Nursing Considerations for patients with Bipolar Disorder
Bipolar disorder is a disorder that is characterized by mood swings ranging from hyperactivity (manic states) to extreme sadness (depression) (Follin, Mill, & Munden, 2006). Because of these characteristics the condition is also referred to as manic-depressive disorder.
Bipolar disorder is thought to be caused by a combination of hereditary, environmental, and psychological factors, although the exact causes have not been clearly identified. Some chemical changes have been identified, such as an increase in intracellular sodium during episodes of manic-depression, but research has not identified whether the changes are due to the mood swings or if they happen because of them. Changes in dopamine and norepinephrine have also been identified (Follin, et al., 2006).
During the depressive state of bipolar the patient exhibits lack of motivation, difficulty concentrating, crying episodes, and difficulty maintaining their normal sleep patterns(either sleeping too much or too little). Manic states may be excessive mania where that patient feels euphoric and engages in high-risk activities such as increased sexual activity and decreased self-control or a lessened state of mania where the patient exhibits some of the same behaviors, but to a lesser extent (Wood, 2011).
Treatment for bipolar disorder includes group therapy and individual therapy combined with drugs such as Lithium, to control mania. Lithium takes about a week to reach therapeutic levels, so antipsychotic drugs may be used until a therapeutic level is reached(Follin, et al., 2006).
Nurses are in a position to build rapport and counsel that bipolar patient on effective techniques for managing the disorder and maintaining a good state of physical health. Interventions for the patient experiencing mania include encouraging patients to eat high-calorie finger foods to help maintain nutrition during states where the patient may not want to sit down to consume a meal(Follin, et al., 2006). It is also important to encourage and provide a quiet non-stimulating environment and quiet activities for the patient to do. During periods of depression, patients should be encouraged to participate in group therapy. It is also helpful to encourage patients to use a journal to write down their feelings when they are having difficulties talking about them.
Follin, S., Mill, E., & Munden, J. (Eds). (2006). Diseases: A nursing process approach to excellent care. Philadelphia, PA: Lippincott Williams & Wilkins.
Wood, D. (2011). What is Bipolar Disorder? Mental Health Matters. Retrieved from: http://www.mental-health-matters.com/bipolar/68-what-is-bipolar-disorder