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Bipolar DisorderManic Episode
Pathophysiology ReviewA manic episode is part of psychiatric disorder called Bipolar Disorder or per the DSM* - Bipolar Spectrum Disorders (BSDs) Bipolar Disorder can have acute episodes of:Mania – elevated, expansive or irritable mood accompanied by changes in activity and energy Hypomania – lesser manic symptoms Major depression - clinical depressive symptomsMixed – concurrent symptoms of both mania and clinical depression Acute symptoms come in cycles with periods of “euthymia” or a stable “normal” mood
Pathophysiology ReviewGenetic factor, and neuroendocrine and neurobiological changes are associated with the development of bipolar disorderNeurotransmitters dopamine, norepinephrine and glutamate, serotonin and GABA are also disrupted.
Primary ConceptMood and Affect: (Giddens, pp. 317)Mood – the way a person feelsAffect – observable response to one’s feelingsMoodand affect are conceptualized as being on a spectrumfrom one end (low mood or depression) to the opposite end (mania)
Primary ConceptSecondary conceptsPsychosis – syndrome of neurocognitive symptoms that impairs cognitive capacity leading to deficits of perception, functioning and social relatedness (Giddens, pp 348) Loss of contact with realityClinical JudgmentPatient Education
Priority Focused AssessmentsMental Status Exam* (MSE) Appearance/Behavior/Motor behaviorunusual dress, hyperactive or “busy” behaviorexcessive engagement in pleasurable activities (like excessive buying, sexual acting out) Speechrapid and “pressured speech” (speech that is hard to interrupt) Mood/Affectfeeling “on top of the world” or be angry and irritablemood can be “labile” (changes rapidly)
Priority Focused AssessmentsMental Status Exam* (MSE) Thought process “flight of ideas” (jumps from subject to subject)easily distracted; may report racing thoughtsThought contentinflated sense of selfgrandiose delusions (false beliefs of having extraordinary powers or abilities)other types of delusions (paranoid or jealous)
Priority Focused AssessmentsMental Status Exam* (MSE)Perceptionhallucinations may be presentInsight /judgmentLittle insight (understanding) of having an illnessjudgment impaired and can lead to painful consequencesimpulsive; can act aggressively Cognitionability to concentrate is impairedeasily distractible
Clinical ManifestationsMemory Tool: Symptoms of Mania: D I G F A S TDistractibility and easy frustrationIrresponsibility and erratic uninhibited behaviorG