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NURS 471 > Chapter 13: Bipolar and Related Disorders > Flashcards

Chapter 13: Bipolar and Related Disorders Flashcards

1
Q

What is the most severe bipolar disorder?

A

bipolar I disorder

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2
Q

What is a period of intense mood disturbance with persistent elevation, expansiveness, irritability, and extreme goal directed activity or energy?

A

mania

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3
Q

How long does a manic episode have to last in order to be considered for a BPD 1 diagnosis?

A

at least 1 week present for most of the day, nearly every day

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4
Q

What are the 7 symptoms that may be seen when considering a BPD I diagnosis?

A

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

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5
Q

What kind of mood disturbance is seen in the DSM-5 criteria for a BPD I diagnosis?

A

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

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6
Q

What can manic episodes not be attributed to according to the DSM-5 when determining a BPD I diagnosis?

A

physiological effects of a substance or to another medical condition

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7
Q

How many of the 7 symptoms must someone experience for a DSM-5 diagnosis of a BPD I manic episode?

A

three or more but 4 if the mood is only irritable

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8
Q

What is the difference between mania, experienced in BPD I, and hypomania, experienced in BPD II?

A

hypomania refers to a low-level and less dramatic mania that tends to be euphoric and often increases functioning

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9
Q

What is BPD I commonly misdiagnosed as?

A

major depressive disorders or personality disorders

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10
Q

What is seen in someone with cyclothymic disorder?

A

symptoms of hypomania alternate with symptoms of mild to moderate depression for at least 2 years in adults and 1 year in children

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11
Q

What is considered rapid cycling in someone with BPD I or BPD II?

A

at least 4 mood episodes in a 12-month period

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12
Q

If someone’s bipolar symptoms occur due to the use of a substance/medication, what is it known as?

A

substance/medication-induced bipolar and related disorder

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13
Q

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?

A

bipolar and related disorder due to another medical condition

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14
Q

What are the differences seen in men and women who have bipolar disorder?

A

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

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15
Q

What is a major risk factor for developing cyclothymic disorder?

A

having a first-degree relative with BPD I

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16
Q

Which disorder is BPD I most closely genetically correlated with?

A

schizophrenia

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17
Q

Which disorder is BPD II most closely genetically correlated with?

A

major depressive disorder

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18
Q

What may be the root of the neurobiological cause of bipolar disorder?

A

receptor site insensitivity

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19
Q

Where is dysfunction seen in the brain with BPD?

A

prefrontal cortex region, amygdala, and hippocampus

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20
Q

What is the prefrontal cortex associated with?

A

executive decision making, personality expression, and social behavior

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21
Q

What is the hippocampus associated with?

A

memory

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22
Q

What is the amygdala associated with?

A

memory, decision making, and emotion

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23
Q

What does the dysregulation of the amygdala, hippocampus, and prefrontal cortex result in for patients with BPD?

A

emotional lability, heightened reward sensitivity, and emotional dysregulation

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24
Q

What type of abuse has the largest association with BPD?

A

emotional abuse

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25
Q

What does early diagnosis of BPD help to prevent?

A

suicide attempts, alcohol/substance use problems and disorders, marital/work problems, development of medical comorbidity

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26
Q

What is commonly seen behavior wise in patients with hypomania?

A

voracious appetites for social engagement, spending and activity, and even indiscriminate sex as well as a decreased need for sleep

27
Q

What is a hallmark symptom of mania and how will it manifest?

A

distractibility
people will lose their focus and go from one activity or place to another and may start many projects without completing any

28
Q

3 common speech patterns and 2 common thought processes associated with BPD

A

pressured speech, tangential speech and circumstantial speech
loose associations and flight of ideas

29
Q

What kind of speech is fast, ranging from rapid to frenetic, conveying an inappropriate sense of urgency?

A

pressured speech

30
Q

What is circumstantial speech?

A

adding unnecessary details when communicating with others

31
Q

What is the key difference between circumstantial and tangential speech?

A

in tangential speech, people lose the point that they were trying to make and never find it again

32
Q

What do loose associations represent in a patient?

A

the disordered way that a person is processing information

33
Q

What is the continuous flow of accelerated speech with abrupt changes from topic to topic?

A

flight of ideas

34
Q

What are the two types of delusions commonly seen in manic patients?

A

grandiose delusions and persecutory delusions

35
Q

What do cognitive deficits correlate with in BPD?

A

greater number of manic episodes, history of psychosis, chronicity or illness, and poor functional outcome

36
Q

What are the goals of the acute phase of a manic or hypomanic episode?

A

symptom reduction and achieving remission

37
Q

What are the things that should be assessed during the maintenance phase of a manic/hypomanic episode?

A

education, support, and problem-solving skills

38
Q

What does the maintenance phase focus on when treating manic BPD?

A

preventing relapse and limiting the severity and duration of future episodes

39
Q

What is a major cause of relapse for a BPD patient?

A

lack of adherence to mood-stabilizing medications

40
Q

Why is it important to be consistent in approach and expectations when treating a manic patient?

A

consistent limits and expectations minimize potential for patient’s manipulation of staff

41
Q

What does hearing and acting on legitimate complaints help minimize?

A

underlying feelings of helplessness and acting out behaviors

42
Q

What are major reasons of non-adherence for medications that treat BPD?

A

they may cause weight gain or other metabolic disturbances

43
Q

What are three support groups for BPD?

A

Depression and Bipolar Support alliance, the National Alliance on Mental Illness (NAMI), and Mental Health America

44
Q

When is lithium given to treat BPD?

A

severe agitation

45
Q

What is the onset of action for lithium?

A

10-21 days

46
Q

What are two things that should be assessed prior to the start of lithium treatment and then annually after that?

A

kidney function and thyroid function

47
Q

What are some signs of lithium toxicity?

A

nausea, vomiting, diarrhea, thirst, polyuria, lethargy, sedation, and fine hand tremor

48
Q

What kind of lithium toxicity is associated with GI upset, coarse hand tremor, confusion, hyperirritability of muscles, sedation, incoordination, and electroencephalographic changes?

A

early toxicity (1.5-2.0mEq/L)

49
Q

When would someone with lithium toxicity experience blurred vision, clonic movements, ataxia, large output of dilute urine, seizures, and severe hypotension?

A

advanced lithium toxicity (2-2.5mEq/L)

50
Q

What are three signs of severe lithium toxicity?

A

convulsions, oliguria, and death (>2.5mEq/L)

51
Q

When should a patient be hospitalized for lithium toxicity?

A

once advanced signs of toxicity have been noted (>2.0mEq)

52
Q

What must be done to prevent further absorption of lithium for someone experiencing advanced lithium toxicity?

A

whole bowel irrigation

53
Q

What may be done in severe cases of lithium toxicity?

A

hemodialysis

54
Q

If someone is beginning to experience lithium toxicity, still below 1.5mEq/L, should treatment be stopped?

A

no, but does should be kept low and kidney and thyroid function should be assessed

55
Q

At what point is it necessary to withhold lithium for a patient?

A

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

56
Q

How much fluid should a patient drink each day while on lithium?

A

1500-3000mL/day

57
Q

Why is maintaining a consistent sodium level important when a patient is on lithium treatment?

A

high sodium intake leads to lower lithium levels (reducing therapeutic effects) and low sodium intake may lead to higher lithium levels (producing toxicity)

58
Q

Lithium therapy is generally contraindicated in patients with? (5)

A

Cardiovascular disease, brain damage, renal disease, thyroid disease, and myasthenia gravis

59
Q

How old should a patient be in order to receive lithium therapy?

A

over the age of 12

60
Q

What can anticonvulsants be given to treat (aside from epilepsy)?

A

acute mania, acute bipolar depression, and/or bipolar maintenance

61
Q

Why should bipolar depression not be treated with an antidepressant alone?

A

it increases the risk of bringing on a manic episode

62
Q

How quickly does ECT typically work?

A

within 1 week of treatment

63
Q

When is ECT most commonly used?

A

in patients with BPD that also have severe levels of depression

64
Q

Why should patients with BPD avoid caffeine?

A

it may cause a relapse

NURS 471 (10 decks)

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