Bipolar Disorder

Psych- NUR-2522
Maria Walton-Maldonado

Bipolar disorder
Maria Walton-Maldonado
For this paper I chose to write about bipolar disorder. I feel like it is one of the most psychiatric
disorders I have seen in patients throughout my healthcare career thus far. I feel that because
psychiatric disorder are such a stigma many people do not go to the doctors to get checked out
for the symptoms they are having until it gets out of hand. People might think I am just sad, or I
am so on top of the world and not think anything past that. Through this paper I hope to give
some information on symptoms, treatments and some education.
There have been studies on bipolar dating back to the seventeenth century. The term bipolar
means two poles signifying the polar opposites of mania and depression. This first appeared in
the American Psychiatric Associations (AMA) Diagnostic and Statistical Manual of Mental
Disorders (DSM) in its third revision in 1980. Because of this patients were no longer called
maniacs. (health line, 2016).
I will start by telling you that there is bipolar I, bipolar II, cyclothymic disorder, & rapid cycling
bipolar disorder. These classifications for diagnosis are per DSMIV manual. Bipolar I diagnosis
is given to a patient who has experienced one or more episodes of mania. It is as common in men
as it is in women (health line, 2016). Although depression is part of bipolar disorder it is not
needed to diagnose a patient with bipolar disorder. The person must be manic at the time or have
been manic for multiple days and have to be hospitalized for bipolar I. For a bipolar II diagnosis
these patient have not had a manic episode. They have shifted back and forth from depression to
hypomania. Hypomania is stage where the disturbance is not sufficiently severe to need
hospitalization or to affect social or occupational functioning. It is more common in women
(health line, 2016). Cyclothymic disorder is less severe and but to be diagnosed the patient must

have a chronic mood disturbance for at least 2 years. The patient will have rapid changes in
mood from mild depression to periods of elevated moods. The patient may experience multiple
mood changes in a week to even multiple in a day. This affects more women than it does men.
The most severe form of bipolar disorder is rapid cycling bipolar disorder. In this type the patient
experiences shorter cycles of manic and depressive episodes and they are more frequent (health
line, 2016). With the estimated risk of suicide at 15% in bipolar disorder, during the depressed
phase of the illness patients are 30 times more likely to attempt suicide (Coello, 2011).
The etiology of this disorder has yet to be found. A chemical imbalance in the brain is the only
evidence that scientists have found. There are genetic factors showing that if one parent has
bipolar disorder the children are at risk for developing it also, and if both parents have it the risk
increases. Some physiological factors include lesions in in various areas of the brain. Medication
side effects can also cause manic symptoms. (Townsend, 2014)
Treatment response is greatest in the early stages, but because many times it is misdiagnosed or
underdiagnosed it complicates treatment (Coello, 2011). Antidepressants like bupropion and
paroxetine are used. Antimanic medication like Lithium carbonate is used but needs to be
monitored closely to avoid toxicity. Ranges for Lithium during acute mania is 1.0-1.5 meq/L and
for maintenance 0.6-1.2 meq/L. This medication can cause many side effects like most
medications but one is fine hand tremors. Anticonvulsants are also used for these patients like
Tegretol 200-1600mg, Klonopin 0.5-20 mg, Valporic Acid 0.5-20mg, this is just to name a few.
The action in treatment of bipolar disorder is unclear. Antipsychotic medications include
Risperidone1-6 mg, Chlorpromazine 75-400 mg, Olanzapine 10-20 mg and many others. Family
therapy, group therapy and occasionally electroconvulsive therapy are other treatments
(Townsend, 2014).

For patient education they should be informed that there is no cure for bipolar disorder, but they
can learn to minimize symptoms and learn to cope with the effects of the illness of mood social
life and career. They should be told that they are not to stop taking medications abruptly even if
they feel better. They should not drive when taking medications that cause drowsiness or
dizziness. Take medications with food if any GI upset occurs when taking them. Let the
physician know if you smoke which can increase the metabolism of some drugs.
The plan for patient in their process to recovery is to develop strategies to keep themselves well.
Per NAMI includes the patient Become an expert of the disorder, take medications regularly,
become aware of earliest symptoms, have a plan for emergencies, identify and reduce sources of
stress and know when to seek help, develop a personal support system and develop a plan for
emergencies (Townsend, 2014). As the nurse we need to be there to support the patient in taking
the appropriate steps to be able to keep these goals. Patient needs to continually follow up with
health provider.
After all the articles and book read if bipolar disorder is diagnosed on time and the patient can
start treatment early including medications, and therapy the prognosis is good. If it is found too
late it will be much harder to treat. In children this is hard to diagnose because at such a young
age their behavior is erratic (health line, 2016). But if as early as possible a patient is diagnosed
the patient can get the help they need to live. Based on (Powell, 2006) in Townsend it states that
people with bipolar disorder have the power to create the lives they want for themselves
(Townsend, 2014). So as long as the patient is willing to put in the work, even though it will be
hard they are able to lead a good life.

References
Krans, B., Churney, K., & Legg, T. J., PHD. (2016, January 28). The History of Bipolar Disorder.
Retrieved June 04, 2016, from http://www.healthline.com/health/bipolar-disorder/historybipolar#2
Townsend, M. C. (2014). Essentials of psychiatric mental health nursing: Concepts of care in
evidence-based practice (6th ed.). Philadelphia: F.A. Davis.
Baldassano, C. F., Hosey, A., & Coello, J. (2011). Bipolar Depression: An Evidence-Based
Approach. Current Psychiatry Reports Curr Psychiatry Rep, 13(6), 483-487.
doi:10.1007/s11920-011-0238-7