24. Bipolar Disorder Flashcards
abnormally and persistently elevated mood, expansive mood, or irritable mood
mania
euphoria or elation
elevated mood
lack of restraints in expression; overvalue self-importance
expansive mood
easily annoyed and provoked to anger
irritable mood
sxs of manic episode
- a lot of energy
- constantly engaged in risky behaviors (regardless of consequences)
- accelerated thinking and pressured speech
- excessive involvement in pleasurable activities (gambling, shopping, sex)
disorder involving periods of severe mood episodes from mania to depression
bipolar I disorder
disorder with a milder form of mood elevation involving mild episodes of hypomania that alternated w/ severe depression
bipolar II disorder
disorder involving hypomania and depressive episodes that don’t meat full criteria for major depressive episode
cyclothymic disorder
how does bipolar manifest in children and adolescents
- depression usually occurs first marked by intense rage
- sxs reflective of developmental level of child
how does bipolar manifest in older adults
- greater neurologic abnormalities and cognitive disturbances
- incidence of mania decreased w/ age
epidemiology of bipolar
- sxs before age 25
- no gender differences
- female patient at greatest risk for depression and rapid cycling than male patients
- male patients at greatest risk for manic episodes
- common comorbid conditions: anxiety (panic disorder and social phobia) and substance use
biologic theories of bipolar
- chronobiologic theories (sleep disturbances common during manic phase; seasonal changes)
- genetic factors
- chronic stress and kindling (role of stress in cognitive impairment associated w/ disorder)
psychosocial theories of bipolar
focus on reducing environmental stress and trauma in genetically vulnerable individuals
biologic nursing assessment for bipolar
- changes in eating, sleeping, and activity
- diet and body weight
- thyroid function testing
- changes in sexual practice
- pharmacologic assessment (substances or previous treatment with antidepressants)
psychosocial nursing assessment for bipolar
- mood and cognition
- thought disturbances
- stress and coping
- risk assessment
- cultural views of mental illness
- social and occupational changes
- any changes resulting from a manic or depressive episode
strength assessment for bipolar
- healthy behaviors
- cues for manic or depressive episodes
- family, friends, and social support
- understanding of illness
- relaxation skills
- stress management skills
- medications
goals of tx for bipolar
- minimize and prevent manic or depressive episodes
- help pt and family learn about disorder and manage it throughout lifetime
priority care issue for bipolar
safety
how to establish therapeutic relationship w/ someone w/ bipolar
- use calm non-threatening approach
- be direct and use single commands
- avoid open-ended sentences; redirect if flight of ideas occur
- limit interaction time
- avoid excessive demands
psychosocial nursing interventions for bipolar
- identify risk factors
- teach about disorder
- relapse prevention (emergency plan)
- individual CBT
- individual interpersonal therapy
- adjunctive theapies
- psychotherapy
- support group
- family interventions (parenting skills, counseling and intensive family therapy)
- family psychoeducation
mental health promotion during periods of remission in bipolar
- teach stress management
- practice relaxation techniques
- develop plan for managing emerging sxs
spectrum of care for bipolar
- inpatient management
- intensive outpatient programs (partial hospitalization or day hospitalization)
biologic nursing interventions for bipolar
- protection from self-harm and harm from other patients
- education about physical care (sleep and nutrition)
- mood stabilizers
- antipsychotics (adjunct or monotherapy)
examples of mood stabilizers
- lithium: gold standard for tx
- anticonvulsants
- atypical antipsychotics
- ECT (severe mania)
indications for lithium
mania and depressive episodes of bipolar
onset of lithium
5 to 7 days but may take up to 2 weeks
how is lithium excreted
kidneys
therapeutic blood levels of lithium
- 8-1.4 mEq/L (narrow TI) -> requires careful level monitoring
- blood draws every 7 days for the first few weeks and every 3 months after stabilized levels
side effects of lithium
- thirst
- metallic taste
- increased urinary frequency
- fine head tremor
- drowsiness
- mild diarrhea
how is lithium levels affected by Na levels
- lithium is a salt
- higher Na levels = lower lithium levels
- lower Na levels = higher lithium levels
- patient should not make any sudden changes in their salt intake
what can lead to lithium toxicity
- dehydration
- sudden decrease in Na in diet
sxs of lithium toxicity
- severe diarrhea
- vomiting
- drowsiness
- muscular weakness
- lack of coordination
what labs are needed for lithium
- baseline kidney function
- lithium levels
- creatinine, thyroid (possible hypothyroidism), and CBC every 6 months
anticonvulsants used for bipolar (calm hyperactivity in brain)
- valproic acid
- divalproex (depakote)
- carbamazepine (Tegretol)
- lamotrigine (Lamictal)
side effects of valproic acid and depakote
- sedation
- GI disturbances
- tremor
- lethargy
- weight gain and alopecia (transitory)
- constipation
- urinary retention
how often are blood levels checked for valproic acid and depakote
every 6 months
black box warning for valproic acid and depakote
- hepatotoxicity
- pancreatitis
- birth defects
side effects of carbamazepine (Tegretol)
- dizziness
- drowsiness
- tremors
- visual disturbances
- N/V
what minimizes side effects of carbamazepine (Tegretol)
low doses and giving w/ food (reduces nausea)
adverse effects of carbamazepine (Tegretol)
- aplastic anemia (rare)
- agranulocytosis
- rare cardiac problems
- SIADH
side effects of lamotrigine (Lamictal)
- benign skin rash
- sedation
- blurred or double vision
- dizziness
- N/V and other GI problems
adverse effects of lamotrigine (Lamictal)
- SJS occurs within 2-9 weeks of tx (highest risk in children)
- immediately discontinue if rash is noted
