Bipolar and Related Disorders Flashcards
examples of anticonvulsant mood stabilizers
–sodium valproate/divalproex sodium/valproic acid
–carbamazepine
–lamotrigine
–gabapentin
examples of antipsychotics
–olanzapine
–risperidone
–aripiprazole
–quetiapine
examples of benzos
–diazepam
–lorazepam
who is more likely to experience bipolar I?
males
who is more likely to have bipolar II?
females
when does cyclothymia start?
usually begins in adolescence or early adulthood
when can bipolar start?
onset can begin at any age
neurotransmitters connected with bipolar disorder
–norepi
–dopamine
–serotonin
neurobiological factors of bipolar disorder
–prefrontal cortical region
–hippocampus
–amygdala
neuroendocrine of bipolar disorder
hypothalamic-pituitary-thyroid-adrenal (HPTA) axis
clinical picture of bipolar I
–most severe form
–highest mortality rate of the three
–at least 1 manic episode
clinical picture of bipolar II
–at least 1 hypomanic episode
–at least 1 major depressive episode
clinical picture of cyclothymic disorder
–alternate with symptoms of mild to moderate depression for at least 2 years
–rapid cycling possible
diagnostic criteria for bipolar I
–abnormally and persistently elevated, expansive, or irritable mood and goal directed activity or energy, for a duration of 1 week
–three or more of symptoms:
(1) inflated self-esteem or grandiosity
(2) decreased need for sleep
(3) more talkative than usual or pressure to keep talking
(4) flight of ideas or subjective experience that thoughts are racing
(5) distractibility
(6) increase in goal-directed activity or psychomotor agitation
(7) excess involvement in pleasurable activities with high potential for painful consequences
marked impairment in social or occupational functioning
characteristics of bipolar I disorder
–at least one manic episode
–symptoms of alternating manic episodes with MDE and/or hypomanic episodes
–psychotic episode or MDE may be absent over the lifetime of the person, but would be unusual
–the more manic episodes that occur the more intense they are
–highs mirror the lows in depth and intensity
DIG FAST (mania)
D-distractibility
I- indiscretion
G-grandiosity
F-flight of ideas
A-activity increase
S-sleep deficit
T-talkativeness
mood lability
rapid extreme mood swings with irritability or sudden outburst of misplaced rage
behaviors of mania
–mood lability
–quick to anger/feels misunderstood/low frustration tolerance
–pacing
–uses jokes, puns
–flamboyant or sexually suggestive dress
characteristics of bipolar II
–presence or history of at least one major depressive episode
–presence or history of at least one hypomanic episode
–never had a manic episode
–impairment in functioning in at least one area
–no psychosis with hypomania but may have during the depressive phase
mixed features
symptoms of both depression and mania occur at the same time
with rapid cycling
–four or more manic episodes for at least 2 weeks in 12 months
–partial or full remission for 2 months at a time or switch to opposite episode
–high risk of recurrence
–resistant to drug therapy
–greater severity of illness
–depressive symptoms predominate
hypomanic episode criteria
same for manic except…
–associated with a definite noticeable change in functioning uncharacteristic for the individual
–NOT severe enough to cause a marked impairment in social or occupational functioning or hospitalization
–no psychotic features in this phase
–elevated, expansive, or irritable mood for at least 4 days
specifics of cyclothymic disorder
–presence for at least 2 years in adults
–multiple hypomanic symptoms but not hypomanic episode
–depressive symptoms but no MDE, manic, and mixed episodes
–symptoms present more than half the time; has not been without symptoms for more than 2 months at a time
–fluctuating hypomanic and depressive symptoms
–rapid cycling possible
mood cues for bipolar
–mania
–hypomania
–depression
–lability
behavior cues for bipolar
–agitated
–manipulative
–restless
–pacing
thought process cues for bipolar disorders
–loose
–tangential
–flight of ideas
thought content cues for bipolar
–grandiose
–paranoid
–persecutory delusions
speech pattern cues for bipolar
–pressured
–circumstantial
–clang
cognitive functioning cues for bipolar
deficits possible
primary outcome goal for the manic phase
injury prevention
nursing care for acute mania
–managing meds
–decreasing physical activity
–increasing food and fluid intake
–ensuring at least 4-6 hours of sleep per night
–intervening for self-care needs and setting limits on behavior
patient/family teaching for bipolar disorder
–chronic and episodic nature
–treatment requires one or more mood stabilizing agents taken a long time
–expected side effects or toxic effects of med
–s/s of relapse that may “come out of the blue”
–role of family members and others in preventing a full relapse
–phone numbers of emergency contacts
–no drugs, alcohol, or caffeine
–good sleep hygiene
–coping strategies
–group and individual therapy
examples of mood stabilizers
–lithium plus an antipsychotic
–divalproex/valproate plus antipsychotic
examples of atypical antipsychotics
–risperidone
–quetiapine
–aripiprazole
–olanzapine
–ziprasidone
examples of benzos
–diazepam
–lorazepam
–clonazepam
indications for lithium carbonate
acute mania and maintenance treatment
contraindications for lithium
–CV disease
–renal disease
–brain damage
–thyroid disease
–pregnant or breast feeding mothers
onset for lithium
5-7 days, may take as long as 2 weeks
action of lithium
–uncertain
–crosses cell membranes
–alters sodium transport
–not protein-bound
lab measurement with lithium
initial labs 1-2x per week then…
–CR, thyroid, and CBC q 6 months
–kidney damage a risk
–thyroid function may decrease (6-18 months) – dry skin, hair loss, constipation, bradycardia, cold intolerance
teaching points for lithium
–risk of SI when Li+ discontinued
–do not restrict sodium
–hydrate (if ill and cannot take in, contact MD)
–intermittent blood tests required
teaching for valproate/divalproex
–check serum levels
–broader spectrum of efficacy
–longer periods of mood stabilization
teaching for carbamazepine
–risk of low WBCs
–check hepatic and renal function
–effective in pts who have no response to lithium or with secondary mania
–rash may be life threatening
teaching for lamotrigine
–for rapid cycling and depressed phase of bipolar
–rash may be life threatening
–used as add-on therapy in refractory mood disorders
gabapentin use
may be effective for acute mania, mood stabilization, and rapid cycling
warnings about lamictal rash
–stop med immediately
–can advance to Steven Johnson Syndrome
–flu like symptoms
–sore throat, fever, chills, blisters, burning eyes
–allergic reaction
–can further advance to toxic epidermal necrosis
ECT usage
–used to subdue severe manic behavior
–useful with treatment-resistant mania and patients with rapid cycling
–more effective than drug-based therapy for treatment-resistant bipolar depression
–depressive episodes
