Title: BIPOLAR DISORDER

The information down below requirements on the research paper.

1. Etiology

2.Pathophysiology

3. Sign & Symptoms

4. How is it Diagnosis

5. Medical Treatment

6. 2 nursing diagnosis

7. 3-5 intervention

 

Bipolar Disorder

Bipolar disorder, also referred to as manic depression, is a chronic mental health condition that causes a person to experience severe emotional highs and lows. People who have bipolar disorder  are torn between two opposite poles of mood that significantly impact their day-to-day life. Emotional highs or hypomania is a period of over-active behavior that lasts for a short period of time.  When a person diagnosed with bipolar disorder comes across a period of hypomania, he or she may feel euphoric, energized, agitated and irritable, and easily distracted. On the other hand, severe emotional lows or depression is characterized by continuous sadness, feeling hopeless, low self-esteem, and sometimes suicidal thoughts.

Etiology

Mental health researchers and experts observed that bipolar disorder usually starts during teenage or adolescence. Up to date, the exact cause of bipolar disorder is still unknown. Most people with bipolar disorder suffer for a long time before seeking help due to lack of knowledge about the disorder. Studies suggest that possible risk factors could be hormonal imbalance, genetics, extreme trauma, and substance abuse.

Scientists have long been working on the genetic basis of bipolar disorder. Baum et al. (2007) conducted a study to over 550 000 single-nucleotide polymorphisms (SNPs) by using DNA pooling of European origin to analyze the potential involvement of multiple genes to the development of bipolar disorder. The researchers used a genome-wide approach to further understand the genetics of complex disease such as bipolar disorder. This modern approach offers a powerful alternative to genetic linkage studies. The research found that none of the replicated genes confers a large risk of disease. However, the gene DGKH contains an SNP that is significantly associated with bipolar disorder even after conservative experiment-wise correction.  These findings suggest that the impact of major genes in bipolar disorder are very uncommon and future studies must be made to discover more of the genetic heterogeneity of bipolar disorder (Baum et al., 2007).

Pathophysiology

In the past few decades, research has progressively clarified the etiopathological mechanisms that correlate circadian rhythm disturbance to mood disorders. A recent study carried out by Muneer (2017) suggest that circadian rhythm disturbance affects the emotional aspect of an individual leading to extreme mood disorders. Mood disorders could be represented by disruption in the sleep-wake schedule, alteration in daily activity levels, and irregularity of mealtimes. Subsequently, profound impact on the circadian rhythm ascends to the emotional highs and lows of a person with bipolar disorder.

The circadian dysregulation hypothesis of mood disorders provides a strong link on the physiological process of bipolar disorder. The process used for calculations of DNA and protein sequence, also known as the molecular clock, is stored in the suprachiasmatic nucleus (SCN) in the hypothalamus. It is formed through transcription-translation circuit that swings back and forth over the duration of about 24 hours. The chief activator of transcription is comprised of a dimerized complex of Circadian Locomotor Output Cycles Kaput (CLOCK) protein and Brain and Muscle ARNT-like Protein 1 (BMAL1). This molecular composite binds to Enhancer-box sequences in the promoters of many genes including the Period (Per) and Cryptochrome (Cry) genes. The PER and CRY proteins are translated in the cytoplasm and are phosphorylated by the priming enzyme, casein kinase 1? before being targeted by glycogen synthase kinase 3β, causing alterations in their viability, relationship, and capacity to enter the nucleus. Upon DNA binding, these inhibit the actions of the CLOCK/BMAL1, thus forming a negative feedback loop. Consequently, many controlling kinases, phosphatases, and secondary feedback loops act on the molecular clock, contributing to further intricacy in the circadian apparatus. The circadian transcription factors partake in a whole range of homeostatic actions in every body system and participates in a wide array of alteration biological and behavioral functions leading to sever mood disorder or bipolar disorder Muneer (2017).

Clinical Signs and Symptoms

Clinical manifestations of bipolar disorder vary from one person to another.  Signs and symptoms mostly depend in their pattern, severity, and frequency. There are four types of mood episodes in bipolar disorder: mania, hypomania, depression, and mixed episodes. Each type of bipolar disorder mood episode has a unique set of symptoms.

In the manic phase of bipolar disorder, a person commonly experiences feelings of heightened energy, creativity, and euphoria. Mania feels good at first but may swiftly shift to engaging in inappropriate sexual activity, delusional behaviors, and impaired judgment and impulsiveness.  Another of bipolar disorder known as the hypomania is a less severe form of mania. A person may also feel extreme joy and productivity, but he/she would not lose touch with reality. With bipolar depression, despite many similarities with regular depression, certain symptoms are more common in bipolar depression. Most people with bipolar depression experiences to involve irritability, guilt, unpredictable mood swings, and feelings of restlessness, physical and mental sluggishness, weight changes, and sleep problems. Sometimes bipolar depression may also put a person at risk to the development of psychotic depression

Diagnosis

Oftentimes, diagnosis of bipolar disorder can be difficult due to different factors. Since children and adolescent have greater changes in mood, behavior, and energy levels, they are often harder to diagnose. Doctors will use several tests and exams to diagnose a person for mental disorder. They may ask you to have a full physical exam rule out other possible causes of your symptoms. A mental health evaluation will also be performed by mental health professionals such as a psychologist or psychiatrist to evaluate your mental health and look for signs of bipolar disorder. The mental health expert must carefully observe the person for major depressive episodes, that lasts for at least two weeks.

There are three main types of bipolar disorder: bipolar I, bipolar II, and cyclothymia. A diagnosis of bipolar disorder I involves either one or more manic episodes, or mixed (manic and depressive) episodes. It may also include a major depressive episode, but it may not. A diagnosis of bipolar II involves one or more major depressive episodes and at least one episode of hypomania.

Medical Treatment

A person experiencing any signs and symptoms of depression or mania must immediately seek help from medical professionals such as doctor or mental health experts. Bipolar disorder needs long time treatment from a mental health professional. Several treatments are available that can help manage your bipolar disorder.  Doctors may prescribe medications mood stabilizers, antipsychotics, antidepressant, and a type of anti-anxiety drug for short term treatment.  Psychotherapy, counseling, and lifestyle changes are also necessary in helping a person manage his/her mental disorder.

Nursing Diagnosis

• Risk for injury related to extreme hyperactivity/physical agitation as evidenced by abrasions, bruises, cuts from running/falling into objects.
• Impaired Social Interaction related to disturbed thought processes as evidenced by loud, obscene, or threatening verbal behavior.

Interventions

To achieve the expected outcomes, the nurse must provide assisted and structured activities for the patient to promote security and focus. It is also helpful to arrange frequent rest periods that will prevents extreme exhaustion due to high energy. Maintaining a low level of stimuli in client’s environment including loud noises, bright light, low-temperature ventilation will minimize upsurge of anxiety. Moreover, it is also necessary to help the patient create a list of activities that he/she loves to decrease tension and provide focus.