Bipolar Disorder
Mania, hypomania and depression
Types
| Bipolar I | At least one manic episode (≥7 days, or any length if hospitalized); depression common |
| Bipolar II | Hypomania (≥4 days, no psychosis, no hospitalization) + major depression |
| Cyclothymia | Milder ups and downs for ≥2 years |
Signs of mania
Elevated or irritable mood, grandiosity, little need for sleep, pressured speech, flight of ideas, distractibility, hyperactivity, risky behavior (spending, sex, driving), possible psychosis.
Nursing care in mania
- Safety first (exhaustion, injury, aggression).
- Low-stimulation environment: quiet room, few visitors, avoid group and competitive activities.
- Calm, firm, consistent limits; short, simple statements; don't argue or debate.
- High-calorie finger foods and fluids they can eat while moving (sandwiches, shakes).
- Channel energy into solitary physical activity (walking, writing).
- Promote rest and sleep; monitor weight, intake, hydration.
Medications
- Lithium (level 0.6–1.2 mEq/L; see Part 1 for toxicity and teaching).
- Valproate, carbamazepine; lamotrigine (prevents depressive episodes).
- Second-generation antipsychotics (quetiapine, olanzapine, aripiprazole, lurasidone, cariprazine).
- Antidepressants alone can trigger mania: used only with a mood stabilizer, if at all.
Teaching
- Take medication even when feeling well (stopping is the top cause of relapse).
- Regular sleep schedule: sleep loss can trigger mania.
- Learn early warning signs (less sleep, racing thoughts, spending).
- Avoid alcohol and drugs; family education; support groups.
Memory hook
Flight of ideas (rapid jumping between related topics) is a sign of mania. Loose associations (unrelated jumps) point to schizophrenia.