Bipolar / Mania
CLASS OBJECTIVES: Bipolar Disorders
1. Define Mania / Hypomania Mood swings from profound depression to extreme
2. Compare and contrast the 3 types of bipolar disorders euphoria (mania), with intervening periods of normalcy
3. Discuss the possible risk factors for bipolar disorders Impair occupational functioning or usual social activities
4. Discuss the treatment of bipolar disorders or relationships
5. Discuss nursing interventions for bipolar disorder - o May require hospitalization to prevent harm to self /
specifically mania others
Mania: 3 Types of Bipolar Disorders- Spectrum
Criteria for Manic Episode – DSM – 5 1. Bipolar 1
Intense alteration in mood – expressed by feelings of: 2. Bipolar 2
o Elevated 3. Cyclothymic
o Expansive
o Irritable Bipolar I Disorder (the worst one)
o Persistently increased goal directed activity or energy Full syndrome of manic symptoms (extreme mania –
o Can change quickly to irritation & anger severe depression)
o Lasting at least 1 wk – most of day – nearly every o Risk for exhaustion
day Usually alternate with episodes of depression / anxiety &
Not due to meds, substances, other disease agitation
Psychosis is possible
Criteria for Mania – DSM 5 o Auditory hallucinations – most common
At least 3 of following S & S: Comorbidity:
Inflated self-esteem or grandiosity o 75% anxiety disorder / ADHD / impulse control /
o Grandiose delusion & persecutory delusions conduct disorder / substance use disorder > 50% /
Decreased need for sleep – some not at all! (This is higher medical issues
leading to mania) o HIGH RISK FOR SUICIDE
o Usually, won’t take time to eat well
More talkative than usual – pressured speech Bipolar II Disorder
o Often circumstantial & tangential Major depression with episodic occurrence of hypomania
Flight of ideas, racing thoughts (less severe / dramatic than mania episode) (hypomania –
o Loose associations / clang association extreme depression)
Distractibility Has never met criteria for full manic episode
Comorbidity
Increase in goal-directed activity (work, school, sexual) /
Psychomotor agitation o Anxiety disorders / eating disorders (binge eating) /
Excessive involvement in activities that have high substance use disorders
potential for painful consequences
Impairment in social or occupational functioning Cyclothymic Disorder
Often necessitates hospitalization to prevent harm to self Symptoms of hypomania alternating with mild to
– CAN BE EMERGENT moderate depression for at least 2 years (adults)
May have other psychotic symptoms (hypomania – mild/mod depression) in the middle of the
Episode is not attributable to effects of substance or spectrum
another medical condition Do not meet criteria for other types – yet disturbing
enough to affect functioning
HYPOMANIA (baby mania) o Comorbidity
Euphoric – Increases – Substance use disorder / sleep disorders / ADHD
functioning
o Excessive activity – energy Bipolar Disorder with Rapid Cycling:
for at least 4 days / at least 4 mood episodes in 12 months
3 of criteria of mania More severe symptoms – resistant to tx
Episode is change for person &
is observable by others Childhood Bipolar???????
Episode not severe enough to High Trend in the past. A lot of psychiatrists were dx
impair functioning or require children w bipolar and started medications
hospitalization. Changed to Disruptive Mood Dysregulation Disorder
No psychosis with manic (DMDD) (found out that when they grew up, they just
portion – but may be present had depression)
in depressive state! If truly Bipolar & teen – very high suicide risk
Not attributable to substance
use
Bipolar Disorder: Developmental Implications
CLASS OBJECTIVES: Bipolar Disorders
1. Define Mania / Hypomania Mood swings from profound depression to extreme
2. Compare and contrast the 3 types of bipolar disorders euphoria (mania), with intervening periods of normalcy
3. Discuss the possible risk factors for bipolar disorders Impair occupational functioning or usual social activities
4. Discuss the treatment of bipolar disorders or relationships
5. Discuss nursing interventions for bipolar disorder - o May require hospitalization to prevent harm to self /
specifically mania others
Mania: 3 Types of Bipolar Disorders- Spectrum
Criteria for Manic Episode – DSM – 5 1. Bipolar 1
Intense alteration in mood – expressed by feelings of: 2. Bipolar 2
o Elevated 3. Cyclothymic
o Expansive
o Irritable Bipolar I Disorder (the worst one)
o Persistently increased goal directed activity or energy Full syndrome of manic symptoms (extreme mania –
o Can change quickly to irritation & anger severe depression)
o Lasting at least 1 wk – most of day – nearly every o Risk for exhaustion
day Usually alternate with episodes of depression / anxiety &
Not due to meds, substances, other disease agitation
Psychosis is possible
Criteria for Mania – DSM 5 o Auditory hallucinations – most common
At least 3 of following S & S: Comorbidity:
Inflated self-esteem or grandiosity o 75% anxiety disorder / ADHD / impulse control /
o Grandiose delusion & persecutory delusions conduct disorder / substance use disorder > 50% /
Decreased need for sleep – some not at all! (This is higher medical issues
leading to mania) o HIGH RISK FOR SUICIDE
o Usually, won’t take time to eat well
More talkative than usual – pressured speech Bipolar II Disorder
o Often circumstantial & tangential Major depression with episodic occurrence of hypomania
Flight of ideas, racing thoughts (less severe / dramatic than mania episode) (hypomania –
o Loose associations / clang association extreme depression)
Distractibility Has never met criteria for full manic episode
Comorbidity
Increase in goal-directed activity (work, school, sexual) /
Psychomotor agitation o Anxiety disorders / eating disorders (binge eating) /
Excessive involvement in activities that have high substance use disorders
potential for painful consequences
Impairment in social or occupational functioning Cyclothymic Disorder
Often necessitates hospitalization to prevent harm to self Symptoms of hypomania alternating with mild to
– CAN BE EMERGENT moderate depression for at least 2 years (adults)
May have other psychotic symptoms (hypomania – mild/mod depression) in the middle of the
Episode is not attributable to effects of substance or spectrum
another medical condition Do not meet criteria for other types – yet disturbing
enough to affect functioning
HYPOMANIA (baby mania) o Comorbidity
Euphoric – Increases – Substance use disorder / sleep disorders / ADHD
functioning
o Excessive activity – energy Bipolar Disorder with Rapid Cycling:
for at least 4 days / at least 4 mood episodes in 12 months
3 of criteria of mania More severe symptoms – resistant to tx
Episode is change for person &
is observable by others Childhood Bipolar???????
Episode not severe enough to High Trend in the past. A lot of psychiatrists were dx
impair functioning or require children w bipolar and started medications
hospitalization. Changed to Disruptive Mood Dysregulation Disorder
No psychosis with manic (DMDD) (found out that when they grew up, they just
portion – but may be present had depression)
in depressive state! If truly Bipolar & teen – very high suicide risk
Not attributable to substance
use
Bipolar Disorder: Developmental Implications
