bipolar and related disorders Flashcards
bipolar 1 disorder
- Most severe form
- Highest mortality rate of the three
- At least 1 manic episode
- big shifts
- admiited for severe mania
bipolar 2 disorder
- at least 1 hypomanic episode- less severe scale
- at least 1 major depressive episode
- productive at work, trying to do a lot of things at once
cyclothymic disorder
- Alternate with symptoms of mild to moderate depression for at least 2 years (adults)
- Rapid cycling possible- at least four mood episodes in a 12-month period
- hypomania
assessment of mania
mood behavior thought processes and speech patterns thought content cognitive functioning
mood assessment for mania
mania: expansive mood, elevated,
and unrestrained emotional expressiveness,
euphoric, irritability, labile
behavior assessment for mania
- Hypomania: love social engagement, spending,
And activity, and indiscriminate sexual activity,
May not sleep for several days (first indication something wrong), less severe - Mania: give away money, prized possessions,
And expensive gifts, distractibility, grandiose (larger then life),
manipulative
thought content assessment for mania
- Grandiose delusions: highly inflated self-regard
- Persecutory delusions: believing that one is being singled out for harm
pressured speech
fast, ranging from rapid to frantic that conveys an inappropriate sense of urgency.
circumstantial speech
adding unnecessary details when communicating with others. The person eventually gets to the point
tangential speech
similar to circumstantial speech, main difference is that the person loses their point that they were trying to make and never find it again.
loose associations
thoughts are only loosely connected to each other in the person’s conversation.
flight of ideas
continuous flow of accelerated speech with abrupt changes from topic to topic.
clang associations
stringing together of words because of their rhyming sounds, without regard to their meaning.
assessment: depressive state
- Mood: depressed mood, anhedonia
- Affect: flat, blunted, constricted
- Behavior: anergia, vegetative signs of depression
- Thought processes: difficulty with problem solving, difficulty thinking clearly, poor judgement, indecisiveness, poor memory and concentration,
- Cognitive changes: helplessness, difficulty completing simple tasks, hopelessness, suicidal ideation, anger, irritability, low self-esteem, worthlessness
manic patient
self assessment
Manic patient
- Manipulative
- Demanding
- Splitting
Staff member actions
- Frequent staff meetings to deal with patient behavior and staff response
Set limits consistently
assessment guidelines for bipolar disorder
Danger to self or others Need for protection from uninhibited behaviors Need for hospitalization Medical status Coexisting medical conditions Family’s understanding
nursing diagnosis
Risk for injury
Risk for violence
- Other-directed
- Self-directed
Ineffective coping
outcomes identification
Acute phase
- Prevent injury- make sure pt. is safe
Continuation phase
- Relapse prevention- minimize s/s
Maintenance phase
- Limit severity and duration of future episodes
- treatting psychotherapy meds
- manoa: high protein snacks and sleeping
- monitor vitals
- no self harm behaviors
planning
Medical stabilization
Maintaining safety
Nursing care
planning manic phase
- Managing medications
- decreasing physical activity
- increasing food and fluid intake
- ensuring at least 4 to 6 hours of sleep per night
- intervening so that self-care needs are met
- Seclusion, restraint, or electroconvulsive therapy (ECT) may be considered during the acute phase.
planning during depressive phase
- Reduction of depressive symptoms
- restoration of psychosocial and work function
- hospitalization may be required
- medication or biological treatments
- prevention of relapse
- prevention of further episodes of depression
implementation depressive episodes
- Hospitalization for suicidal, psychotic, or catatonic signs
- Medication concerns about bringing on a manic phase
manic episodes implementation
- Hospitalization for acute mania (bipolar I disorder)
- Communicating challenges and strategies
- be direct with limits
lithium carbonate use
mood stabilizer
lithium therapeutic level
maintenance blood level
Therapeutic blood level: 0.8 to 1.4 mEq/L
Maintenance blood level: 0.4 to 1.3 mEq/L
lithium toxic level
Toxic blood level: 1.5 mEq/L and above
- need blood test every 5d
lithium contraindications
- assess renal function and thyroid status
- cardiovascular disease
- pregnant women
- breast feeding mothers
Anticonvulsant Mood Stabilizers
Valproate (Depakote)
- better than lithium
- used for acute mania and maintain depression, rapid cycling
- monitor platelets & lsts
Carbamazepine (Tegretol)
Lamotrigine (Lamictal)
Second-Generation Antipsychotics
Olanzapine (Zyprexa)
Risperidone (Risperdal)
with lithium for severe agitation
Medications for Bipolar Depression
- Treatment of bipolar with a common antidepressant alone increases the risk of bringing on a manic episode, risk vanishes with a combination of an antidepressant and mood stabilizer
- Second-generation antipsychotics: lurasidone (Latuda) and quetiapine (Seroquel)
- Symbyax: made up of the second- generation antipsychotic olanzapine (Zyprexa) and SSRI fluoxetine (Prozac)
- antidepressant and mood stabilizer due to being manic from anti
