chapter 12: bipolar disorders Flashcards
bipolar disorder
a disorder characterized by mood swings from profound depression to extreme euphoria w/ intervening periods of normalcy
bipolar disorder terms
- cyclothymic
- hypomania
- mania
cyclothymic
characterized by chronic mood disturbance involving numerous episodes of hypomania and depressed mood with less intensity
hypomania
a mild form of mania
mania
predominant mood that is elevated, expansive, or irritable w/ frenzied motor activity. also known as “manic episodes”
types of bipolar disorders
- bipolar I
- bipolar II
bipolar I
the classic image of bipolar disorder w/ manic symptoms and mst likely depressive episodes
bipolar II
-recurrent bouts of major depression w/ episodic occurrence of hypomania. this pt may never have experienced a full episode of mania
cyclothymic
a chronic mood disturbance of at least a 2 year duration involving numerous episodes of hypomania and depressed mood but of less intensity
causes of bipolar disorder
- altered levels of serotonin, dopamine, and/or norepinephrine will have an effect on mood. Increased levels are believed to be present in manic episodes and decreased in depressive ones
- genetics
- a combination of genetics and biochemical factors along w/ environmental triggers such as stressful life events may present the most comprehensive picture
- medical conditions and medications can trigger an episode in susceptible people
facts about bipolar disorders
- 4.4% of the American population will suffer from this disorder in their lifetime
- affects males and females at approximately the same rate
- episodes may or may not be associated w/ periods of depression
- average age of onset is 25
- after the first episode, there is a high risk of recurrence
- some have periodic episodes separate by years and others have much more frequent cycles
- most common cause of postpartum psychosis
symptoms
- the manic phase may last from days to months and cause marked disruption of occupational and social functioning. it can include psychotic features
- depressed phase of bipolar disorder in similar to those described for major depressive disorders in chapter 11
manic symptoms
- very elevated mood
- excess activity (hyperactivity)
- increased energy
- racing thoughts, flight of ideas
- taling a lot
- very high self esteem (false beliefs about self or abilities)
- easily distracted
- little need for sleep (may feel rested after 3 hours of sleep)
- poor temper control, easily agitated and irritable
reckless behavior and lack of self control in mania including
- drinking and/or drug use, binge eating
- poor judgment
- sex w/ many partners (promiscuity)
- spending sprees
in the early phase of a manic episode…
an individual can become more engaging and outgoing w/ high achievements, energy, and success
- as a manic phase accelerates, this individual can become frenzied and out of control, leading to impaired decision making and potentially hazardous actions
medical treatment
- mood stabilizer medications are the primary treatment
- psychotherapy helps w/ support and medication compliance
mood stabilizers
- lithium
- anticonvulsants including carbapazepine, gabapentin, valproic acid, lamotrigine
- additional medications may include antianxiety and antipsychotic drugs in some patients
lithium monitoring
- lithium requires close monitoring including regular blood levels
- therapeutic levels are between 0.5-1.2 milliequivalents per liter for most patients (1.0=1.5 in acute mania)
- the blood levels can become elevated in dehydration, profuse sweating, and chronic diarrhea leading to toxicity
- toxicity can cause tremors, confusion, seizures, coma, and even death
early warning signs of lithium toxicity include
nausea
vomiting
sedation
nursing interventions for bipolar disorders
- patience
- monitor lithium levels: monitor for side effects
- promote honest/therapeutic communication
- provide consistency in care
- encourage healthy nutrition
- encourage appropriate activity
- provide clear, firm limits
- ensure patient safety
