Bipolar Disorders Flashcards
What is the acute phase?
The earliest of three phases of mania, during which the person experiences poor judgement, excessive and constant motor activity, probable dehydration, and difficulty evaluating reality. The overall outcome of the acute phase is injury prevention.
Anticonvulsant drugs.
A group of drugs (e.g., carbamazepine, valproic acid) used especially in treating people with mania that has been refractory to lithium therapy. These drugs are also useful in treating people who need rapid de-escalation and do not respond to other treatment approaches.
Bipolar I disorder
A chronic, recurrent illness marked by shifts in mood, energy, and ability to function and in which at least one episode of mania alternates with major depression. Psychosis may accompany the manic episode.
Bipolar II disorder
A chronic, recurrent illness marked by shifts in mood, energy, and ability to function and in which hypomanic episode(s) alternate with major depression. Psychosis is not present. Hypomania tends to be euphoric and often increases functioning; depression in this disorder tends to put people at particular risk for suicide.
Clang associations
The stringing together of words because of their rhyming sounds, without regard to their meaning.
Continuation phase
The second of three phases of bipolar disorder, lasting four to nine months, during which the overall outcome is relapse prevention. Many other outcomes must be accomplished to achieve this outcome.
Cyclothymic disorder
Symptoms of hypomania alternate with symptoms of mild to moderate depression for at least 2 years in adults and 1 year in children.
Euphoric mood
When associated with mania, unstable mood during which the patient may describe an intense feeling of well-being. The overly joyous mood may seem out of proportion to the situation, and cheerfulness may be inappropriate for the circumstances, considering that the person is full of energy but has had little or no sleep.
Flight of ideas
A nearly continuous flow of accelerated speech, with abrupt changes from topic to topic that are usually based on understandable associations or plays on words.
Grandiosity
A state in which people with mania may exaggerate their achievements or importance, say that they know famous people, or believe they have great powers. Grandiosity is also apparent in behaviour. Boasts of exceptional powers and status can take delusional proportions. Also called inflated self-regard.
Hypomania
State in which people have voracious appetites for social engagement, spending, activity, and even indiscriminate sex. During hypomania, constant activity and a reduced need for sleep prevent proper rest.
Maintenance phase
Focuses on supporting and consolidating the gains made during the action stage and continued focus on avoiding lapse or more significant relapse.
Mania
An exaggerated euphoria or irritability.
Manic episode
Individuals experiencing a manic episode feel euphoric and energized, don’t sleep or eat, and are in perpetual motion. They often take significant risks and engage in hazardous activities.
Rapid cycling
Four or more mood episodes in a 12-month period. The term is used to indicate more severe symptoms, such as poorer global functioning, high recurrence risk, and resistance to conventional somatic treatments.
Seclusion protocol
An outline of the proper reporting procedure, through the appropriate channels, to be used when seclusion is used as a treatment.
What is the average age of onset for a Bipolar Disorder?
10–15 years
16–20 years
21–25 years
26–30 years
16–20 years
Which of the following is the first-line drug used to treat mania?
Lithium carbonate (Lithium)
Carbamazepine (Tegretol)
Lamotrigine (Lamictal)
Clonazepam (Rivotril)
Lithium carbonate (Lithium)
A person who has numerous hypomanic and dysthymic episodes can be assessed as demonstrating characteristics of which of the following?
Bipolar II disorder
Bipolar I disorder
Cyclothymia
Seasonal affective disorder
Cyclothymia
Which behaviour would be most characteristic of a patient during a manic episode?
Going rapidly from one activity to another
Taking frequent rest periods and naps during the day
Being unwilling to leave home to see other people
Watching others intently and talking little
Going rapidly from one activity to another
The nurse can expect a patient demonstrating typical manic behaviour to be attired in which of the following types of clothing?
Dark coloured and modest
Colourful and outlandish
Compulsively neat and clean
Ill-fitted and ragged
Colourful and outlandish
A bipolar patient tells the nurse, “I have the best voice in the world. The three tenors who do all those TV concerts are going to retire because they can’t compete with me.” The nurse would make the assessment that the patient is displaying which of the following?
Flight of ideas
Distractibility
Limit testing
Grandiosity
Grandiosity
When a patient experiences four or more mood episodes in a 12-month period, the patient is said to be which of the following?
Dyssynchronous
Incongruent
Cyclothymic
Rapid cycling
Rapid cycling
Which room placement would be best for a patient experiencing a manic episode?
A shared room with a patient with dementia
A single room near the unit activities area
A single room near the nurses’ station
A shared room away from the unit entrance
A single room near the nurses’ station
When a hyperactive manic patient expresses the intent to strike another patient, the initial nursing intervention would be to do which of the following?
Question the patient’s motive
Set verbal limits
Initiate physical confrontation
Prepare the patient for seclusion
Set verbal limits
When a patient reports that lithium causes an upset stomach, the nurse suggests taking the medication in which of the following ways?
With meals
With an antacid
30 minutes before meals
2 hours after meals
With meals
Which behaviour exhibited by a person with mania should the nurse choose to address first?
a. Indiscriminate sexual relations
b. Excessive spending of money
c. Declaration of “being at one with the world”
d. Demonstration of flight of ideas
a. Indiscriminate sexual relations
True or false: Bipolar disorder frequently goes unrecognized.
True
Is Bipolar I disorder characterized by manic or hypomanic episodes?
Bipolar I disorder is characterized by the presence or history of at least one manic episode, whereas bipolar II disorder is characterized by the presence or history of at least one hypomanic episode
True or false: Genetics do not play a strong role in the risk for the bipolar disorders.
False. They do play a strong role.
Why is early detection and treatment of bipolar disorder important?
Early detection of bipolar disorder can help diminish comorbid substance abuse, suicide, and decline in social and personal relationships and may help promote more positive outcomes.
What percentage of Canadians will experience bipolar disorder?
approx 1%
What are three types of bipolar and related disorders?
Bipolar I
Bipolar II
Cyclothymic disorder
What are the DSM-5 criteria for Bipolar I disorder, manic phase?
A. A distinct period of abnormally and persistently elevated, expansive, or irritable
mood and abnormally and persistently increased goal-directed activity or energy,
lasting at least 1 week and present most of the day, nearly every day (or any duration
if hospitalization is necessary).
B. During the period of mood disturbance and increased energy or activity, three (or
more) of the following symptoms (four if the mood is only irritable) are present to a
significant degree and represent a noticeable change from usual behavior:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant
external stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually)
or psychomotor agitation (i.e., purposeless non-goal-directed activity).
7. Excessive involvement in activities that have a high potential for painful
consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions,
or foolish business investments).
C. The mood disturbance is sufficiently severe to cause marked impairment in social or
occupational functioning or to necessitate hospitalization to prevent harm to self or
others, or there are psychotic features.
D. The episode is not attributable to the physiological effects of a substance (e.g., a drug
of abuse, a medication, other treatment) or to another medical condition.
Note: A full manic episode that emerges during antidepressant treatment (e.g.,
medication, electroconvulsive therapy) but persists at a fully syndromal level beyond
the physiological effect of that treatment is sufficient evidence for a manic episode
and, therefore, a bipolar I diagnosis.
Note: Criteria A–D constitute a manic episode. At least one lifetime manic episode is
required for the diagnosis of bipolar I disorder.
Which of the following is the priority nursing diagnosis for a hyperactive manic patient during the acute phase?
Risk for injury
Ineffective role performance
Risk for other-directed violence
Impaired verbal communication
Risk for injury is high, related to the patient’s hyperactivity and poor judgement.
A manic patient tells a nurse, “Bud. Crud. Dud. I’m a real stud! You’d like what I have to offer. Let’s go to my room.” Which of the following would be the best approach for the nurse to use?
“What an offensive thing to suggest!”
“I don’t have sex with patients.”
“No thanks, let’s go work on your art project.”
“Let’s walk down to the seclusion room.”
No thanks, let’s go work on your art project.”
Which of the following would be a desired outcome for the maintenance phase of treatment for a manic patient?
The patient would exhibit optimistic, energetic, playful behaviour
The patient would adhere to follow-up medical appointments
The patient would take medication more than 50% of the time
The patient would use alcohol to moderate occasional mood “highs”
The patient would adhere to follow-up medical appointments
What action should the nurse take on learning that a manic patient’s serum lithium level is 1.8 mEq/L?
Withhold medication and notify the physician.
Continue to administer medication as ordered.
Advise the patient to limit fluids for 12 hours.
Advise the patient to curtail salt intake for 24 hours.
Withhold medication and notify the physician.
To plan care for a manic patient, the nurse must consider that lithium cannot be started until which of the following?
The physical examination and laboratory tests are analyzed
The initial doses of antipsychotic medication have brought behaviour under control
Seclusion has proven ineffective as a means of controlling assaultive behaviour
Electroconvulsive therapy can be scheduled to coincide with lithium administration
The physical examination and laboratory tests are analyzed
Which of the following would be a desirable short-term goal for the nursing diagnosis Defensive coping related to biochemical changes as evidenced by aggressive verbal and physical behaviours?
Making no attempts at self-harm within 12 hours of admission
Sleeping soundly for 12 of the next 24 hours
Willingly taking prescribed medication as offered by staff within 24 hours of admission
Demonstrating psychomotor retardation associated with sedation from prescribed medication within 6 hours of admission
Making no attempts at self-harm within 12 hours of admission
Which adverse effects of lithium can be expected at therapeutic levels?
Fine hand tremor and polyuria
Nausea and thirst
Coarse hand tremor and gastrointestinal upset
Ataxia and hypotension
Fine hand tremor and polyuria
When the wife of a manic patient asks about genetic transmission of bipolar disorder, the nurse’s answer should be predicated on knowledge of which of the following?
No research exists to suggest genetic transmission.
Much depends on the socioeconomic class of the individuals.
Highly creative people tend toward development of the disorder.
The rate of bipolar disorder is higher in relatives of people with bipolar disorder.
The rate of bipolar disorder is higher in relatives of people with bipolar disorder
A patient taking lithium carbonate therapy is states “I think I will stop taking my lithium and only do the cognitive-behavioural therapy.” Which factors would the nurse expect to be contributing to that patient’s decision? (Select all that apply.)
The adverse effects are unpleasant.
The voices tell the patient to stop taking it.
The patient prefers to feel “high” and energetic.
The patient feels well and denies the possibility of recurrence.
The adverse effects are unpleasant
The patient prefers to feel “high” and energetic.
What are the most appropriate nursing outcomes for a patient experiencing the acute phase or a manic, hypomanic, or depressive episode? (Select all that apply.)
Be well hydrated.
Maintain stable respiratory status.
Demonstrate thought self-control.
Make no attempt at self-harm.
Be well hydrated.
Demonstrate thought self-control.
Make no attempt at self-harm.
What are key nursing Dx with manic phase bipolar?
Risk for Suicide
Risk for Injury
Risk for Violence (self and others)
Ineffective Coping, Impulse control
What are the goals for acute phase of bipolar depression or mania?
Stabilize
- Maintain safety
- Self-care needs (sleeping and eating)
What are the goals of the continuation phase of bipolar?
Aim for medication adherence
- Teaching
- Referrals
What is the goal for the maintenance phase for bipolar disorder?
How to prevent a relapse
What are treatments for bipolar disorder?
ECT
Support Groups
Health teaching and promotion
Psychotherapy
Medication
What nursing care is involved for patients taking lithium?
- Ensure baseline physical and labs done prior to initiation: renal function, thyroid function, cardiac function.
- Encourage normal salt intake
- Monitor for signs of toxicity and teach patient what it looks like and what to do
- Monitor serum levels: always ensure you know what their last level was before administering. This is a priority.
- No diuretics, Teach to eliminate or decrease caffeine.
- To discontinue taper off.
What other category of medication is used as a mood stabilizer (off label use)?
anticonvulsants
How do anticonvulsants work to treat mood disorders?
In the 1980’s it was discovered that anticonvulsants are useful in treating mood disorders, specifically for rapid or continuously
cycling moods.They decrease neuronal excitability (GABA and Glutamate). Primarily for people with an absent family history of
bipolar. These meds diminish impulsivity and aggression.
Also used for treatment of anxiety (GABA neurotransmitter involved)
What are important aspects to remember with bipolar disorder?
When stabilizing mania the patient is at high risk for injury. There is a loss of judgment and insight. Nurses will need to keep the patients dignity and safety intact. Distraction, limit setting, therapeutic alliance and, if warranted, restraints.
Lithium remains a first line treatment. Know expected adverse effects, what toxicity is and when to expect to see therapeutic effects after initiation.
Know the names of the anticonvulsants used to stabilize mood.
What percentage of people with bipolar disorder have a concurrent substance use disorder?
50% or more have a concurrent substance abuse disorder
Why are we worried when a patient using lithium has excessive diarrhea, vomiting or sweating?
Can lead to dehydration. Dehydration can raise lithium levels to toxic levels. Stop taking lithium and inform physician.
Is bipolar I more common in men or women?
Men
Is bipolar II more common in men or women?
Women
When does cyclothemia usually begin?
Cyclothymia usually begins in adolescence or early adulthood
What are critical to assess in the manic phase?
SLEEP and eating
Why can hyponatremia increase the risk of lithium toxicity?
Hyponatremia can increase risk of toxicity because increased kidney reabsorption of sodium leads to increased
reabsorption of lithium as well*
Why is thyroid function monitored?
THYROID FUNCTION monitored (long term use possible enlargement and possible hypothyroidism)
What should the nurse always do before administering lithium?
Always ensure you know what their last level was before
administering. This is a priority.
