Bipolar Flashcards
Bipolar 1
more common in males
runs in families
most severe
at least 1 manic episode
psychotic episode (delusions/hallucinations)
highs mirror the lows in intensity
clinical features of mania (DIGFAST)
D- distractibility
I- Indiscretion
G- Grandiosity
F- Flight of ideas
A- Activity increase
S- Sleep Deficit
T- Talkativeness
what does mania look like?
mood lability: extreme mood swings
quick to anger/ feels misunderstood/ low frustration tolerance
pacing
dramatic mannerisms
uses jokes, puns
flamboyant or sexually suggestive
spends extravagantly on self or others
hostile/physically threatening
Bipolar 2
NEVER had a manic episode
more common in women- onset at 20
NO psychosis with hypomania; but may have psychosis during depressive side
presence of at least one major depressive episode
specifiers for bipolar and related disorders
mixed features- symptoms of both mania and depression at the same time
rapid cycling- 4 or more manic episodes for at least 2 weeks in 12 months
high risk of recurrence; resistant to drug therapy, greater severity of illness, depressive symptoms predominate
hypomanic episode
definite noticeable change in functioning uncharacteristic of person
NOT severe enough to cause marked impairment in social or occupational functioning or hospitalization
NO psychotic features in hypomanic phase
Elevated, expansive, or irritable mood for at least 4 days
cyclothymic disorder
presence for at least 2 years in adults, 1 in child/ado
multiple hypomanic symptoms but not hypomanic episodes
has not been without symptoms for more than 2 months at a time
fluctuating hypomanic symptoms and depressive symptoms
rapid cycling
nursing assessment for bioplar
mood
behavior
thought process
thought content
speech patterns
cognitive functioning
assessment guidelines for bipolar
danger to self or others
need for protection from uninhibited behaviors
need for hospitalization
medical status
coexisting medical conditions
family’s understanding
what is the primary outcome for an acute manic phase?
injury prevention
nursing care for acute mania
managing meds
decreasing physical activity
increase food and fluid intake
ensuring at least 4 to 6 hours of sleep per night
intervening for self care needs and setting limits on behaviors
patient/family teaching for biplar
bipolar is chronic and episodic
long term condition
whom to call and where to go incase of adverse reaction
signs and symptoms of relapse
preventing full relapse
emergency contact people
use of drugs, ETOH, caffeine (energy drinks), and OTC meds can cause relapse
good sleep hygiene is critical. early symptom of manic episode is lack of sleep.
meds for acute mania
mood stabilizer- Lithium plus antipsychotic or valproate plus antipsychotic
atypical antipsychotic- rispiridone, quetiapine, aripiprazole, olanzapine
benzodiazepines (rare and short term)- diazepam, lorazepam, clonazepam
meds for mood stabilizaion
Anticonvulsants (valporate, carbamazepine, lamotrigine, gabapentin- good for rapid cycling)
Lithium carbonate
combo med: symbax (olanzapine and fluoxetine)
Second generation antipsychotics- olanzapine, rispiridone, aripiprazole, lurasidone, quetiapine, ziprasidone
Lithium Carbonate
acute mania and maintenance treatment
therapeutic level: 0.6-1.4
TOXIC at 1.5 and above
contraindicated for: cardiovascular disease, renal disease, brain damage, thyroid disease, pregnant or breast feeding
early symptoms of lithium toxicity
coarse hand tremors
GI upset, confusion
hyperirritability of muscles
incoordination
1.5-3.0
sever toxicity
convulsions
oliguria
death
>2.5
Lithium as a mood stabilizer
most widely use mood stabilizer
onset 5-7 days may take as long as 2 weeks
monitor creatinine, thyroid, and CBC q6 months
kidney damage may be at risk
thyroid function may decrease, usually after 6-18 months; observe for dry skin, hair loss, constipation, bradycardia, and cold intolerance
teaching points of lithium
increased risk of SI with lithium discontinued
DO NOT restrict sodium; maintain normal sodium intake
hydrate
if sweating hydrate more
if illness causes loss of fluid contact MD
intermittent blood tests required.
valproate
depakote
anticonvulsant mood stabilizer
check serum levels
broad spectrum of efficacy
longer periods of mood stabilization
carbamazepine
tegretol
risk of low WBC and renal function
effective in pt’s who have no response to lithium or with secondary mania
RASH MAY BE LIFE THREATENING
lamotrigine
lamictal rash
stop med immediately
can advance to steven Johnson syndrome (occurs within first few months)
flu like symptoms
sore throat, fever, chills, blisters, burning in eyes
its an allergic reaction
can advance to toxic epidermal necrosis
lamotrigine uses
rapid cycling and depressed phase of bipolar illness
rash may be life threatening
used as add on therapy on refractory mood disorders
gabapentin
neurontin
may be effective for acute mania, mood stabilization, and rapid cycling
other treatments of bipolar
ECT
teamwork and safety
seclusion
support groups
health teaching and promotion
ECT
used in pts treatment-resistant mania ad pts with rapid cycling
used in depressive disorders particularly those with sever, catatonic, or treatment-resistant depression
advanced practice interventions for bipolar
CBT
family focused therapy
interpersonal and social rhythm therapy
suicidal ideation
thinking about, considering, or planning to take ones life
suicide intent
at the time of injury or death, the person had thoughts of taking one’s own life
suicidal behavior
acts associated with suicidal intent
suicidal plan
the organized plan and time frame or taking one’s own life
interrupted self-directed violence by self of other
other: person takes steps to injure self but stopped by someone else prior to injury
self: takes steps to injure self by stops prior to fatal injury
suicide attempt
non fatal self directed potentially injurious behavior with intent to die
suicide
the voluntary and intentional act of taking ones own life by any means
suicide survivor
family and friends grieving a loved ones suicide
non-suicidal self directed violence
no evidence of suicidal intent, behavior is self directed and deliberately results in injury or the potential for injury to ones self
suicidal self directed violence
self directed and deliberately results in injury or the potential for injury to oneself with evidence of suicidal intent
unacceptable terms for suicide
completed suicide/committed suicide
successful suicide
failed attempt
nonfatal suicide
parasuicide/suicide gesture
suicidality
levels of intervention
prevention: activities that provide support, information, and education to prevent suicide
treatment: treatment of the actual suicidal crisis
postvention: interventions with a circle of surviors left by individuals who have died by suicide and the traumatic effects
