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Mood Disorders Part II: Bipolar Disorders - Coggle Diagram
Mood Disorders Part II: Bipolar Disorders
Definition & Classification: Bipolar disorder involves severe mood changes between 'highs' (mania/hypomania) and 'lows' (depression).
Cyclothymia: Milder, chronic form with hypomanic and mild depressive episodes for ≥2 years.
Other Types: Substance-induced or due to another medical condition.
Bipolar I: At least one manic episode (may have hypomanic/major depressive episodes).
Bipolar II: Major depressive episodes alternating with hypomanic episodes.
Mania vs. Hypomania: Mania causes marked impairment, often requires hospitalization, and can include psychotic features. Hypomania is a less severe version without these extremes.
Epidemiology: Affects 1-5% of the population. Median onset age is 25. Affects men and women equally.
Etiology:
Biological: Strong genetic component (25-75% risk based on parental history). Neurotransmitter hypothesis (excess norepinephrine and dopamine).
Psychological: Psychoanalytic view (mania as a defense against underlying depression).
Assessment (Manic Episode):
Mood: Unstable euphoria, irritability, labile mood.
Behavior: Hyperactivity, impulsivity, poor judgment, reduced need for sleep, spending sprees, reckless behavior, bizarre dress.
Interpersonal Relationships: Superficial, intrusive, overly familiar.
Thought Process: Flight of ideas, pressure of speech, clang associations, grandiosity, poor concentration, distractibility, delusions (grandeur, persecution), hallucinations.
Nursing Management: Primary goal is to prevent exhaustion and harm.
Risk for Other-Directed Violence: Maintain a low-stimulation environment, remove hazards, provide structured activities, redirect energy, use calm attitude, set clear limits.
Impaired Social Interaction: Set limits on manipulative behavior, offer feedback, identify positive self-aspects, use solitary/non-competitive activities initially.
Impaired Verbal Communication: Use short, concise statements; therapeutic techniques; help patient focus.
Altered Thought Process: Focus on feelings behind delusions, distract with reality-based topics.
Self-Care Deficit / Imbalanced Nutrition: Provide high-calorie finger foods/fluids, minimize distractions during meals, give step-by-step reminders for hygiene.
Sleep Pattern Disturbance: Reduce stimuli, discourage caffeine, encourage daytime activity.
Treatment Modalities:
Pharmacology: Mood stabilizers (Lithium, Anticonvulsants), Atypical Antipsychotics, Antidepressants (with caution).
Psychotherapy: Cognitive Therapy, CBT, Family-Focused Therapy, Psychoeducation.
ECT: For severe, treatment-resistant cases.