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Psych > 24. Bipolar Disorder > Flashcards

24. Bipolar Disorder Flashcards

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1
Q

abnormally and persistently elevated mood, expansive mood, or irritable mood

A

mania

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2
Q

euphoria or elation

A

elevated mood

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3
Q

lack of restraints in expression; overvalue self-importance

A

expansive mood

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4
Q

easily annoyed and provoked to anger

A

irritable mood

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5
Q

sxs of manic episode

A
  • 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)
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6
Q

disorder involving periods of severe mood episodes from mania to depression

A

bipolar I disorder

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7
Q

disorder with a milder form of mood elevation involving mild episodes of hypomania that alternated w/ severe depression

A

bipolar II disorder

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8
Q

disorder involving hypomania and depressive episodes that don’t meat full criteria for major depressive episode

A

cyclothymic disorder

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9
Q

how does bipolar manifest in children and adolescents

A
  • depression usually occurs first marked by intense rage

- sxs reflective of developmental level of child

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10
Q

how does bipolar manifest in older adults

A
  • greater neurologic abnormalities and cognitive disturbances
  • incidence of mania decreased w/ age
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11
Q

epidemiology of bipolar

A
  • 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
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12
Q

biologic theories of bipolar

A
  • 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)
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13
Q

psychosocial theories of bipolar

A

focus on reducing environmental stress and trauma in genetically vulnerable individuals

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14
Q

biologic nursing assessment for bipolar

A
  • 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)
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15
Q

psychosocial nursing assessment for bipolar

A
  • 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
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16
Q

strength assessment for bipolar

A
  • healthy behaviors
  • cues for manic or depressive episodes
  • family, friends, and social support
  • understanding of illness
  • relaxation skills
  • stress management skills
  • medications
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17
Q

goals of tx for bipolar

A
  • minimize and prevent manic or depressive episodes

- help pt and family learn about disorder and manage it throughout lifetime

18
Q

priority care issue for bipolar

A

safety

19
Q

how to establish therapeutic relationship w/ someone w/ bipolar

A
  • 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
20
Q

psychosocial nursing interventions for bipolar

A
  • 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
21
Q

mental health promotion during periods of remission in bipolar

A
  • teach stress management
  • practice relaxation techniques
  • develop plan for managing emerging sxs
22
Q

spectrum of care for bipolar

A
  • inpatient management

- intensive outpatient programs (partial hospitalization or day hospitalization)

23
Q

biologic nursing interventions for bipolar

A
  • protection from self-harm and harm from other patients
  • education about physical care (sleep and nutrition)
  • mood stabilizers
  • antipsychotics (adjunct or monotherapy)
24
Q

examples of mood stabilizers

A
  • lithium: gold standard for tx
  • anticonvulsants
  • atypical antipsychotics
  • ECT (severe mania)
25
Q

indications for lithium

A

mania and depressive episodes of bipolar

26
Q

onset of lithium

A

5 to 7 days but may take up to 2 weeks

27
Q

how is lithium excreted

A

kidneys

28
Q

therapeutic blood levels of lithium

A
  1. 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
29
Q

side effects of lithium

A
  • thirst
  • metallic taste
  • increased urinary frequency
  • fine head tremor
  • drowsiness
  • mild diarrhea
30
Q

how is lithium levels affected by Na levels

A
  • 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
31
Q

what can lead to lithium toxicity

A
  • dehydration

- sudden decrease in Na in diet

32
Q

sxs of lithium toxicity

A
  • severe diarrhea
  • vomiting
  • drowsiness
  • muscular weakness
  • lack of coordination
33
Q

what labs are needed for lithium

A
  • baseline kidney function
  • lithium levels
  • creatinine, thyroid (possible hypothyroidism), and CBC every 6 months
34
Q

anticonvulsants used for bipolar (calm hyperactivity in brain)

A
  • valproic acid
  • divalproex (depakote)
  • carbamazepine (Tegretol)
  • lamotrigine (Lamictal)
35
Q

side effects of valproic acid and depakote

A
  • sedation
  • GI disturbances
  • tremor
  • lethargy
  • weight gain and alopecia (transitory)
  • constipation
  • urinary retention
36
Q

how often are blood levels checked for valproic acid and depakote

A

every 6 months

37
Q

black box warning for valproic acid and depakote

A
  • hepatotoxicity
  • pancreatitis
  • birth defects
38
Q

side effects of carbamazepine (Tegretol)

A
  • dizziness
  • drowsiness
  • tremors
  • visual disturbances
  • N/V
39
Q

what minimizes side effects of carbamazepine (Tegretol)

A

low doses and giving w/ food (reduces nausea)

40
Q

adverse effects of carbamazepine (Tegretol)

A
  • aplastic anemia (rare)
  • agranulocytosis
  • rare cardiac problems
  • SIADH
41
Q

side effects of lamotrigine (Lamictal)

A
  • benign skin rash
  • sedation
  • blurred or double vision
  • dizziness
  • N/V and other GI problems
42
Q

adverse effects of lamotrigine (Lamictal)

A
  • SJS occurs within 2-9 weeks of tx (highest risk in children)
  • immediately discontinue if rash is noted

Psych (17 decks)

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