14 Bipolar Disorders Flashcards
bipolar disorder
mood disorder w recurrent episodes of depression + mania
bipolar disorder
emergence
usually in early adulthood
-early-onset can also be diagnosed in pediatric clientsq
its difficult to diagnose bipolar in children bc…
manifestation can mimic ADHD
during mania, clients can exhibit…
- psychosis
- paranoia
- bizarre behavior
3 phases of bipolar
1 ACUTE
2 CONTINUATION
3 MAINTENANCE
Acute Phase Bipolar
- acute mania, hospitalization may be required
- goals are reduction of mania + client safety
- determine risk os self harm or harm of others
- one-on-one may be indicated
Continuation Phase Bipolar
- remission of manifestation
- Tx is usually 4-9 mos
- goal is relapse prevention thur education, med adherence, psychotherapy
Maintenance Phase Bipolar
incr ability to function
- Tx is generally lifetime
- goal is prevention of future manic episodes
types of behaviors shown w bipolar
- mania
- hypomania
- rapid cycling
Mania
- abnormally elevated mood
- expansive, irritable
- requires hospitalization
how long can mania vs hypomania last?
M: atleast 1 week
HM: atleast 4 days
Hypomania
- less severe episode
- accompanied by 3+ manifestations of mania
- hospitalization is NOT required
- less impaired
- can progress into mania
Rapid Cycling
- 4+ episodes of hypomania/acute mania w/in 1 year
- assoc w increased recurrence + resistance to treatment
Bipolar I
client has at least 1 ep of MANIA alternating w depression
Bipolar II
client has 1 or more HYPOMANIC ep alternating w depression
Cychothymic Disorder
atleast 2 years of repeated HYPOMANIC manifestations
-does NOT meet the criteria for hypomanic ep alternating w minor depressive episodes
risk factors
- genetics
- physiological (neurobiologic or neuroendocrine disorders)
- environmental (incr stress in environment)
relapse
- use of substanced can lead to episodes of mania
- sleep disturbances can come before, be assoc w, or bought on by episode of mania
- psychological stressors can trigger mania
manic characteristics
- labile mood w euphoria
- aditation + irritability
- restless
- dislike of interferance
- intolerance of criticism
- incr in talking + activity
- flight of ideas
- grandiose view of self
- impulsive
- demanding/manipulative behavior
- dect attention span
- poor judgment
- attention seeking behavior
- impaitment in social/occupation
- decr sleep
- neglect of ADL (nutrtn, hydrtn)
- possibly delusion/hallucinatn
- denial of illness
depressive characteristics
- flat blunted labile affect
- tearful, crying
- lack of energy
- anhedonia
- physical discomfort
- difficulty concentrating, prblm solvng
- self destructv, suicidal
- decr hygience
- loss/incr in appetite, sleep
- psychomotor retardation
standardized screening tool
mood disorder questionnaire
acute manic episode
nursing care
- safe environment
- assess for suicidal thoughts
- decr stimulation wo isolating them
- restrains/ one-on one if at risk
- frequent rest periods
- physical activity but not one that lasts a long time or requires high level concentratoin
- protect fr poor judgment/impulsiveness
maintenance of self care needs
monitor sleep, fluid intake, nutrition
- provide portable nutritious food
- supervise choice of clothes
- step-by-step reminders for hygience + dress
communication
- use calm, matter of fact approach
- concise explanations
- consistency w expectations
- limit setting
- avoid power struggles
- listen to + act on legitimate grievances
types of meds
- mood stabilizer
- 1st gen antypsychotic
- 2nd gen antipsychotic
- antidepressants like SSRI fluocetine
therapeutic procedures
ECT
bipolar requires long term __ + ___ support
pharmacological + psychological support
precipitating factors of relapse
educate pt to watch for sleep disturbance, use of ETOH, or caffeine
bipolar complications
physical exhaustion or death
-in true manic state, pt will NOT stop moving, does NOT eat, drink or sleep
someone who is bipolar 2 (4 days+ of mania) can later be diagnosed as bipolar 1 i if…
1wk + of manic episode
median age of onset for bipolar 1 + 2
1: 18
2: 20
can still be diagnosed later
in 75% of women, bipolar 1 tends to manifest as…
depressive episode
Bipolar 1 + 2 and their sex
1: more in female
2: more in males
women w bipolar are more likely to…
develop HYPO-THYROID
-assoc w long term use of lithium
types of foods
high caloric + finger foods
main med class to help bipolar
mood stabilizers like lithium
lithium + pregnancy
category D, esp in 3rd trimester
lithoim long term use
hypo -thryoid
-renal complications
lithium teaching
- narrow therapeutic range
- close monitoring of Li, Na, TFT, Renal
- maintain normal salt + fluid intake
- take w food
- careful w exercise, diarrhea, vimir, nsaid, diuretic> toxcty
fluid intake w lithium
1.5-3L/day
lithium decr ___
Na reabsorption in kidneys
>Na deficiency
>toxicity
Li toxicity levels
early: 1.5+, N/V diarrhea polyuria
advanced: 1.5-2 mental confusion, coarse tremors, GI distress
severe: 2-2.5extreme polyuria of dilute urine, tinnitus
greater than 2.5: coma/death
