Nursing Journals ON Bipolar Disorder.

Running head: BIPOLAR DISORDER

Journal 2: Bipolar Disorder

Author's Name

Institutional Affiliation

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Optionone

Write about the situation that you felt you handled well. What did

you do? Provide justification and reasoning for your actions. This

commentary should include a reference to relevant course

content or research.

was abnormally upbeat, energetic, and exhibited a much-exaggerated sense of confidence.

Noteworthy, these are some of the major symptoms of hypomania episodes. From the initial

engagement, I discovered that the patient was having depressed moods, has lost a significant

amount of body weight, and was losing interest in almost all activities, including his education

and relationships. Also, I established that the patient had two of his siblings with almost similar

symptoms.

One of the things that I believed I performed well was diagnosis and testing. According to Mayo

Clinic (2020), psychiatric assessment entails filling a psychological self-assessment or

questionnaire. In addition, the patient's family members may be requested to provide more

information about his or her symptoms. This is precisely I did. Begin by asking the patent to fill

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factors for the disorder. This gave me confidence because my diagnosis was backed with

scientific information. Moreover, I conducted a physical exam as well as lab tests to establish

any medical problems that may potentially be causing the patient's symptoms.

The other thing that I believe I performed well is treatment. Firstly, I prescribed Risperidone for

the patient. According to WebMD (2019), Risperidone is a type of medication belonging to a

class of drugs known as atypical antipsychotics. Essentially, this drug works by helping to

restore the balance of certain natural substances contained in the human brain. The rationale for

prescribing Risperidone in this particular case is that the drug helps to think clearly in order to

effectively perform other activities well. However, Risperidone has several side effects,

including headache, tremors, anxiety, and restlessness.

education and life in general. For this reason, it was imperative to find ways to return him back

to healthy and positive thinking. According to Cox et al. (2014), a combination of medications

and psychotherapy also the most effective strategy to treat bipolar disorder.

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L Besada

Sleep disorders come in two kinds, one related to sleep apnea and the other related to

the failure to stay awake due to stress.

I disagree with this statement. There are more sleep disorders that are not related to sleep

apnea and failure to stay awake. For instance, insomnia doesn’t belong to these categories

since approximately 50%&of insomnia cases are related to depression, anxiety or psychological

stress (NAMI, 2020). While sleep apnea has three main types: obstructive sleep apnea, central

maintaining wakefulness.

Here are some common types of sleep disorders:

Insomnia: Difficulty falling asleep or staying asleep, which can be caused by various factors including

stress, anxiety, depression, or poor sleep habits.

Sleep Apnea: This disorder involves interruptions in breathing during sleep, which can lead to

fragmented sleep and daytime sleepiness. There are different types of sleep apnea, including

obstructive sleep apnea and central sleep apnea.

Restless Legs Syndrome (RLS): RLS is characterized by uncomfortable sensations in the legs and an

irresistible urge to move them, often leading to difficulty falling asleep or staying asleep.

Narcolepsy: Narcolepsy involves excessive daytime sleepiness and may also include symptoms like

Stress can certainly exacerbate or contribute to various sleep disorders, including insomnia and sleep

apnea. However, it's not typically classified as a specific type of sleep disorder in and of itself.

If someone experiences persistent difficulties with sleep or excessive daytime sleepiness, it's important

for them to consult with a healthcare professional or sleep specialist for proper diagnosis and

treatment.

Sleep Apnea:

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Sleep apnea is a serious sleep disorder characterized by repeated interruptions in breathing during

sleep. These interruptions, called apneas, can last for seconds to minutes and may occur many times

throughout the night.

The two main types of sleep apnea are:

Symptoms of sleep apnea include loud snoring, gasping or choking during sleep, daytime sleepiness,

morning headaches, irritability, and difficulty concentrating.

Treatment options for sleep apnea may include lifestyle changes (such as weight loss), continuous

positive airway pressure (CPAP) therapy, oral appliances, surgery, or positional therapy.

Insomnia:

Insomnia refers to difficulty falling asleep, staying asleep, or both, despite having the opportunity to

sleep.

Insomnia can be acute (short-term) or chronic (long-term) and may be caused by various factors,

including stress, anxiety, depression, medical conditions, medications, and poor sleep habits.

Symptoms of insomnia include difficulty falling asleep, waking up frequently during the night, waking up

the legs and an irresistible urge to move them.

Symptoms typically worsen during periods of rest or inactivity, particularly in the evening or at night,

which can disrupt sleep.

The sensations in the legs are often described as crawling, tingling, itching, or creeping, and the urge to

move the legs provides temporary relief.

RLS can lead to difficulty falling asleep or staying asleep, resulting in daytime fatigue and impaired

function.

Treatment for RLS may involve lifestyle changes, such as regular exercise and avoidance of caffeine and

alcohol, as well as medications to help manage symptoms.

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Narcolepsy:

Narcolepsy is a chronic neurological disorder characterized by excessive daytime sleepiness and

Parasomnias are a group of sleep disorders characterized by abnormal behaviors, movements,

emotions, perceptions, or dreams during sleep.

Examples of parasomnias include sleepwalking (somnambulism), night terrors, sleep talking, sleep-

related eating disorder, and REM sleep behavior disorder (RBD).

Parasomnias can disrupt sleep and may cause safety concerns for individuals and their sleep partners.

Treatment for parasomnias depends on the specific type and may involve addressing underlying factors,

improving sleep hygiene, and, in some cases, medication or behavioral therapy.

Circadian Rhythm Disorders:

Circadian rhythm disorders involve disruptions to the body's internal clock, which regulates the sleep-

wake cycle and other physiological processes.

someone you know is experiencing persistent sleep problems or excessive daytime sleepiness, it's

important to consult with a healthcare professional or sleep specialist for proper evaluation and

treatment.

Bruxism:

Bruxism is a sleep-related movement disorder characterized by grinding or clenching of the teeth during

sleep.

It can lead to dental problems, jaw pain, headaches, and disrupted sleep for both the individual and

their sleep partner.

Bruxism may be caused by stress, anxiety, sleep apnea, or other factors.

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Treatment options for bruxism may include stress management techniques, dental appliances (such as

mouthguards), and addressing underlying sleep disorders if present.

Treatment for hypersomnia depends on the underlying cause and may include medications to promote

wakefulness, lifestyle modifications, and addressing any contributing factors.

Sleep-Related Movement Disorders:

Sleep-related movement disorders involve abnormal movements or behaviors during sleep.

Examples include periodic limb movement disorder (PLMD), which involves repetitive limb movements

earlier.

functioning.

contributing to the movement disorder.

UARS involves increased resistance to airflow in the upper airway during sleep, leading to fragmented

sleep and daytime sleepiness.

therapy, continuous positive airway pressure (CPAP), oral appliances, and in some cases, surgery.

Understanding the specific characteristics and potential causes of different sleep disorders is crucial for

accurate diagnosis and effective treatment. If you suspect that you or someone you know may have a

sleep disorder, it's important to seek evaluation and guidance from a healthcare professional or sleep

specialist.

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The use of over-the-counter sleep aids should be encouraged over prescription sleep

aids as they are safer and are not habit-forming.

This statement is true and false. The use of over the counter (OTC) sleep aids should be

encouraged over prescription sleep aids. However, in my opinion, they can become a habit for

individuals using it. To the point that some may believe they won’t be able to sleep well if not

used. In addition, they may create a tolerance for these OTC medications. Some of these OTC

effects.

Effectiveness: The effectiveness of sleep aids can vary depending on the individual and the underlying

cause of the sleep problem. OTC sleep aids may be effective for occasional insomnia or short-term use.

Habit-Forming Potential: While some prescription sleep aids have a higher risk of dependency and

extended period.

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Impact on Quality of Life: Sleep disturbances during menopause can have a significant impact on a

woman's overall quality of life. Fatigue, irritability, difficulty concentrating, and decreased productivity

are common consequences of poor sleep quality, affecting both personal and professional aspects of

quality. In some cases, hormone replacement therapy (HRT) or other medications may be recommended

to alleviate symptoms such as hot flashes and night sweats.

Overall, menopause can significantly impact sleep patterns and quality for many women. It's important

for women experiencing sleep disturbances during menopause to discuss their symptoms with a

healthcare provider to explore appropriate treatment options and strategies for improving sleep and

overall well-being during this transitional phase.

Sleep Architecture Changes: Menopause can lead to alterations in sleep architecture, affecting the

different stages of sleep. Women may experience decreased slow-wave sleep (deep sleep) and rapid eye

movement (REM) sleep, which are crucial for restorative rest. As a result, menopausal women may wake

up feeling less refreshed and more fatigued.

Vulnerability to Insomnia: Menopausal women are at increased risk of developing insomnia,

characterized by difficulty falling asleep, staying asleep, or waking up too early and being unable to

Impact on Cognitive Function: Sleep disturbances during menopause can impair cognitive function,

including memory, concentration, and decision-making abilities. Chronic sleep deprivation associated

with menopausal sleep disturbances may increase the risk of cognitive decline and negatively impact

overall cognitive performance.

anxiety, which can further exacerbate sleep problems. Sleep disturbances and mood disorders can

create a vicious cycle, with poor sleep quality contributing to worsened mood, and vice versa.

Weight Gain and Metabolic Changes: Changes in sleep patterns during menopause may contribute to

weight gain and metabolic disturbances. Sleep deprivation and disruptions in circadian rhythms can

affect hunger-regulating hormones, leading to increased appetite, cravings for high-calorie foods, and

alterations in metabolism, potentially predisposing women to weight gain and metabolic disorders.

Bone Health: Sleep disturbances during menopause may negatively impact bone health. Disruptions in

sleep quality and quantity can interfere with the body's ability to repair and regenerate bone tissue,

potentially increasing the risk of osteoporosis and fractures in menopausal women.

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Relationship between Hormones and Sleep: Estrogen and progesterone levels decline during

menopause, which can affect sleep-regulating mechanisms in the brain. Estrogen has been shown to

modulate neurotransmitters involved in sleep, such as serotonin and gamma-aminobutyric acid (GABA).

sleep quality are essential for maintaining health and well-being during the menopausal transition.

particularly a decline in estrogen and progesterone levels. These hormonal changes can disrupt the

body's internal clock, leading to alterations in sleep patterns and sleep quality.

can occur during the day or night. Night sweats, a nocturnal manifestation of hot flashes, can cause

sudden awakenings and discomfort, leading to sleep disturbances and insomnia.

leading to fatigue, irritability, difficulty concentrating, and decreased productivity. Poor sleep can also

affect interpersonal relationships and overall well-being.

as hot flashes and night sweats.

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Overall, menopause can have a profound impact on sleep quality and overall sleep health for many

women. It's essential for women experiencing sleep disturbances during menopause to seek support

and guidance from healthcare professionals to develop individualized treatment plans and improve

Arand, 2020). In clinical practice, initial treatment typically involves sleep hygiene instruction and

stimulus control procedures. If follow-up indicates that further treatment is needed, then more

formal CBT-I alone or in combination with medication may be used for six weeks. For patients

who respond to therapy, the medication can be tapered or used as needed while continuing the

CBT-I. Patients whose symptoms recur after discontinuation of therapy may require re-

evaluation for referral for polysomnography or additional CBT-I, with or without pharmacologic

therapy.

benzodiazepines are not typically recommended as a first-line treatment for insomnia, especially for

chronic or long-term use. While benzodiazepines can be effective in promoting sleep, they are

associated with several potential risks and limitations:

Dependency and Tolerance: Benzodiazepines have a high potential for dependency and tolerance,

falls and fractures due to dizziness, impaired balance, and motor coordination.

Drug Interactions: Benzodiazepines can interact with other medications, including alcohol and certain

antidepressants, leading to adverse effects and potentially dangerous interactions.

Respiratory Depression: In high doses or when combined with other central nervous system

depressants, benzodiazepines can suppress respiratory function, particularly in individuals with

respiratory disorders such as sleep apnea.

Given these risks, benzodiazepines are generally reserved for short-term use in cases of severe or acute

insomnia that have not responded to other treatments. Cognitive-behavioral therapy for insomnia (CBT-

I), which focuses on addressing maladaptive sleep behaviors and thought patterns, is considered the

first-line treatment for chronic insomnia due to its effectiveness and lower risk of side effects.

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judiciously and under the guidance of a healthcare professional, as they can also have side effects and

interactions with other medications.

they are not typically recommended as a first-line treatment due to their potential risks and limitations.

promote sleep.

Quazepam (Doral)

Short-Acting vs. Long-Acting: Benzodiazepines vary in their duration of action. Short-acting

benzodiazepines like triazolam are typically used for initiating sleep, while longer-acting

latency) and increasing total sleep time. They are often prescribed for short-term use in situations where

insomnia is severe or significantly impacting quality of life.

Limitations and Risks:

withdrawal symptoms, including rebound insomnia, anxiety, agitation, and seizures.

Side Effects: Common side effects of benzodiazepines include drowsiness, dizziness, confusion, impaired

coordination, memory impairment, and daytime sedation. These side effects can persist into the next

day, impairing cognitive function and physical performance.

Risk of Abuse: Benzodiazepines have a potential for abuse and can be habit-forming, especially when

used inappropriately or for extended periods.

Guidelines for Use: Due to their risks and limitations, benzodiazepines are generally recommended for

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term use of benzodiazepines for chronic insomnia is discouraged, and alternative treatments such as

cognitive-behavioral therapy for insomnia (CBT-I) are preferred.

and individuals with a history of substance abuse, respiratory disorders, or mental health conditions.

alternative treatment options as appropriate.

receptors on GABA neurons, benzodiazepines increase the inhibitory tone of GABA, leading to a

reduction in neuronal excitability and promoting relaxation and sedation.

agonists or sedating antidepressants have not been effective. They may be prescribed for individuals

experiencing significant sleep disturbances or impairment in daytime functioning due to insomnia.

Dosage and Administration: Benzodiazepines are typically taken orally in tablet or capsule form. The

dosage and timing of administration depend on the specific benzodiazepine prescribed, the severity of

insomnia, and individual patient factors. It's important to follow the prescribing physician's instructions

carefully and not exceed recommended dosages.

Duration of Treatment: Benzodiazepines are intended for short-term use only, generally ranging from a

few days to a few weeks. Prolonged use of benzodiazepines for insomnia is discouraged due to the risk

of tolerance, dependence, withdrawal symptoms, and other adverse effects.

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Potential Side Effects: Common side effects of benzodiazepines include drowsiness, dizziness, cognitive

impairment, memory disturbances, reduced motor coordination, and increased risk of falls, particularly

in older adults. Daytime sedation and residual effects upon awakening may also occur.

Risk of Tolerance and Dependence: With prolonged use, tolerance to the sedative effects of

seizures in severe cases.

populations, including older adults, individuals with a history of substance abuse or addiction, those

with respiratory disorders (e.g., sleep apnea), and pregnant or breastfeeding women, due to potential

risks and adverse effects.

Monitoring and Follow-up: Patients prescribed benzodiazepines for insomnia should be monitored

closely by their healthcare provider to assess treatment response, monitor for adverse effects, and

evaluate the need for ongoing medication use. Regular follow-up appointments are important to ensure

safe and appropriate use of benzodiazepines.

should be carefully considered and limited to situations where the benefits outweigh the risks. Patients

should be informed about the potential side effects, risks of tolerance and dependence, and the

safer and more sustainable management of insomnia.

common in the general adult population, and as the population ages, the prevalence of these

behaviors, medical history, psychological factors, and lifestyle habits. Here are some best practices for

conducting an insomnia assessment:

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Detailed Sleep History: Begin by obtaining a detailed sleep history from the patient, including their

sleep-wake schedule, sleep environment, bedtime routines, sleep onset latency (time taken to fall

asleep), number and duration of awakenings during the night, and perceived sleep quality.

Medical History and Medication Review: Inquire about the patient's medical history, including any

these psychological factors on sleep quality and daytime functioning.

latency, awakenings, total sleep time, and daytime functioning. It can help identify patterns and triggers

contributing to insomnia.

sleep studies may be indicated to evaluate for underlying sleep disorders, such as obstructive sleep

apnea, periodic limb movement disorder, or REM sleep behavior disorder, especially when symptoms

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Comprehensive Evaluation: An effective assessment of insomnia involves a comprehensive evaluation of

the patient's sleep habits, patterns, and related factors. This includes exploring the frequency, severity,

and duration of sleep difficulties, as well as their impact on the patient's daily functioning and quality of

patterns, stressors, or life events that may be contributing to insomnia.

conditions or psychiatric disorders that may be associated with insomnia, such as chronic pain,

respiratory disorders (e.g., sleep apnea), mood disorders (e.g., depression, anxiety), or neurological

conditions. Review the patient's past medical treatments, surgeries, and medications, including

prescription drugs, over-the-counter medications, and supplements.

Medication Review: Evaluate the patient's current medication regimen to assess for potential sleep-

disrupting side effects or drug interactions that may contribute to insomnia. Pay particular attention to

medications with stimulant effects (e.g., antidepressants, decongestants, corticosteroids) or those that

affect sleep architecture (e.g., beta-blockers, antipsychotics).

Sleep Diary: Encourage the patient to keep a sleep diary for at least one to two weeks to track their

sleep patterns, including bedtime, wake time, total sleep time, awakenings during the night, and

Sleep Hygiene Assessment: Evaluate the patient's sleep hygiene practices and behaviors, including their

bedtime routine, sleep environment (e.g., noise, light, temperature), use of electronic devices before

bedtime, caffeine and alcohol consumption, and physical activity patterns. Educate the patient about

healthy sleep hygiene practices and strategies to optimize their sleep environment.

conditions that may impact sleep, such as obesity, hypertension, thyroid disorders, or chronic pain

syndromes. Pay attention to physical findings that may suggest sleep-related breathing disorders, such

as obesity hypoventilation syndrome or upper airway resistance syndrome.

Objective Sleep Assessment: Consider referring the patient for objective sleep assessments, such as

polysomnography (PSG) or home sleep apnea testing (HSAT), if there are concerns about the presence

of sleep disorders, such as obstructive sleep apnea, restless legs syndrome, or periodic limb movement

disorder. These tests can provide objective data about the patient's sleep architecture, respiratory

parameters, and nocturnal movements.

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Multidisciplinary Collaboration: Work collaboratively with other healthcare providers, such as sleep

medicine specialists, psychologists, psychiatrists, and behavioral therapists, to develop a comprehensive

treatment plan that addresses the multifaceted nature of insomnia. Consider integrating

insomnia (CBT-I), sleep restriction therapy, relaxation techniques, and mindfulness-based interventions,

to optimize treatment outcomes and promote long-term sleep health.

thorough understanding of the patient's sleep difficulties, identify contributing factors, and tailor

interventions to address the underlying causes of insomnia effectively. This comprehensive approach

can enhance the quality of care and improve outcomes for patients experiencing sleep disturbances.

Patient Interview and History Taking:

Explore any stressors, life events, or psychological factors that may contribute to insomnia, such as

Sleep Diary:

Encourage the patient to maintain a sleep diary for at least one to two weeks to track their sleep-wake

The sleep diary should include information on bedtime, wake time, total sleep duration, number of

Medical and Psychiatric Evaluation:

Obtain a comprehensive medical history to identify any underlying medical conditions or comorbidities

that may contribute to insomnia, such as chronic pain, respiratory disorders, or neurological conditions.

with insomnia, such as depression, anxiety, post-traumatic stress disorder (PTSD), or obsessive-

compulsive disorder (OCD).

Review the patient's medication history, including prescription medications, over-the-counter drugs,

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Physical Examination:

Perform a physical examination to evaluate for signs of medical conditions or physical health issues that

Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Beck Depression Inventory (BDI).

These tools can help quantify the patient's symptoms, track changes over time, and monitor treatment

outcomes.

Multidisciplinary Collaboration:

Consider involving a multidisciplinary team of healthcare professionals, including sleep specialists,

Collaborate with other providers to address the complex interplay of medical, psychological, and

patient's needs.

healthcare providers can gain a deeper understanding of the underlying factors contributing to the

nocturnal awakenings, complementing subjective reports from the patient's sleep diary.

Polysomnography (PSG) is a comprehensive sleep study conducted in a sleep laboratory that records

physiological parameters including brain activity, eye movements, muscle tone, heart rate, and

Assessment of Circadian Rhythms:

Evaluate the patient's circadian rhythms and chronotype, which influence the timing of sleep and

wakefulness.