Bipolar & Related Disorders Flashcards
What are the 3 types of bipolar disorders. From most to least severe
- Bipolar I
- Bipolar II
- Cyclothymic
Bipolar I
1.One or more manic episodes
2.Experienced episodes of depression (requires hospitalization)
Bipolar I
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
Bipolar I
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
Rapid cycling
Bipolar I or II: may have @ least 4 mood episodes in 12 mo period
Mood episodes, major depressive, manic, hypo manic
Rapid cycling
Can occur w/ the course of a month or even 24 hr period
Rapid cycling
Severe symptoms: poor global functioning, high recurrence risk, resistance to conventional Tx
Global how well is the individual is functioning
Stage 1 Hypomania s/s
Seen in Bipolar II or Cyclothymic
1. Cheerful
2. Expansive
3. Irritability
4. Flighty thinking
5. Rapid flow of ideas
6. Increase motor activity
Stage 1 Hypomania seen in Bipolar II & Cyclothymic
- 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
Stage 2 Mania: Bipolar I
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
Stage III Delirious Mania: Bipolar I
Serious disorder
May exhibit dispar: Merriment & ecstasy-irritable, indifferent to environment-Panic level anxiety
Clouding of consciousness(confusion, disorientation, stupor)
Stage 3 Delirius Mania: Bipolar I
Very labile
Delusions: Religious, Grandeur, persecution
Hallucinations: auditory, visual
Extremely distracted/incoherent
Psychomotor activity frenzied, agitated, purposeless movements
Stage 3 Delirius Mania: Bipolar I
⚠️ without intervention: exhaustion, Injury to self or others & eventually DEATH!!!!!
Primary symptoms of manic attack
Distractibility
Indiscretion
Grandiosity
Flight of ideas
Activity increase
Sleep deficit
Talkativeness
Depressive Episodes
Same symptoms & risks as major depressive disorder.
More intense
Hospitalization may be required
Suicidal ideation, psychosis, catatonic is present
Depressive Episodes
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)
Bipolar II
Low level mania (Hypomania) alternates w/ profound depression
Bipolar II
Not usually severe that will cause serious impairment in occupational or social functioning, hospitalization is rare
Bipolar II
Abnormal/persistently elevated mood and ⬆️ activity
Energy lasting @ 4 consecutive days
Bipolar II
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.
Cyclothymic disorder
2yrs for adults ( 1 yr for children/adolescents) symptoms of Hypomania & symptoms of mild to moderate depression
Cyclothymic disorder
Symptoms are disturbing enough to cause social and occupational impairment
Cyclothymic disorder
Hypomania/ depressive symptoms do not meet the criteria for bipolar II or major depressive disorder
Cyclothymic disorder
Patients suffering from this disorder to have irritable Hypomanic episodes
Cyclothymic disorders
In children this is can cause sleep disturbances & irritability
Etiology
Theories of the development of bipolar disorders focus on:
Biological factor Genetics 🧬
Biochemical/ Physiological influences, Biogenic amines, Neuro anatomical factors
Psychosocial theories
Etiology
-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”
Mood stabilizing Medication: LITHIUM CARBONATE, LITHIUM
-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
Mood stabilizing Medication: LITHIUM CARBONATE, LITHIUM
Side Effects
-Mild thirst
-Loss of appetite
-restlessness
-find hand tremors
-Wt.gain or loss
-Dry mouth or excessive saliva
-constipation
-stomach irritation
Mood stabilizing Medication: LITHIUM CARBONATE, LITHIUM
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
Mood stabilizing Medication: LITHIUM CARBONATE, LITHIUM
-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
Mood stabilizing Medication: LITHIUM CARBONATE, LITHIUM
-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.
Mood stabilizing Medication: LITHIUM CARBONATE, LITHIUM
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.
Mood stabilizing Medication: LITHIUM CARBONATE, LITHIUM
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
Mood stabilizing Antiepileptic Medication: Valporate, Divalproex (Depakote), Valproic Acid
-Inhibiting sodium channels on neurons, enhancing the effects of GABA
Mood stabilizing Antiepileptic Medication: Valporate, Divalproex (Depakote), Valproic Acid
SE: N/V, weakness, somnolence, indigestion, diarrhea, dizziness
AE: hepatotoxicity, thrombocytopenia, blood dyscracias, pancreatitis, fatal hemorrhagic, teratogenicity
Mood stabilizing Antiepileptic Medication: Valporate, Divalproex (Depakote), Valproic Acid
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
- Valproate: acute mania. 50-125mcg/ml therapeutic level
Mood stabilizing Antiepileptic Medication: Carbamazepine (equetro, tegretol)
Inhibiting the hight frequency firing of sodium channels
Mood stabilizing Antiepileptic Medication: Carbamazepine (equetro, tegretol)
SE: dizziness, somnolence, N/V, ataxia, blurred vision, hyponatremia or leukopenia may occur
AE: Steven Johnson syndrome, blood dyscracias
Mood stabilizing Antiepileptic Medication: Carbamazepine (equetro, tegretol)
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
- 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.
Mood stabilizing Antiepileptic Medication: Lamotrigine (Lamictal)
Inhibits Na+ channels & modulates the release of excitatory neurotransmitters glutamate, aspartate maintenance therapy. Bipolar depression
Mood stabilizing Antiepileptic Medication: Lamotrigine (Lamictal)
SE: double or blurred vision, dizziness, headache, N/V, ataxia, rhinitis
AE: Steven Johnsons syndrome (Toxic epidermal necrolysis)
Mood stabilizing antiepileptic Medication: Lamotrigine (Lamictal)
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.
Mood stabilizing antiepileptic Medication:
⚠️ Warning sign on all 3 that can increase suicidal thoughts and behaviors. Monitored in changes and mood and behaviors
Other Medications: Anticonvulsants that act as mood stabilizers:
Clonzepam (Klonopin), Gabapentin (Neurontin), Oxcabazepine (Trileptal), Topiramate (Topax)
Other Medications: 2nd generation antipsychotics
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)
Interventions
-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
Interventions
-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
