Chapter 13: Bipolar and Related Disorders Flashcards
bipolar 1 disorder
most severe form
at least 1 manic episode and 1 episode of major depression
bipolar 2 disorder
at least 1 hypomanic episode and at least 1 major depressive episode
cyclothymic disorder
doesn’t meet criteria for either diagnosis
hypomania alternating with symptoms of mild to moderate depression for at least 2 years
rapid cycling possible
rapid cycling possible
more quickly than bipolar 1 and 2
at least 4 times per year
hypomanic vs mania
lesser form of mania
mania - lite
more functional
still impactful on brain
if mania is euphoric
many people do not want to take meds
can cyclothymic disorders can develop bipolar disorder
yes
why are substance use disorders common with cyclothymic disorder and bipolar
used to self medicate
splitting
breaking apart staff unity to get what they want
grandiosity
thinking they are the best at something
big self esteem
pressured speech
on-off, stumbling over words
circumstantial speech
adding extra detail, will get to the point
tangenital speech
on a tangent
loose asscoations
ideas loosely connected
flight of ideas
fast speach, topic to topic
clang associations
rhyming, lyrical, rapping
persecutory delusions
paranoid, people are after me
what is persecutory normally associated with
grandiose
more time in mania or occurences
the harder to pull out of mania
normal priority diagnosis
risk for injury
risk for self directed violence
risk for other directed violence
acute phase
prevent injury
stablize
maintence phase
maintain
prevent future exacerbation of the mania or hypomania
bipolar has what 2 sides
mania and depression
pharmacologic interventions
two main parts
agitation
mood stabilization
medication of depression may push patient into
mania
what is the gold standard for bipolar
lithium
lithium
first line for bipolar
frequent follow up
monitor kidney and liver
lithium therapeutic blood levels
0.8-1.4
toxic level of lithium
1.5 and above
what is the sign you are moving into toxicity
fine hand tremor
early signs of toxicity
GI upset, coarse hand tremor, confusion, hyper irritability of muscles, sedation, incoordination
advanced signs of toxicity
ataxia
blurred vision
clonic movements
seizures
stupor
severe hypotension
coma
severe toxicity
convulsion, oliguria, death
what is key to inform your patient about weight with lithium
in the first week you might gain 5 pounds of water weight
3 anticonvulsant drugs
valproate
carbamazepine
lamotrigine
carbamazepine
- works well with rapid cyclers
- paranoid thinking
- monitor blood levels
valproate sodium
- rapid cycling
- dysphoric symptoms
lamotrigine and gabapentin
useful for pateitns refractory to other therapy
lamotrigine does not push patient into mania/depression
second generation antipsychotics
olanzapine
risperidone
aripiprazole
asenaprine
cariprazine
lurasidone
quetiapine
ziprasidone
why do we use second gen antispychotics in biopolar
get someone out of the manic stage
calm people down
first generation antipsychotics
chlorpromazine
loxapine
why do we use first generation antipsychotics
acute mania and agitation
biggest side effect of ECT is
short term memory loss
therapies for bipolar
cognitive behavior therapy
interpersonal and social rythm
- help recognize routine and learn to integrate relationships
