Bipolar Disorder

Question 1

overview of mania

Answer 1

usually 10 episodes over the lifespan
inititial episode usually manic in males and depressive in females
25 is median age of onset
> occurances in ^ socioeconomic classes, divorced & single people

Question 2

biologic etiology

Answer 2

external stressors can triggers 1st manic episode - creates sensitivity in the brain so less stress causes another episode

Question 3

lifespan & bipolar disorder

Answer 3

bipolar children usually present w/ ADHD

Question 4

bipolar I

Answer 4

1+ manic episode that can be accompanied by an episode of depressed mood

Question 5

bipolar II

Answer 5

1+ depressed episode accompanied by at least 1 hypomanic episode

Question 6

“MANIC EPISODE”

Answer 6

M - mood swings
A - active, aggressive
N - "nothing is wrong" (denial)
I - irritable, impulsive, intrusive
C - can't sit still
E - euphoric mood
P - poor judgement, provacative
I - increased sexual interest
S - substance abuse
O - omnipotent feelings
D - decreased need for sleep 
E - endless energy

Question 7

interventions: communication

Answer 7

be calm & relaxed but firm when setting limits
serve as a role model
build a trusting relationship

Question 8

interventions: intake

Answer 8

provide finger foods & fluids

encourage to eat & drink hourly

Question 9

intended effects of litium

Answer 9

tx of acute mania
long-term maintainence of bipolar disorder
> efficiacy of antidepressants & antipsychotics
improving behavior & outcome in impulse control disorder

Question 10

side effects of lithium

Answer 10

polyuria
polydypsia
significant weight gain
nausea
increased wbc
hypothyroidism
kidney damage
fine tremor

Question 11

toxic effects of lithium

Answer 11

vomiting
ataxia
tremor
stuttering
confusion
sedation
seizures - may lead to coma & death

Question 12

therapeutic index of lithium

Answer 12

0.5 - 1.2 mEq/L

Question 13

contraindications of lithium

Answer 13

pregnant/nursing
kidney disease
dehydration
electrolyte imbalances
diabetes
thyroid disease
urinary retention
seizures

Question 14

teaching needs for lithium

Answer 14

check lithium, TSH, & creatinine often
lithium blood levels can be increased by NSAIDs (naproxen) & diuretics (thiazides)
results are not immediate so continue other antipsychotics as directed

Question 15

anticonvulsant meds

Answer 15

valproic acid - divalproex, depakote, depakene, valproate

Question 16

action of anticonvulsant meds

Answer 16

increased concentration of GABA

Question 17

intended effects of anticonvulsants

Answer 17

tx of bipolar disorder, acute mania, aggressive behavior

decrease in mood swings

Question 18

side effects of anticonvulsants

Answer 18

GI symptoms
headache
dizziness
anxiety
confusion
sedation
diplopia (double vision)
edema
tremor
wt gain
alopecia
jaundice

Question 19

toxic effects of anticonvulsants

Answer 19

liver dysfunction/failure

blood dyscrasias

Question 20

contraindications of anticonvulsants

Answer 20

kidney or liver disease
pregnant/nursing
current blood dyscrasias

Question 21

teaching needs for anticonvulsants

Answer 21

monitor for toxicity
monitor liver & kidney function, CBC w/ diff
do not chew/crush pills
avoid blood thinners

Question 22

mood stabilizers

Answer 22

atypical antipsychotic (zyprexa)
anxiolytic (klonopin)

Question 23

use of zyprexa (antipsychotic) in bipolar

Answer 23

sedation, psychomotor slowing, decrease levels of agitation

Question 24

use of klonipin (anxiolytic) in bipolar

Answer 24

decrease brain stimulation immediately

- addicting & will not be used long term

Question 25

other tx

Answer 25

ECT - rarely used