Bipolar Disorder Flashcards
overview of mania
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
biologic etiology
external stressors can triggers 1st manic episode - creates sensitivity in the brain so less stress causes another episode
lifespan & bipolar disorder
bipolar children usually present w/ ADHD
bipolar I
1+ manic episode that can be accompanied by an episode of depressed mood
bipolar II
1+ depressed episode accompanied by at least 1 hypomanic episode
“MANIC EPISODE”
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
interventions: communication
be calm & relaxed but firm when setting limits
serve as a role model
build a trusting relationship
interventions: intake
provide finger foods & fluids
encourage to eat & drink hourly
intended effects of litium
tx of acute mania
long-term maintainence of bipolar disorder
> efficiacy of antidepressants & antipsychotics
improving behavior & outcome in impulse control disorder
side effects of lithium
polyuria polydypsia significant weight gain nausea increased wbc hypothyroidism kidney damage fine tremor
toxic effects of lithium
vomiting ataxia tremor stuttering confusion sedation seizures - may lead to coma & death
therapeutic index of lithium
0.5 - 1.2 mEq/L
contraindications of lithium
pregnant/nursing kidney disease dehydration electrolyte imbalances diabetes thyroid disease urinary retention seizures
teaching needs for lithium
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
anticonvulsant meds
valproic acid - divalproex, depakote, depakene, valproate
action of anticonvulsant meds
increased concentration of GABA
intended effects of anticonvulsants
tx of bipolar disorder, acute mania, aggressive behavior
decrease in mood swings
side effects of anticonvulsants
GI symptoms headache dizziness anxiety confusion sedation diplopia (double vision) edema tremor wt gain alopecia jaundice
toxic effects of anticonvulsants
liver dysfunction/failure
blood dyscrasias
contraindications of anticonvulsants
kidney or liver disease
pregnant/nursing
current blood dyscrasias
teaching needs for anticonvulsants
monitor for toxicity
monitor liver & kidney function, CBC w/ diff
do not chew/crush pills
avoid blood thinners
mood stabilizers
atypical antipsychotic (zyprexa) anxiolytic (klonopin)
use of zyprexa (antipsychotic) in bipolar
sedation, psychomotor slowing, decrease levels of agitation
use of klonipin (anxiolytic) in bipolar
decrease brain stimulation immediately
- addicting & will not be used long term
other tx
ECT - rarely used
