Bipolar Disorders

• Mania - 7 days
• Hypomania - 4 days
• Depression - 1 week
• Major Depression - 2 weeks
• Bipolar 1


  Presence of only one manic episode with or without depression
• Bipolar 1 Mixed

  Presence of only one manic episode with depression
• Bipolar 2


  Presence of one hypomanic episode with major depression
• Cyclothymia 


  Presence of several hypomanic episodes and depression over a period of 2 years
• Cyclothymia

  Interval: 2 months
• Cyclothymia

  <2 months interval: Rapid cycling
• Dysthymia 


  Presence of a depressed mood for at least 2 years for more days than not
• Psychosocial risk factor of Bipolar Disorder: Type A personality
• Sociocultural risk factor of Bipolar Disorder: Upper Class
• Bipolar Disorder is caused by an increase of serotonin and norepenephrine
• Defense mechanism of Bipolar Disorder: Reaction Formation, Projection
• Best activity for bipolar client: gardening
• Drug of choice for Bipolar Disorder: Lithium Carbonate


  Mechanism: to stabilize the mood

  Onset: 3 weeks

  Peak: 3 hours

  Blood test: every 3 days
• Therapeutic levels of Lithium: 0.6 – 1.2 mEq/L
• Toxicity of Lithium starts at 1.5 mEq/L
• Lithium levels of >3 mEq/L requires dialysis
• The common side effect of lithium is fine tremors, which is normal as it disappears in 1-2 weeks
• With lithium, mannitol must be at bedside as it increases elimination of the drug during toxicity