Bipolar Disorders

Key Points

• Bipolar disorders involve recurrent mood polarity shifts between depression and mania/hypomania.
• Acute manic phases require safety, structure, and clear communication boundaries.
• Long-term outcomes improve with combined medication, psychotherapy, and rhythm/relapse management.
• Nursing care adapts across phases while preserving autonomy, dignity, and continuity.

Pathophysiology

Bipolar disorders likely arise from interacting genetic vulnerability, neurotransmitter dysregulation, circadian instability, and environmental stress triggers. Polarity shifts alter sleep, judgment, impulse control, and functional capacity.

Comorbid anxiety, substance use, and suicidality increase complexity and risk.

Classification

• Polarity states: Depressive episodes, manic episodes, hypomanic episodes, and mixed features.
• Severity context: Symptom burden ranges from mild functional disruption to hospitalization-level crises.
• Treatment phase: Acute stabilization versus maintenance/relapse prevention.

Nursing Assessment

NCLEX Focus

Differentiate mania from hypomania and assess immediate safety/impulsivity risk first.

• Assess current polarity state, symptom intensity, and psychosis presence.
• Assess sleep disruption, impulsivity, risk-taking behavior, and suicidal ideation.
• Assess medication adherence, side effects, and prior response history.
• Assess co-occurring substance use and social determinant stressors.
• Assess early relapse cues reported by client/family/supports.

Nursing Interventions

• In mania, use low-stimulation setting, concise directions, and firm respectful boundaries.
• In depression, use empathic communication and active suicide-risk monitoring.
• Support medication adherence and routine lab/side-effect surveillance (for example lithium safety monitoring).
• Reinforce psychoeducation on triggers, sleep regularity, and relapse-action plans.
• Coordinate psychotherapy and family-focused interventions to improve long-term stability.

Polarity Mismatch Treatment

Inadequate polarity assessment can lead to interventions that worsen instability (for example poorly monitored antidepressant activation).

Pharmacology

Core medication groups include mood stabilizers, selected atypical antipsychotics, and adjunctive therapies. Nursing priorities include toxicity monitoring (notably lithium), interaction checks, hydration guidance, and adherence support through phase transitions.

Clinical Judgment Application

Clinical Scenario

A client in acute mania has minimal sleep, pressured speech, grandiosity, spending sprees, and escalating irritability with refusal of routine medication.

Recognize Cues: High-risk manic syndrome with impaired judgment and potential safety threats. Analyze Cues: Immediate stabilization is required before deeper insight-based interventions. Prioritize Hypotheses: Priority is behavioral safety and rapid mood stabilization. Generate Solutions: Implement structured milieu, medication support, and close monitoring. Take Action: Apply de-escalation, coordinate prescriber adjustments, and engage supports. Evaluate Outcomes: Track sleep restoration, agitation reduction, and improved decision control.

Related Concepts

• depressive-disorders - Covers depressive-polarity overlap and differential needs.
• the-spectrum-of-mood-disorders - Places bipolar illness within dimensional mood frameworks.
• self-harm-and-suicide - Addresses elevated suicidality risk across bipolar phases.
• psychopharmacology - Expands medication-mechanism and safety management details.
• client-engagement - Supports sustained adherence and relapse-prevention collaboration.