Chapter 13: Bipolar and Related Disorders Flashcards
What is the most severe bipolar disorder?
bipolar I disorder
What is a period of intense mood disturbance with persistent elevation, expansiveness, irritability, and extreme goal directed activity or energy?
mania
How long does a manic episode have to last in order to be considered for a BPD 1 diagnosis?
at least 1 week present for most of the day, nearly every day
What are the 7 symptoms that may be seen when considering a BPD I diagnosis?
Inflated self-esteem/grandiosity
decreased need for sleep
more talkative than usual/pressure to keep talking
flight of ideas or thoughts that are racing
distractibility
increase in goal-directed activity or psychomotor agitation
excessive involvement in activities that have a high potential for painful consequences
What kind of mood disturbance is seen in the DSM-5 criteria for a BPD I diagnosis?
sufficiently severe to cause marked impairment in social or occupational functioning or severe enough for hospitalization due to prevention of harm to self or others
What can manic episodes not be attributed to according to the DSM-5 when determining a BPD I diagnosis?
physiological effects of a substance or to another medical condition
How many of the 7 symptoms must someone experience for a DSM-5 diagnosis of a BPD I manic episode?
three or more but 4 if the mood is only irritable
What is the difference between mania, experienced in BPD I, and hypomania, experienced in BPD II?
hypomania refers to a low-level and less dramatic mania that tends to be euphoric and often increases functioning
What is BPD I commonly misdiagnosed as?
major depressive disorders or personality disorders
What is seen in someone with cyclothymic disorder?
symptoms of hypomania alternate with symptoms of mild to moderate depression for at least 2 years in adults and 1 year in children
What is considered rapid cycling in someone with BPD I or BPD II?
at least 4 mood episodes in a 12-month period
If someone’s bipolar symptoms occur due to the use of a substance/medication, what is it known as?
substance/medication-induced bipolar and related disorder
What is it known as if a patient is experiencing mania/hypomania that may be mixed with depression and is related to a specific condition?
bipolar and related disorder due to another medical condition
What are the differences seen in men and women who have bipolar disorder?
men are more likely to have legal problems and commit acts of violence
women with BPD are more likely to misuse alcohol, commit suicide, and develop thyroid disease
What is a major risk factor for developing cyclothymic disorder?
having a first-degree relative with BPD I
Which disorder is BPD I most closely genetically correlated with?
schizophrenia
Which disorder is BPD II most closely genetically correlated with?
major depressive disorder
What may be the root of the neurobiological cause of bipolar disorder?
receptor site insensitivity
Where is dysfunction seen in the brain with BPD?
prefrontal cortex region, amygdala, and hippocampus
What is the prefrontal cortex associated with?
executive decision making, personality expression, and social behavior
What is the hippocampus associated with?
memory
What is the amygdala associated with?
memory, decision making, and emotion
What does the dysregulation of the amygdala, hippocampus, and prefrontal cortex result in for patients with BPD?
emotional lability, heightened reward sensitivity, and emotional dysregulation
What type of abuse has the largest association with BPD?
emotional abuse
What does early diagnosis of BPD help to prevent?
suicide attempts, alcohol/substance use problems and disorders, marital/work problems, development of medical comorbidity
What is commonly seen behavior wise in patients with hypomania?
voracious appetites for social engagement, spending and activity, and even indiscriminate sex as well as a decreased need for sleep
What is a hallmark symptom of mania and how will it manifest?
distractibility
people will lose their focus and go from one activity or place to another and may start many projects without completing any
3 common speech patterns and 2 common thought processes associated with BPD
pressured speech, tangential speech and circumstantial speech
loose associations and flight of ideas
What kind of speech is fast, ranging from rapid to frenetic, conveying an inappropriate sense of urgency?
pressured speech
What is circumstantial speech?
adding unnecessary details when communicating with others
What is the key difference between circumstantial and tangential speech?
in tangential speech, people lose the point that they were trying to make and never find it again
What do loose associations represent in a patient?
the disordered way that a person is processing information
What is the continuous flow of accelerated speech with abrupt changes from topic to topic?
flight of ideas
What are the two types of delusions commonly seen in manic patients?
grandiose delusions and persecutory delusions
What do cognitive deficits correlate with in BPD?
greater number of manic episodes, history of psychosis, chronicity or illness, and poor functional outcome
What are the goals of the acute phase of a manic or hypomanic episode?
symptom reduction and achieving remission
What are the things that should be assessed during the maintenance phase of a manic/hypomanic episode?
education, support, and problem-solving skills
What does the maintenance phase focus on when treating manic BPD?
preventing relapse and limiting the severity and duration of future episodes
What is a major cause of relapse for a BPD patient?
lack of adherence to mood-stabilizing medications
Why is it important to be consistent in approach and expectations when treating a manic patient?
consistent limits and expectations minimize potential for patient’s manipulation of staff
What does hearing and acting on legitimate complaints help minimize?
underlying feelings of helplessness and acting out behaviors
What are major reasons of non-adherence for medications that treat BPD?
they may cause weight gain or other metabolic disturbances
What are three support groups for BPD?
Depression and Bipolar Support alliance, the National Alliance on Mental Illness (NAMI), and Mental Health America
When is lithium given to treat BPD?
severe agitation
What is the onset of action for lithium?
10-21 days
What are two things that should be assessed prior to the start of lithium treatment and then annually after that?
kidney function and thyroid function
What are some signs of lithium toxicity?
nausea, vomiting, diarrhea, thirst, polyuria, lethargy, sedation, and fine hand tremor
What kind of lithium toxicity is associated with GI upset, coarse hand tremor, confusion, hyperirritability of muscles, sedation, incoordination, and electroencephalographic changes?
early toxicity (1.5-2.0mEq/L)
When would someone with lithium toxicity experience blurred vision, clonic movements, ataxia, large output of dilute urine, seizures, and severe hypotension?
advanced lithium toxicity (2-2.5mEq/L)
What are three signs of severe lithium toxicity?
convulsions, oliguria, and death (>2.5mEq/L)
When should a patient be hospitalized for lithium toxicity?
once advanced signs of toxicity have been noted (>2.0mEq)
What must be done to prevent further absorption of lithium for someone experiencing advanced lithium toxicity?
whole bowel irrigation
What may be done in severe cases of lithium toxicity?
hemodialysis
If someone is beginning to experience lithium toxicity, still below 1.5mEq/L, should treatment be stopped?
no, but does should be kept low and kidney and thyroid function should be assessed
At what point is it necessary to withhold lithium for a patient?
once the patient is experiencing early signs of toxicity and the plasma level is above 1.5mEq/L as the dosage needs to be reevaluated
How much fluid should a patient drink each day while on lithium?
1500-3000mL/day
Why is maintaining a consistent sodium level important when a patient is on lithium treatment?
high sodium intake leads to lower lithium levels (reducing therapeutic effects) and low sodium intake may lead to higher lithium levels (producing toxicity)
Lithium therapy is generally contraindicated in patients with? (5)
Cardiovascular disease, brain damage, renal disease, thyroid disease, and myasthenia gravis
How old should a patient be in order to receive lithium therapy?
over the age of 12
What can anticonvulsants be given to treat (aside from epilepsy)?
acute mania, acute bipolar depression, and/or bipolar maintenance
Why should bipolar depression not be treated with an antidepressant alone?
it increases the risk of bringing on a manic episode
How quickly does ECT typically work?
within 1 week of treatment
When is ECT most commonly used?
in patients with BPD that also have severe levels of depression
Why should patients with BPD avoid caffeine?
it may cause a relapse
