Panna dhai maa subharti nursing college

Amritanshu chanchal
M.Sc Nursing 2nd Year
Bipolar Disorder
Definition
• Bipolar disorder is a chronic or episodic (which means occurring
occasionally and at irregular intervals) mental disorder. It can cause
unusual, often extreme and fluctuating changes in mood, energy, activity,
and concentration or focus. Bipolar disorder sometimes is called manic-
depressive disorder or manic depression, which are older terms.
Introduction
• Everyone goes through normal ups and downs, but bipolar disorder is
different. The range of mood changes can be extreme. In manic episodes,
someone might feel very happy, irritable, or “up,” and there is a marked
increase in activity level. In depressive episodes, someone might feel sad,
indifferent, or hopeless, in combination with a very low activity level. Some
people have hypomanic episodes, which are like manic episodes, but less
severe and troublesome. Most of the time, bipolar disorder develops or
starts during late adolescence (teen years) or early adulthood. Occasionally,
bipolar symptoms can appear in children. Although the symptoms come
and go, bipolar disorder usually requires lifetime treatment and does not go
away on its own. Bipolar disorder can be an important factor in suicide, job
loss, and family discord, but proper treatment leads to better outcomes.
• The symptoms of bipolar disorder can vary. An individual with bipolar
disorder may have manic episodes, depressive episodes, or “mixed”
episodes. A mixed episode has both manic and depressive symptoms. These
mood episodes cause symptoms that last a week or two or sometimes
longer. During an episode, the symptoms last every day for most of the day.
Mood episodes are intense. The feelings are intense and happen along with
changes in behavior, energy levels, or activity levels that are noticeable to
others.
• Some people with bipolar disorder may have milder symptoms than others
with the disorder. For example, hypomanic episodes may make the
individual feel very good and be very productive; they may not feel like
anything is wrong. However, family and friends may notice the mood
swings and changes in activity levels as behavior that is different from
usual, and severe depression may follow mild hypomanic episodes.
Types Of Bipolar Disorder
• There are three basic types of bipolar disorder; all of them involve clear
changes in mood, energy, and activity levels. These moods range from
periods of extremely “up,” elated, and energized behavior or increased
activity levels (manic episodes) to very sad, “down,” hopeless, or low
activity level periods (depressive episodes). People with bipolar disorder
also may have a normal (euthymic) mood alternating with depression. Four
or more episodes of mania or depression in a year are termed “rapid
cycling.”
• Bipolar I Disorder is defined by manic episodes that last at least seven days
(most of the day, nearly every day) or when manic symptoms are so severe that
hospital care is needed. Usually, separate depressive episodes occur as well,
typically lasting at least two weeks. Episodes of mood disturbance with mixed
features (having depression and manic symptoms at the same time) are also
possible. „
• Bipolar II Disorder is defined by a pattern of depressive episodes and
hypomanic episodes, but not the full-blown manic episodes described above.
• Cyclothymic Disorder (also called cyclothymia) is defined by persistent
hypomanic and depressive symptoms that are not intense enough or do not last
long enough to qualify as hypomanic or depressive episodes. The symptoms
usually occur for at least two years in adults and for one year in children and
teenagers. „
• Other Specified and Unspecified Bipolar and Related Disorders is a category
that refers to bipolar disorder symptoms that do not match any of the recognized
categories.
Conditions That Can Co-Occur With Bipolar Disorder

• Many people with bipolar disorder also may have other mental health
disorders or conditions such as: „ Psychosis. Sometimes people who have
severe episodes of mania or depression also have psychotic symptoms, such
as hallucinations or delusions. The psychotic symptoms tend to match the
person’s extreme mood. For example:
• Someone having psychotic symptoms during a manic episode may falsely
believe that he or she is famous, has a lot of money, or has special powers.
• Someone having psychotic symptoms during a depressive episode may
believe he or she is financially ruined and penniless or has committed a
crime. „ Anxiety Disorders and Attention-Deficit/Hyperactivity Disorder
(ADHD). Anxiety disorders and ADHD often are diagnosed in people with
bipolar disorder. „ Misuse of Drugs or Alcohol. People with bipolar disorder
are more prone to misusing drugs or alcohol. „ Eating Disorders. People
with bipolar disorder occasionally may have an eating disorder, such as binge
eating or bulimia.
• Some bipolar disorder symptoms are like those of other illnesses, which can
lead to misdiagnosis. For example, some people with bipolar disorder who
also have psychotic symptoms can be misdiagnosed with schizophrenia.
Some physical health conditions, such as thyroid disease, can mimic the
moods and other symptoms of bipolar disorder. Street drugs sometimes can
mimic, provoke, or worsen mood symptoms. Looking at symptoms over the
course of the illness (longitudinal follow-up) and the person’s family
history can play a key role in determining whether the person has bipolar
disorder with psychosis or schizophrenia.
What causes bipolar disorder?
• Genes: Bipolar disorder often runs in families, and research suggests that this
is mostly explained by heredity—people with certain genes are more likely to
develop bipolar disorder than others. Many genes are involved, and no one
gene can cause the disorder. But genes are not the only factor. Some studies of
identical twins have found that even when one twin develops bipolar disorder,
the other twin may not. Although people with a parent or sibling with bipolar
disorder are more likely to develop the disorder themselves, most people with
a family history of bipolar disorder will not develop the illness.
• Brain Structure and Function: Researchers are learning that the brain
structure and function of people with bipolar disorder may be different from
the brain structure and function of people who do not have bipolar disorder or
other psychiatric disorders. Learning about the nature of these brain changes
helps doctors better understand bipolar disorder and may in the future help
predict which types of treatment will work best for a person with bipolar
disorder. At this time, diagnosis is based on symptoms rather than brain
imaging or other diagnostic tests.
• High Stress: People who experience traumatic events are at higher risk for
developing bipolar disorder. Childhood factors such as sexual or physical
abuse, neglect, the death of a parent, or other traumatic events can increase
the risk of bipolar disorder later in life. Highly stressful events such as
losing a job, moving to a new place, or experiencing a death in the family
can also trigger manic or depressive episodes. Lack of sleep can also
increase risk of a manic episode.
• Substance Abuse: People who abuse drugs or alcohol are also at risk for
developing bipolar disorder. Substance use doesn’t cause the disorder, but it
can make mood episodes worse or hasten the onset of symptoms.
Sometimes medications can also trigger the onset of a manic or depressive
episode.7 However, because substance use can trigger psychosis, a person
may have to detox from substances before a doctor can give them a
diagnosis of bipolar disorder.
How is bipolar disorder diagnosed?
• To diagnose bipolar disorder, a doctor or other health care provider may: „
• Complete a full physical exam. „
• Order medical testing to rule out other illnesses. „
• Refer the person for an evaluation by a psychiatrist.
• A psychiatrist or other mental health professional diagnoses bipolar disorder
based on the symptoms, lifetime course, and experiences of the individual.
• Some people have bipolar disorder for years before it is diagnosed. This may be
because: „
• Bipolar disorder has symptoms in common with several other mental health
disorders. A doctor may think the person has a different disorder, such as
schizophrenia or (unipolar) depression. „
• Family and friends may notice the symptoms, but not realize that the symptoms
are part of a more significant problem. „
• People with bipolar disorder often have other health conditions, which can make
it hard for doctors to diagnose bipolar disorder.
How is bipolar disorder treated?
• Medications :Certain medications can help control the symptoms of
bipolar disorder. Some people may need to try several different medications
and work with their doctor before finding the ones that work best. The most
common types of medications that doctors prescribe include mood
stabilizers and atypical antipsychotics. Mood stabilizers such as lithium can
help prevent mood episodes or reduce their severity when they occur.
Lithium also decreases the risk for suicide. Additional medications that
target sleep or anxiety are sometimes added to mood stabilizers as part of a
treatment plan. Talk with your doctor or a pharmacist to understand the
risks and benefits of each medication. Report any concerns about side
effects to your doctor right away. Avoid stopping medication without
talking to your doctor first.
• A number of medications are used to treat bipolar disorder. The types and
doses of medications prescribed are based on your particular symptoms.
• Medications may include:
• Mood stabilizers. You'll typically need mood-stabilizing medication to
control manic or hypomanic episodes. Examples of mood stabilizers
include lithium (Lithobid), valproic acid (Depakene), divalproex sodium
(Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine
(Lamictal).
• Antipsychotics. If symptoms of depression or mania persist in spite of
treatment with other medications, adding an antipsychotic drug such as
olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel),
aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or
asenapine (Saphris) may help. Your doctor may prescribe some of these
medications alone or along with a mood stabilizer.
• Antidepressants. Your doctor may add an antidepressant to help manage
depression. Because an antidepressant can sometimes trigger a manic
episode, it's usually prescribed along with a mood stabilizer or
antipsychotic.
• Antidepressant-antipsychotic. The medication Symbyax combines the
antidepressant fluoxetine and the antipsychotic olanzapine. It works as a
depression treatment and a mood stabilizer.
• Anti-anxiety medications. Benzodiazepines may help with anxiety and
improve sleep, but are usually used on a short-term basis.
• Psychotherapy (sometimes called “talk therapy”) is a term for a variety of
treatment techniques that aim to help a person identify and change troubling
emotions, thoughts, and behaviors. Psychotherapy can offer support,
education, skills, and strategies to people with bipolar disorder and their
families. Psychotherapy often is used in combination with medications;
some types of psychotherapy (e.g., interpersonal, social rhythm therapy)
can be an effective treatment for bipolar disorder when used with
medications.
• Family-Focused Therapy 
• Family-focused therapy (FFT) includes both the person with BD and their
parents, spouse, or other family members. FFT typically lasts about 12
sessions (depending on the family’s needs) given by a single therapist.
Early sessions focus on education about the condition: its symptoms and
how they cycle over time, its causes, how to recognize the early warning
signs of new episodes, and what to do as a family to prevent the episodes
from getting worse. Later sessions focus on communication and problem
solving skills, especially to address family conflicts. In many
randomized trial conducted by my labs at University of Colorado and
UCLA, we have found that people with BD who get FFT and medication
after an episode have less severe mood symptoms and better functioning
over 1-2 year periods than those who get medications and briefer treatments
or case management.
• Interpersonal And Social Rhythm Therapy
• IPSRT is an individual therapy in which the person with BD keeps daily
records of their bed times, wake times, and activities, and the effects of
changes in these routines on their moods. The clinician coaches the person
on how to regulate their daily routines and sleep-wake cycles as a way to
stabilize moods. The person and his/her therapist identify one or more
interpersonal problem areas (e.g., conflicts with coworkers; difficulty
sustaining friendships) and discuss potential solutions to prevent similar
problems from emerging in the future. 
• Cognitive Behavioral Therapy
• Cognitive behavioral therapy (CBT) is an individual therapy focused on the
relationship between a person's thoughts, feelings and behaviors. CBT teaches
people to:
• Identify negative assumptions and thinking patterns, and challenge themselves to
rehearse more adaptive ways of thinking. 
• Monitor their activity levels to make sure they are engaged with rewarding aspects
of their environment when depressed, and are not overly stretched when manic.   
• Dialectical Behavior Therapy
• Dialectical behavior therapy is a skill-based approach that includes both individual
and group therapy. It teaches mindfulness and acceptance skills, such as the ability
to experience moment-to-moment thoughts, emotions and their accompanying
physical sensations from an observer’s stance, without negative judgment. It also
teaches distress tolerance, emotion regulation and interpersonal effectiveness. 
• Group Psychoeducation
• People with BD get together (often accompanied by family members) and are
led by a group facilitator (either a psychologist or a trained peer mental health
counselor). Some groups are highly structured and follow an educational and
skill-training agenda. Others are oriented toward telling one’s story and getting
support and suggestions from people who have gone through similar
situations. These groups, including those provided by NAMI and the
Depression and Bipolar Support Alliance, are quite beneficial to people
because they reduce feelings of isolation that often come with mental illness. 
 
Over time, the specific type of therapy may not be as important as the
continuity of having a therapist or a group that knows you well and makes you
feel comfortable enough to disclose important issues. Along with medications,
support from mental health professionals who understand your journey are key
to an effective treatment plan and recovery.
Other Treatments
• Some people may find other treatments helpful in managing their bipolar
symptoms, including: „
• Electroconvulsive therapy is a brain stimulation procedure that can help
people get relief from severe symptoms of bipolar disorder. This type of
therapy is usually considered only if a patient’s illness has not improved
after other treatments (such as medication or psychotherapy) are tried, or in
cases where rapid response is needed, as in the case of suicide risk and
catatonia (a state of unresponsiveness), for example. „
• Regular vigorous exercise, such as jogging, swimming, or bicycling, helps
with depression and anxiety, promotes better sleep, and is healthy for your
heart and brain. Check with your doctor before you start a new exercise
regimen. „
• Keeping a life chart, which records daily mood symptoms, treatments,
sleep patterns, and life events, can help people and their doctors track and
treat bipolar disorder.
Coping With Bipolar Disorder
• Living with bipolar disorder can be challenging, but there are ways to help
make it easier for yourself, a friend, or a loved one. „
• Get treatment and stick with it—recovery takes time and it’s not easy. But
treatment is the best way to start feeling better. „
• Keep medical and therapy appointments, and talk with the provider about
treatment options. „
• Take all medicines as directed. „
• Structure activities: keep a routine for eating and sleeping, and make sure to
get enough sleep and exercise. „
• Learn to recognize your mood swings. „ Ask for help when trying to stick
with your treatment. „
• Be patient; improvement takes time.
• Social support helps.
Summary
• Bipolar disorder, formerly called manic depression, is a mental health
condition that causes extreme mood swings that include emotional highs
(mania or hypomania) and lows (depression). When you become depressed,
you may feel sad or hopeless and lose interest or pleasure in most activities.