Bipolar Disorders Flashcards by Kate Carmie

Involve extreme mood swings from episodes of mania to episodes of depression

Bipolar Disorders

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severe mood elevation, expansion, or irritability that causes impairment in social or occupational function

Mania

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Mania last for how long?

Must last at least one week

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a milder form of mania

Hypomania

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Hypomania must present for how long?

Must be present for at least 4 consecutive days

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neutral mood

Euthymia

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Manic Phase Symptoms

-Brightly colored clothing
-Flamboyant
-Sexually suggestive
-Attention:getting
-Pressured speech
-Difficulty sitting still

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Unrelentingly rapid and often loud speech without pauses

Pressured speech

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What are the types of Bipolar Disorders?

-Bipolar I Disorder
- Bipolar II Disorder
- Cyclothymia

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Depression + Mania

Bipolar I Disorder

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Depression + Hypomania

Bipolar II Disorder

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Chronic mood disturbance for at least 2 years

Cyclothymia

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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.

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Serves as defense against the feelings of depression

Mania

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May impact the onset of bipolar disorder, particularly in those patients with a family history of mood disorders

Large increase in springtime solar insolation

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Management for Bipolar Disorders

Mood Stabilizers
-Lifetime treatment
-Can prevent acute cycles of bipolar behavior
-Regimen involves lithium, anticonvulsants, and atypical antipsychotics

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The mechanism of action of Lithium Carbonate (Eskalith)

Normalizes reuptake of serotonin, NE, and Dopamine

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The Lag Period of Lithium

5 to 14 days

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Must know in Lithium

-Not metabolized and is excreted via urine
-Completes for salt receptor sites
-May elevate TSH levels

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Lithium therapeutic range in acute mania

0.8 to 1.5 mEq/L

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Lithium therapeutic range in maintenance

0.5 to 1.0 mEq/L

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On what level toxicity occurs

Toxicity occurs at 1.5 mEq/L

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Causes of Lithium Toxicity

-Dose is too high
- Diarrhea, vomiting
- Diaphoresis
- Dehydration

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Range of Mild Lithium Toxicity

1.5 to 2.0 mEq/L

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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!