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MENTALHEALTH > Bipolar & Related Disorders > Flashcards

Bipolar & Related Disorders Flashcards

1
Q

What are the 3 types of bipolar disorders. From most to least severe

A
  1. Bipolar I
  2. Bipolar II
  3. Cyclothymic
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2
Q

Bipolar I

A

1.One or more manic episodes
2.Experienced episodes of depression (requires hospitalization)

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3
Q

Bipolar I

A

Mania:
1.Is abnormal & persistently elevated
2. Expansive
3. Irritable
4. There mood & energy will last 1 wk. May be present most of the day

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4
Q

Bipolar I

A

S/S will be 3 or more that are present
1. Inflated self esteem or grandiosity
2. ⬇️ need in sleep
3. Talkative then usual/ pressure to keep talking
4.Flight of ideas “Racing Thoughts”
5. Distractibility
6. ⬆️ goal directed activity/ agitation
7. Excessive involvement in activities/ high potential for painful consequences
EX: Poor judgment, impulsive, spending money, sexual

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5
Q

Rapid cycling

A

Bipolar I or II: may have @ least 4 mood episodes in 12 mo period

Mood episodes, major depressive, manic, hypo manic

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6
Q

Rapid cycling

A

Can occur w/ the course of a month or even 24 hr period

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7
Q

Rapid cycling

A

Severe symptoms: poor global functioning, high recurrence risk, resistance to conventional Tx

Global how well is the individual is functioning

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8
Q

Stage 1 Hypomania s/s

A

Seen in Bipolar II or Cyclothymic
1. Cheerful
2. Expansive
3. Irritability
4. Flighty thinking
5. Rapid flow of ideas
6. Increase motor activity

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9
Q

Stage 1 Hypomania seen in Bipolar II & Cyclothymic

A
  1. Talk & laugh loud & inappropriate
    8.Increased libido
    9.Anorexia/ wt. loss
    10.Engaging in inappropriate behaviors
    There self are ideas have great worth, easily distracted
    Extrovert, talk loud, inappropriate, running up credit cards
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10
Q

Stage 2 Mania: Bipolar I

A

Require hospitalization
Easily changes to anger/crying
Reading taught
Accelerated speech
Lying
May go for many days w/ no sleep & not look tired
Excessive makeup/jewelry

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11
Q

Stage III Delirious Mania: Bipolar I

A

Serious disorder
May exhibit dispar: Merriment & ecstasy-irritable, indifferent to environment-Panic level anxiety
Clouding of consciousness(confusion, disorientation, stupor)

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12
Q

Stage 3 Delirius Mania: Bipolar I

A

Very labile
Delusions: Religious, Grandeur, persecution
Hallucinations: auditory, visual
Extremely distracted/incoherent
Psychomotor activity frenzied, agitated, purposeless movements

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13
Q

Stage 3 Delirius Mania: Bipolar I

A

⚠️ without intervention: exhaustion, Injury to self or others & eventually DEATH!!!!!

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14
Q

Primary symptoms of manic attack

A

Distractibility
Indiscretion
Grandiosity

Flight of ideas
Activity increase
Sleep deficit
Talkativeness

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15
Q

Depressive Episodes

A

Same symptoms & risks as major depressive disorder.
More intense
Hospitalization may be required
Suicidal ideation, psychosis, catatonic is present

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16
Q

Depressive Episodes

A

Standard Screen Tool: Mood disorder questionnaire
Is a standardized tools that places mood progression on a continuum for HYPOMANIA (euphoric) to acute acute mania to delirium (completely out of touch w/ reality)

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17
Q

Bipolar II

A

Low level mania (Hypomania) alternates w/ profound depression

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18
Q

Bipolar II

A

Not usually severe that will cause serious impairment in occupational or social functioning, hospitalization is rare

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19
Q

Bipolar II

A

Abnormal/persistently elevated mood and ⬆️ activity
Energy lasting @ 4 consecutive days

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20
Q

Bipolar II

A

3 or more following symptoms
Inflated self esteem or grandiosity
⬇️ need for sleep
More talkative then usual or pressure to keep talking
Flight of ideas (racing thoughts)
Distracted
⬆️ goal directed activity or psychomotor agitation
Excessive involvement in activities high potential for painful consequences.

21
Q

Cyclothymic disorder

A

2yrs for adults ( 1 yr for children/adolescents) symptoms of Hypomania & symptoms of mild to moderate depression

22
Q

Cyclothymic disorder

A

Symptoms are disturbing enough to cause social and occupational impairment

23
Q

Cyclothymic disorder

A

Hypomania/ depressive symptoms do not meet the criteria for bipolar II or major depressive disorder

24
Q

Cyclothymic disorder

A

Patients suffering from this disorder to have irritable Hypomanic episodes

25
Q

Cyclothymic disorders

A

In children this is can cause sleep disturbances & irritability

26
Q

Etiology

A

Theories of the development of bipolar disorders focus on:
Biological factor Genetics 🧬
Biochemical/ Physiological influences, Biogenic amines, Neuro anatomical factors
Psychosocial theories

27
Q

Etiology

A

-Underline genetic vulnerability
-NorEpi/Dopamine
-Acetylcholine
-Serotonin
-Frontal Lobe. Pre frontal cortex
-Childhood trauma is psych changes maybe linked to bipolar, suicidal risk, substance abuse
-Use of steroids Tx in other dz later in life they have been known to develop manic symptoms of bipolar “SLE”

28
Q

Mood stabilizing Medication: LITHIUM CARBONATE, LITHIUM

A

-Produces NeroTrans change: Serotonin, NorEpi, Glutamate, GABA, Dopamine
-Bipolar mood swings
-Antimanic
-Bipolar depression
-Onset of action w/in 10-21 days
-therapeutic level w/in 7-14days or longer

29
Q

Mood stabilizing Medication: LITHIUM CARBONATE, LITHIUM

A

Side Effects
-Mild thirst
-Loss of appetite
-restlessness
-find hand tremors
-Wt.gain or loss
-Dry mouth or excessive saliva
-constipation
-stomach irritation

30
Q

Mood stabilizing Medication: LITHIUM CARBONATE, LITHIUM

A

Level: 0.8-1.2 mEq/L
Toxicity: Levels >1.2mEq/L(signs: Vomiting,sedation, confusion)
Over 2mEq/L: tremors, sedation, confusion
Over 3.5mEq/L: delirium, seizures, coma, cardiovascular collapse, DEATH

31
Q

Mood stabilizing Medication: LITHIUM CARBONATE, LITHIUM

A

-Helps with Flight of ideas, anxiety, manipulation, excitability, granulation, self injury behavior
-Used for Bipolar with agitation
-Early in treatment with second generation antipyschiotic, anticonvulsant, anti anxiety medication since it has a late onset
-They miss the high of the manic

32
Q

Mood stabilizing Medication: LITHIUM CARBONATE, LITHIUM

A

-Small window
-Must reach the therapeutic level. Given at first in acute manic 600-1200 mg a day in 2 to 3 divided doses then increase every few days to 300mg a day the max dose of 1800 a day.

33
Q

Mood stabilizing Medication: LITHIUM CARBONATE, LITHIUM

A

Target serum range for maintenance is 0.6-0.8, Lithium level shoud be 0.8-1.2. 1st lithium dose given thelab should be drawn every 2-3 days after treatment or dosage change until level is reached. Them lab should be drawn every 3-6 months after.
Baseline function before giving will be checking thyroid levels, Kidney function, ECG. Can get Renal toxicity, goiter, hypothyroidism can occur with long term use.

34
Q

Mood stabilizing Medication: LITHIUM CARBONATE, LITHIUM

A

PT education: helps prevent relapse, continue taking, monitor the levels, continue monitoring to prevent toxicity, increase fluid intake 1500-3000ml a day/ 6x12 oz of fluids.
-High sodium can lower levels, Low sodium levels can increase levels of lithium
STOP TAKING if has, diarrhea, vomiting, excessive sweating= dehydration which will increase lithium levels
-Inform HCP if on diuretics, to have renal/thyroid checked. NO OTC meds unless check with HCP (no NSAIDS)

-In the 1st week will gain up to 5 lbs of water weight and additional. TAKE WITH FOOD

35
Q

Mood stabilizing Antiepileptic Medication: Valporate, Divalproex (Depakote), Valproic Acid

A

-Inhibiting sodium channels on neurons, enhancing the effects of GABA

36
Q

Mood stabilizing Antiepileptic Medication: Valporate, Divalproex (Depakote), Valproic Acid

A

SE: N/V, weakness, somnolence, indigestion, diarrhea, dizziness

AE: hepatotoxicity, thrombocytopenia, blood dyscracias, pancreatitis, fatal hemorrhagic, teratogenicity

37
Q

Mood stabilizing Antiepileptic Medication: Valporate, Divalproex (Depakote), Valproic Acid

A

Anticonvulsant drugs
Used for Acute mania, acute bipolar depression, bipolar maintenance.
More effective with no FHX of bipolar disorder
Can control mania in 2 weeks and 3 weeks for depression

  1. Valproate: acute mania. 50-125mcg/ml therapeutic level
38
Q

Mood stabilizing Antiepileptic Medication: Carbamazepine (equetro, tegretol)

A

Inhibiting the hight frequency firing of sodium channels

39
Q

Mood stabilizing Antiepileptic Medication: Carbamazepine (equetro, tegretol)

A

SE: dizziness, somnolence, N/V, ataxia, blurred vision, hyponatremia or leukopenia may occur

AE: Steven Johnson syndrome, blood dyscracias

40
Q

Mood stabilizing Antiepileptic Medication: Carbamazepine (equetro, tegretol)

A

Anticonvulsant drugs
Used for Acute mania, acute bipolar depression, bipolar maintenance.
More effective with no FHX of bipolar disorder
Can control mania in 2 weeks and 3 weeks for depression

  1. Carbamazepine: second line agent for bipolar disorder is reduces the pierubate over excited neurons of sodium channels.Monitor LFTs, CBCs, ECG, Na levels at baseline and after, blood levels 4-12mcg/ml therapeutic levels. Pregnancy test is needed before treatment. Steven Johnson syndrome is a severe rash seen mostly in the Asian population so genetic testing is needed. If the genetic test is positive then the physician will not administer the medication.
41
Q

Mood stabilizing Antiepileptic Medication: Lamotrigine (Lamictal)

A

Inhibits Na+ channels & modulates the release of excitatory neurotransmitters glutamate, aspartate maintenance therapy. Bipolar depression

42
Q

Mood stabilizing Antiepileptic Medication: Lamotrigine (Lamictal)

A

SE: double or blurred vision, dizziness, headache, N/V, ataxia, rhinitis

AE: Steven Johnsons syndrome (Toxic epidermal necrolysis)

43
Q

Mood stabilizing antiepileptic Medication: Lamotrigine (Lamictal)

A

Anticonvulsant drugs
Used for Acute mania, acute bipolar depression, bipolar maintenance.
More effective with no FHX of bipolar disorder
Can control mania in 2 weeks and 3 weeks for depression

3.Lamotrigine: maintenance therapy in bipolar disorder will inhibit sodium channels and monduclates excitatory neurotransmitters glutamate and aspatate. Dose titration. Report any rashes. 10% of People within 8 weeks a rash appears.

44
Q

Mood stabilizing antiepileptic Medication:

A

⚠️ Warning sign on all 3 that can increase suicidal thoughts and behaviors. Monitored in changes and mood and behaviors

45
Q

Other Medications: Anticonvulsants that act as mood stabilizers:

A

Clonzepam (Klonopin), Gabapentin (Neurontin), Oxcabazepine (Trileptal), Topiramate (Topax)

46
Q

Other Medications: 2nd generation antipsychotics

A

For acute mania/ Sedative properties during early phase Tx (Help w/ insomnia, anxiety, agitation) Mood Stabilizing properties:
Olanzapine(Zyprexa)
Quetiapine( Seroquel)
Aripiprazole (Abilify)
Carpirazine (Vraylar)
Risperidone (Risperdal)
Ziprasidone (Geodon)
Asenapine (Saphis)

47
Q

Interventions

A

-Reduce environmental stimuli
-Stay w/ the pt who is hyperactive & agitated
-Provide structural schedule of activities that include established rest periods throughout the day.
-provide physical activities
-observe the pt behavior frequently
-intervene @ the 1st signs of ⬆️ anxiety,agitation, verbal or behavioral aggression: Say “You seem anxious” or “How can I help?”
-Maintain & convey a calm attitude: respond matter-of-factory to verbal hostility
-Anxiety increases offer some alternatives to participate in physical activity

48
Q

Interventions

A

-Provide ⬆️ protein, ⬆️ calorie, nutritious finger food & drinks that can be consumed “on the run”
-Set limits on manipulative behaviors
-Do not argue, bargain, or try to reason w/ the pt
-use a firm yet calm, relaxed approach
-use short & concise explanations or statements

MENTALHEALTH (3 decks)

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