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PSYCH > Bipolar dx > Flashcards

Bipolar dx Flashcards

1
Q

Bipolar 1 is more common in…

A

men

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2
Q

Bipolar 2 is more common in…

A

women

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3
Q

When can bipolar dx onset?

A

Any age

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4
Q

rf for bipolar dx

A
  • exact cause unknown
  • genetics
  • NT (dp, nor, sr), gaba
  • PFC, hippo, amygdala
  • HPtA axis (hypothyroid)
  • enviro–fam stress and adverse events
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5
Q

cyclothymic dx

A

alternate with sx mild-mod dep for 2Y
- rapid cycle possible

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6
Q

Anticonvulsant mood stabilizers

A
  • sodium valproate/divalproex sodium valproic acid
  • carbamazapine
  • lamotrigine
  • gabapentin
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7
Q

When does cyclothymia begin?

A

In adolescence or early adulthood

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8
Q

Bipolar 1 vs 2

A
  • 1 more severe, highest mort, at least 1 manic episode
  • 2 at least 1 hypomanic, at least 1 major dep dx
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9
Q

Bipolar 1 manic ep dx (DSM)

A
  • abnorm or pers elevated irritable mood and goal directed energy for at least 1 wk
  • 3+ infl SE, dec need for sleep, more chatty, flight of ideas, distractibility, inc goal-directed activity or psycho agit, excess involve in pleasurable activities with high potential for painful consequences
  • marked impairment in social or occup fxn OR psychotic ft
  • not caused by sub use, meds, w/d, med condx
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10
Q

BP comorb

A

anx, SUD

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11
Q

The manic highs mirror the depressive lows in…

A

depth and intensity

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12
Q

The more manic episodes one has the more…

A

intense they are

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13
Q

Bipolar 1 dx general

A
  • at least 1 manic ep
  • usually recog sx of alt manic w/ major dep episodes (MDE) and/or hypomanic ep
  • psychotic ep (delus/halluc) or MDE may be absent over lifetime of the person (unusual)
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14
Q

Clinical features of mania

A

Distractibility
Indiscretion
Grandiosity

Flight of Ideas
Activity increase
Sleep deficit
Talkativeness

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15
Q

Bx of mania

A
  • mood lability - rapid extreme mood swings, w/ irritability or sudden outburst of misplaced rage
  • quick to anger/feels misunderstood/low frus trol
  • pacing
  • dramatic mannerisms
  • uses jokes, puns
  • flamboyant or sex suggestive dress
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16
Q

Bipolar 2 dx

A
  • presence of hx of at least one major dep ep or at least one hypomanic ep
  • never had a manic ep
  • impairment in fxn in at least 1 area
  • no psychosis with hypomania but may have with dep
  • v impulsive - suicide
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17
Q

Difference in mania btwn 1 or 2

A

hypomania in 2 is not strong enough to cause marked impairment in social or occup fxn or causes hospitalization

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18
Q

DSM 5 for hypomanic episode

A
  • distinct pd of abnormal and pers elevated, expansive or irritable mood and inc activity or energy lasting at least 4 consecutive days and lasting most of day
  • 3+ sx during mood disturbance: infl SE, dec sleep, chatty, flight of ideas, distractible, inc goal directed activity, excess involve in activities with high potential for painful consequences
  • chx in fxn
  • observable mood and fxn chx by others
  • not marked impairment or need hospital
  • not from subs or med condx
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19
Q

mixed features

A

sx dep and mania occur at same time

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20
Q

Rapid cycling

A

4+ manic episodes for at least 2w in 12M
- partial of full remission for 2M at a time or switch to opp episode
- high risk reccur
- greater severity of illness

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21
Q

Which sx dominate for rapid cycling?

A

Depressive

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22
Q

Do drugs work on rapid cycling?

A

Often resistant

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23
Q

hypomanic episode (general)

A
  • episode assoc with definited noticeable chx in fxn unchar for ind
  • NOT severe enuf to cause marked impair in social or occup fxn or hospital
  • no psychotic ft
  • elevated, expansive, or irritable mood for at least 4d
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24
Q

cyclothymic dx

A
  • present for at least 2y in adults (1y kids/adol)
  • multiple hypomanic sx but not ep
  • dep sx but not dep dx
  • sx present over half the time (and not w/o sx for more than 2M at a time)
  • fluc hypomanic sx and dep sx
  • alt with sx of mild to mod dep for at least 2y (adults)
  • rapid cycling possible
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25
Q

Atypical antipsychotics

A
  • risperidone
  • quetiapine
  • ariprprazole
  • olanzapine
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26
Q

Mood stabilizers for acute mania

A
  • lithium plus antipsychotic
  • divalproex plus antipsychotic
27
Q

Why do we avoid just giving antideps for bp?

A

Can send you into mania

28
Q

Which med is often given for bp ppl more on the dep side?

A

Olanzapine and fluoxetine

29
Q

Possible thought process for bipolar

A

loose, tangential, flight of ideas, circumstantial

30
Q

Possible thought content for bp dx

A

grandiose, paranoid, persecutory delusions

31
Q

Possible speech for bp dx

A

pressured, clang, loud, rapid

32
Q

bp assessments

A
  • danger to self/others
  • medical status
  • need protection
  • coexist med condx
  • need hospital
  • fam understand
33
Q

What to teach fam friends of bp person?

A

s/s relapse

34
Q

nc for bp dx

A
  • med manage
  • dec PA
  • inc food/fluids
  • 4-6h sleep at night
  • meet self-care
  • who to call for s/s relapse
  • coping and group/ind
35
Q

What to avoid if bp?

A

lots caff, alc, drugs, some OTC meds like ephedrine bc they can cause relapse

36
Q

Meds for full mania

A

Mood stabilizers, atypical antipsychotics, some BDZs

37
Q

tx for acute hypomania

A

lithium

38
Q

Why is sleep important in bp?

A

Can prevent a manic episode

39
Q

atatypical antipsychotics

A

olanzapine, risperidone, ariprprazole, lurasidone, quetiapine, ziprasidone

40
Q

Lithium therapeutic range

A

0.6-1.4

41
Q

Lithium CI

A

CVD, renal, brain damage, thy disease, preg/bf mom

42
Q

Dosing of lithium

A
  • Usually start low and titrate
  • onset 5-7d, 2w
  • often dose 1200-3000
  • often start on Li and antipsych and d/c antipsych after mania is done
43
Q

Expected SE of lithium

A

N/V/D, tremor, renal tox, goiter, hypo
- assess levels
- seen <1.5

44
Q

lithium early tox SE

A

GI, hand tremor (coarse), confuse, hyperirritable, EEG chx, sedate, incoor
- 1.5-2

45
Q

What to do if suspect early Li tox

A

w/h med and get blood level
- reevaluate dose
- start again the next day

46
Q

Advanced signs of Li tox

A

ataxia, EEG chx, clonic mvt, lots diluted urine, sz, stupor, severe hypo, coma
- 2-2.5

47
Q

Risk of death with adv Li tox

A

death from pulm condx

48
Q

Tx for adv Li tox

A
  • hospital
  • drug stop
  • may need bowel irrigation
49
Q

Severe tox of Li SE

A
  • convuls, oliguira, death
  • over 2.5
50
Q

Tx for severe Li tox

A

hemodialysis

51
Q

Lithium NC

A
  • can see inc SI when d/c Li
  • don’t restrict Na in diet (maintain normal levels)
  • hydrate (esp if sweat)
  • if ill (dec fluids) and call dr
  • intermittent blood tests
52
Q

Lab monitoring for Li

A
  • 1-2x/w at first
  • monitor creatinine conc, thy hor, CBC q6h
  • risk of kidney damage
  • thy can dec after 6-18M, watch for dry skin, hair dec, brady, cold intol, constipate
53
Q

Action of Li

A

Action unknown
- cross cell membrane, alter Na transport, not protein-bonding

54
Q

NC for valproate

A
  • check serum levels
  • broad spec efficacy
  • longer mood stable
55
Q

Carbamazapine NC

A
  • when Li not work well or 2nd choice
  • check serum levels
  • risk of low WBCs
  • check hepatic/renal fxn
56
Q

Dangerous sx of carbamazpine

A

RASH

57
Q

Topiramate

A

anticonvulsant mood stabilizer

58
Q

Gabapentineuse

A

May be effective for acute mania and rapid cycling

59
Q

Lamotrigine

A
  • used for rapid cycle and dep bp phase or add in refrac mood dx
  • can get rash that can lead to SJS
60
Q

What to do if see rash with lamotrigine

A

STOP med

61
Q

Sx of SJS

A
  • flu-like and blister, burn eyes
  • toxic epidermal necrosis (top layer of skin separates)
62
Q

Other tx for bp dx

A

ECT, team safety, seclusion protocol, support group, health teach
- CBT, interpersonal and social, fam focused (APRN)

63
Q

ECT for bp dx

A
  • subdues severe manic bx esp in pt with tx-resist mania and pt with rapid cycle
  • more effective than drug-based therapy for tx-resist bp dp
  • for dep episodes

PSYCH (15 decks)

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