BIPOLAR DISORDER

1. BIPOLAR DISORDER

2. TABLE OF CONTENTS
 Objectives
 Definition of Bipolar Disorder
 Types of Bipolar Disorder
 Etiology
 Sign and Symptoms

3. OBJECTIVE

4. What is
Bipolar
Disorder???

5. Video

6. Bipolar Disorder
 formerly called manic-depressive illness or
manic depression
 is a mental disorder that causes unusual
shifts in mood, energy, activity levels,
concentration, and the ability to carry out
day-to-day tasks.
 Bipolar disorder is a serious mental illness
that is characterized by extreme mood
swings from mania to depression.
 Mania is an abnormally elevated mood
while depression is an abnormally low
mood

7. TYPES OF
BIPOLAR
DISORDER

8. BIPOLAR 1 DISORDER
 defined by manic episodes that last at least 7
days, or by manic symptoms that are so
severe that the person needs immediate
hospital care.
 Usually, depressive episodes occur as well,
typically lasting at least 2 weeks. Episodes of
depression with mixed features (having
depressive symptoms and manic symptoms at
the same time) are also possible.

9. BIPOLAR II DISORDER
 defined by a pattern of
depressive episodes and
hypomanic episodes, but
not the full-blown manic
episodes that are typical of
Bipolar I Disorder.

10. BIPOLAR DISORDER NOT OTHERWISE
SPECIFIED(BP-NOS)
 is most commonly ascribed when a mood disorder is
characterized by depression alternating with short
episodes of hypomania (a milder form of mania).
Oftentimes, the mood swings are rapid, occurring
within days of each other.
 By and large, children and adolescents are most
frequently diagnosed with NOS as they will be least
likely to have a previous history of mood dysfunction.

11. CYCLOTHYMIC DISORDER
 also called “Cyclothymia”
 defined by periods of hypomanic
symptoms as well as periods of
depressive symptoms lasting for
at least 2 years (1 year in children
and adolescents). However, the
symptoms do not meet the
diagnostic requirements for a
hypomanic episode and a
depressive episode.

13. The Brain and Bipolar Disorder
 Experts believe bipolar disorder
is partly caused by an underlying
problem with specific brain
circuits and the functioning of
brain chemicals called
neurotransmitters.
Scientist are learning about the
possible causes of bipolar
disorder

15.  Norepinephrine and serotonin have been consistently linked to
psychiatric mood disorders such as depression and bipolar
disorder. Nerve pathways within areas of the brain that regulate
pleasure and emotional reward are regulated by dopamine.
1.Norepinephrine
2. Serotonin
3.Dopamine

16. Is Bipolar
Disorder
Genetic?

17. GENETICS
 Bipolar Disorder tends to run in families. Children with
a parent or sibling who has a bipolar disorder are
four(4) to six(6) times more likely to develop the illness,
compared with children who do not have a family
history of bipolar disorder.
 Studies of identical twins have shown that the twin of a
person with bipolar illness does not always develop
the disorder. The results suggest factors besides genes
are also at work.

18. ENVIRONMENT
 Outside factors can also contribute bipolar disorder. These
considerations can include:
Ultimate stress
Traumatic Experience
Physical sickness

19. SYMPTOMS
 People suffering from
bipolar disorder go
through episodes severe
mania all the way down
to severe depression

20. MANIC EPISODES
Symptoms:
 Inflated self-esteem or grandiosity
 Decreased need for sleep
 Pressured speech or more talkative than usual
 Flight of ideas or racing thoughts
 Distractibility
 Psychomotor agitation or increase in goal directed activity
 Hedonistic interest

21. HYPO MANIC EPISODES
Similarities with Manic Episode = same symptoms
Differences:
 Length of time
 Impairment not as severe to

22. MAJOR DEPRESSIVE EPISODE
 Depressed mood, such as feeling sad, empty, hopeless or tearful (in
children and teens, depressed mood can appear as irritability)
 Marked loss of interest or feeling no pleasure in all — or almost all —
activities
 Significant weight loss when not dieting, weight gain, or decrease or
increase in appetite (in children, failure to gain weight as expected can be
a sign of depression)
 Either insomnia or sleeping too much
 Either restlessness or slowed behavior
 Fatigue or loss of energy
 Feelings of worthlessness or excessive or inappropriate guilt
 Decreased ability to think or concentrate, or indecisiveness
 Thinking about, planning or attempting suicide

23. MIXED EPISODE
 the presence of high and low symptoms
occurring at the same time, or as part of a
single episode, in people experiencing an
episode of mania or depression.
 In most forms of bipolar disorder, moods
alternate between elevated and depressed
over time. A person with mixed features
experiences symptoms of both mood
"poles“, mania and depression,
simultaneously or in rapid sequence.

24. BIPOLAR DISORDER
AND OTHER
CONDITIONS

25. PSYCHOSIS
 People having psychotic symptoms
during a manic episode may have the
unrealistic belief that they are famous,
have a lot of money, or have special
powers.
 People having psychotic symptoms
during a depressive episode may
falsely believe they are financially
ruined and penniless, have committed
a crime, or have an unrecognized
serious illness.

26. Anxiety:
It is common for people with bipolar
disorder to also have an anxiety
Attention-Deficit Hyperactivity
Disorder (ADHD):
It is common for people with bipolar
disorder to also have ADHD.

27. Misuse of Drugs or Alcohol:
People with bipolar disorder may misuse alcohol or
drugs and engage in other high-risk behaviors at
times of impaired judgment during manic episodes.
Although the negative effects of alcohol use or drug
use may be most evident to family, friends, and
health care providers, it is important to recognize
the presence of an associated mental disorder.
Eating Disorders:
In some cases, people with bipolar disorder also
have an eating disorder, such as binge eating or
bulimia.

28. MANIC EPISODE VS DEPRESSIVE EPISODE
People Having a Manic Episode may: People having a depressive episode may:
Feel very “up,” “high,” elated, or irritable or touchy Feel very sad, “down,” empty, worried, or hopeless
Feel “jumpy” or “wired” Feel slowed down or restless
Have a decreased need for sleep Have trouble falling asleep, wake up too early, or sleep
too much
Have a loss of appetite Experience increased appetite and weight gain
Talk very fast about a lot of different things Talk very slowly, feel like they have nothing to say, forget
a lot
Feel like their thoughts are racing Have trouble concentrating or making decisions
Think they can do a lot of things at once Feel unable to do even simple things
Do risky things that show poor judgment, such as eat
drink excessively, spend or give away a lot of money, or
have reckless sex
Have little interest in almost all activities, a decreased or
absent sex drive, or an inability to experience pleasure
(“anhedonia”)
Feel like they are unusually important, talented, or
powerful
Feel hopeless or worthless, think about death or suicide

29. 3. Identify the particular strategies
currently being used with these clients.
The strategies currently being used with
these clients are basically to treat acute
episodes safely with medication and
work with the client in long-term
maintenance to prevent further episodes
and optimize function using combination
of psychotherapeutic and
pharmacological techniques.

30. 1. Psychotherapy
Psychotherapy aims to assist a person with bipolar disorder in
accepting and understanding their diagnosis, coping with
various types of stress, improving their interpersonal
relationships, and recognizing prodromal symptoms before full-
blown recurrence.
a. Cognitive Behavioral Therapy
b. Interpersonal and Social Rhythm Therapy (IPSRT)
c. Family-Focused Therapy

31. a) Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT), which involves trying
to change your patterns of thinking, is effective for bipolar
disorder, according to the American Psychological
Association. Strategies that are used in CBT include role-
playing to get ready for interactions that could be
problematic, facing fears directly rather than practicing
avoidance, and learning techniques to calm and relax the
mind and body. CBT can help a person with bipolar to
recognize the warning signs of a mood change and can
help them learn to change unhealthy patterns of behavior.

32. b) Interpersonal and Social Rhythm Therapy (IPSRT)
Interpersonal and Social Rhythm Therapy, an adjunctive therapy for
individuals with mood disorders. These outlines techniques to improve
medication adherence, manage stressful life events, and reduce disruptions
in social rhythms. With this form of therapy, patients learn skills that can
help them protect themselves against the development of future
episodes. Managing the patient’s symptoms and improving his
interpersonal relations is the primary focus of IPSRT.

33. c) Family-Focused Therapy
Family members are taught to recognize the warning signs of either a
manic or a depressive episode. Both family members and patients are
taught better communication skills. A family member can help to
identify when a person with bipolar disorder is about to go into a new
episode before it happens.
A core component of family-focused therapy is psychoeducation. This
means educating people about the illness, the treatments available, and
the risk of non-adherence to medication.

34. 2.) Pharmacological Strategy
Medications is shown in studies that it is more effective for a
long-term treatment for bipolar and it decreases the risk for
relapse. It reduces the amount of hospital admissions required.
You may have to discuss with your doctor the reasons for the
medication they have prescribed, the risks and benefits involved,
side effects and how regularly you should get a check up. Doctors
may give advice for other treatments that may work well with
medication.

35. a.) Mood stabilizers for mania and hypomania.
Lithium and the anticonvulsants carbamazepine, lamotrigine, and valproic
acid are classed as mood stabilizers due to their effect on the mood states in
bipolar disorder. Lithium is preferred for long-term mood
stabilization, although it erodes kidney and thyroid function over extended
periods.
b.) Antipsychotics for hallucinations/delusions.
Antipsychotic medications are effective for short-term treatment of bipolar
manic episodes and appear to be superior to lithium and anticonvulsants for
this purpose. Olanzapine is effective in preventing relapses, although the
supporting evidence is weaker than the evidence for lithium.
Carbamazepine effectively treats manic episodes, with some evidence it has
greater benefit in rapid-cycling bipolar disorder, or those with more psychotic
symptoms or more symptoms similar to that of schizoaffective disorder.

36. c.) Antidepressants for depression.
It is believed that the medicine works by boosting the
functioning of nerve cells in the brain that
communicate through the chemical (neurotransmitter)
serotonin.
d.) Benzodiazepines
Benzodiazepines are used in addition to other
medications for calming effect. Until mood
stabilizers become effective.

38. 3.) BRAIN STIMULATION
a) Electroconvulsive therapy is a brain stimulation
procedure that can help people get relief from severe symptoms
of bipolar disorder. With modern ECT, a person usually goes
through a series of treatment sessions over several weeks. ECT
is delivered under general anaesthesia and is safe. It can be
effective in treating severe depressive and manic episodes,
which occur most often when medication and psychotherapy are
not effective or are not safe for a particular patient.
Reference: TMS - Bing images

39. b.) Transcranial magnetic stimulation (TMS).
TMS is a newer approach to brain stimulation that uses
magnetic waves. It is delivered to an awake patient
most days for 1 month. Research shows that TMS is
helpful for many people with various subtypes of
depression, but its role in the treatment of bipolar
disorder is still under study.
Reference: TMS - Bing images

40. 4.) Hospitalization if client is behaving
dangerously, feeling suicidal, or you
become detached from reality.
Reference: TMS - Bing images

41. 4. Identify specifically and clearly the HCA
responsibilities and accountability in assisting
these clients with a mental challenge and
illness.
4.1 Self Care.
Clients with bipolar disorder has disturbed sleep pattern.
1. Encourage frequent rest periods during periods during the
day to promote relaxation and minimize manic behavior.
2. Encourage frequent rest periods during the day
3. At night, encourage warm baths and soothing music. This
promotes relaxation, rest and sleep.

42. b) Imbalanced Nutrition
1. Monitor intake, output, and vital signs. Ensure adequate fluid and
caloric intake; minimizes dehydration and cardiac collapse.
2. Frequently remind the client to eat. The manic client cannot tell
that they are hungry.
3. Encourage a frequent high-calorie protein drinks and finger food.
Constant fluid and calorie replacement are needed. Client might be
too active to sit at meals. Finger foods allow “eating on the run”.
c) Elimination needs.
Monitor bowel movements; offer fluids and high fiber foods. Evaluat
for the need to give stool softeners and laxative. Assist patient in
going to bathroom.

43. d) Grooming/Dressing
1) Give simple step by step reminders for
hygiene and dress. Clients with bipolar
disorder have poor concentration and is
countered by simple and concrete
instructions.
2) Supervise choice of clothes; minimize
flamboyant and bizarre dress to lessen the
potential for inappropriate attention, which
can increase the level of mania.

44. 4.2 Coping strategies.
Clients with bipolar disorder are mentally stressed
and may behave in socially unacceptable ways or may
be harmful to themselves or others. It is the
responsibility and accountability of HCA to intervene
when this behaviour happens and to help clients find
better ways of coping.
1) Use a calm and firm approach in communication
especially if patient is out of control.
2) Use short, simple and brief explanations or
statements. Bipolar clients have short attention span
and understanding to small pieces of information.

45. 3) Remain neutral as possible; Do not argue with the client.
Client can use inconsistencies and value judgements as
justification for escalating mania.
4) Maintain a low level of stimuli in client’s environment (e.g.,
loud noises, bright light, low-temperature ventilation) to
minimize escalation of anxiety and manic symptoms.
Provide an environment with minimum stimuli like quiet, soft
music and dim lighting.
5) Redirect violent behavior or activities that distracts
attention like physical exercise which help to decrease tension
and provide focus.

46. 6) Encourage client with solitary activities requiring short
attention span with mild physical exertion like drawing, board
games, writing, painting and photography. Discourage client with
competitive games that can stimulate aggression and can
increase psychomotor activity.
7) Frequently assess the client’s behavior for signs of increased
agitation and hyperactivity. Early detection and intervention of
escalating mania will prevent the
8) Protect client from giving away money and possessions. Hold
valuables in a hospital safe until rational judgement return.
Because client’s “generosity” is a manic defense that is
consistent with irrational, grandiose thinking.

47. 4.3 Observe for signs of lithium toxicity and report to
nurse (e.g., nausea, vomiting, diarrhea, drowsiness,
muscle weakness, tremor, lack of coordination,
blurred vision, or ringing of ears).
4.4 While you are caring for and providing support to
a person with a mental health disorder, your actions
should always focus on respect and acceptance of the
client and the family. Always remember the principles
of DIPPS. As an HCA, our scope of practice should be
paralleled with the principles of Mental Health Care.

48. Principles of Mental Health Care.
1. Follow the care plan. Tell your supervisor if support measures are
not working.
2. Do no harm. Provide a safe, comfortable setting for the client. You
need to provide both safe care and protection from harm at all times.
3. Accept each client as a whole person. You should be accepting of
the client and refrain from making any judgements.
4. Be patient and supportive. Speak calmly; avoid speaking in a loud
or sharp tone of voice.
5. Develop mutual trust. Remember to do what you say you will
do. Being on time, providing the care as promised, and explaining all
procedures will promote trust and reduce your client's anxiety.

49. 6. Explore behaviours and emotions. Many clients will share with you
what they are feeling and thinking if they trust you and if you take the time
to listen to them.
7. Observe the client carefully. Observe for any changes in the client's
behaviour, mood, and thinking, such as signs and symptoms of fatigue,
stress, anxiety, fear, and frustration, as well as signs and symptoms of
illness. Report and record all of your observations, according to employer
policy.
8. Encourage responsibility. Taking responsibility for their own actions
helps clients build self-worth, dignity, and confidence.
9. Encourage effective adaptation. It is often your responsibility to
intervene when this behaviour happens and to help clients find better ways of
coping.
10. Provide consistency. Maintaining a routine promotes a sense of control.
Consistency and reliability of your care will also provide security and stability
for the client. This will, in turn, help reduce the client's stresses and
anxieties.

50. 5. Examples of How an HCA can assist the client
with the specific mental challenge to live
independently within their capability?
HCA can assist clients live independently within their capability in
their homes instead of moving to an assisted living facility or a
nursing home. By providing assistance in:
Personal Care Services
1. Assist with bathing, dressing, grooming
2. Assist with walking and transferring from bed to wheelchair
3. Toileting, incontinence Care
4. Medication reminders

51. Light Housekeeping Services
1. Preparing meals
2. Cleaning kitchen, bedrooms and bathrooms
3. Changing and making beds
4. Sweeping and vacuuming floors
5. Running errands
6. Laundry
7. Providing transportation
Companion Services
1. Accompanying client to doctor appointments
2. Engage client in meaningful conversation
3. Encouraging exercise routines, as directed by a health care
provider
4. Assist clients in attending meaningful social/recreational
activities

52. Supporting Clients with Bipolar
The support worker can assist in keeping a chart of daily mood
symptoms, treatments, sleep patterns, and life events to help
the client and the family to better understand and cope with
the illness. A description of phases of treatment of bipolar and
related disorders and the role of the support worker.
During depression:
• Follow the guidelines for major depression.
During manic periods:
• Provide a calm environment without too many distractions.
• Encourage periods of rest.
• Encourage self-care; assist as required.
• Do not argue; arguing could irritate the client.

53. Phase Period Goal Of treatment Your Role
Acute treatment:
Symptoms are beginning to
escalate.
6-12
months
To reduce symptoms and
inappropriate behaviors.
Observe for changes in the
client's behavior.
Report these changes to your
supervisor.
Provide a safe, secure,
consistent environment for the
client.
Continuation: Symptoms
are still evident, but they
are beginning to decrease
with treatment.
4–9
months
To prevent relapses into
distressing emotional states.
Observe the client for any
signs or symptoms of
depression or mania.
Report these to your
supervisor
Maintenance: The client
does not have acute
symptoms
Indefinite To prevent recurrences, as
some clients think they are
“cured” and stop taking their
medication
Same as above
TABLE 35–1 Chapter 35 Supporting Clients with Bipolar and Related disorders Mosby’s Canadian textbook for support worker (Sorrentino p .780)
Phases of Treatment of Bipolar and Related Disorders and the Role of the Support Worker

54. 6. Prepare a hand out of the resources available
for these clients in the community setting.
Health System Resources for Mental Health and addictions Care in Canada
Currently, a wide range of care exists for individuals with mental health needs,
ranging from less intensive for severe and persistent health needs. Care can be
provided in the community.

55. Note!
The Canadian government provides people with bipolar disorder, or other
physical/mental disabilities, disability benefits designed to offset the
financial and emotional burden a disability can put on a family.
What Foods and Drinks Should People with Bipolar Disorder Avoid?
Caffeine. “Stimulants can trigger mania and should be avoided,”
Alcohol. Alcohol and bipolar disorder are a bad combination. ...
Sugar
Salt
Fat.
Eat a balance of protective, nutrient-dense foods. These foods include fresh
fruits, vegetables, legumes, whole grains, lean meats, cold-water fish,
eggs, low-fat dairy, soy products, and nuts and seeds. These foods provide
the levels of nutrients necessary to maintain good health and prevent
disease.

56. Organizations/Programs for Bipolar Disorder
Depression and Bipolar Support Alliance (DBSA)
The Depression and Bipolar Support Alliance (DBSA) is a national
organization that focuses on supporting individuals who have depression and
bipolar mood disorders. The organization also offers a support network for
parents of children with paediatric mood disorders. Support is offered
through local chapter meetings and online resources, such as videos,
educational materials, and online support groups. The organization's website
offers information for the newly diagnosed, as well as recovery steps and
ways to help a loved one who has depression and bipolar disorder.
National Alliance on Mental Illness
The National Alliance on Mental Illness or NAMI works to support and
educate the public about various mental disorders, with the goal of
improving the quality of life for all people diagnosed with mental illness.
NAMI’s web site provides the latest facts, statistics, and research advances
on different types of mental health conditions.

57. American Academy of Child and Adolescent Psychiatry
The American Academy of Child and Adolescent Psychiatry (AACAP) is a
leading non-profit organization of physicians and other mental health
professionals dedicated to helping children, teens, and families affected by
mental, behavioral, or developmental problems. On the web site, the
AACAP provides resources for parents, including a link to find a nearby
psychiatrist for children and adolescents.
Medication isn’t the only effective treatment for bipolar disorder. Individuals
with this disease may also benefit from psychosocial treatment, experts
say. But some patients with bipolar disorder may have trouble complying
with medication and/or dealing with the consequences of the disorder. This
is where psychosocial treatments can make a difference.
Psychosocial treatment can not only improve a patient’s adherence to
medication but can increase their understanding of the illness. Psychosocial
treatments that can be beneficial are as follows

58. Black Dog Institute Program
This is one of Black Dog Institute support groups. It is a psychological
wellbeing group that lasts for 9-weeks. This is recommended for those with
depression or bipolar disorder as it helps them manage the illness and stay
healthy. The principles and topics discussed are to benefit the individual’s
life while coping with the disorder.
The requirements you need to meet before you can enter the program are:
Need to be over 18 years old.
Must be diagnosed with either depression or bipolar over one year
Must attend every session.Should be able to deal with a group setting.
Are accepting of their illness and wanting to imply strategies that may
change them.

59. Daily Mood Swing Chart

60. Interesting Facts and Statistics:
About 2.4% of people around the world have had a diagnosis of bipolar disorder
at some point in their lifetime, according to the first comprehensive international
figures on the topic.
The United States has the highest lifetime rate of bipolar disorder at 4.4%, and
India the lowest, with 0.1%.
Bipolar disorder is characterized by cycles of depression and mania, a euphoric,
high-energy state that can result in heightened levels of creativity or output as
well as erratic or risky behaviour. People with bipolar disorder are at high risk of
substance abuse and suicide, and treatment includes psychiatric care and
medication.
However, fewer than half of people with the disorder were treated by a mental
health professional, and only a quarter of those in lower-income countries sought
treatment, according to the 11-nation study in the March issue of Archives of
General Psychiatry.

61. Reference: U.S. has highest bipolar rate in 11-nation study - CNN.com
About 2.4% of people around the world have had a diagnosis of bipolar disorder at
some point in their lifetime, according to the first comprehensive international figures
on the topic.Reference: U.S. has highest bipolar rate in 11-nation study - CNN.com

62. Takeaway from this team Project……
People have this stigma that having bipolar disorder
prevents you from functioning adequately in life.
However, that is untrue. Many people with this
disorder are capable of having successful career, a
family, and generally a good life.
Bipolar disorder does not define who someone is.

63. A growing number of celebrities has opened up about living with
bipolar disorder, defined by the Mayo Clinic as a lifelong mental
health condition that “causes extreme mood swings that include
emotional highs (mania or hypomania) and lows (depression).”
Celebrities with bipolar disorder: Stars who spoke out (pagesix.com)

64. For your Information:
 World Bipolar Day is celebrated globally every year on March 30.
It aims to bring awareness to bipolar disorder.
 March 30 was chosen as the date for World Bipolar Day because
it’s Vincent van Gogh’s birthday. The famous painter is believed to
have had bipolar disorder.
 As more people learn about and understand bipolar disorder, it
can help reduce the stigma surrounding mental illness.
 In support of this goal, there are many ways you can celebrate
World Bipolar Day — and the people who live with this condition.

65. FYI!!

66. REFERENCES:
Sorrentino, Sheila A. (2017). Mosby’s Canadian Textbook for the Support Worker
(4th ed.). Toronto: Elsevier Canada.
Bipolar disorder - Wikipedia
Bipolar Disorders Nursing Care Plans - Nurseslabs
Canadian Institute for Health Information
https://secure.cihi.ca/free_products/CIHI-comm-mental-health-en-web.pdf
https://secure.cihi.ca/free_products/Mental%20Health%20Annual%20Report%202009-
2010%20FY_2012_EN-web.pdf
Treatments for Bipolar Disorder: Cognitive Behavioral Therapy and More
https://www.psycom.net/bipolar-psychosocial-treatment
Bipolar Disorder Guide
https://www.verywellmind.com/bipolar-disorder-symptoms-and-diagnosis-379962
https://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-causes
Celebrities with bipolar disorder: Stars who spoke out (pagesix.com)