BIPOLAR DISORDER - FINAL EXAM Flashcards
bipolar 1 disorder
at least 1 manic episode (some depression), highest mortality rate and most severe
bipolar 2 disorder
at least one 1 hypomanic and 1 depressive episode (mostly depressive)
cyclothymic disorder
symptoms of mild to mod depression for at least 2 yrs with rapid cycling btw depression and mania
hypomania
low level and less dramatic mania that is more functional, euphoric and less dangerous
epidemiology
men and women equal, 4 times more likely to get postpartum psychosis
comorbidity of bipolar 1
substance use, ADHD/disruptive/impulse control/conduct disorders, anxiety disorders
comorbidities of bipolar 2 disorder
substance use, anxiety, eating (binge) disorders
comorbidity of cyclothymic disorder
substance use, sleep disorders, ADHD in kids with DMDD
risk factors of bipolar
bipolar 1 genetically similar to schiz
bipolar 2 genetically similar to MDD
ALL are more prevalent in pt with hypothyroidism
assessing behaviors
can be manipulative and demanding with splitting
thought processes and speech pattern assessment
pressured speech, flight of ideas, loose and clang associations, circumstantial and tangential speech
pressured speech
forcing everything out of head not allowing comments from other
circumstantial speech
going off topic but soon reaching point
tangential speech
going off topic and never reaching point
loose association
putting words together that only have meaning toward pt
flight of ideas
changing topics rapidly and often losing listener
clang associations
putting words together that sound the same
cognitive function assessment
dysfunction in ADL, sleep and eating with deficits from mania, hx of psychosis and chronic illness
thought content assessment
grandiose/persecutory delusions
assessment guidelines for bipoalr
danger to self or others, need for protection, fam understanding, med conditions
acute phase of outcomes
prevent injury, maintain cardiac status, hydration, tissue integrity, sleep, thought self control and no self harm
maintenance phase outcomes
knowledge of disorder, identify risk factors, preventative measures and support, problem solve with new coping skills
planning acute phase
med stabilization, safety, seclusion, restraint, ECT
planning maintenance phase
prevent relapse, long term med adherence, limit severity and duration of episodes, support
implementation of depressive episodes
hosp for suicidal, psychotic, catatonic and med concerns of causing mania
implementation of manic episodes
hosp for acute mania, communication
acute phase of implentation
safety (acute mania), imposes control on destructive behaviors, meds for stabilization
maintenance phase implementation
prevent relapse, nutrition, support, sleep, med adherence
communication techniques
firm and calm, short concise explanations, identify expectations, hear legit complains, redirect energy
health teaching
inform on illness, warning sings, importance of regularity, therapy
documented data of seclusion or restraints must show
risk of harm to self or others, unable to control actions, other measures failed
long term evaluation outcomes
adhere to meds, resume functioning, achieve stability, improve coping skills
main focus of treatment is
preventing agitation and mood stabilization
pharmacotherapy
lithium, depakote, olanzapine, risperidone, clonazepam, lorazepam
lithium
treats acute mania and for maintenance treatment with onset of 10-21 days
therapeutic levels of lithium
must have labs drawn every 2 wks, 600-1200mg or .8-1.2 meq and can increase to 300mg daily PRN
toxic levels
can cause EPS, provide anticholinergics and decrease by 300mg
pt education on lithium
NEVER stop abruptly
contraindications of lithium
pregnancy and breastfeeding
electroconvulsive therapy
electric current through brain to treat levels of depression in bipolars
CBT
used with pharmacotherapy
interpersonal and social rhythm therapy
regulate social routines and stabilize relationships to improve depression and prevent relapse
