Bipolar Disorder

Patients suffering from mood disorders often have difficulty with interpersonal
interactions. Substance abuse occurs as patients attempt to self-medicate.

Introduction:

Some patients experience episodes of depression alternating with episodes of mania
or hypomania. These episodes may occur in a mixed or cyclic manner. There tends
to be a high comorbidity with substance abuse in these patients. Depressive
episodes tend to last longer than the manic episodes. During mania the patients are
overenthusiastic, elated, hyperactive, and often engage in activities that they later
regret. Others may be drawn to the patient during manic episodes due to their out-
going, engaging behavior. Later the patient’s behavior tends to alienate due to
mood swings, irritability, aggression, and grandiosity. There is a positive correla-
tion between creative behavior and mood disorders. During the manic phase, the
patient has grandiose ideas.

PROGNOSIS

Proper medication management is necessary to control the symptoms of bipolar
disorder. Initial diagnosis and treatment of depression without recognition of the
coexisting mania can lead to the onset of mania due to the antidepressant treat-
ment. It is important to treat both components of the disorder to effectively man-
age the patient. Ongoing treatment is often necessary to prevent the patient from
cycling into another manic or depressive episode. Some patients may have psy-
chotic symptoms as part of the disease process.

SIGNS AND SYMPTOMS

• Elation
• Hyperactivity
• Increased irritability
• Flight of ideas
• Grandiosity
• Diminished need for sleep
• Rapid speech
• Easily distracted
• Excessive spending
• Hypersexuality
• Episodes of depression
• The patient may stray from medication regimen because he or she feel weighed
down

TREATMENT

• Mood stabilizers:
• lithium
• valproic acid
• carbamazapine
• lamotrigine
• Antipsychotic medications:
• olanzapine
• risperidone
• aripiprazole
• Psychotherapy.
• Assess suicide risk.
• Antidepressants.

NURSING DIAGNOSIS

• Powerlessness
• Social isolation
• Risk for loneliness
• Altered sexuality patterns


NURSING INTERVENTION
• Monitor patient frequently when first admitted.
• Ask about suicidal ideation.
• Monitor medication intake.
• Discuss patient response to therapy.