2.3: Bipolar

Module Outline, Learning Outcomes, and Concepts

This module aligns with key elements of APNA’s “Growth & Development” and “Clinical Decision Making” (American Psychiatric Nurses Association Education Council, Undergraduate Branch, 2022).

Module Outline

• Assessment of Bipolar Disorders
• Nursing Diagnoses Associated with Bipolar Disorders
• Treatment of Bipolar Disorders

Module Learning Outcomes

• Describe the signs and symptoms of bipolar disorders.
• Identify the common nursing diagnoses associated with bipolar disorders.
• Summarize the treatment of bipolar disorders.

Concepts

• Mood
• Affect
• Safety
• Legal and Ethical Issues

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Bipolar Disorders

There are two types of Bipolar Disorder- Bipolar I and Bipolar II. A diagnosis of Bipolar I Disorder is made when there is at least one manic episode. This manic episode can be preceded by or followed by a hypomanic or major depressive episode, however, diagnostic criteria for a manic episode is the only criteria that needs to be met for a Bipolar I diagnosis. A diagnosis of Bipolar II Disorder is made when there is a current or history of a hypomanic episode and a current or past major depressive episode. In simpler words, if an individual has ever experienced a manic episode, they qualify for a Bipolar I diagnosis; however, if the criteria has only been met for a hypomanic episode, the individual qualifies for a Bipolar II diagnosis.

Below is an overview of a nurse’s consideration for the assessment, problems, and treatment of Bipolar.

See Jain and Mitra (2022) to read more about this topic.

Psych Hub. (2022). What is bipolar disorder? [Video]. YouTube. https://youtube.com/watch?v=G9vkGCo7...SIkaIECMiOmarE

Assessment

Assessment of Mania

The signs and symptoms associated with a manic episode are:

• Increased activity or energy
• Appear excessively happy, often engaging haphazardly in sexual or personal interactions
• Rapid shifts in mood, also known as mood lability, ranging from happy, neutral, to irritable
• Inflated self-esteem or grandiosity, occasionally can appear delusional
• Require a decreased need for sleep, sleeping as little as a few hours a night yet still feeling rested, reduced need for sleep may also be a precursor to a manic episode, suggesting that a manic episode is to begin imminently
• Rapid, pressured speech, disorganized or incoherent speech
• Racing thoughts and flights of ideas.

In hypomania, the above signs and symptoms may be present, but are not as extreme as in mania.

The depressive mood phase in a Bipolar diagnosis is associated with the signs and symptoms previously discussed in MODULE 6: DEPRESSION.

Instruments

The Mood Disorder Questionnaire (MDQ) can be used to assess mood disorder issues (Rhoads, 2021).

Problems

Problems associated with a Bipolar diagnosis are:

• Risk for injury
• Imbalanced nutrition: less than body requirements
• Disturbed thought processes
• Self-Care deficit

Mood stabilizers such as Lithium are the psychotropic class used to treat Bipolar Disorders. Unfortunately, non-adherence to the medication regimen is often the issue with these patients. Patients diagnosed with Bipolar often desire the euphoric highs that are associated with manic and hypomanic episodes, leading them to forgo their medication. A combination of psychopharmacology and psychotherapy aimed at increasing the rate of adherence to medical treatment may be the most effective treatment option for bipolar I and II disorder. Other treatment options include newer antidepressants early in treatment. However, antidepressants may trigger a manic or hypomanic episode in bipolar patients. Because of this, the first-line treatment option for Bipolar Disorder is mood stabilizers, particularly Lithium. See MODULE 4: PSYCHOPHARMACOLOGY for a review of this topic.

Lithium is the gold standard of treatment of bipolar disorder (Jain & Mitra, 2022).

Social skills training and problem-solving skills are also helpful techniques to address in the therapeutic setting as individuals with bipolar disorder often struggle in this area.

Mental Health Promotion

There are various ways to promote mental health and well-being. Long-term treatment for bipolar should include mental health promotion approaches.

Some specific strategies to promote mental health related to Mood disorders, including a Bipolar diagnosis include:

• Improve screening and diagnosis in primary care settings
• Create a crisis or relapse prevention plan
• Cultivate a social support network
• Incorporate behavioral changes that promote optimum health
• Encourage the patient to develop solutions (Videbeck, 2020).

Visit the MODULE 5-MENTAL HEALTH PROMOTION chapter to learn more about this topic.

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Key Takeaways and Concept Map Activity

You should have learned the following in this section:

• A manic episode is characterized by a specific period of time in which an individual reports abnormal, persistent, or expansive irritable mood for nearly all day, every day, for at least one week.
• Treatment of bipolar disorder involves mood stabilizers such as Lithium, psychological interventions, social skills training, and problem-solving skills.
• Medication adherence is a consideration in pharmacological treatment as individuals may be hesitant to extinguish euphoric feelings associated with mania.

Concept Map Activity

• Create a concept map that depicts the assessment and treatment of Bipolar.
• If needed, see the INTRODUCTION for a concept map tutorial.

Adapted from Fundamentals of Psychological Disorders 2nd Edition- Module 4 by Alexis Bridley, Ph.D. and Lee W. Daffin Jr., Ph.D. licensed under a Creative Commons Attribution 4.0 International License. Modifications: revised for clarity and flow .