Bipolar Disorders Flashcards
Involve extreme mood swings from episodes of mania to episodes of depression
Bipolar Disorders
severe mood elevation, expansion, or irritability that causes impairment in social or occupational function
Mania
Mania last for how long?
Must last at least one week
a milder form of mania
Hypomania
Hypomania must present for how long?
Must be present for at least 4 consecutive days
neutral mood
Euthymia
Manic Phase Symptoms
-Brightly colored clothing
-Flamboyant
-Sexually suggestive
-Attention:getting
-Pressured speech
-Difficulty sitting still
Unrelentingly rapid and often loud speech without pauses
Pressured speech
What are the types of Bipolar Disorders?
-Bipolar I Disorder
- Bipolar II Disorder
- Cyclothymia
Depression + Mania
Bipolar I Disorder
Depression + Hypomania
Bipolar II Disorder
Chronic mood disturbance for at least 2 years
Cyclothymia
Theoretical Basis (Genetics)
-First-degree relatives of people with BP-1 are approximately 7 times more likely to develop BP-1 than the general population.
- Offspring of a parent with bipolar disorder have a 50% chance of having another major psychiatric disorder.
-Twin studies demonstrate a concordance of 33-90% for BP-1 in identical twins.
Serves as defense against the feelings of depression
Mania
May impact the onset of bipolar disorder, particularly in those patients with a family history of mood disorders
Large increase in springtime solar insolation
Management for Bipolar Disorders
Mood Stabilizers
-Lifetime treatment
-Can prevent acute cycles of bipolar behavior
-Regimen involves lithium, anticonvulsants, and atypical antipsychotics
The mechanism of action of Lithium Carbonate (Eskalith)
Normalizes reuptake of serotonin, NE, and Dopamine
The Lag Period of Lithium
5 to 14 days
Must know in Lithium
-Not metabolized and is excreted via urine
-Completes for salt receptor sites
-May elevate TSH levels
Lithium therapeutic range in acute mania
0.8 to 1.5 mEq/L
Lithium therapeutic range in maintenance
0.5 to 1.0 mEq/L
On what level toxicity occurs
Toxicity occurs at 1.5 mEq/L
Causes of Lithium Toxicity
-Dose is too high
- Diarrhea, vomiting
- Diaphoresis
- Dehydration
Range of Mild Lithium Toxicity
1.5 to 2.0 mEq/L
Range of Moderate Lithium Toxicity
2.0 to 3.0 mEq/L
Range of Severe Lithium Toxicity
3.0 mEq/L and above
The earliest sign of Mild Lithium Toxicity
Nausea/Vomiting or Diarrhea
Classic signs of Mild Lithium Toxicity
Muscle weakness
Classic signs of Moderate Lithium Toxicity
Muscle Rigidity
May precipitate Diabetes Insipidus
Moderate Lithium Toxicity
Classic signs of severe lithium toxicity
-Arrhythmias
-Shock-line manifestations
- Seizures
Nursing responsibility for Lithium Toxicity
Promote adequate water intake (-2L/day) and continue with the usual amount of dietary table salt
Nursing Responsibilities of Mild Lithium Toxicity
-Know when was the last dose of lithium given
- Facilitate testing of serum lithium level (12 hours after last dose)
- Doses may be suspended over a few days or reduced
Nursing Responsibilities of Moderate Lithium Toxicity
-Facilitate STAT testing of serum lithium level
- Insert NGT and facilitate gastric lavage
- Administer IV fluids to replace lost electrolytes and maintain renal function
Nursing Responsibilities of Severe Lithium Toxicity
-All preceding interventions
- Administer drugs that promote lithium excretion, as ordered
(Aminophylline)
(Mannitol)
-Hemodialysis
- Cardiovascular, Respiratory and Thyroid support as necessary
What’s the anticonvulsants drugs?
-Carbamazepine
- Valproic Acid
-Clonazepam
Mechanism of action of Carbamazepine
Unknown-off label use
Side effects of Carbamazepine
drowsiness, sedation, dry mouth, rashes, orthostatic hypotension
This drug may cause aplastic anemia (bone marrow does not produce sufficient blood cells
Carbamazepine
Factors that cause aplastic anemia
- Anemia
- Leukopenia
- Thrombocytopenia
Carbamazepine has 2 causes
-May cause aplastic anemia
- Agranulocytosis
Absence of granulocytes leading to dangerously low WBC count
Agranulocytosis
What must be monitored in Agranulocytosis?
-Monitor for sore throat, fever, oral ulcerations
The anticonvulsants drugs
-Valproic acid
- Clonazepam
Side effects of Valproic Acid
-Drowsiness
-sedation
- dry mouth
-weight gain
- alopecia
- hand tremors
MOA of valproic acid
Increases GABA levels
This drug may cause a liver failure, pancreatitis
Valproic Acid
A teratogenic drug which can cause neural tube defects
Valproic Acid
A benzodiazepine anticonvulsant
Clonazepam
This drug is used as adjunct to lithium and other mood stabilizers but must not be used alone in bipolar disorders
Clonazepam
This drug may develop dependence
Clonazepam
The antipsychotics drugs
-Aripiprazole
- Ziprasidone (Geodon)
- Quetiapine (Seroquel)
A third-generation antipsychotic
Aripiprazole (Abilify)
This drug is used when mood stabilizers alone are inadequate to control bipolar symptoms
Aripiprazole (Abilify)
A second-generation antipsychotics
Ziprasidone (Geodon), Quetiapine (Seroquel)
This drug is used in combination with mood stabilizers or antidepressants to treat bipolar disorders
Ziprasidone (Geodon), Quetiapine (Seroquel)
Safety Precautions in Bipolar Disorders
-Directly ask patient for suicidal ideation and plans or thought of hurting others
-Monitor patient’s whereabouts and behaviors frequently
- Orient the patient that staff members will help him/her control the behavior if he/she cannot do so alone
Limit setting in Bipolar Disorders
-It is important to clearly identify the unacceptable behavior and the expected, appropriate behavior
- All staff must consistently set and enforce limits for those limits to be effective
Nutritional Management for Bipolar Disorders
-Offer finger foods
-Finger foods are things client can eat while moving around are the best options to improve nutrition
-High in calories and protein (sandwiches, protein bars, fortified shakes)
-Provide snacks in between meals
-Observe and supervise at mealtimes to prevent patient from taking food from others
Communication Strategies for Bipolar Disorders
-Use clear and simple sentences
- Validate understanding by letting the patient repeat instructions
-Minimize distractions when engaging in conversations
Behavior Modification Strategies for Bipolar Disorder
-Direct need for movement into socially acceptable, large motor activities:
-Arranging chairs for a community meeting
-Walking
Approach/Attitude: Uses a matter of fact attitude when dealing with sexually inappropriate behaviors, NEVER RIDICULE PATIENT!
