Bipolar Disorder

Bipolar disorder is best recognized as an illness of distinct mood episodes, not simply “mood swings.” The bedside question is the patient’s current state—mania, hypomania, depression, mixed features, or euthymia—and whether changes in energy, sleep, judgment, psychosis, intake, or suicidal thinking have created immediate risk. Episode duration and functional change separate mania from hypomania. Substances, medications, delirium, thyrotoxicosis, corticosteroids, stimulants, and other medical conditions can produce a similar presentation and must be considered before attributing symptoms to primary bipolar disorder. A fully syndromal episode that begins during antidepressant treatment can still support bipolar diagnosis if it persists beyond the treatment’s physiological effect. For an RPN in Canada, assessment, medication administration, observation, and teaching occur within provincial scope, employer policy, and prescriber orders. The practical priority is to recognize a dangerous change early, reduce stimulation and access to harm, protect hydration and sleep, and immediately notify the prescriber or nurse practitioner when the patient’s behaviour or physiology exceeds the safe outpatient or unit-based plan; activate the emergency response system or call 911 for an immediate threat to life.