Types of Bipolar Disorder

Bipolar disorder is a condition that affects everyone differently. There are two types of bipolar disorders, and manifestations are not usually the same in different genders. The disorder is inherited in families that are affected by it, but it is not primarily acquired by the family. Bipolar disorder can also present itself in individuals with no family history of the disorder. The condition can potentially be life-threatening, and individuals suffering from it should seek treatment.

Disease or Disorder

Bipolar disorder is a mood disorder characterized by episodes of mania, or hypomania, and major depression (Cerimele, Chwastiak, Chan, Harrison, & Un??tzer, 2013). Manifestations of mania are the decreased need for food and sleep, labile mood, irritability, racing thoughts, high distractibility, rapid and pressured speech, inflated self-esteem, and excessive involvement with pleasurable activities (Grossman & Porth, 2014). Symptoms of major depression are depressed mood, anhedonia, feelings of worthlessness or excessive guilt, decreased concentration, psychomotor agitation or retardation, insomnia or hypersomnia, decreased libido, changes in weight or appetite, and thoughts of death or suicidal ideation (Grossman & Porth, 2014). Hypomania is a less extreme type of mania that is not severe enough to impair function and there are no psychotic features (Trakalo, Horowitz, & McCulloch, 2015). Rapid cycling is also another manifestation of bipolar disorder and is characterized by four or more shifts in mood from normal in a 1-year period (Grossman & Porth, 2014).

Detailed Pathophysiology

According to Trakalo, Horowitz, and McCulloch (2015), there is no definitive cause identified for bipolar disorder. It is thought to arise from a combination of genetic, physiological, environmental, and psychosocial factors. Immunological abnormalities might contribute to the pathophysiology of bipolar disorder. Mitochondrial dysfunction and stress might also be involved in bipolar disorder. Children of parents with the disorder have a 4%-15% risk of developing it as well. Stress; sleep disruptions; family or caregivers with high emotion; and emotionally overinvolved, hostile and critical communication patterns are associated with heritability. Glycogen synthase kinase-3?? and other genes and loci have been determined to have a possible association with bipolar disorder (Trakalo et al., 2015, p. 1809).

There are two types of bipolar disorder: bipolar I and bipolar II disorder. Bipolar I disorder is characterized by one or more manic episodes followed by major depressive episodes (Trakalo et al., 2015, p. 1809). Bipolar II is characterized by one or more major depressive episodes followed by at least one hypomanic episode (Trakalo et al., 2015, p. 1809). Trakalo et al. (2015) state the disorder tends to be recurrent and tends to increase in frequency with age. Bipolar disorder usually appears between ages 15 and 30. Risk factors include family history, drug abuse, periods of high stress, and major life-altering events. Women and men are at equal risk, but women are more likely to experience rapid cycling, depressive symptoms, and are at a greater risk for alcohol abuse (Trakalo et al., 2015, p. 1809).

Behavioral or Psychosocial Related Issues

Individuals with bipolar disorder vary in behavior, depending on what episode they are currently having. Trakalo et al. (2015) explain that the patient may be euphoric when they are manic, and their behaviors will be excessive. They may alter between euphoric and irritable, and increased sexual behavior is common. Women may dress in a seductive manner, and grandiosity can reach delusional proportions. Manic patients do not believe they are sick, even when there is financial or legal trouble, and often refuse treatment. Hypomanic patients feel like they are on top of the world and do not recognize behavior changes in themselves, but those who know them well are aware of changes in behavior (Trakalo et al., 2015).

Genetics or Genomics

Bipolar disorder is a highly heritable disease, with a prevalence of about 85% in twins (Schulze & Ozkan, 2017). How the disorder is inherited is unclear, but the risk of developing the condition is higher for first-degree relatives (Bipolar disorder, n.d.). Studies have found that variations in many genes can combine to increase the risk of getting the disorder; however, further research has not verified the genetic variations (Bipolar disorder, n.d.).

Related Nursing Process

Individuals with bipolar disorder are at risk for injury and have disturbed thought processes, impaired social interaction, self-care deficits, sleep deprivation, and are at risk for suicide (Trakalo et al., 2015, p. 1813). According to Trakalo et al. (2015), the safety of the individual should be of great concern. They should be in a safe environment with reduced stimuli. Low lighting can be used to calm a manic patient. Smoking materials should be removed or prohibited, and smoking should only be allowed under direct supervision. Nurses should facilitate the patient's ability to interact with others and identify behavior that needs to be changed. Tasks that will help improve interactions with others should be assigned. Mediation between the patient and others may be needed if the patient shows negative behavior (Trakalo et al., 2015, p. 1814).

Intake and output should be monitored because the manic patient may be unable to sit down and eat (Trakalo et al., 2015, p. 1815). High-calorie finger foods and nutritious liquids should be given if the patient cannot eat because of hyperactivity (Trakalo et al., 2015, p. 1815). Hyperactive patients that are unable or unwilling to perform activities of daily living should be assisted (Trakalo et al., 2015, p. 1815). Constipation is a common occurrence because manic patients suppress the urge to defecate (Trakalo et al., 2015, p. 1815).

Conclusion

Bipolar disorder manifests in episodes of mania and depression and varies in severity. There is no definitive cause for the disorder, but it is believed to arise from a combination of many factors. Women and men are at equal risk; however, the symptoms usually differ by gender. Behavior changes can place the patient at risk due to hyperactivity or depression. Hyperactivity can cause a deficiency in self-care, therefore, finger-food that is high in calories should be provided for snacking on the go. Depression also places the patient at risk for suicidal thoughts. Although the cause is unknown, heredity of the disease is high. Bipolar disorder symptoms are often not recognized by the patient, and they may not believe they are sick. Safety is critical for patients with this disorder.

References

Bipolar disorder - Genetics Home Reference - NIH. (n.d.). Retrieved September 30, 2018, from https://ghr.nlm.nih.gov/condition/bipolar-disorder

Cerimele, J. M., Chwastiak, L. A., Chan, Y.-F., Harrison, D. A., & Un??tzer, J. (2013). The presentation, recognition and management of bipolar depression in primary care. JGIM: Journal of General Internal Medicine, 28(12), 1648“1656. https://doi-org.db07.linccweb.org/10.1007/s11606-013-2545-7

Grossman, S. C. & Porth, C. M. (2014). Porth's pathophysiology: Concepts of altered health states (9th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Schulze, T. G., & Ozkan, S. (2017). Update on Research into the Genetics and Pharmacogenetics of Bipolar Disorder. Dusunen Adam: Journal of Psychiatry & Neurological Sciences, 30(3), 165“169. https://doi-org.db07.linccweb.org/10.5350/DAJPN20173003001

Trakalo, K., Horowitz, L., & McCulloch, A. (Eds.). (2015). Nursing: A concept-based approach to learning (2nd ed.). Boston, MA: Pearson.

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