Transcript Chapter 13
Chapter 13 Mood Disorders: Bipolar Bipolar disorder Called Manic Depressive Disorder Characterized by 2 opposite poles: maniaexaggerated euphoria or irritability and depression Defined as alternating mood episodes characterized by mania, hypomania, depression, & concurrent mania and depression (mixed episodes) Chronic, recurrent, and life threatening that require monitoring Bipolar disorder: most to least severe Bipolar I: at least 1 episode of mania alternating with major depression. Psychosis may accompany mania Bipolar II: Hypomania alternating with major depression. No psychosis. Hypomania in this disorder tends to be euphoric and the depression puts people at risk for suicide Cyclothymia: Hypomanic episodes alternating with minor depressive episodes . Tend to have irritable hypomanic episodes Rapid Cycling: 4 or more mood episodes in a 12 month period Prevalence and comorbidity Bipolar disorder emerges between 18-30 yrs 1st episode in males most likely mania 1st episode in females most likely depression Cyclothymia usually begins in adolescence Substance abuse/use common, possibly to selfmedicate Associated with other psychiatric disorders Theory Bipolar disease is defined as a disorder involving complex disturbances in relationships, marked disruption in sleep patterns, linking environment, genes, neural systems, & behaviors and high rates of certain psychological and medical comorbidities Biological Theory Neurobiological Factors Genetic Factors: strong genetic component Neurotransmitters are link to causal factors in mania and depression Psychological Influences Stressful life events can trigger symptoms bipolar Cultural considerations Diagnosed people with bipolar disorder tend to achieve higher levels of education and occupational status. Proportion is higher among creative writers, artists, highly educated men and women and professional persons Clinical picture Individuals with bipolar disorder Misdiagnosed Underdiagnosed On average, spend 8 yrs seeking treatment before receiving correct diagnosis Goal of early diagnosis- Avoid the following Suicide (1 in 5) Substance abuse Marital or work problems Development medical comorbidity Application of nursing process Assessment Mood Disorder Questionnaire (screening tool) pg 249 Level of Mood: euphoric or depressed Behavior: mania, indiscriminate sex, spending sprees Thought Process: flight of ideas, grandiose Cognitive function: verbal, Assessment Guidelines sustained attention Diagnosis: Risk for Injury Outcomes Identification Phase Phase Phase 1: Acute Phase (Acute Mania) 2: Continuation of Treatment Phase 3: Maintenance Treatment Phase Application of nursing process Planning Geared toward the particular phase that is occurring Acute Phase (0-2 months) Continuation Phase (2-6 months) Maintenance Phase (6 months) Implementation Acute Phase Communication Guidelines Milieu Therapy: seclusion, safety & physical needs Pharmacology/Biological/Integrative Mood Stabilizers: Lithium Anticonvulsive: Depakote, Tegretol, Lamictal Evaluation Outcome criteria dictate the frequency of evaluation