1. Bipolar Disorders
Sheila Lechado, RN

2. OVERVIEW

3. Bipolar disorders
• Also considered mood disorders,
include the occurrence of depressive
episodes and one or more elated
mood episodes
• An elated mood can include a range of
affect, from normal mood to
hypomania to mania

4. Bipolar disorders
• In the most intense presentation, the
person with bipolar disorder
experiences altered thought
processes, which can produce bizarre
delusions.

5. DIAGNOSTIC EVALUATION

6. • Rating scale assessment tools:
• Young Mania Rating Scale
• Manic State Rating Scale
• There appear to be no laboratory
features that distinguish major
depressive episodes found in major
depressive disorder from those in
bipolar I or bipolar II disorder.

7. • Complete psychophysiologic
examination.
• Complete assessment to rule out
medical conditions.

8. MANAGEMENT

9. • Patients may receive treatment in
acute inpatient psychiatric hospitals
or in the community in an outpatient
program
• The decision about treatment
setting is made according to
severity of patient's illness,
including degree of mania or
depression as well as risk of self-
harm or harm to others.

10. • Inpatient treatment is directed
toward drug management as well as
supportive psychotherapy in order to
alleviate the acute manic symptoms.
• Pharmacologic treatment for acute
mania consists of the following:
• Lithium (Lithobid)
• Anticonvulsants, such as
carbamazepine (Tegretol) and
valproate (Depakene), for mood-
stabilizing properties

11. • Neuroleptic agents, such as
risperidone (Risperdal), for acute
psychotic thinking
• Benzodiazepines, such as
clonazepam (Klonopin) or
lorazepam (Ativan), for acute
agitation
• Psychotherapy is used as described
above in the section related to
depression.

12. • Psychiatric home care nursing to
facilitate compliance with drugs and
therapeutic interventions.
• Community-based support group
participation.

13. DRUG ALERT
• Patients taking lithium can develop toxicity related
to elevated levels in the blood; therefore, lithium
blood levels must be monitored periodically.
• Initial therapy requires daily monitoring until a safe,
therapeutic level is attained; weekly and then
monthly monitoring is then recommended.
• Lithium toxicity is related to decreased serum
sodium levels and inadequate hydration.
• Therefore, patients taking lithium must have normal
sodium intake and drink at least 2 to 3 qt (2 to 3 L)
of water daily.

14. COMPLICATIONS

15. • Untreated bipolar disorder can lead
to physical exhaustion.
• Poor judgment and risk-taking
behavior can lead to financial
problems.
• Alcohol and drug abuse problems can
develop and cause disruption in the
family.
• Concurrent medical conditions may
be exacerbated.