Bipolar Disorder
Manic Episode
Pathophysiology Review
A
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 symptoms
Mixed – concurrent symptoms of both mania and clinical
depression
Acute symptoms come in cycles with periods of “euthymia”
or a
stable “normal” mood
Pathophysiology Review
Pathophysiology Review
Genetic factor, and neuroendocrine and
neurobiological changes are associated
with the development of bipolar disorder
Neurotransmitters dopamine,
norepinephrine and glutamate, serotonin
and GABA are also disrupted.
Primary Concept
Mood and Affect: (Giddens, pp. 317)
Mood – the way a person feels
Affect – observable response to one’s
feelings
Mood
and
affect
are conceptualized as
being on a
spectrum
from one end (low
mood
or depression) to the opposite end
(mania)
Primary Concept
Secondary concepts
Psychosis – syndrome of neurocognitive
symptoms that impairs cognitive capacity
leading to deficits of perception, functioning
and social relatedness (Giddens, pp 348)
Loss of contact with reality
Clinical Judgment
Patient Education
Priority Focused Assessments
Mental Status Exam* (MSE)
Appearance/Behavior/Motor behavior
unusual dress, hyperactive or “busy” behavior
excessive engagement in pleasurable activities (like
excessive buying, sexual acting out)
Speech
rapid and “pressured speech” (speech that is hard to
interrupt)
Mood/Affect
feeling “on top of the world” or be angry and irritable
mood can be “labile” (changes rapidly)
Priority Focused Assessments
Mental Status Exam* (MSE)
Thought process
“flight of ideas” (jumps from subject to subject)
easily distracted; may report racing thoughts
Thought content
inflated sense of self
grandiose delusions (false beliefs of having
extraordinary powers or abilities)
other types of delusions (paranoid or jealous)
Priority Focused Assessments
Mental Status Exam* (MSE)
Perception
hallucinations may be present
Insight /judgment
Little insight (understanding) of having an illness
judgment impaired and can lead to painful consequences
impulsive; can act aggressively
Cognition
ability to concentrate is impaired
easily distractible
Clinical Manifestations
Memory Tool:
Symptoms of Mania
:
D I G F A S T
D
istractibility and easy frustration
I
rresponsibility and erratic uninhibited behavior
G
