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Bipolar Disorder NCM 401 Ma. Tosca Cybil A. Torres, RN
Objectives: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Objectives: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Key Terms: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Key Terms: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Review of Unipolar and Suicide
Bipolar Disorder Defined: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bipolar Disorder
Causative Factors: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Psychodynamic ,[object Object],[object Object]
Example: ,[object Object],[object Object],[object Object],[object Object]
Existential Theory ,[object Object],[object Object],[object Object],[object Object]
Biogenic Amine theory ,[object Object],[object Object],[object Object]
The " kindling " theory ,[object Object]
Cognitive-behavioral model of bipolar disorder ,[object Object]
Neuroendocrine influence ,[object Object],[object Object],[object Object]
Chronobiology study   ,[object Object],[object Object]
Variations in Brain Structure and Impaired Functions in Bipolar Disorder -memory performance -verbal memory (recall of a story or single word)  -attention dysfunction -verbal learning -verbal fluency  -Psychomotor speed -declarative memory (conscious recollection of facts and events)  - diencephalon (thalamus, mamillothalasmic tract and medullary lamina) -prefrontal cortex -frontal subcortical  -brain lesions  -midsagittal Areas reduction  -Abnormal white brain matter( increase with age) -Medial temporal lobe (hippocampus, parahippocampal and periphinal cortices- episodes of depression and mania may result in hypercortisolemia, producing damage)  -Basal ganglia  Functional Impairment  (all decreased) Structural variation/abnormality
BIPOLAR DISORDER ACROSS THE LIFE SPAN ,[object Object],Comorbidity-Substance abuse   28% 5% 14-30% 18-33% 42% 42-66% OCD Panic Disorder GAD Phobia Bipolar type II Bipolar type I 21% 18% 46% 41% Alcohol Drugs Unipolar Bipolar
Symptoms of Bipolar Disorder: ,[object Object]
Types of Mood Episodes
MANIA ,[object Object],[object Object],[object Object],[object Object]
HYPOMANIA ,[object Object],[object Object],[object Object],[object Object],[object Object]
BIPOLAR DEPRESSION   ,[object Object],[object Object],[object Object]
MIXED ,[object Object],[object Object]
Types of Bipolar Disorder
Bipolar I Disorder –  Mania and depression   ,[object Object],[object Object],[object Object],[object Object]
Diagnostic Criteria For Bipolar I Disorders ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bipolar I Disorder, Most Recent Episode Hypomanic ,[object Object],[object Object],[object Object],[object Object]
Bipolar I Disorder, Most Recent Episode Manic ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bipolar I Disorder, Most Recent Episode Mixed ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bipolar I Disorder, Most Recent Episode Depressed ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bipolar I Disorder, Most Recent Episode Unspecified ,[object Object],[object Object],[object Object],[object Object],[object Object]
Bipolar II Disorder –  Hypomania and depression   ,[object Object],[object Object],[object Object]
Diagnostic Criteria for Bipolar II Disorder ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cyclothymia –  Hypomania and mild depression   ,[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnostic Criteria for Cyclothymic Disorder ,[object Object],[object Object]
Diagnostic Criteria for Cyclothymic Disorder ,[object Object],[object Object],[object Object],[object Object]
Diagnostic criteria for Substance-Induced Mood Disorder ,[object Object],[object Object],[object Object]
Diagnostic criteria for Substance-Induced Mood Disorder ,[object Object],[object Object],[object Object]
Diagnostic criteria for Substance-Induced Mood Disorder ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bipolar Disorder Not Otherwise Specified ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnostic Criteria for Mood Disorder due to (indicate the general medical condition) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Multi-axial system ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Application of the Nursing Process: Depression   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
General appearance and motor behavior ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mood and affect ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thought process and content ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sensorium and intellectual processes ,[object Object],[object Object],[object Object],[object Object],[object Object]
Judgment and insight  ,[object Object],[object Object],[object Object]
Self-concept ,[object Object],[object Object],[object Object],[object Object],[object Object]
Roles and Relationships   ,[object Object],[object Object],[object Object],[object Object],[object Object]
Physiologic and self-care considerations   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Depression rating scale ,[object Object],[object Object],[object Object],[object Object]
Data Analysis: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Outcome Identification:   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intervention:   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Evaluation: ,[object Object],[object Object],[object Object]
Application of Nursing Process: Mania ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
General appearance and motor behavior ,[object Object],[object Object],[object Object],[object Object]
Mood and affect ,[object Object],[object Object],[object Object],[object Object]
Thought process and content  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sensorium and intellectual processes ,[object Object],[object Object],[object Object],[object Object],[object Object]
Judgment and insight  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Self-concept ,[object Object],[object Object],[object Object]
Roles and Relationships ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physiologic and self-care considerations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Data Analysis: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Outcome Identification:   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intervention: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Evaluation:   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Modalities:   ,[object Object],Lithium or divalproex Divalproex  Divalproex or Lithium w/ antipsychotic (atypical or conventional) Euphoric mania or hypomania Mixed or dysphoric mania Mania with psychosis
Commonly Used mood stabilizers, usual Adult doses and therapeutic serum levels   0.6-1.2mEq/L 50-100u/ml 412u/ml N/A 600-1800mg/d 750-4200mg/d 400-1600mg/d 300-500mg/dl 400-1600mg/d Lithium (Eskalith, Lithobid, Lithonate) Divalproex  (Depakote) Other anticonvulsants used as mood stabilizers Carbamazipine  (Tegretol, Carbatrol) Lamotrigine  (Lamictal) Topiramate  ( Topamax) Therapeutic Serum Levels Adult Dose Range Mood Stabilizer
Antidepressants used in Bipolar Disorder ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]

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Bipolar Disorder

  • 1. Bipolar Disorder NCM 401 Ma. Tosca Cybil A. Torres, RN
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  • 6. Review of Unipolar and Suicide
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  • 18. Variations in Brain Structure and Impaired Functions in Bipolar Disorder -memory performance -verbal memory (recall of a story or single word) -attention dysfunction -verbal learning -verbal fluency -Psychomotor speed -declarative memory (conscious recollection of facts and events) - diencephalon (thalamus, mamillothalasmic tract and medullary lamina) -prefrontal cortex -frontal subcortical -brain lesions -midsagittal Areas reduction -Abnormal white brain matter( increase with age) -Medial temporal lobe (hippocampus, parahippocampal and periphinal cortices- episodes of depression and mania may result in hypercortisolemia, producing damage) -Basal ganglia Functional Impairment (all decreased) Structural variation/abnormality
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  • 21. Types of Mood Episodes
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  • 80. Commonly Used mood stabilizers, usual Adult doses and therapeutic serum levels 0.6-1.2mEq/L 50-100u/ml 412u/ml N/A 600-1800mg/d 750-4200mg/d 400-1600mg/d 300-500mg/dl 400-1600mg/d Lithium (Eskalith, Lithobid, Lithonate) Divalproex (Depakote) Other anticonvulsants used as mood stabilizers Carbamazipine (Tegretol, Carbatrol) Lamotrigine (Lamictal) Topiramate ( Topamax) Therapeutic Serum Levels Adult Dose Range Mood Stabilizer
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