Bipolar Disorder Flashcards
Bipolar I
at least one episode of mania alternating with major depression
Bipolar II
one or more episodes of hypomania alternating with major depression
mania
severe impairment lasting 1 week that usually requires hospitalization to prevent harm with 3+ symptoms
hypomania
change in functioning lasting at least 4 days
reality testing is not impaired and hospitalization is not usually required
rapid cycling
2+ episodes of alternating mania/depression in a 12 month period
mixed features
depressive symptoms occur during manic episode
mania symptoms X7
inflated self/esteem decreased need for sleep more talkative flight of ideas distractibility increase in goal directed activity excessive involvement in activities with high potential for consequences
unipolar depression clinical picture
may be present with manic symptoms but they do not meet criteria for diagnostic
bipolar depression medication
antidepressants must be used in conjunction with mood stabilizers
unipolar depression s/s X5
- affects more women than men
- appears later in life
- loss of appetite
- insomnia
- lesser risk of drug abuse/suicide
bipolar depression s/s X5
- affects women and men equally
- onset younger age
- alt binge eating/anorexia
- hypersomnia and difficulty waking
- greater risk of drug abuse/unipolar
comorbidities with bipolar disorder
-substance use disorders
-anxiety disorders
-borderline personality
ADHD
genetics and biopolar
strong genetic factor
neurotransmitters and bipolar
epi and nor epi high in mania and low in depressino
serotonin and dopamine affected too
psychosocial factors of bipolar
may be triggered by stress
more prevalent in upper socioeconomic classes
high among writers, artists, highly educated professions
acute phase planning
medical stabilization and maintaining safety
potential hospitalization
continuation phase planning
relapse prevention via:
medication compliance, psycho-education, referrals, support groups
maintenance phase planning
relapse prevention through coping strategies, psychotherapy, recovery/support groups
communication
be firm and calm
short and concise statments
clear limit setting
firmly redirect and distract PRN
antidepressants and bipolar
should not be given alone - must use mood stabilizers
hypomania/mania may result
preferred antidepressants with bipolar
bupropion, venlafaxine or SSRI’s
preferred antipsychotics with bipolar
onlanzapine, quetiapine, risperidone, ziprasidone
first line treatment bipolar
lithium
lithium MOA
alters excitatory neurotransmitters and neuronal activity
lithium maintenance level and onset time
0.4-0.1, effects begin in 5-7 days but may take 2-3 weeks for full effect
lithium SE X4
hand tremor
polyuria
nausea
weight gain
long term risks of lithium
hypothyroidism
kidney impairment
contraindicated in pregnancy
severe lithium toxicity SE X8
ataxia EKG changes blurred vision clonic movements polyuria seizures hypotension pulmonary complications
severe lithium toxicity level
2.0-2.5
lithium pt ed X7
monitor blood levels, thyroid, kidney level
maintain salt and fluid intake
s/s of toxicity
do not take diuretcs/OTCs
avoid pregnancy
take with meals
do not stop abruptly
mood stabilizers MOA
depresses CNS by increasing GABA
mood stabilizers X8
divalproex valproate valproic acid carbamazepine lamotrigine gabapentin topiramate oxcarbazepine
