Ch. 17 Bipolar Disorder

Question 1

Mania

Answer 1

is an alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, and accelerated thinking and speaking.

Question 2

Bipolar Disorder

Answer 2

is characterized by mood swings from profound depression to extreme euphoria (mania), with intervening periods of normalcy.

Question 3

Bipolar I Disorder

Answer 3

Most Severe; extreme mania, extreme depression, men more likely to experience

Question 4

Bipolar II Disorder

Answer 4

Characterized by bouts of major depression with episodic occurrence of hypomania
Has never met criteria for full manic episode

Question 5

Cyclothymic disorder

Answer 5

Chronic mood disturbance
At least 2-year duration
Numerous episodes of hypomania and depressed mood of insufficient severity to meet the criteria for either bipolar I or II disorder
LEAST SEVERE

Question 6

Substance-induced bipolar disorder

Answer 6

A disturbance of mood (depression or mania) that is considered to be the direct result of the physiological effects of a substance (e.g., ingestion of or withdrawal from a drug of abuse or a medication or other treatment)

Question 7

Bipolar disorder associated with another medical condition

Answer 7

Characterized by an abnormally and persistently elevated, expansive, or irritable mood and excessive activity or energy that is judged to be the result of direct physiological effects of another medical condition

Question 8

Stage I. Hypomania

Answer 8

Symptoms not sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalization

Cheerful mood
Rapid flow of ideas; heightened perception
Increased motor activity

Question 9

Stage II. Acute mania

Answer 9

Marked impairment in functioning; usually requires hospitalization

Elation and euphoria; a continuous “high”
Flight of ideas; accelerated, pressured speech
Hallucinations and delusions
Excessive motor activity
Social and sexual inhibition
Little need for sleep

Question 10

Stage III. Delirious mania

Answer 10

A grave form of the disorder characterized by an intensification of the symptoms associated with acute mania. The condition is rare since the advent of antipsychotic medication.

Labile mood; panic anxiety
Clouding of consciousness; disorientation
Frenzied psychomotor activity
Exhaustion and possibly death without intervention

Question 11

Delusions of grandeur

Answer 11

belief that one is famous or powerful

Question 12

Delusion of persecution

Answer 12

belief that someone is going to cause them harm or that they are being constantly judged

Question 13

Delusion of reference

Answer 13

Belief that insignificant remarks, events, or objects in one’s environment have personal meaning or significance

Question 14

Delusion of control/influence

Answer 14

Belief that another person, group of people, or external force controls one’s general thoughts, feelings, impulses, or behavior

Question 15

Nursing Diagnosis for Bipolar

Answer 15

Risk for injury
Risk for Violence
Disturbed Thought Process
Disturbed sensory perception
impaired social interaction
insomnia related to
imbalanced nutrition

Question 16

Psychopharmacology

Answer 16

For mania
Lithium carbonate
Anticonvulsants
Antipsychotics
Anxiolytics

For depressive phase
Use antidepressants with care (may trigger mania).

Question 17

Lithium

Answer 17

First choice of treatment!!!
effective in 7-14 days
very narrow therapeutic index, must keep blood levels between 0.4-1.3mEq/L

Requires frequent labs that must be drawn 8-12hrs after last dose given. Once therapeutic level reached blood levels drawn every month for a period of time, then every three months.

Question 18

Side effects of lithium

Answer 18

expected common side effects are fine hand tremor and weight gain
Toxicty occurs w levels over 1.5mEq/L–> tremor increase, nausea, vomiting, confusion, seizures, coma, hypotension, loss of bodily movements

Treatment: discontinuation of the drug, IV fluids, emetic meds, possibly hemodialysis

Question 19

lithium long term risks

Answer 19

hypothyroidism and kidney impairment

Question 20

lithium teaching

Answer 20

Lithium decreases sodium reabsorption in the kidneys which can lead to sodium deficiency. Decreased sodium can lead to lithium retention and toxicity

Question 21

Anticonvulsants

Answer 21

Depakote
Lamictal
Tegretol

Diminishes impulsive and aggressive behaviors.

Question 22

Depakote

Answer 22

Used for lithium non-responders who are in acute mania and rapid cycling. Effective in the treatment of both acute mania and bipolar depression. Monitor liver (AST & ALT), depakote level, and platelet counts.

Question 23

Lamictal

Answer 23

Very effective 1st line treatment used for bipolar depression. Serious reaction is life threatening rash (Steven’s Johnson).

Question 24

Tegretol

Answer 24

Used in treatment resistant bipolar disorder often in combination with Lithium an antipsychotic drug. Works well in patients whose mania is angry and paranoid. Also good for bipolar depression. Monitor liver and platelet counts and beware of possible bone marrow suppression or liver inflammation.

Question 25

Antipsychotics

Answer 25

often given when someone is diagnosed, works almost immediately

Abilify, Zyprexia, Seroquel, Risperdal are all useful to treat severe mania as well as depression

Question 26

Anxiolytics

Answer 26

Klonopin and Ativan-Useful in acute mania to reduce psychomotor agitation. Avoid with a patient who has concurrent substance abuse problems.