NURSING MANAGEMENT OF PATIENT WITH MOOD DISORDER.pptx

NURSING MANAGEMENT OF PATIENT WITH MANIA DEPRESSION & BIPOLAR DISORDER.THERAPEUTIC MODALITIES AND DRUG REGIMEN UTILIZED FOR THE MANAGEMENT.

1. AMRITANSHU CHANCHAL NURSING TUTOR SLMGNC NURSING MANAGEMENT OF PATIENT WITH MOOD DISORDER

2. Mood disorder are characterized by a disturbance of mood, accompanied by a full or partial manic or depressive syndrome , which is not due to any other physical or mental disorder. The prevalence rate of mood disorder is 1.5 percent, and its uniform throughout the world. MOOD DISORDER

3. Mania refers to a which the central features are over activity, mood change and self important ideas. The lifetime risk of manic episode is about 0.8-1%. This disorder occurs in episodes lasting usually 3-4 months, followed by complete recovery. M anic episode

4. Neurotransmitters & Structural Hypothesis: Manic episodes are related excessive levels of nor-epinephrine and dopamine, an imbalance between cholinergic and nor adrenergic system or a deficiency in serotonin. Biologic findings suggest that lesion are more common I the right hemisphere or bilateral sub-cortical and periventricular gray matter. E tiology

5. Monozygotic twins have a higher rate of incidence than normal siblings and other close relatives. Siblings and close relatives. Siblings and close relatives have a higher incidence of manic depressive illness than a general population, and cyclothymic characteristics are common among family member of bipolar patient. First degree: 5-10 % chance Identical twin with bipolar disorder: About 40-70% chance G enetic Consideration

6. Developmental theories have hypothesized that faulty family dynamics during early life are responsible for manic behavior in later life. Another psychodynamic hypothesis explains manic episodes as a defense against or denial of depression. P sychodynamic Theories

7. P sychopathology

8. Elevated , Expansive or Irritable Mood: Elevated mood in mania is has four stages depending on the severity of manic episodes. Expansive mood is unceasing and unselective enthusiasm for interacting with people and surrounding environment. Sometimes irritable mood may be predominant, especially when the person is stopped from doing what he wants. There may be rapid, short lasting shifts from euphoria to depression or anger. C linical features

9. Psychomotor Activity There is an increased psychomotor activity ranging from over activeness and restlessness to maniac excitement. The person involves in ceaseless activity. These activities are goal oriented and based on external environment cues. Speech and Thought Flight of ideas: Thought racing in the mind, rapid shifts from one topic to another. Pressure of speech: Speech is forceful, strong and difficult to interrupt. Uses playful language with punning, rhyming, joking, teasing and speaks loudly.

10. Clang Association: These are ideas that are related only by similar or rhyming sounds rather than actual meaning. Delusion of grandeur Delusion of persecution Distractibility Other features Increased sociabilities Impulsive behavior Disinhibition Hypersexual & promiscous behavior Poor judgment

11. S ymptoms of hypomania

12. Psychological tests such as Young mania rating scale ICD 10 diagnostic criteria Based on sign and symptoms D iagnosis

13. Electroconvulsive Therapy : ECT can also be used to acute manic excitement if not adequately responding to antipsychotics and lithium. Psychosocial Treatment: Family and marital therapy is used to decrease intrafamilial and interpersonal difficulties and to reduce or modify stressors. The main purpose is to ensure continuity of treatment and adequate drug compliance.

14. Guidelines for responding to a person experiencing mania If appropriate, arrange for a review of the person’s medication for mania and an initial or follow-up psychiatric assessment if their care plan needs reviewing. A mental health assessment may be appropriate to undertake & see the essentials resource ‘What is a mental health assessment?’. A person’s cultural background can influence the way symptoms of mental illness are expressed or understood. It is essential to take this into account when formulating diagnosis and care plans. Tell the person what is expected of him or her, but be realistic. For example, if the person needs to pace, facilitate this in an area that does not disrupt others. N ursing management

15. Encourage respect for the personal space of others, and also show respect for the person experiencing mania. Encourage and support any ideas the person has that are realistic and in keeping with his or her healthcare regime. It is possible for people to experience a mixed episode in which mood can alter rapidly between euphoria, sadness and irritability. Suicidal thoughts and psychotic features may be present. Ensure your ongoing assessment includes asking about thoughts of self-harm and suicide. Provide the person with consistent limits. Make sure all staff are clear about these and that they reinforce set limits. Give the person clear, simple directions. It is far more effective to suggest alternative strategies, because the person will be easily distracted, rather than directly forbid an action.

16. Encourage the person to organize and slow his or her thoughts and speech patterns, by focusing on one topic at a time and asking questions that require brief answers only. If his or her thoughts and speech become confused, try to cease the conversation and sit quietly together to help him or her calm down. Avoid verbal confrontations with the person, who is likely to have minimal tolerance. Limit the person’s interactions with others as much as possible and remove any external stimulation (for example, noise) where possible. Attempt to provide an area that is private, quiet and dimly lit.

17. However, be careful to avoid completely isolating the person. Encourage the development of regular sleeping patterns, and remove distractions during normal sleeping periods. Monitor recovery, compliance with medication and general physical health (including nutrition, weight, blood pressure etc). Provide education on possible side effects to any mood stabilizing medication (such as lithium carbonate or sodium valproate) and work with the person to develop appropriate actions to address any issues. If lithium has been prescribed, be aware of signs of toxicity (for example, vomiting, diarrhea, tremors, drowsiness, muscle weakness and/or ataxia). Lithium has a narrow therapeutic margin and requires regular monitoring of blood levels.

18. The person may find it hard to sit down long enough to take adequate food and fluids. Offer food and drinks that can be taken ‘on the run’, such as sandwiches. It is important to monitor fluid intake, especially if lithium has been prescribed, because dehydration will exacerbate lithium toxicity. Provide family members and caretakers with information about mania if appropriate, as well as reassure and validate their experiences with the person .

19. Encourage family members and caretakers to look after themselves and seek support if required. Be aware of your own feelings when caring for a person experiencing mania. Arrange for debriefing for yourself or for any colleague who may need support or assistance — this may occur with a clinical supervisor or an Employee Assistance Service counsellor. Treatment of mania Careful assessment to rule out organic conditions is an important first step in the management of mania. Often hospitalization is required for someone who is experiencing acute mania. Both mood stabilizing agents such as lithium carbonate or sodium valproate and an antipsychotic may be needed to treat psychotic symptoms, agitation, thought disorder and sleeping difficulties.

20. Benzodiazepines may be useful to reduce hyperactivity. Treatment with lithium alone may have a relatively slow response rate (up to two weeks after a therapeutic blood level is established), so that adjunctive medication such as sodium valproate is usually required. Regular monitoring of blood levels for lithium and valproate is essential because of the potential for toxicity. Hypomania may be managed with lithium or valproate and benzodiazepines. Doses can be lower than for mania, and may prevent progression to a manic episode.

21. Maintenance therapy needs to be based on an assessment of severity, recurrences and risks of ongoing use of medication. Psychosocial strategies including education, counselling and support for the person and his or her family can help with understanding, stress management and compliance with medication.

22. Depression

23. Depression is a widespread mental health problem affecting many people. The lifetime risk of depression in males 8-12% and in females its 20-26%. Depression occurs twice as frequently in women as in men. The median age at onset of bipolar disorder is 18 years in men and 20 years in women. The highest incidence of depressive symptoms has been indicated in individuals without close interpersonal relationship and in person who are divorced or separated. Prevalence of suicide shows large peak in spring and a smaller one in October. Major depressive often is associated with a variety of medical conditions. Depression is one of the leading cause of disability across the world. The World Health Organization 2006 estimates that depression will rank second only to heart disease by 2020 in terms of global disability. An estimated 3-4 % of India’s 100 crore plus population suffer from major mental disorders about 7-10% of the population suffers from minor depressive disorder. Depressive Episode

24. An estimated 3.8% of the population experience depression, including 5% of adults (4% among men and 6% among women), and 5.7% of adults older than 60 years. Approximately 280 million people in the world have depression. Depression is about 50% more common among women than among men. Worldwide, more than 10% of pregnant women and women who have just given birth experience depression.

25. C lassification of Depression (ICD 10)

26. Biological Factors Genetic, neurological, hormonal, immunological, and neuroendocrinological mechanisms appear to play a role in the development of major depression, and many of these factors center around reactions to stressors and the processing of emotional information. Etiological processes may be modified by gender and developmental factors. Environmental and Personal Vulnerabilities Etiological models for depression are largely diathesis-stress models in which stressful experiences trigger depression in those who may be vulnerable due to biological and psychosocial characteristics and circumstances. Environmental stressors associated with depression include acute life events, chronic stress, and childhood exposure to adversity. Personal vulnerabilities associated with depression include cognitive, interpersonal, and personality factors. Biological, environmental, and personal vulnerabilities interact to contribute to the development of depression and also may be affected by depressive states in a bidirectional process. E tiology

27. Co-Occurring Disorders Depression rarely occurs independent of other psychological disorders, including anxiety, substance abuse, behavioral, and personality disorders, as well as other medical illnesses. The presence of co-occurring psychological and medical disorders exacerbates the clinical and social consequences of depression, and makes it more challenging to treat. Resilience and Protective Factors Certain biological, environmental, and personal factors have also been associated with the protection from or the overcoming of risk factors and adverse conditions related to the development of depression.

28. Neurochemical Decreased level of nor-epinephrine and serotonin Genetic theories In 1 st degree relatives & 70% in twins Endocrine Theories Disturbance in HPA (hypothalamic pituitary adrenaline) cause malfunction and creates hormonal imbalance. Ex. Cortisol & Thyroid Circadian Rhythm Changes in circadian rhythm, changes in sleep wake cycle, changes in medication, nutrition, hormones etc Changes in brain anatomy Loss of neurons in frontal lobes, cerebellum and basal ganglia Psychoanalytic theory Fixation in oral sadistic phase of development. Eg . Loss of loved object Behavior theory Depressio n is conditioned by repeated loss in the past Cognitive theory Negative condition in environment, self and expectation of future Sociological theory Social life events eg . Death, marriage, financial loss

29. According to transactional model of stress/adaptation, depression occurs as a combination of predisposing factors, past experiences and existing conditions. Because of weak ego strength, patients is unable to use coping mechanism used are denial, regression, repression, suppression, displacement and isolation. All these factors lead to clinical depression . P sychopathology

30. The psychopathology of the affective disorders can most easily be described by reference to the similarity of the abnormal affect with normal emotions of the same kind. In depression, the patients’ sadness deepens to a morbid depression, and the difficulty in concentration becomes retardation of all thought and actions. Depressive patients may show a complete failure of all insight, deny that they are ill and hold steadfastly to their ideas of guilt and punishment. P sychopathology

31. Clinical features Depressed Moods Sadness of mood or loss of interest and loss of pleasure & persistent sadness Depressive cognition Hopelessness, Helplessness and Worthlessness unreasonable guilt and Self blame Suicidal thoughts Ideas of hopelessness , Worthlessness. These gloomy preoccupation may progress to plan for suicide Psychomotor activity Psychomotor retardation Monotonous Voice Agitation Anxiety Restlessness Uneasiness Psychotic features Delusion Hallucination Dysphoric mood Nihilistic

32. Psychological tests: Beck Depression Inventory, Hamilton Scale for depression to assess severity and prognosis Dexamethasone supression Test: The dexamethasone suppression test measures whether cortisol secretion by the adrenal gland can be suppressed. It can also help assess the reason for an excess of cortisol in your body such as if it is due to an excess of adrenocorticotrophic hormone (ACTH) secretion by the pituitary. Toxicology screening suggesting drug induced depression D iagnosis

33. Common symptoms Other symptoms Apathy Fatigue Sadness Thoughts of death Sleep Disturbances Decreased libido Hopelessness Dependency Helplessness Spontaneous Crying Worthlessness Passiveness S ymptoms of depression

34. Psychopharmacology: Antidepressant establish a blockade for the reuptake of nor epinephrine and serotonin into their specific nerve terminals. This permits more available to post synaptic receptors. Antidepressant also increase the sensitivity of the post synaptic receptor sites. SSRIs act by inhibiting the reuptake of serotonin Tricyclic antidepressant mode of action is by blocking the reuptake of nor-epinephrine and serotonin at the nerve terminals, thus increasing the NE & 5HT levels at the receptor site. MAOIs are responsible for the degradation of catecholamines after reuptake.the final effect is the same a functional increase in the NE & 5-HT levels at the receptor site. Atypical antidepressant modestly inhibit the reuptake of nor-epinephrine and dopamine. T reatment modalities

35. Selective Serotonin Reuptake Inhibitors Citalopram , Fluoxetine & Sertraline Tricyclic Antidepressant Amitryptyline , Clomipramine , Imipramine Monoamine oxidase inhibitors Isocarboxazid , Phenelzine Newer Antidepressant Bupropion , Maprotiline A ntidepressant categories

36. Electroconvulsive therapy: Severe Depression with suicidal risk is the most important indication for ECT Light therapy: Sometimes called phototherapy involves exposing the patient to an artificial light source during winter month to relieve seasonal depression. The light source must be very bright, full spectrum light, usually 2500 Lux. Repetitive Transcranial Magnetic Stimulation & Vagus Nerve Stimulation directly affects brain function by stimulating the nerves that are direct extension of the brain. P hysical Therapies

37. Psychotherapy Cognitive therapy Supportive psychotherapy Group therapy Family therapy Behavior therapy P sychosocial Treatment

38. ASSESSMENT Obtain History, Physical Examination and Laboratory Tests BACKGROUND After determining that the patient is stable, the goal is to gain a complete understanding of the patient’s medical, social, and mental health history and recognize current signs and symptoms of depression for diagnostic and treatment purposes. The diagnosis of Major Depressive Disorder includes: • A clinical course that is characterized by one or more major depressive episodes without a history of manic, mixed, or hypomanic episodes, or without being attributed to other medical or mental disorders Presence of depressed mood or loss of interest or pleasure, along with at least 4 additional symptoms as defined by the DSM-IV-TR criteria for MDD Symptoms have been present during the same 2-week period, nearly every day, and represent a change from previous functioning Symptoms cause clinically significant distress or impairment in social and occupational functioning N ursing Intervention

39. Symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). Key elements in the clinical assessment include: • A clinical interview focusing on past medical history and a brief review of systems is generally sufficient to rule out medical disorders causing major depression Focused physical examination and laboratory testing as indicated by the review of systems • Findings of depression in Mental Status Exams including slow speech, sighing, psychomotor retardation or agitation, downcast eyes, and little or no smiling are important indicators Determination of medication history and substance abuse/dependence that may contribute to the symptoms or cause the depression • Laboratory testing directed toward detection of associated general medical conditions.

40. RECOMMENDATIONS Once the patient is stable, the clinical assessment should be completed by the primary care provider, including a relevant history, physical examination, and laboratory tests as indicated. Relevant history may include the following: Review of the impact of depressive symptoms on functional status. Typical questions include: During the past few weeks have any physical or emotional problems interfered with your typical daily activities?” “ Has it been more difficult to do things on your own or with your (family, friends, neighbors, church, etc.)?" If positive, areas for brief inquiry include: job, pleasurable hobbies, social activities, and important personal relationships. Review of psychiatric, marital, family, and military service history, past physical or sexual abuse, and medication or substance use.

41. Treatment for any prior mental health problems, past psychiatric hospitalizations, or inability to function in usual life roles. Additional information to help diagnose depression and determine severity of symptoms, such as: Medically unexplained physical symptoms Chronic, debilitating medical conditions Current substance abuse/use Decrease in sensory, physical, or cognitive function Victim of current or past physical or sexual abuse or emotional neglect Family history of major depression

42. Physical examination Appropriate physical examination including mental status exam; in certain subpopulations (e.g., elderly, traumatic brain injury), a screen for cognitive impairment is appropriate. Laboratory tests as clinically indicated, e.g., complete blood count (CBC), chemistry profile, thyroid studies, B12 and folate assessments, pregnancy screen and toxicology screen and an ECG for patients over the age of 40.

43. Obtain a Psychiatric History Key elements of the past history of depression include: prior antidepressant use, past hospitalization for depression or suicidality , and inability to function in usual life roles. Substance use and misuse can cause and/or exacerbate depression. Use of screening tools (such as the Alcohol Use Disorders  Identification  Test can improve detection of substance use disorders There is a high likelihood of depression among individuals with past or present physical or sexual abuse or a history of substance use disorders. Primary care physicians should respectfully ask each patient direct and specific questions about physical or sexual abuse during the history.

44. Physical Examination A brief screening physical examination may uncover endocrine, cardiac, cerebrovascular , or neurologic disease that may be exacerbating or causing depressive symptoms. Particularly in the elderly patient, a full Mental Status Examination (MSE) includes a cognitive screening assessment that may consist of a standardized instrument such as the Folstein Mini-Mental State Examination (MMSE ).

45. If screening is suggestive of cognitive impairment and the patient is not delirious, then a laboratory evaluation to assess for reversible causes of dementia is appropriate. The depression assessment should be continued ( Forsell , et al., 1993). If delirium is present, consider it an emergency and stabilize the patient before returning the algorithm to continue with depressive assessment. Other MSE findings of importance in depression include slow speech, sighing, psychomotor retardation or agitation, downcast eyes, and little or no smiling

46. Laboratory Evaluation Use the history and physical examination findings to direct a conservative laboratory evaluation. There is no biomarker test for depression, so testing is directed toward detection of associated general medical conditions. Appropriate laboratory studies to rule out medical disorders that may include complete blood count (CBC), chemistry profile, thyroid studies, and toxicology screen. For patients over the age of 40, an ECG may be useful. In female patients of childbearing age, consider a pregnancy test to guide treatment decisions. Diagnostic imaging and neuropsychological or psychological testing is not a part of the standard laboratory evaluation for depression. Proceed with the algorithm while awaiting the completion of the laboratory evaluation.

47. Subjective Data: Persistent feelings of sadness, hopelessness, or emptiness. Loss of interest in previously enjoyed activities. Feelings of worthlessness or excessive guilt. Difficulty concentrating, remembering details, or making decisions. Thoughts of death or suicide . Objective Data: Changes in weight. Sleep disturbances (insomnia or hypersomnia ). Observable psychomotor agitation or retardation. Evidence of self-harm behaviors .  

48. Nursing Assessment for Depression   Mental Health Assessment:  Evaluate mood, affect, thought processes, and cognitive function. Risk Assessment for Suicide:  Identify any suicidal ideation, plan, or intent. Physical Assessment:  Monitor for changes in weight, sleep patterns, and energy levels. Social and Functional Assessment:  Assess the impact of depression on relationships and daily functioning. Changes in appetite Fatigue or loss of energy  

49. Nursing Diagnosis for Depression   Risk for Suicide related to depressive symptoms. Disturbed Sleep Pattern related to depression. Imbalanced Nutrition: Less Than Body Requirements related to decreased appetite. Impaired Social Interaction related to withdrawal and reduced interest in activities. Hopelessness related to negative thinking and depressive mood .   Nursing Interventions and Rationales for Depression   Suicide Risk Assessment: Regularly assess for suicidal ideation and plan appropriate interventions .   Rationale: Early identification of suicidal thoughts allows for timely intervention and prevention of harm .

50. Encourage Social Interaction: Promote participation in group activities or therapy sessions .   Rationale: Social engagement can improve mood and reduce feelings of isolation . Sleep Hygiene Education: Provide guidance on establishing a regular sleep routine and a conducive sleeping environment .   Rationale: Adequate sleep is crucial for mental health and overall well-being . Coping Strategies: Teach stress management and coping skills . Rationale: Effective coping mechanisms can help manage depressive symptoms and improve resilience. Assist with Self-Care Activities: Encourage and assist with daily self-care routines.  Rationale: Support in self-care activities can improve self-esteem and promote independence .

51. Nursing Evaluation for Depression   Mood and Affective State:  Regular assessment of mood improvements and changes in affect. Suicide Risk:  Routine evaluation of suicide risk and effectiveness of safety measures. Daily Functioning:  Monitor the patient’s ability to engage in routine activities and social interactions. Treatment Adherence:  Assess adherence to medication and participation in therapy or counseling.

52. Risk for Suicide related to depressive symptoms. Disturbed Sleep Pattern related to depression. Imbalanced Nutrition: Less Than Body Requirements related to decreased appetite. Impaired Social Interaction related to withdrawal and reduced interest in activities. Hopelessness related to negative thinking and depressive mood. L ist for nursing diagnosis

53. B ipolar Disorder

54. 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. I ntroduction

55. 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.

56. 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. S ign & Symptoms

57. SYMPTOMS OF A MANIC EPISODE SYMPTOMS OF A DEPRESSIVE EPISODE Feeling very up, high, elated, or extremely irritable or touchy Feeling very down or sad, or anxious Feeling jumpy or wired, more active than usual Feeling slowed down or restless Racing thoughts Trouble concentrating or making decisions Decreased need for sleep Trouble falling asleep, waking up too early, or sleeping too much Talking fast about a lot of different things (“flight of ideas”) Talking very slowly, feeling like you have nothing to say, or forgetting a lot Excessive appetite for food, drinking, sex, or other pleasurable activities Lack of interest in almost all activities Thinking you can do a lot of things at once without getting tired Unable to do even simple things Feeling like you are unusually important, talented, or powerful Feeling hopeless or worthless, or thinking about death or suicide

58. 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.

59. 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 activitylevel 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. „ B ipolar disorder types

60. 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.

61. 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. „ Conditions That Can Co-Occur With Bipolar Disorder

62. 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.

63. 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. E tiology

64. 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.

65. 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. D iagnostic method

66. 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. T reatment

67. 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. Psychotherapy

68. Risk for Injury related to impulsivity and altered judgment during manic episodes . Disturbed Sleep Pattern related to decreased need for sleep during manic episodes. Imbalanced Nutrition: Less Than Body Requirements related to poor appetite or disinterest in food during depressive episodes. Risk for Suicide related to the presence of suicidal ideation, hopelessness, and depressive symptoms. Social Isolation is related to mood swings, erratic behaviors, and stigma associated with bipolar disorder. N ursing diagnosis for bipolar disorder

69. Ineffective Coping is related to difficulties in managing stressors and mood fluctuations. Risk for Noncompliance related to lack of insight, medication side effects, or denial of illness. Impaired Verbal Communication related to rapid or pressured speech during manic episodes or psychomotor agitation. Disturbed Thought Processes related to cognitive impairments, such as poor concentration or racing thoughts during manic episodes. Chronic Low Self-Esteem related to the impact of bipolar disorder on self-image and functioning.

70. The following are the nursing priorities for patients with bipolar disorders: Mood stabilization.  Managing and stabilizing mood fluctuations to minimize the severity and duration of manic and depressive episodes in patients with bipolar disorder. Medication adherence.  Ensuring consistent adherence to prescribed medications to effectively manage symptoms and prevent relapses. Suicide risk assessment and prevention.  Assessing and monitoring the risk of suicide in patients with bipolar disorder, implementing appropriate interventions, and providing support to prevent self-harm. Psychoeducation and self-management skills.  Providing education to patients and their families about bipolar disorder, its symptoms, triggers, and strategies for managing the condition to enhance self-awareness and empower them to actively participate in their treatment. Psychosocial support and therapy.  Offering psychosocial support, counseling, and therapy to address emotional challenges, improve coping skills, and enhance overall quality of life for patients with bipolar disorder.