistics/
THANK
YOU!

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