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Bipolar Flashcards

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1
Q

What is Bipolar Disorder?

A

Characterized by mood swings from profound depression to extreme euphoria with intervening periods of normalcy.

  • Delusions may be present
  • Onset of symptoms may have seasonal patterns
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2
Q

Diagnosis - 5

A
  • Bipolar I
  • Bipolar II
  • Cyclothymic Disorder
  • Medication/Substance Induced
  • Due to medical condition
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3
Q

Epidemiology

A
  • average Onset early 20s
  • prevalence equal in male and female
  • following first manic episode disorder tends to be recurrent
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4
Q

Etiology

A
  • Genetic
  • Neuroanatomical Factors
  • Biochemical
  • Drug induced
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5
Q

Genetic Factors Prevalence

A
  • Monozygotic twins - 60-80%

- Child of 2 parents with bipolar - 50-60 %

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6
Q

Etiology - Biochemical Influences - Mania vs Depression

(Dopamine, Norepinephrine, and Cholinergic Transmission

A
  • Mania: Excess in Dopamine and Norepinephrine; Inadequacy in Cholinergic Transmission
  • Depression: Deficiency in Dopamine and Norepinephrine; Excess in Cholinergic Transmission
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7
Q

Etiology - Neuroanatomical Factors

A
  • Right-sided lesions to limbic system, temporobasal areas, basal ganglia, and thalamus induce mania
  • Enlarged third ventricle
  • Subcortical white matter
  • Periventricular hyperintensities
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8
Q

Etiology - Medications

A

Steroids, Amphetamines, Narcotics and Anti-depressants

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9
Q

What is a manic episode?

A
  • At least 1 week period of elevated, expansive or irritated mood.
  • Causes marked impairment (i.e. Hospitalization)
  • Not attributable to substances, medications, and medical conditions
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10
Q

Symptoms of Manic Episodes

A
  • Inflated Self-Esteem/Grandiosity
  • Decreased need for sleep
  • Talkative/pressured speech
  • Flight of ideas/racing thoughts
  • Distractibility
  • Increase in goal directed activity
  • Excessive involvement in activities with potential for painful consequences
  • Agitation, irritation, and aggression
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11
Q

Hypomanic episode

A
  • 4 day period of elevated, expansive, or irritated mood
  • Episode is a change of behavior
  • Disturbance in mood and change in functioning are observable by others
  • Not severe enough for marked impairment in functioning
  • Not attributable to medications, substances, and medical conditions
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12
Q

Bipolar I vs II - Distinguishing Factors

  • Manic
  • Hypomanic
  • Major Depressive Episode
  • Marked impairment in functioning
A

Bipolar I

  • Yes Manic episode - 1 week
  • Maybe depressive episode and must be at least 2 weeks
  • Yes marked impairment in functioning

Bipolar II

  • No manic episode
  • Yes hypomanic episode - 4 days
  • Yes major depressive episode - at least 2 weeks
  • No marked impairment in functioning
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13
Q

What is Cyclothymic Disorder?

A
  • Chronic, fluctuating mood disturbance of at least 2 year duration
  • Numerous periods of elevated mood (does not meet criteria for hypomanic)
  • Numerous period of depressed mood (does not meet criteria for Major depressive episode)
  • Never without symptoms for more than 2 months
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14
Q

What is substance/medication induced bipolar disorder?

A
  • Direct result of physiological effects of a substance (withdrawal or ingestion)
  • Causes significant distress or impairment
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15
Q

What is bipolar disorder due to another medical condition?

A
  • Direct result of physiological consequence of another medical condition
  • Causes significant distress or impairment
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16
Q

Bipolar in children

A
  • hard to diagnose
  • may present with co-morbid disorders or ADHD
  • children with parents with bipolar at higher risk
17
Q

Suicide Risk in Bipolar

A
  • Lifetime risk 15 times higher than general population
18
Q

Nursing Diagnoses

A
  • Risk for Injury
  • Risk for violence: self-directed or other directed
  • imbalanced nutrition
  • disturbed thought processes
  • disturbed sensory perception
  • insomnia
  • impaired social interaction
19
Q

Nursing Interventions

A
  • Ensure safety of self and others
  • Reduce environmental stimuli
  • limit group activities
  • stay with client who is agitated or hyperactive (may need 1:1)
  • remove hazardous objects
  • provide structure
  • Mechanical restraints or seclusions
  • limit setting
  • administer medication
20
Q

Restraints and Seclusion Guidelines

A
  • Initiated only when less restrictive measures have proven ineffective
  • Behavior poses danger to to self or others
  • within 1 hour of restraint: 1 to 1 with MD, PA, RN, NP,
  • New order every 4 hours for adults, 1-2 for children
  • 15 minute checks or 1:1
  • Rn monitor hourly
  • Debriefing
21
Q

Treatment

A
  • Psychopharmocology
  • Psychotherapy
  • Recovery Model
  • ECT (electric convulsive therapy)
22
Q

Psychopharmocology - Mood stabilizers/anti-convulsants

A

Mood stabilizers: Lithium carbonate (Eskalith, Lithobid)
Anti-convulsants: Depakene, Depakote (Valproic Acid), Lamatrogine (Lamictil), Tegretol (Carbamezepine)
- Anti-convulsants can be used as mood stabilizers

  • May take 1-3 weeks to take effect
  • Patient on mood stabilizer needs to be on adjunctive treatment with with an antipsychotic or benzodiazepine until symptoms start to resolve
23
Q

Psychopharmocology - Anti-Psychotics

A

Clozapine (Clozaril), Risperdone (Risperdal), Quetiapine (Seroquel), Olanzapine (Zyprexa), Aripiprazole (Abilify)

24
Q

Lithium

A

Margin between therapeutic and toxic levels of Lithium carbonate are narrow
Ranges: Acute mania: 1.0-1.5
Maintenance: 0.6-1.2

25
Q

Lithium side effects

A
  • Drowsiness, dizziness, headache
  • dry mouth, thirst
  • GI upset, vomiting
  • Polyuria, dehydration
  • fine hand tremors
  • weight gain
  • lithium toxicity
  • acne
26
Q

Lithium Toxicity

A
  • Life threatening
  • renal impairment
  • Nephrogenic diabetes insipidus
  • hypotension, arrhythmias, pulse irregularities
27
Q

Lithium Lab Test

A

Before Treatment:

  • kidney and thyroid function
  • ECG after 50
  • Weight, BMI

Initiation of Treatment:

  • 1-2 weeks untile stable
  • Monthly after 6 months

Maintenance treatment:

  • Every 3-6 months
  • Kidney function 1-2 times a year
28
Q

Anticonvulsants Side Effects: Valproic Acid (Depakote), Lamotrigine (Lamictil), Carbamazepine (Tegretol)

A
  • Valproic Acid (depakote): sedation, weight gain, hepatotoxicity with liver failure, pancreatitis, and prolonged bleeding time
  • Lamotrigine (Lamictile): Steven Johnson Syndrome
  • Carbamazepine (Tegretol): Steven Johnson syndrome, aplastic aneumia, hyponatremia
29
Q

Anticonvulsants Lab Tests: Carbamezapine (Tegretol), Valproic Acid (Depakote), Lamotrigine (Lamictil)

A
  • Carbamezapine (Tegretol): Initiation: CBC, liver, kidney, thyroid function
    Treatment: CBC every 2 weeks for 2 months, then every 3-6 months, liver, kidney, thyroid function every 6-12 months
  • Valproic Acid (Depakote): Initiation: platelet count, liver function, weight. Every 6 months
  • Lamotrigine (Lamictil): None
30
Q

Lithium treatment teaching

A
  • sodium intake
  • exercise
  • adequate fluid intake 2500-3000 ml/day
  • monitor weight
  • contraceptive use
  • take as prescribed
  • carry id or card indicating they are taking lithium
  • symptoms of toxicity
  • caution when driving
31
Q

Anti-convulsant teaching

A
  • Do not stop med abruptly
  • Report: skin rash, unusual bleeding, bruising, sore throat, malaise, fever, dark urine, yellow eyes or skin
  • carry card identification of med
  • caution with driving
  • lab tests
32
Q

Anti-psychotic teaching

A
  • Do not discontinue abruptly
  • use sunblock
  • orthostatic hypotension
  • stay hydrated
  • ETOH avoidance
  • good hygiene
  • contraceptives,
  • id card
  • caution driving

Psych (8 decks)

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