14 Bipolar Disorders

Question 1

bipolar disorder

Answer 1

mood disorder w recurrent episodes of depression + mania

Question 2

bipolar disorder

emergence

Answer 2

usually in early adulthood

-early-onset can also be diagnosed in pediatric clientsq

Question 3

its difficult to diagnose bipolar in children bc…

Answer 3

manifestation can mimic ADHD

Question 4

during mania, clients can exhibit…

Answer 4

• psychosis
• paranoia
• bizarre behavior

Question 5

3 phases of bipolar

Answer 5

1 ACUTE
2 CONTINUATION
3 MAINTENANCE

Question 6

Acute Phase Bipolar

Answer 6

• 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

Question 7

Continuation Phase Bipolar

Answer 7

• remission of manifestation
• Tx is usually 4-9 mos
• goal is relapse prevention thur education, med adherence, psychotherapy

Question 8

Maintenance Phase Bipolar

Answer 8

incr ability to function

• Tx is generally lifetime
• goal is prevention of future manic episodes

Question 9

types of behaviors shown w bipolar

Answer 9

• mania
• hypomania
• rapid cycling

Question 10

Mania

Answer 10

• abnormally elevated mood
• expansive, irritable
• requires hospitalization

Question 11

how long can mania vs hypomania last?

Answer 11

M: atleast 1 week
HM: atleast 4 days

Question 12

Hypomania

Answer 12

• less severe episode
• accompanied by 3+ manifestations of mania
• hospitalization is NOT required
• less impaired
• can progress into mania

Question 13

Rapid Cycling

Answer 13

• 4+ episodes of hypomania/acute mania w/in 1 year

- assoc w increased recurrence + resistance to treatment

Question 14

Bipolar I

Answer 14

client has at least 1 ep of MANIA alternating w depression

Question 15

Bipolar II

Answer 15

client has 1 or more HYPOMANIC ep alternating w depression

Question 16

Cychothymic Disorder

Answer 16

atleast 2 years of repeated HYPOMANIC manifestations

-does NOT meet the criteria for hypomanic ep alternating w minor depressive episodes

Question 17

risk factors

Answer 17

• genetics
• physiological (neurobiologic or neuroendocrine disorders)
• environmental (incr stress in environment)

Question 18

relapse

Answer 18

• 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

Question 19

manic characteristics

Answer 19

• 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

Question 20

depressive characteristics

Answer 20

• 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

Question 21

standardized screening tool

Answer 21

mood disorder questionnaire

Question 22

acute manic episode

nursing care

Answer 22

• 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

Question 23

maintenance of self care needs

Answer 23

monitor sleep, fluid intake, nutrition

• provide portable nutritious food
• supervise choice of clothes
• step-by-step reminders for hygience + dress

Question 24

communication

Answer 24

• use calm, matter of fact approach
• concise explanations
• consistency w expectations
• limit setting
• avoid power struggles
• listen to + act on legitimate grievances

Question 25

types of meds

Answer 25

• mood stabilizer
• 1st gen antypsychotic
• 2nd gen antipsychotic
• antidepressants like SSRI fluocetine

Question 26

therapeutic procedures

Answer 26

ECT

Question 27

bipolar requires long term __ + ___ support

Answer 27

pharmacological + psychological support

Question 28

precipitating factors of relapse

Answer 28

educate pt to watch for sleep disturbance, use of ETOH, or caffeine

Question 29

bipolar complications

Answer 29

physical exhaustion or death

-in true manic state, pt will NOT stop moving, does NOT eat, drink or sleep

Question 30

someone who is bipolar 2 (4 days+ of mania) can later be diagnosed as bipolar 1 i if…

Answer 30

1wk + of manic episode

Question 31

median age of onset for bipolar 1 + 2

Answer 31

1: 18
2: 20

can still be diagnosed later

Question 32

in 75% of women, bipolar 1 tends to manifest as…

Answer 32

depressive episode

Question 33

Bipolar 1 + 2 and their sex

Answer 33

1: more in female
2: more in males

Question 34

women w bipolar are more likely to…

Answer 34

develop HYPO-THYROID

-assoc w long term use of lithium

Question 35

types of foods

Answer 35

high caloric + finger foods

Question 36

main med class to help bipolar

Answer 36

mood stabilizers like lithium

Question 37

lithium + pregnancy

Answer 37

category D, esp in 3rd trimester

Question 38

lithoim long term use

Answer 38

hypo -thryoid

-renal complications

Question 39

lithium teaching

Answer 39

• 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

Question 40

fluid intake w lithium

Answer 40

1.5-3L/day

Question 41

lithium decr ___

Answer 41

Na reabsorption in kidneys
>Na deficiency
>toxicity

Question 42

Li toxicity levels

Answer 42

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