Many Americans are suffering form mood disorders that affect the ability to function normally one major mood disorder is bipolar. Bipolar is a mental disorder that presents one or more episodes of abnormal energy levels, cognition, and mood. These moods or behaviors are commonly referred to as mania, hypomania, mixed episode or cyclothymic disorder. In this essay I will describe the types of bipolar disorders (e.g. bipolar I and II, and cyclothymia). Also topics to be discussed are the etiology of bipolar, medications used as treatment and the behaviors associated with these disorders. The following paragraph will begin with the types of bipolar disorders.
Bipolar disorders are defined by the individual type such as bipolar I, bipolar II, and cyclothymia. Bipolar I is when the paient experiences at lest one or more episodes of mania alternating with major depression. A manic episode is when a client has an abnormally elevated mood that is accompanied by abnormal behavior that inhibits the ability to function normally. Patients with bipolar I disorder might also suffer from occurrences of depression. As stated by Montgomery, Richardson 2008 “the recurring, episodic nature of the mood disturbances involved can cause long-term damage to the psychological, occupational and social functioning of those affected”. Often times, a pattern of cycling involving mania and depression are present. Even though a patient is diagnosed with bipolar disorder they can still function normally in between episodes of mania and depression. Some examples of manic behavior might be spending money far beyond your means or having sex with random people, or pursuing flamboyant, impractical goals. Unfortunately during severe manic episodes, a client loses extreme touch with reality. Some clients that have severe episodes may also become delusional and at times behave in a peculiar way. In America according to Vidbeck 2008 on pg 317, “The lifetime risk for bipolar disorder is at least 1.2% with a risk of completed suicide for 15%”. These numbers of completed suicides are causing a detrimental affect considering the small percent of those diagnosed. Most of these issues arise because of depression.
Depression may follow shortly after one has been diagnosed with bipolar, or not appear for weeks or months. Depression is a severe issue that is surrounding suicide that is why nurses must take great into account when doing their assessment on a patient. Bipolar disorder has also been linked to neurocognitive impairment which is the next topic of discussion.
Science has advanced Many people with bipolar also experience long periods of neurocongive degeneration. As stated by Wingo, Harvey, Baldessarini 2009, “We hypothesize that neurocognitive impairment in BPD patients adversely affects functional recovery, which is strikingly uncommon or delayed, even when euthymia is achieved with modern symptomatic treatments” (2009). Euthymia is a reasonably positive mood however it is the impaired thought processing due to nuerocognitive impairment that can cause behavioral disorders. This can arise from underlying issues that are primarily associated with bipolar and its neurological aspects. Brain functions normally when neuronal synapses are in place with no abnormal dysfunction. This is commons sense if abnormalities are present in the brain there is no way the human body can function normally. Next topic is based on the various alternative remedies that can help people with bipolar.
Patients that have bipolar disorders may usually stay with problematic issues forever and to alleviate the pain occurrences patients have found alternative routes to aid them. Fortunately as psychology improves more and more therapeutic forms of treatment are being tested as possible therapeutic aids in fights against bipolar. Some examples are: complimentary alternative medicine (CAM) which includes light therapy, meditation, and herbal/dietary therapy. As stated in Mohr 2009 pg 329-331 “Clients employ a wide variety of CAM therapies for mood disorders, especially depression”. The CAM therapies have been very useful in reducing some of the depression associated with bipolar. Another alterative is psychopharmacology which is discussed in the following paragraph.
Base on various problems concerning the high rates of people diagnosed with bipolar many researchers try to find the causes or root of the problem in a biological aspect and try to prevent the reoccurrence through use of medication. Though the cause of bipolar is truly unknown many pharmacologic studies have led to hypotheses involving the neurotransmitters catecholamine and serotonin as explanatory links contributing to bipolar disorder. Researchers have known for decades that a relation exists between mood disorders, neurotransmitters and medication. Once medication is given neuro-transmitters in the brain trigger the mood disorders. The six most effective mood stabilizers as stated by John McManamy 2008 are: Lithium, Carbamazepine, and Depakote, Lamictal, Neurontin, Topamax. McManamy states that “more than 65 percent of patients with classical symptoms adequately respond to this common salt” (Lithium). These medications are equally effective as certain acute phases of treatments for mania, although lithium is usually the first treatment of choice because of its long research, relative safety, and inexpensiveness. Another thing to consider is the patients’ ability to pay for the medication. The affordability of the medication is another reason why most clients don’t adhere to a therapeutic medication regime they simply can’t afford it. Usually according to a review article by Bowden 2010, the first, pharmacological options given by most clinicians are lithium, valproate, and carbamazepine which are standard treatments, and, clozapine, and antipsychotic medication can be given as alternative or adjunctive therapies to the medcation regime. Importance of psychosocial issues for understanding patients’ illnesses and factors affecting treatment compliance are very important. Mood stabilizers like lithium, some anticonvulsants like depakote and antidepressants like clozapine are the traditional medications that are used in the treatment of bipolar disorder and major depression Bowden 2010. In nursing careful administration of these drugs need to be taken into account. Nurses should always check vital signs, laboratory results, EKG results, and any other somatic aspects accordingly. Serious problems have aroused because of nurses inadequate monitoring. One thing to consider when administering medication like lithium nurses should be watching out for patients drinking to much water because lithium is a salt that increases thirst in the body. The over hydration can lead to fluid imbalances and other problematic issues. When administering depakote nurses should analyze bilirubin levels for possible liver intoxication causing loss of appetite, tiredness, nausea, and yellowing of skin and eyes (jaundice). Bipolar I and II have some similarities however another type to consider is rapid-cycling which is the next topic.
A minority of those diagnosed with bipolar have rapid-cycling. Symptoms of rapid cycling include mania and depression with the patient possibly alternating between mania and depression in the same day. Depressive episodes in bipolar disorder are similar to typical clinical manifestations of depression, with issues like loss of pleasure, depressed mood, low energy and activity, feelings of guilt or worthlessness, and thoughts of suicide. Rapid cyclying ocurrs more often in women than in men as research indicates. According to decades of old research done by Tondo, M.D., and Ross J. Baldessarini, M.D 1998 women and men, respectively, represented 71.7% (357/498) and 28.3% (141/498) of rapid-cycling cases (a 2.53-fold difference), but rapid cycling occurred in only 29.6% of women and 16.6% of men. Since women are more prone to this issue nurses should gear there assessment and planning options around these factors. Things to consider about female clients experiencing rapid cycling as mentioned earlier are the high possibilities of committing suicide. Check for certain patterns, analyze patients past history of attempted suicide(s), check cognitive level and ask open-ended questions to get more information. Nurses should take these necessary precautions when looking to formulate planning options for clients with this type of bipolar disorder.
In conlusion bipolar disorder is a mental impairment that many Americans are diagnosed with every year. Many people are insensitive to individuals who have bipolar disorders however one thing should be made clear, bipolar disorder is not something that many patients can control with ease. It’s hard to control impulse controlled by neurological dysfunctions. Bipolar disorder affects many people around the world and as research advances people who experience bipolar will have better options. At times clinicians might be quick to give medication without looking to the ramifications clearly. Patients are human beings with desires like everyone else these aspects of life should not be overlooked. Nurses are caregivers who should always place safety first when give therapeutic care to patients. Thing like medication errors are always being blamed on nurses.
Wingo AP, Harvey PD, Baldessarini RJ. Neurocognitive impairment in
bipolar disorder patients: functional implications. Bipolar Disord 2009: 11: 113-125. a 2009 The Authors Journal compilation a 2009 Blackwell Munksgaard
Montgomery P, Richardson AJ. Omega-3 fatty acids for bipolar disorder. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD005169. DOI: 10.1002/14651858.CD005169.pub2.
John McManamy 2008 McMan’s Depression and Bipolar Web
A Placebo-Controlled 18-Month Trial of Lamotrigine
and Lithium Maintenance Treatment in Recently
Manic or Hypomanic Patients With Bipolar I Disorder
Charles L. Bowden, MD; Joseph R. Calabrese, MD; Gary Sachs, MD; Lakshmi N. Yatham, MB, FRCPC, MRCPsych;
Shaheen Akthar Asghar, MD; Magne Hompland, MD; Paul Montgomery, PharmD; Nancy Earl, MD;
Tonya M. Smoot, MS; Joseph DeVeaugh-Geiss, MD, for the Lamictal 606 Study Group