5 Bipolar Disorder Flashcards
1
Q
Bipolar disorder is characterized by __ __ from profound __ to extreme __ with intervening periods of __.
A
mood swings
depression
euphoria
normalcy
2
Q
Can delusions be present for someone with bipolar disorder?
A
YES
3
Q
Onset of symptoms of bipolar disorder may have a __ __
A
seasonal pattern
4
Q
What are the 5 bipolar disorder diagnoses?
A
- Bipolar I
- Bipolar II
- Cyclothymic Disorder
- Substance/Medication Induced Bipolar Disorder
- Bipolar Disorder due to another Medical Condition
5
Q
Bipolar disorder affects ~ __ million or __% of adults in the US
A
- 7
2. 6
6
Q
Is bipolar disorder more prevalent in women or men?
A
EQUALLY prevalent in both men and women
7
Q
What is the average age of onset of bipolar disorder ?
A
early 20’s
8
Q
Bipolar disorder tends to be recurrent following __ _ ___
A
first manic episode
9
Q
Etiology
Bipolar Disorder is … (4)
A
- genetic
- biochemical
- neuroanatomical factors
- medication/drug induced
10
Q
Genetic Factors Prevalence of bipolar disorder in the general population:
A
2.6%
11
Q
Genetic Factors Prevalence of bipolar disorder in monozygotic twins:
A
60-80%
12
Q
Genetic Factors Prevalence of bipolar disorder in dizygotic twins
A
10-20%
13
Q
Genetic Factors Prevalence of bipolar disorder in child of 1 parent with bipolar disorder:
A
28%
14
Q
Genetic Factors Prevalence of bipolar disorder in child of 2 parents with bipolar disorder
A
50-60%
15
Q
Is there an excess or deficiency of DOPAMINE in:
A) Mania
B) Depression
A
A) Mania - EXCESS
B) Depression - DEFICIENCY
16
Q
Is there an excess or deficiency of NOREPINEPHRINE in:
A) Mania
B) Depression
A
A) Mania - Excess
B) Depression - Deficiency
17
Q
Is there an excessive or inadequate amount of CHOLINERGIC TRANSMISSION in:
A) Mania
B) Depression
A
A.) Mania - Inadequate
B.) Depression - Excessive
18
Q
Neuroanatomical Factors for Bipolar Disorder:
__-sided lesions in: (4) areas
A
right
- limbic system
- temporobasal areas
- basal ganglia
- thalamus induced mania
19
Q
Neuroanatomical Factors for Bipolar Disorder:
enlarged __ __
A
third ventricles
20
Q
Neuroanatomical Factors for Bipolar Disorder:
__ __ __
A
subcortical white matter
21
Q
Neuroanatomical Factors for Bipolar Disorder:
__ __
A
periventricular hyperintensities
22
Q
Medications for bipolar disorder (4)
A
- steroids
- amphetamines
- antidepressants
- narcotics
23
Q
Manic episode is defined as at least __ __ period of elevated, expansive or irritable mood
A
1 week
24
Q
A manic episode causes __ __ , i.e. ____
A
marked impairment
hospitalization
25
manic episode is not attributable to __, ___, and __ __
substances
medications
medical conditions
26
What are 8 symptoms of a manic episode?
1. inflated self-esteem/grandiosity
2. decreased need for sleep
3. talkative/pressured speech
4. flight of ideas/racing thoughts
5. distractibility
6. increase in goal directed activity
7. excessive involvement in activities with high potential for painful consequences
8. agitation, irritability, aggression
27
A hypomanic episode is a __ day period of elevated, expansive, or irritable mood
4
28
A hypomanic episode is an episode where there is a __ in __
change in behavior
29
In a hypomanic episode, the disturbance in mood and change in functioning are...
observable by others
30
In a hypomanic episode, is it severe enough to cause marked impairment in functioning?
NO
31
A hypomanic episode is OR is not attributable to a substance/medication, medical condition?
IS NOT
32
Bipolar I and II Distinguishing Factors:
Manic Episode
A) Bipolar I
B) Bipolar II
A) Yes at least 1 week duration
B) NO
33
Bipolar I and II Distinguishing Factors:
Hypomanic Episode
A) Bipolar I
B) Bipolar II
A) n/a
B) Yes at least 4 days duration
34
Bipolar I and II Distinguishing Factors:
Major Depressive Episode
A) Bipolar I
B) Bipolar II
A) May be present and must be at least 2 weeks
B) Yes at least 2 weeks
35
Bipolar I and II Distinguishing Factors:
Marked impairment in functioning
A) Bipolar I
B) Bipolar II
A) Yes (i.e. hospitalization)
B) No (hospitalization)
36
Name this disorder.
| Chronic, fluctuating mood disturbance of at least 2 years duration
Cyclothymic Disorder
37
Cyclothymic Disorder has numerous periods of __ __ (does not meet criteria for hypomanic episode)
elevated mood
38
Cyclothymic Disorder has numerous periods of __ __ (does not criteria to meet MDD)
depressed mood
39
In a client with Cyclothymic Disorder, there is never without symptoms for more than __ __
2 months
40
Substance/Medication-Induced Bipolar Disorder is a direct result of __ __ of a substance (__ or __)
physiological effects
ingestion; withdrawal
41
Substance/Medication-Induced Bipolar Disorder causes significant __ or __
distress
| impairment
42
Bipolar disorder in children and adolescents is __ to diagnose
difficult
43
Bipolar disorder in children and adolescents may present with co-morbid __ __ or ___
co-morbid conduct disorders or
| attention deficit/hyperactivity disorder (ADHD)
44
Children of __ parents at higher risk for bipolar disorder
bipolar
45
Lifetime risk of suicide in individuals with bipolar disorder is __ times that of the general population
15
46
If the person has a past history of __ __, increases suicide risk in bipolar disorder
suicide attempt
47
Bipolar I lifetime prevalence rates of suicide attempts
32.4%
48
Bipolar II lifetime prevalence rates of suicide attempts
36.3%
49
Nursing diagnoses for bipolar disorder (7)
1. risk for injury
2. risk for violence: self directed or other directed
3. imbalanced nutrition
4. disturbed through processes
5. disturbed sensory perception
6. impaired social interaction
7. insomnia
50
9 nursing interventions for bipolar disorder
1. ensure safety of self and others
2. reduce environmental stimuli
3. remove hazardous object
4. stay with client who is hyperactive and agitated (may need 1:1)
5. provide structure
6. limit group activities
7. administer tranquilizing medications as prescribed
8. limit setting
9. mechanical restraints or seclusion
51
seclusion and restraints are initiated only when ....
less restrictive measure have proven ineffective
52
seclusion and restrains are used when ...
behavior poses serious and imminent danger to the person, staff or others
53
There must be a face evaluation by a MD, NP, RN, PA within _ __ of restraint
1 hour
54
There must be a new order of seclusion/restraints made every __ __ for an adult and every __-__ __ for children and adolescents
4 hours
1-2 hours
55
There should be __ __ checks or a 1:1 for a person in seclusion or on restraints
15 minute checks
56
RN must at least monitor __ for someone on restraints/in seclusion
hourly
57
__ is done for someone on seclusion/restraints
debriefing
58
what are the treatments for bipolar disorder? (4)
1. psychopharmacology
2. psychotherapy
3. recovery model
4. ECT
59
What two drug classes are used to treat someone with bipolar disorder?
1. mood stabilizers
| 2. anticonvulsants
60
What mood stabilizer is used for someone with bipolar disorder ?
```
lithium carbonate (Eskalith, Lithobid)
(most commonly used)
```
61
What anticonvulsants are used for someone with bipolar disorder? (7)
```
1. Tegretol (Carbamazepine)
(most commonly used)
2. Klonipin (Clonazepam)
3. Depakene, Depakote (Valproic Acid) (most commonly used)
4. Lamictil (Lamotrigine) (most commonly used)
5. Neurontin (Gabapentin)
6. Topamax (Topiramate)
7. Trileptal (Oxcarbazepine)
```
62
Which antipsychotics are used for someone with bipolar disorder? (7)
1. Olanzapine (Zyprexa)
2. Chlorpromazine (Thorazine)
3. Quetiapine (Seroquel)
4. Risperdone (Risperdal)
5. Ziprasidone (Geodone)
6. Asenapine (Saphris)
7. Lurasidone (Latuda)
63
__ and the __ may take 1-3 weeks (more with __/__) to take effect
Lithium
anticonvulsants
Lamictil/Lamotrigine
64
Patient with mania started on a mood stabilizer needs __ treatment with an __ and/or a __ until symptoms start to resolve
adjunctive
antipsychotic
benzodiazepine
65
Lithium normal ranges:
1. ) Acute mania
2. ) Maintenance
1. 1.0-1.5 mEq/L
| 2. 0.6-1.2 mEq/L
66
What are the 8 Lithium side effects?
1. Drowsiness, dizziness, headache
2. Dry mouth, thirst
3. GI upset nausea/vomiting
4. Fine hand tremors
5. Polyuria, dehydration
6. Weight gain
7. Acne
8. Lithium toxicity
67
Lithium toxicity is __ __ and can cause:
1. )
2. )
3. )
life threatening
1. ) renal impairment
2. ) nephrogenic diabetes insipidus
3. ) hypotension, arrhythmias, pulse irregularities
68
Symptoms when Lithium serum levels are between 1.5-2.0
1. blurred vision
2. persistent nausea
3. vomiting
4. severe diarrhea
69
Symptoms when Lithium serum levels are between 2.0-3.5
1. excessive output of dilute urine
2. increasing tremors
3. muscular irritability
4. psychomotor retardation
5. mental confusion
6. giddiness
70
Symptoms when Lithium serum levels are above 3.5
1. impaired consciousness
2. nystagmus
3. seizures
4. coma
5. oliguria/anuria
6. arrhythmias
7. MI
8. cardiovascular collapse
71
Lithium lab tests before initiation of treatment
1. kidney, thyroid function
2. ECG after 50
3. weight, BMI
72
Lithium lab tests during initiation of treatment
1. 1-2 weeks until stable
| 2. monthly first 6 months
73
Lithium lab tests during maintenance treatment
1. every 3-6 months
| 2. kidney function 1-2 times/year
74
Important side effects of Valproic Acid (Depakote)
1. sedation
2. weight gain
3. hepatotoxicity with liver failure
4. pancreatitis
5. prolonged bleeding time
75
Important side effect of Lamotrigine (Lamictil)
Steven Johnson's Syndrome
76
Important side effects of Carbamazepine (Tegretol)
1. ) Steven Johnson's Syndrome
2. ) Aplastic anemia
3. ) hyponatremia
77
lab tests done for tegretol (Carbamazepine) during:
1. initiation
2. treatment
1. CBC, liver, kidney, thyroid function
| 2. CBC every 2 weeks for 2 months, then every 3-6 months, liver, kidney, and thyroid function every 6-12 months
78
lab tests done for depakote (valproic acid) during:
1. initiation
2. How often are these tests done?
1. Platelet count, liver function test, weight
| 2. every 6 months
79
Any lab tests done for Lamictil (Lamotrigine)?
NOPE
80
What should your teaching include about lithium treatment? (9)
1. sodium intake
2. exercise
3. adequate fluid intake: 2,500-3,000 ml/day
4. monitor weight
5. take lithium as prescribed
6. carry card or ID noting that he or she is taking Lithium
7. symptoms of toxicity
8. use caution with driving until stable
9. contraceptive use
81
What should you include when teaching about anticonvulsants?
1. do not stop medication abruptly
2. Report any: skin rash, unusual bleeding, bruising, sore throat, fever, malaise, dark urine, yellow skin or eyes
3. carry card identifying the name of medication
4. use caution with driving until stable
5. laboratory testing
82
What should you include when teaching about antipsychotics?
1. do not discontinue abruptly
2. use sunblock
3. orthostatic hypotension
4. stay hydrated
5. good oral care
6. avoid ETOH
7. contraceptives
8. carry card identifying med
9. caution driving
10. report if you experience symptoms (on separate flash card)
83
When should you report immediately when taking antipsychotics?
When you experience:
1. sore throat, fever, malaise
2. unusual bleeding, bruising
3. persistent n/v
4. severe headache
5. rapid HR
6. muscle twitching;tremors
7. dark colored urien
8. excessive hunger
9. pale stools
10. muscle uncoordination
11. skin rash
12. yellow skin or eyes
84
What types of psychotherapy are there for someone with bipolar disorder? (5)
1. interpersonal and social rhythm therapy (IPSRT)
2. family therapy
3. CBT
4. individual therapy
5. group therapy: the person is stable
85
What does the recovery model consist of for bipolar disorder? (7)
1. knowledge about bipolar disorder
2. take medications as prescribed
3. awareness of early symptoms
4. family awareness of early symptoms
5. develop emergency plan
6. identify and reduce stress
7. develop a personal support system
