Bipolar Spectrum Disorders 2. Bipolar II disorder: • Usually presents with recent severe & prolonged periods of depression that alternates with at least 1 or more Hypomanic episode(s ) • Hypomania - tends to be euphoric, not psychotic and usually not life-threatening & hospitalization not usually required (symptomatic at least 1-2 contiguous days) • No psychosis (if occurs, becomes Dx’d as Bipolar I) • Depressive component , increased energy and cognition may increase risk for suicide • Red flags for Hypomania – decreased need for sleep with excessive daytime fatigue • Impairment in work, interpersonal relationships and social functioning is not usually as severe as in Bipolar I, but is still significant and can be very disruptive • Onset can occur peripartum and also present with catatonia 122
Comparison of Hypomania and Mania Hypomania (Bipolar II) 1. Unstable affective state (crying, rage, euphoria, flatness) 2. Change in behavior to expansive or agitated state, possibly euphoric 3. Rarely perceptual disturbances except possibly racing thoughts 4. Vegetative functions (disturbance in appetite, sleep, energy and sex) 5. Functional impairment (some difficulty carrying out and problem-solving ADLs) 6. Increased risk for suicide & Substance Use Disorder (SUD) 7. No psychosis Mania (Bipolar I) 1. Extreme mood swings (elation & major depression) 2. Change in behavior to euphoria or agitated state 3. Often varying degrees of perceptual disturbances (racing thoughts, grandiose delusions, difficulty concentrating, impulsivity, poor perception of reality & lack of insight) 4. Vegetative functions (fluctuation between cravings of carbohydrates and no appetite, doesn’t feel the need to sleep (for days), excessive energy and preoccupation or lack of interest in sex) 5. Functional Impairment (Often major impairment, may be reckless and dangerous) 6. High increased risk for suicide & SUD 7. Often psychotic (hallucinations &/or delusions) 8. Nursing priorities (assess for risk of suicide, self-harm or violence; reduce risk for problems with food and fluid intake (inadequate, choking-use finger foods ), risk for injury (falls, fights), risk for exhaustion/cardiac complications and death, decrease milieu stimulation, early recognition of escalation and need for limit-setting and de-escalation techniques) 123 See Varcarolis, pp 224-225 and Table 16-1, p. 229 for more details
124 Giddens (2017) Fig. 33-3, p. 324 Hypomania Mania Depression
Bipolar Spectrum Disorders – cont . 3. Cyclothymia: • Hypomanic episodes alternating with minor depressive episodes (at least 2 yrs. duration in adults, 1 yr. in children) • Irritable hypomanic episodes fluctuating with dysthymic depression 4. Bipolar Disorder Unspecified: • Disorders with bipolar features that do not meet criteria for any of the previously specified disorders • Although these disorders can cause distress and disruption in the individual’s work, social, and private life, they are not a distinct bipolar disorder 5. Bipolar Disorder with Rapid Cycling features (can be within minutes or days): •
You've reached the end of your free preview.
Want to read all 224 pages?
- Winter '16
- janice lawrence
- Nursing, Selective serotonin reuptake inhibitor, Major depressive disorder, Antidepressant