Mood Disorders (Bipolar)
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Outline
Overview
- What’s a mood? Emotional states that are subjective and difficult to define / long term emotional states
Nursing Points
General
- Mood disorders: emotional extremes and challenges in regulating mood (think long-term)
- Bipolar disorder and depressive disorders
Assessment
- Bipolar includes periods of mania and depression with normal periods in between
- Extremely high highs
- Extremely low lows
- Inability to self-regulate
- Mania definition: a mood disorder marked by hyperactive, wildly optimistic state
- Depression: Module 02.07… 5+ depressive symptoms for 2+ weeks
Therapeutic Management
- Goals are to manage acute episodes, provide support and resources for long-term management
- Meds
- Anti-anxiety meds used during manic episodes; use caution with patients who have a history of substance abuse
- Antipsychotics: Zyprexa, Abilify, Risperdal (due to sedative and mood stabilizing)
- Mood stabilizer
- Lithium
- Regular labs to check therapeutic level
- Toxicity can result if stable sodium intake and fluid intake (2-3L/day) is not maintained
- Lithium
- Depakote, Lamictal, Tegretol also given for patients with mood disorders
- Interventions for Mania
- Make sure environment is safe
- Reorient as necessary
- Promote appropriate sleep/wake cycles
- Controlled, calm, focused interactions
- Don’t argue!
- High-calorie finger foods
- Promote appropriate clothing choices
- Set boundaries related to behaviors
- Watch for dangerous hyperactivity
- Ensure medication compliance
- One on one, sedentary activity
- Promote gross motor activities
Nursing Concepts
- Safety
- Mood Affect
- Coping
Patient Education
- Identify and avoid triggers for mania (there are not always triggers, sometimes it’s spontaneous)
- Report signs of hyperactivity / mania
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Transcript
So, we’re going to talk about Mood Disorders. Specifically, we’re going to look at Bipolar Disorder and how to assess and care for these clients.
So first, let’s just define mood – Mood is a long-term emotional state. It’s not just what you feel right now, it’s more long-term, more all encompassing than just simple emotions or feelings. Under normal circumstances, in a client who doesn’t have Bipolar Disorder, our mood may swing a bit, but we are able to regulate it and keep it pretty close to baseline all the time, especially when it comes to our long-term mood. But, not everyone can regulate this as well and they may struggle to keep their mood at baseline. Now this is NOT when someone is happy one minute and sad 10 minutes later, it’s much more invasive than that.
So, let me illustrate what I’m talking about when I say regulation. So if this is “normal” – our baseline. Let’s say something really great happens like you ace a test or you are getting married. Your mood is going to elevate, right? You’re happy! So it will come up here for a little while, a few days, a week, maybe longer, and then eventually you’ll kind of come off that high and come back down to baseline, right? Same thing if something sad happens – like you don’t do as well as you wanted on a test, or go through a bad break up – your mood will go down, justifiably. You’ll be sad for a little while, and over time you’ll be able to self-regulate back to a baseline mood. So Mood Disorders occur when someone has a difficult time regulating back to baseline OR when they have extreme versions. So instead of their happy being here – their happy is WAY up here. They’re overly excited, they probably aren’t sleeping, they may spend money they don’t have, they could work for days and days and they feel so good. This is called mania. Their highs are incredibly high. And they struggle to bring it back down to a healthy level. You just can’t live like that for that long! They could even have hallucinations and delusions.
Now, they could also swing to the other end and have extremely low lows. At this point they may not even be able to get out of bed, or take care of themselves, they may cry all the time, they’ve completely lost interest in things they used to enjoy. And again, they can’t seem to regulate their mood back to a healthy level. Remember, it’s okay to be happy and it’s okay to be sad – but when someone struggles with a mood disorder, it’s usually an extreme and they really struggle to self-regulate their mood. What we want for both mania and depression is to get people to a manageable level where they can successfully care for themselves and function in daily life. Now, for the purposes of this lesson we’re going to focus on interventions and priorities during mania – the next lesson will cover depression in detail.
So, when we talk about managing mania, we will usually use medications. We can use anti-anxiety meds like Benzodiazepines, especially in the acute phases or during hyperactivity. But the most common med you’ll see for Bipolar Disorder is going to be a mood stabilizer called Lithium. There’s an individual lesson on Mood Stabilizers and Lithium in the next module, so make sure you check that out. As far as interventions – Safety is always #1, do a self-harm assessment – ask if they have a plan to harm themselves or anyone else. Remember they could even be having hallucinations or delusions so we want to orient them to reality and stay in reality – but don’t argue with them. And with any interventions, we want to start small and progress. This might mean starting with 1:1 interaction, then progress to more group settings. Or maybe start with small, quick, easy to complete tasks, and slowly build to the more complex tasks. This keeps them from being overwhelmed or feeling any sense of anxiety or failure.
Some other practical things we’ll do for them is promote regular sleep/wake cycles. We want them to sleep at night and be awake during the day, even though their condition is trying to force them to stay awake at all hours. We also focus on good nutrition. Now here’s something I actually remember from nursing school as being a question on multiple exams – High-Calorie Finger Foods! We want to provide something that they could easily grab and go and eat while they’re walking around that will give them good nutrients and calories in a small amount. Remember they’re on this super high high, they may be pacing or wanting to be on their feet all the time – the last thing we want to try to force them to do is sit down and eat a full meal. Promote appropriate clothing choices – sometimes during a manic episode, clients may make some choices they wouldn’t normally make in their baseline state, so we just want to encourage them to wear clothes appropriate to the situation they’re in. We encourage gross motor activities – those are things involving the extremities like walking, running, swimming (if they’re not in an in-patient setting of course). These are easier to complete when you’re in a high energy state than fine motor things like using your hands and fingers. This is why you’ll see us allow patients to pace in their room or the hallways. Just be cautious of letting them pace in a day room with other patients – it may be a trigger for other patients and cause a safety concern.
Priority nursing concepts for a client with a Mood Disorder will be Safety, of course – always. Mood/Affect because we want to determine where they’re at and if we can get them to a manageable state. Now, in your outline I put coping – which is still true – there can be some underlying anxiety, so it’s important to give healthy coping strategies. But, one of the things I’ve seen most often in clients with Mood Disorders is they are either not eating at all or eating everything in sight. Not to mention, when they aren’t eating and they’re extremely active, this can cause some serious dehydration and malnutrition issues if it goes on for too long – so I want to make sure you focus on this part as well!
So, let’s recap. Mood is a long-term emotional state, not just an instantaneous emotion. Clients with Mood Disorders tend to have difficulty regulating their moods and find themselves experiencing very high highs and very low lows. As far as medications, specifically for Mania, we use anti-anxiety meds like benzodiazepines and mood stabilizers like Lithium. We make sure they sleep appropriately, give them high-calorie finger foods to make sure they’re getting nutrition, and we help them choose appropriate clothing and perform gross motor activities like walking. And, of course, as always, safety first. We want to make sure they’re oriented to reality, we don’t argue with them, and we want to ensure they aren’t going to harm themselves or anyone else.
So that’s it for Mood Disorders, remember to check out the lesson on depression to see the other end of the spectrum, and check out the patient story and other resources in this lesson to learn more. Now, go out and be your best self today. And, as always, happy nursing!
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