Bipolar disorder Flashcards
1
Q
bipolar disorder
A
- marked by disturbances in mood
- mood swings ranging from significant depression to extreme euphoria (mania)
- recurrent mood disorder featuring at least one episode of mania or hypomania
2
Q
incidence and prevalence
A
- Bipolar Disorder affects approximately 2.6% of the U.S. population
- The average age of clients experiencing their first manic episode is 25 years
- Earlier age of onset is associated with worse outcomes, including rapid cycling in adulthood
- It is estimated that 25% to 50% of clients with bipolar disease attempt suicide at least once in their life with 15% completing suicide
3
Q
comorbidity
A
- Substance Abuse
- Personality Disorders
- Anxiety Disorders
- Psychosis
4
Q
rates of morbidity and mortality, with bipolar, are associated with:
A
Cardiovascular, cerebrovascular, and respiratory diseases and other psychiatric illnesses and substance use disorders
5
Q
types of mood episodes
A
mania
hypomania
depression
6
Q
manic episodes
A
- sudden onset
- last few days to a few months
- abnormal and persistent elevated, expansive or irritable mood
- extreme mood swings, sudden outbursts, sleep disturbance, feeling full of energy, gradiosity, distracted, restless, exaggerated self-esteem, “flight of ideas,” pressured speech, sexual promiscuity and flamboyant in dress
- NOT severe enough to cause marked impairment
- NEED hospitalization to prevent harm to self or others
- symptoms not due to other causes
7
Q
hypomania
A
- Judgement remains fundamentally intact
- Not severe enough to cause marked impairment
- No need for hospitalization to prevent HARM TO SELF OR OTHERS
- Symptoms not due to other causes (Substance abuse, physical disease, etc.)
No psychotic features
8
Q
bipolar 1 disorder
A
- One or more manic episodes alternating with major depressive episodes
- Depressive symptoms tend to be far less responsive to conventional therapies than manic symptoms
- A mixed state or episode is when the individual has rapidly alternating moods between depression and mania
9
Q
bipolar 2 disorder
A
- A major depressive episode and at least one hypomanic episode
- No history of a manic episode or a mixed episode
- Diagnosing Bipolar II disorder sometimes is difficult, particularly if the clients present for the first time with a depressive episode
10
Q
cyclothymia
A
- Clients experience repeated periods of nonpsychotic depression and hypomania for at least 2 years (1 year for children and adolescents)
- Cyclothymia is diagnosed only if a client’s symptoms have never met the criteria for a major depressive or manic episode
11
Q
rapid cycling
A
- Clients have four or more manic episodes for at least 2 weeks in a single year
- Episodes marked by either partial or full remission for at least 2 months or a switch to an episode of opposite type
- Associated with high risk of recurrence and resistance to conventional drug treatments
- Greater severity of illness and prominent depressive symptoms
12
Q
assessment
A
early detection can prevent:
- suicide
- accidents
- substance abuse
- marital or work problems
- medical comorbidity
- legal problems
- financial problems
13
Q
Assessment: Characteristics of Mania (mood and behavior)
A
Mood: - Hypomanic to Manic - Sociality and Euphoria to Hostility, Irritability, Paranoia Behavior: - Hyperactivity - Bizarre and colorful dress - Highly distractible - Impulsive
14
Q
assessment: characteristics of mania (thought processes and cognitive function)
A
Thought processes: - Flight of ideas - Grandiosity - Poor judgment - Auditory hallucinations & delusional thinking Cognitive function: - Significant and persistent problems - Difficulties in psychosocial areas
15
Q
self assessment of the nurse
A
Manic patient: - Manipulative - Splitting - Aggressively demanding Staff member actions: - Set limits consistently - Frequent staff meetings to deal with patient behavior and staff response
16
Q
assessment for danger to self or others
A
- assess for suicidal thoughts or plans
- may exhaust themselves to the point of needing emergency medical interventions
- may not eat or sleep for days at a time
- poor impulse control
17
Q
nursing diagnosis
A
Risk for Violence Self / Others Ineffective Health Maintenance Impaired Social Interaction Ineffective Coping Disturbed Thought Processes Situational Low Self – Esteem Ineffective Therapeutic Regimen Management
18
Q
planning phases
A
acute phase
continuation phase
maintenance phase
19
Q
acute phase
A
Maintain safety
Medication stabilization
Self-care
20
Q
continuation phase
A
Maintain medication compliance
Psycho-education teaching
Counseling
21
Q
maintenance phase
A
prevent relapse
22
Q
implementing acute phase
A
Communication
Structure in a safe milieu
Physiological safety
Self-care needs
23
Q
communication techniques with manic patient
A
Use firm, calm approach
Use short and concise explanations
Remain neutral: avoid power struggles
Be consistent in approach and expectations
Firmly redirect energy into more appropriate areas
24
Q
treatment: psychotherapy
A
Psychotherapy continues to be used extensively for Bipolar Disorder
Common Modalities include:
Psycho-education Cognitive-Behavioral Therapy Family focused treatment Interpersonal therapy Milieu therapy Intensive outpatient program
25
treatment modalities: medications
Mood stabilizers: First-line treatment drugs for Bipolar Disorders
Two properties that define:
Provide relief from acute episodes of mania or depression
They do not worsen depression or mania or lead to increases in cycling
26
medications
Lithium- first line mood stabilizer
Prevention and treatment of mania
Affects the clock cycle to restore daily rhythms
May also be used to reduce suicidal tendencies in Bipolar clients
27
medication in place of lithium
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Anticonvulsants- sometimes prescribed instead of Lithium when clients don’t experience a response from Lithium or have intolerable side-effects to Lithium
Examples:
Depakote
Tegretol
Lamictal
Equetro
```
28
lithium therapeutic and maintenance levels
Takes 7 to 14 days to reach therapeutic levels in blood
Therapeutic blood level0.8 to 1.4 mEq/L
Maintenance blood level0.4 to 1.3 mEq/L
29
major long term risk of lithium
- hypothyroidism
| - impairment of kidney's ability to concentrate urine
30
contraindications for lithium
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Cardiovascular disease
Brain damage
Renal disease
Thyroid disease
Myasthenia gravis
Pregnancy
Breastfeeding mothers
Children younger than 12 years
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31
initial treatment of acute mania since lithium can take several days to take affect...
As Lithium can take several days to take effect in an acute situation, other treatments are used while the patient is in the acute phase
Antipsychotics
Antipsychotic or benzodiazepine
32
antipsychotics
(i.e.: Zyprexa & Seroquel):
Slow thought process slowing speech
Inhibit aggression
Decrease psychomotor activity
33
antipsychotic or benzodiazepine to prevent:
(i.e.: Klonopin & Ativan)
Exhaustion
Coronary collapse
Death
34
client and fam teaching for lithium therapy
Effects of treatment
Need to monitor lithium blood levels
Side effects at therapeutic levels (fine hand tremors, GI upset, thirst and muscle weakness) and adverse effects at toxic level (persistent GI upset, coarse hand tremors, confusion, hyperirritability of muscles, sedation and ECG changes)
Effects of food and over-the-counter medications
Educate on consistent sodium intake, decreased sodium intake can decrease excretion of Lithium leading to toxic levels
When to call the provider
35
side effects of lithium at therapeutic levels
(fine hand tremors, GI upset, thirst and muscle weakness) and adverse effects at toxic level (persistent GI upset, coarse hand tremors, confusion, hyperirritability of muscles, sedation and ECG changes)
36
electroconvulsive therapy
- Used if pharmacologic interventions fail or symptoms require immediate relief
- Severe manic behavior
- Rapid cycling
- Paranoid, destructive features
- Acutely suicidal behavior
37
milieu therapy: seclusion room or restraints
Used in an emergency for client when:
Clear risk of harm to client or others
Client's behavior has continued despite use of less restrictive methods to keep client and others safe
38
issues with seclusion or restraints
- therapeutic behaviors
- ethics
- state and federal laws
- hospital protocols
- specific documentation
