Chapter 13: Bipolar & Related Disorders

The three primary disorders discussed are Bipolar I, characterized by at least one full manic episode which may include psychotic features and necessitate hospitalization; Bipolar II, requiring at least one hypomanic and one major depressive episode; and Cyclothymic Disorder, involving long-term, fluctuating hypomanic and mild depressive symptoms. The etiology is multifaceted, combining a strong genetic predisposition with neurobiological factors, such as dysregulation of key neurotransmitters (dopamine, norepinephrine, serotonin) and structural abnormalities in areas like the prefrontal cortex and amygdala. High rates of comorbidity with anxiety and substance use disorders, particularly alcohol misuse, contribute to a high mortality risk from suicide. Acute manic episodes present with symptoms like unstable euphoria progressing to irritability, constant physical activity, distractibility, excessive goal-directed energy, and hallmark thought process changes, including pressured speech, flight of ideas, and delusions. Nursing care is prioritized around safety and stabilization, focusing on injury prevention, restoring physiological integrity (hydration, sleep, nutrition), and implementing firm, non-threatening limit-setting techniques in a low-stimulus environment. Pharmacological management relies heavily on mood stabilizers, notably Lithium (which requires careful monitoring of therapeutic and toxic blood levels) and anticonvulsant agents, supplemented by second-generation antipsychotics for agitation or maintenance. Finally, the chapter details adjunctive psychosocial interventions like Cognitive Behavioral Therapy (CBT), Interpersonal and Social Rhythm Therapy, and Family-Focused Therapy, all crucial for enhancing medication adherence and preventing future relapses.