Bipolar Affective Disorder

Bipolar affective disorder is a serious mental health condition where the individual may experience periods of
depression and mania (elevated mood). The aetiology behind the condition is due to genetics, environment and
substance abuse.

Symptoms
 Chronic irritability
 Panic attacks
 Affective Symptoms (e.g prolonged sadness, lack of interest)
 Mood Lability (changes in mood)
 Subthreshold manic /hypomanic symptoms (manic one week – hypomanic four days)
E.g Manic symptoms - Decreased need for sleep, flight of ideas or racing thoughts.
Hypomanic symptoms- More talkative than usual, attention easily drawn to unimportant stimuli.
 Depressive episode – feelings of worthlessness, fatigue or lethargic
 Functional Impairment

Bipolar I — with extreme, long-lasting highs (mania) as well as depressive episodes. It may also
include psychosis (difficulty knowing what is real or not).

Bipolar II — with highs that are less extreme (hypomania) that only last or a few hours or days, as well as depressive
episodes. It will also include periods of normal mood.

Nursing Intervention as a Mental Health Nurse:

 Develop rapport (empathy and trust) – Assessing suicidal risks, MSE,
 Providing therapeutic communication
 Providing safe environment
 Meeting psychological needs
 Promote positive health behaviours – relapse prevention for substance abuse
 Collaboration with relevant service provides – ECT (induces a mild seizure that disrupts severe bipolar
disorder)

Pharmacological Treatments
Mood Stabilizers Mechanism of Action: Reducing BPD symptoms, particularly emotion dysregulation and impulsivity
symptoms.

Lithium S4 Drug | Class: Antipsychotic| Brand Name: Lithicarb

Use: is an atypical antipsychotic, antimanic and mood stabilising agent.
Oral |Should be taken with food | to admin every 12 hrs | do not crush
Dose: 1800 mg (acute mania) 900-1200mg (long term therapy)
Side Effects: Tremor, Hypothyroidism, weight gain, sedation. | (it alters the plasma concentration -> lithium
toxicity) Plasma level – <1.5mmol/L | Toxicity level -> 1.5 – 2.0mmol/L -exp coma, brain damage, or death.
Plasma cons allows the doctor to track the dosage of the individual patient and to obtain the maximum therapeutic
effect with minimal risk of toxicity

Sodium Valproate S4 Drug | Class: Anticonvulsant / Antipsychotic | Brand Name: Epilim

Use: reduce or prevent manic episodes by increasing the amount of a chemical called (GABA) in the brain. GABA
blocks transmission across nerves in the brain and has a calming effect.
Oral | Should be taken with food | admin twice daily | can be crushed
Dose: 400mg – 1500mg
Side effects: Weight gain, sedation, acne, hair loss, pancreatitis.

Lamotrigine S4 Drug | Class: Anticonvulsant | Brand Name: Lamictal

Use: it is use to stabilise mood from below baseline thereby preventing switches to mania or episode acceleration.
Oral | Admin pref before meals
Dose: 50 – 200mg
Side effects: Dizziness, drowsiness, headache, tremor, blurred vision, confusion
 Borderline Personality Disorder
Borderline personality disorder (BPD) is a common mental health disorder that can be treated. It affects
people’s thoughts, emotions and behaviours, making it difficult for them to cope in all areas of life. The
aetiology behind the condition is due to biological theories e.g genetics or psychodynamic theories e.g
childhood traumas.

Symptoms
 Self – image & identity issues
 Intense & unstable relationships w/ others
 Impulsiveness
 Chaotic interpersonal relationships
 Fluctuating between idealisation and devaluation of others

• Cluster A. Cluster A includes people whose behaviour appears odd or eccentric and includes paranoia,
schizotypal, and schizoid personality disorders.
• Cluster B. Cluster B includes people who appear dramatic, emotional, or erratic and includes antisocial or
narcissistic personality disorders.
• Cluster C. Cluster C includes people who appear anxious or fearful and includes avoidant, dependent, and
obsessive-compulsive personality disorders.

Nursing intervention as a Mental Health Nurse:

 Develop rapport (empathy and trust) – Assessing suicidal Risks, MSE,
 Helping clients to cope and to control emotions E.g giving them a journal
 Structuring the client’s daily activities – can help client manage time alone
 Teaching effective communication skills – eye contact, active listening, taking turns talking.

Non- Pharmacological Treatments

Dialectical Behaviour Therapy (DBT)
• To teach the client how to learn to better take control of their lives, their emotions and themselves through
self knowledge, emotional regulation & cognitive restructuring
Cognitive Behavioural Therapy (CBT)
• Identify and alter unhelpful patterns of belief and behaviour and to implement strategies to break these
patters Mindfulness
• Is experiencing the world that is firmly in the ‘here and now’
• Effective in increasing fulfilment, reducing stress, raising self-awareness, enhancing emotional intelligence &
undermining destructive emotional, cognitive and behavioural processes
Acceptance & Commitment Therapy (ACT)
• Accepting what is out of personal control and taking actions to improve and enrich life
• Identification of meaning in life
• Teaching psychological skills to manage painful thoughts and feelings

Nursing GOALS
 The client will be safe and free of significant injury.
 The client will not harm others or destroy property.
 The client will demonstrate increased control of impulsive behaviour.
 The client will take appropriate steps to meet his or her own needs.
 The client will demonstrate problem-solving skills.
 The client will verbalize greater satisfaction with relationships
 Major Depression
Depressive disorder (also known as depression) is a common mental disorder. It involves a depressed mood or
loss of pleasure or interest in activities for long periods of time. The aetiology behind the condition is due to
biological, genetic, environmental and psychosocial factors.

Symptoms
 Feelings of guilt or worthlessness
 Lethargy
 Psychomotor retardation or agitation
 Sleep disturbances
 Suicidal ideation
 Anhedonia or decreased interest in pleasurable activities
 Persistently low or flat affect

Nursing Intervention as a Mental Health Nurse:

 Develop rapport (empathy and trust) – Assessing suicidal Risks, MSE (behaviour, cognition, mood,
thought form and perception.
 Encourage patients to be active
 Communicate with patients
 Consider night time strategies
 Discuss lifestyle changes
 Collaboration with relevant service provides – ECT (induces a mild seizure that disrupts severe
depression)

Pharmacological Treatments
Antidepressants Mechanism of Action: Antidepressants affect several chemicals in the brain
(neurotransmitters) that influence mood and anxiety, including: serotonin (chemical that carries message
between nerve cells in the brain and throughout the body), noradrenaline, dopamine (a chemical released in
the brain that makes you feel positive) and melatonin

Fluoxetine Class: Antidepressant (SSRIs) Selective serotonin reuptake inhibitors { increase serotonin levels in
the brain} S4 Drug
Brand Name: Prozac
Use: Major depression
Oral |May be taken with or without food | can be crushed
Anxiety Disorder
Dose: initially
Anxiety 20mg/day
- a state wherein(morning) may aincr
a person feels aftersense
strong several wks to(fear).
of dread max 80mg/day divide dose.
Side Effects: Hypersensitivity, anxiety, insomnia, hypomania, tremor, sexual dysfunction
Anxiety disorder - This feelings of dread does not necessarily have a specific reason or is disproportionate for
Duloxetine
the emotionClass:
and asAntidepressant (SNRIs)
a result it impacts the Serotonin and noradrenaline
person’s social & occupationalreuptake inhibitors
functioning. {ease depression
The triggers can be
by affecting
caused chemical
by physical messengersfear
environment, thatofis the
used to communicate
unknown, between
rigid routine, braindiscomfort
physical cells} S4 Drug
etc.
Brand Name: Cymbalta
Use: Major depression.
Symptoms
Oral |Should be taken
Thoughts- with food
Intrusive or |unwanted
admin once daily
ideas (e.g| insomnia
can’t be crushed
or poor concentration)
Dose:initiate start at
Feelings 30mg/day
– they toimpending
feel the improve tolerability and thenthat
doom (impression 60mg/day
something tragic is about to occur)
Side effects: Hypotension,
 Behaviours Insomnia,
– repetitive Dry mouth,
actions Agitation, Urinary frequency retention, dry mouth.
or avoidance
 Physical changes – Involuntary responses by body in response to fight or flight
Reboxetine Class: Antidepressant (NARIs) Noradrenaline reuptake inhibitors {increase the amount of the
increased heart rate, trembling, sweating etc.
neurotransmitter norepinephrine in the brain by preventing its reuptake in the synapses, or spaces, between
Fight
nerveor flight
cells} S4-Drug
an automatic physiological reaction to an event that is perceived as stressful or frightening.
Nursing Intervention
Brand Name: Edronaxas a Mental Health Nurse:

Use: Major Develop
depressionrapport (empathy and trust) – Assessing suicidal Risks, MSE (behaviour, cognition, mood,
Oral | Admin thought form and
pref before perception.
meals |
Dose: 4mg Encourage
twice dailypatients to be active
if incomplete – join
response group
after programs
3wks, may incr to 10mg/day

Side effects: Communicate with patients
Headache, asthenia (physical weakness), tachycardia, vasodilation (relaxation of blood vessel’s
Consider
 walls),
muscular night time strategies
hypertension.
 Discuss lifestyle changes
 Collaboration with relevant service provides
Pharmacological Treatments
Anxiolytics Mechanism of Action: Anxiolytics work by targeting key chemical messengers in the brain. This is
thought to help decrease abnormal excitability.

Diazepam {increasing the levels of a calming chemical in your brain.} S4 Drug| Class: Anticonvulsant
Brand Name: Valium
Use: Anxiety disorder management; short-term relief of anxiety symptoms
Oral |May be taken with or without food | can be crushed
Dose: 5-40mg / day
Side Effects: Fatigue, drowsiness, tremor, slurred speech, confusion

Clonazepam {use for panic disorder } Class: Anticonvulsant

S4 Drug| Brand Name: Cymbalta
Use: Panic Disorder.
Oral | Should be taken with food | admin once daily | can’t be crushed
Dose: initially 1mg/ day may incr to 4-8 mg/day; max 20 mg/day, maintenance.
Side effects: Anxiety, nervousness, hostility, hallucination.

Lorazepam {slowing activity in the brain to allow for relaxation} Class: Antianxiety S4 Drug
Brand Name: Ativan
Use: Major depression
Oral | May be taken with or without food | can be crushed
Dose: usually 2-3 mg/day in divided doses, range 1-10 mg/day
Side effects: dizziness; sedation; unsteadiness; weakness; dry mouth
 Alcohol & substance abuse (addiction)
A substance use disorder involves using too much alcohol, tobacco or other drugs. It can also be called substance
abuse, substance dependence or addiction. The aetiology behind the condition is due to biological, genetic,
environmental and psychosocial factors.

Symptoms
 Feelings of urge of having the next dose
 Performing impulsive behaviours while intoxicated leading to negative outcomes
 Experiencing withdrawal symptoms e.g irritability, aches nausea and vomiting.
 Experience of cravings

Nursing Intervention as a Mental Health Nurse:

 Develop rapport (empathy and trust) – Assessing suicidal Risks, MSE (behaviour, cognition, mood,
thought form and perception, AWS (alcohol withdrawal scale) { to determine if the intervention is
effective}
 Encourage patients to be active
 Communicate with patients
 Discuss lifestyle changes
 Collaboration with relevant service provides

Pharmacological Treatments
Antidepressants Mechanism of Action: Antidepressants affect several chemicals in the brain (neurotransmitters)
that influence mood and anxiety, including: serotonin (chemical that carries message between nerve cells in the
brain and throughout the body), noradrenaline, dopamine (a chemical released in the brain that makes you feel
positive) and melatonin

Acamprosate (Campral) Class: Drug dependence {decrease cravings to alcohol} S4 Drug

Brand Name: Campral
Use: alcohol dependent patients
Oral |Should be taken with food | can’t be crushed
Dose: >60kg: 2 tablets 3 times daily. Treatment period for 1 year
Side Effects: Rash, Impotence (helplessness), Libido changes, frigidity (inability to exp sexual response) and
diarrhoea

Methadone Class: Narcotic analgesics {maintenance for opiate-dependent clients} S8 Drug

Brand Name: Aspen
Use: alcohol dependent patients
Liquid | May be given without food|
Dose: 10-20mg/day
Side effects: Withdrawal symptoms, dry mouth, blurred vision, hypotension, dizziness, drowsiness.

Alepam which belongs to a group of medicines called benzodiazepine (Class: Anxiolytic agent) {S4 drug}
Brand name: Oxazepam
Use: alcohol dependent patients
Oral | May be taken with or without food|can be crushed
Dose: 7.5 – 15mg 3-4 times daily
Side effects: Dependence, drowsiness, headache, hallucination, Impaired alertness.