Mania is the main feature of bipolar disorder. A manic episode is a state of mind characterised by high energy, excitement, and euphoria over a period of time. The experienced extreme change in mood and cognition can easily interfere with the person’s school, work, or home life.
Manic Episode Symptoms
- increased energy
- overactivity
- ‘snapping’ words (pressure of speech)
- difficulty in attaining attention
- inflated self-esteem, overconfidence and grandiose ideas
- flight of ideas
- irritability
- lack of social inhibitions
- mood elevation
- may experience psychotic symptoms
HypoMania Symptoms
HypoMania is a mild form of mania featuring elation and hyperactivity. HypoMania symptoms are not severe and do not disrupt the person’s lifestyle. Symptoms of HypoMania include:
- mild mood elevation that persists for at least several days
- increased energy
- increased sociability
- increased talkativeness
- increased over-familiarity
- increased libido
- mild over-spending
- possible impairment of attention and concentration
- decreased need for sleep
Manic Episode Causes
- organic brain lesions
- increased stress level
- lack of sleep or changes in the individual’s sleep pattern
- use of recreational drugs
- alcohol use
- seasonal changes
- significant life change/s
- childbirth
Manic Episode Nursing Approaches
- Address the physical, psychological and social consequences following a manic episode
- If a mood-stabilising drug is prescribed, ensure that no major problems are experienced as side effects, and that the person can maintain a therapeutic drug level within the body
- Once the manic episode subsides, discuss with the person possible trigger factors and encourage self-managing strategies for better coping with future manic episodes
- Encourage adequate fluid and food intake
- Discuss self-activities which can be managed by the person in a safe way
- Encourage activities which can be performed during night-time with the least noise possible so others’ sleep pattern is not interrupted
- Consider night-time sedation to ensure adequate sleep
- Ensure the person’s safety
Manic Episode ICD-10 Reference: https://icd.who.int/browse10/2016/en#/F30-F39
Bipolar Affective Disorder
Bipolar Affective Disorder is characterised by two or more episodes in which the person’s mood and activity levels are significantly disturbed, featuring periods of mood elevation (mania) and periods of low mood (depression). In total there are 9 sub-types of Bipolar Affective Disorder.
Bipolar Affective Disorder ICD-10 Reference: https://icdlist.com/icd-10/index/bipolar-disorder-f31
Cyclothymia
Cyclothymia is a milder chronic form of bipolar disorder which lasts at least 2 years (in adults; in children and adolescents it lasts at least 1 year). In cyclothymia, mood swings are unrelated to life events and they usually initiate early in adult life.
Cyclothymia is characterised by multiple periods of hypomanic and depressive symptoms that do not meet the criteria for mania or major depressive episode, that cause significant distress or impairment, and which are ongoing for more than 2 months at a time.
Bipolar Disorder Management
PSYCHOLOGICAL MANAGEMENT: CBT, Interpersonal Therapy or Behavioral Couples Therapy
PHARMACOLOGICAL MANAGEMENT: Mood Stabilisers including Lithium, Anti-Epileptics (Sodium Valproate– Epilim), Anti-Psychotics, and Anti-Depressants (prescribed as short-term treatment when the person is in the depressive stage). Other mood stabilisers include Carbamazepine (Tegretol – DO NOT use in pregnancy) and Lamotrigine (limited evidence, thus usually avoided).
Lithium
- 1st line treatment for Bipolar Affective Disorder
- If highest therapeutic dose is not effective enough, Lithium is coupled with Sodium Valproate (NOT for child-bearing aged females), Anti-Depressants (Fluoxetine) and Anti-Psychotics (Olanzapine)
- Blood should be tested after the first week of treatment, followed by re-testing every 3 months in the first year, and every 6 months in the years to follow, to ensure Lithium level is kept within the therapeutic range, i.e. 0.6-0.8mmol/ltr
Side Effects:
- increased weight
- GI disturbances
- oedema in the ankle region
- tremors
- polyuria (increased amount and frequency of urination)
- polydipsia (increased thirst and fluid intake)
- chronic kidney failure (in long term lithium treatment)
- hypothyroidism (in long term lithium treatment)
Manic Episode Nursing Care Plan
The following Manic Episode Nursing Care Plan is based on the situation shown in the above video…
Immediate Goals
- compile full history including current manic episode and any possible other similar episodes in the past
- compile a list of current medications and other comorbidities to ensure that therapy suggested is suitable for the person
- explain to the person that while you believe that his reality includes certain aspects such as God speaking to him or ideas with numbers and cancer treatment, all this is not part of my (and others’) reality
- the person should be prescribed a mood stabiliser such as Lithium, to be started immediately
- refer for psychological therapy such as CBT
- ensure the person accepts the need for psychological and pharmacological treatment; if not, consider possibility for detainment
Short Term Goals
- review symptoms and situation
- order lithium blood test within a week to ensure the lithium level of the person is within the therapeutic range i.e. between 0.6-0.8mmol/ltr
- review medication and see if any changes in dose or additional psychotic drugs need to be prescribed along Lithium
- educate about compliance to medication
- make sure that the person has started to sleep adequately; prescription for sleeping pills should be considered so the person can rest well during the night
- educate the person about the importance of continuing psychological therapy eg. CBT so coping techniques can be learned to avoid relapse
- encourage nutritional food intake and adequate fluid intake and if need be encourage nutritional support through the help of a nutritionist
- teach the importance of keeping with follow-up appointments
- encourage person to restart investing time in past or new hobbies to keep self occupied
Long Term Goals
- review symptoms and situation
- review medication and psychological therapy and their effectiveness
- order follow-up blood tests every 3 months for the first year, and every 6 months thereof, to keep testing Lithium level, ensuring it stays within normal range as long as person stays on lithium treatment
- ensure person is eating and drinking adequately
- ensure person is sleeping well at night
- teach person to notice things that may have triggered past manic episodes, and ways to cope so as to avoid rebound manic episodes as much as possible
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Claire is keen about public education on health-related subjects as well as holistic patient-centered care. She is also passionate about spreading awareness on the negative effects that domestic abuse leaves on its victims’ mental, emotional, social and physical wellbeing.
Claire aspires to continue studying following completion of her Nursing Degree, because she truly believes in lifelong education.
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