Bipolar disorder Flashcards

You may prefer our related Brainscape-certified 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

comorbidity

A
  • Substance Abuse
  • Personality Disorders
  • Anxiety Disorders
  • Psychosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

types of mood episodes

A

mania
hypomania
depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

assessment

A

early detection can prevent:

  • suicide
  • accidents
  • substance abuse
  • marital or work problems
  • medical comorbidity
  • legal problems
  • financial problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
Q

treatment modalities: medications

A

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
Q

medications

A

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
Q

medication in place of lithium

A
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
Q

lithium therapeutic and maintenance levels

A

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
Q

major long term risk of lithium

A
  • hypothyroidism

- impairment of kidney’s ability to concentrate urine

30
Q

contraindications for lithium

A
Cardiovascular disease
Brain damage
Renal disease
Thyroid disease
Myasthenia gravis
Pregnancy
Breastfeeding mothers
Children younger than 12 years
31
Q

initial treatment of acute mania since lithium can take several days to take affect…

A

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
Q

antipsychotics

A

(i.e.: Zyprexa & Seroquel):
Slow thought process slowing speech
Inhibit aggression
Decrease psychomotor activity

33
Q

antipsychotic or benzodiazepine to prevent:

A

(i.e.: Klonopin & Ativan)
Exhaustion
Coronary collapse
Death

34
Q

client and fam teaching for lithium therapy

A

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
Q

side effects of lithium at therapeutic levels

A

(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
Q

electroconvulsive therapy

A
  • Used if pharmacologic interventions fail or symptoms require immediate relief
  • Severe manic behavior
  • Rapid cycling
  • Paranoid, destructive features
  • Acutely suicidal behavior
37
Q

milieu therapy: seclusion room or restraints

A

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
Q

issues with seclusion or restraints

A
  • therapeutic behaviors
  • ethics
  • state and federal laws
  • hospital protocols
  • specific documentation