bipolar disorder Flashcards
bipolar disorder
extreme mood fluctuations from mania to depression; may have periods of euthymic mood, can be mania or hypomania, may also have mixed episodes
type 1 vs type 2 bipolar disorder
type 1: full mania
type 2: hypomania
mixed episode bipolar
mania and depression rapidly cycling throughout the day
hypomania
periods over active or excited behavior that can have a significant impact on day to day life
when does bipolar disorder occur
onset in late teens to early thirties
which episodes have sudden onset; how long do they last
manic; last from one week to several months
symptoms of mania
talking excessively, racing thoughts, hostility, less sleep, delusions
symptoms of depression
extreme fatigue, prolonged sadness, memory loss, poor nutrition
triggers in bipolar disease
insufficient amounts of sleep, altercations with loved ones, alcohol and drug misuse, certain antidepressants and other medications, pregnancy and other hormonal conditions, a change in season
mania
distinct period where mood is abnormally and persistently elevated, expansive or irritable
sx of mania
inflated self-esteem and grandiosity, decreased need for sleep and increased activity and/or psychomotor agitation, excessive and pressured speech, excessive involvement in pleasure seeking or risk taking behaviors, deny problems and blame others, may have delusions and/or hallucinations
sx of hypomania
cheerful, enthusiastic, abnormally elevated or especially irritable mood, does not impair ability to function, excessive and pressured speech, decreased need for sleep and increased activity and/or psychomotor agitation
effects of age of onset on prognosis
earlier onset, tend to have more frequent episodes; newly diagnosable in children, more likely to have irritability and rage
in what ways is bipolar a progressive conditions
time between episodes decreases as symptoms progress
effect of age on symptoms
incidence of mania tends to decrease with age; older adults have more neurological and cognitive effects
assessment of pts. with bipolar disorder
general appearance and behavior: risk taking, sexually suggestive
speech (rapid, pressured, flight of ideas, clang associations)
thought process (circumstantiality)
mood (grandiose, euphoric)
exaggerated self-concept with labile emotions
interventions for pts with bipolar
safety, encourage medication compliance and socially appropriate behavior
preventing manic episodes
maintain regular sleep and eating schedules, encourage appropriate social interactions, explain the need for continued medication treatment, early crisis intervention for stressful life events
what are somethings that can cause a manic episode
medication non-adherence, stressful life events, disruption in social rhythms
interventions for pts. with bipolar disorder
encourage ADLs, set limits on inappropriate behaviors, provide high protein finger foods and encourage hydration, avoid triggering situations due to labile mood, distraction is one of the most effective tools, provide a structured environment
pharmacological interventions for BPD
mood stabilizers, antipsychotics if active hallucinations or delusions, do not administer anti-depressants without concurrent mood stabilizer
non-pharmaceutical treatment methods for BPD
psychotherapy (mildly depressive)
not effective during manic stages d/t disturbances in cognition and judgement
lithium
normalizes reuptake of neurotransmitters.
why do you have to maintain current intake of sodium
its a salt substance.
increased salt intake causes lower lithium levels
decreased salt intake causes increased lithium levels and potential toxicity
lithium levels must be monitored. what is the goal? how often do you check?
1 mEq/L
monitor levels at least every week until dose and stabalized
side effects of lithium side effects
edema of hands/feet, fine hand tremor, mild diarrhea, metallic taste, polyuria
symptoms of mild lithium toxicity, value?
<1.5mEq/L
exaggeration of expected side effects
metallic taste in mouth, nausea, polyuria, polydipsia, diarrhea, muscle weakness, weight gain, edema
symptoms of moderate lithium toxicity; value?
1.5-2.5 mEq/L
severe diarrhea, dry mouth, n/v, ataxia, incoordination, tinnitus, slurred speech, vertigo, muscle twitching, asymmetric deep tendon reflexessssy
symptoms of moderate lithium toxicity; value?
1.5-2.5 mEq/L
severe diarrhea, dry mouth, n/v, ataxia, incoordination, tinnitus, slurred speech, vertigo, muscle twitching, asymmetric deep tendon reflexes
symptoms of severe toxicity; value?
> 2.5 mEq/L
fasciculations, nystagmus, coarse tremors, cardiac arrhythmias, hallucinations, oliguria, peripheral vascular collapse, confusion, seizures, coma
anticonvulsant agents
mood stabilizers
ex. carbamazepine, valproic acid, topiramate, lamotrigine
