Bipolar Disorders DSM V.ppt

Bipolar disorder by Dr farooq

1. Bipolar Affective Disorder

3. DEFINITION
Bipolar disorder is a chronic mood
syndrome that manifests as alternating
and recurring mood episodes
throughout a person’s life.
Alternating mood episodes are
characterized by mania, hypomania,
depression, and concurrent mania and
depression (mixed episodes) alternating
with periods of normal functioning.

4. BIPOLAR DISORDERS
Types
Bipolar, manic
Bipolar, depressed
Bipolar, mixed
Cyclothymia

5. BIPOLAR DISORDERS
Types (cont)
Bipolar I-Mania alternating with
depression.
Bipolar II-Hypomanic episodes
alternating with depression.
Cyclothymia-Hypomanic episodes
alternating with dysthemia.

6. DSM 5 Criteria for Mania
Manic Episode Criteria
–A distinct period of abnormally and persistently
elevated, expansive, or irritable mood.
–Lasting at least 1 week.
–Three or more (four if the mood is only irritable) of
the following symptoms:
1.Inflated self-esteem or grandiosity
2.Decreased need for sleep
3.Pressured speech or more talkative than usual
4.Flight of ideas or racing thoughts
5.Distractibility
6.Psychomotor agitation or increase in goal-directed activity
7.Hedonistic interests

7. Ctd..
Manic Episode Criteria (cont.)
Causes marked impairment in occupational
functioning in usual social activities or
relationships, or
Necessitates hospitalization to prevent harm to
self or others, or
Has psychotic features
Not due to substance use or abuse (e.g., drug
abuse, medication, other treatment), or a general
medial condition (e.g., hyperthyroidism).
A full manic episode emerging during
antidepressant treatment

8. 8
Diagnosis: Manic Symptoms at School
Symptom/Definition Example
Distractibility: Increased
inattentiveness beyond child’s
baseline attentional capacity.
A child is distracted by sounds
in the hallway, which would
typically not bother her.
Increase in Goal-Directed Activity
or Psychomotor Agitation: Hyper-
focused on making friends, engaging
in multiple school projects or hobbies
or in sexual encounters, or a striking
increase in and duration of energy..
A child starts to rearrange the
school library or clean
everyone’s desks, or plan to
build an elaborate fort in the
playground, but never finishes
any of these projects.
Excessive Involvement in
Pleasurable or Dangerous
Activities:Sudden unrestrained
participation in an action that is likely
to lead to painful or very negative
consequences.
A previously mild-mannered
child may write dirty notes to the
children in class or attempt to
jump out of a moving school
bus.
From Lofthouse & Fristad (2006, p. 215)

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DSM-5Diagnosis
Hypomanic Criteria
Similarities with Manic Episode
Same symptoms
Differences from Manic Episode
Length of time
Impairment not as severe
May not be viewed by the individual as pathological
However, others may be troubled by erratic behavior
APA (2013)

10. 10
DSM-5Diagnosis
Major Depressive Episode Criteria
A period of depressed mood or loss of interest or
pleasure in nearly all activities
In children and adolescents, the mood may be
irritable rather than sad.
Lasting consistently for at least 2 weeks.
Represents a significant change from previous
functioning.
APA (2013)

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DSM-5Diagnosis
Major Depressive Episode Criteria (cont.)
Five or more of the following symptoms (at least one of
which is either (1) or (2):
1)Depressed mood
2)Diminished interest in activities
3)Significant weight loss or gain
4)Insomnia or hypersomnia
5)Psychomotor agitation or retardation
6)Fatigue/loss of energy
7)Feelings of worthlessness/inappropriate guilt
8)Diminished ability to think or concentrate/indecisiveness
9)Suicidal ideation or suicide attempt
APA (2013)

12. 12
DSM-5Diagnosis
Major Depressive Episode Criteria (cont.)
Causes marked impairment in occupational
functioning or in usual social activities or
relationships
Not due to substance use or abuse, or a .general
medial condition
Not better accounted for by Bereavement
After the loss of a loved one, the symptoms persist for
longer than 2 months or are characterized by marked
functional impairment, morbid preoccupation with
worthlessness, suicidal ideation, psychotic symptoms,
or psychomotor retardation
APA (2013)

13. Prevalence and Comorbidity
•1.2% to 3%
•Substance abuse
•Personality disorders
•Anxiety disorders

14. Biological Theories
Genetics-
Neurobiological Factors-Neurotransmitter
alteration: NE , DA and 5-HT
Norepinephrine, dopamine, serotonin
Neuroendocrine Factors-Hypotalamic-
pituitary-thyroid-adrenal axis
Neuroanatomical Factors-Dysregulation in
neurological circuits

15. Sociological Findings
–Education
–Occupation
–Economic status
–Creativity
Psychological Influences
–Highly expressed emotions
–Childhood experiences

16. Assessment-Depressed
Symptoms for the depressed cycle of
the Bipolar Disorder-Depressed are the
same as the symptoms of Major
Depression. The difference is that the
bipolar patient has the history of at least
one manic episode.

17. Nursing Diagnosis
Risk for other-directed violence
Risk for self-directed violence
Risk for injury
Disturbed thought process
Imbalanced nutrition, less than…
Disturbed sleep pattern
Self care deficit
Impaired social interaction

18. Goals
The client
–Has not harmed self or others
–Is no longer exhibiting signs of
physical agitation
–Eats a well-balanced diet with snacks to
prevent weight loss and maintain
nutritional status

19. Goals (cont.)
The client (cont)
–Verbalizes an accurate interpretation of
the environment
–Accepts responsibility for own
behaviors
–Does not manipulate others for
gratification of own needs
–Interacts appropriately with others

20. BIPOLAR DISORDERS
NURSING INTERVENTION
Firm and calm approach.
Short and concise explanations.
Remain neutral, avoid power struggles.
Be consistent in approach.
Have frequent staff meetings to plan consistent
approach.
consequences of inappropriate behavior.

21. BIPOLAR DISORDERS
NURSING INTERVENTION (cont.)
When violent or extreme agitation use
antipsychotics and seclusion.
Protect client from giving away money and
possessions.
Supervise hygiene and choice of clothing.
Give simple step-by-step directions.
When able to learn teach about disorder,
medication and community agencies.

22. PSYCHOPHARMACOLOGY
ANTIPSYCHOTICS
BENZODIAZEPINES
MOOD STABILIZERS
–LITHIUM CARBONATE
Eskalith
Lithane
–Lithobid
–ANTICONVULSANTS
Carbamazepine (Tegretol)
Valproic acid (Depakote)
Lamotrigine (Lamictal)
Gabapentin (Neurontin)
Oxcarbazepine (Trileptal)
Tiagabine (Gabitril)
Topiramate (Topomax)

23. LITHIUM
SIDE EFFECTS
–METALLIC TASTE
–FINE HAND TREMORS
–WEIGHT GAIN
–NAUSEA
–EDEMA
TOXICITY
–DROWSINESS
–SLURRED SPEECH
–DIZZINESS,
–CONVULSIONS & DEATH

24. NURSING IMPLICATIONS OF
LITHIUM
TEACH PATIENT TO
–MAINTAIN A NORMAL SALT INTAKE
–DRINK 8 GLASSES OF FLUIDS /DAY

25. Client/Family Education
Nature of illness
–Causes of bipolar disorder
–Cyclic nature of the illness
–Symptoms of depression
–Symptoms of mania

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Treatment
Alternative Treatments
–Light Therapy
–Electro-Convulsive Therapy (ECT) & Repeated
Transcranial Magnetic Stimulation (r-TMS)