Chapter 13: Bipolar And Related Disorders Flashcards
Is bipolar disease mostly classified as severe
Yes
Mortality rate for bipolar
60% attempted
2nd to schizophrenias
Bipolar I or II
1 Manic episode, 7 days in a row.
&
How many of the following
Psychotic
Extreme drive
Grandiosity
Reduced sleep
Pressured speech
Easily distracted
Obsessed with goal
Dangerous Behavior
3
Dysphoric mania is…
Depressive sx with mania
Bi polar I or II
Atleast 1 major depressive episode
Atleast 1 episode of hypomania
Last 4 days
Euphoric, increases in functioning
Rarely hospitalized
With 3 of the following
Extreme drive
Grandiosity
Reduced sleep
Pressured speech
Easily distracted
Obsessed with goal
Dangerous Behavior
Bipolar II
Cyclothymia
Hypomania and mild to moderate depression
How long does it last for….
2 years or more adults
1 year children
Rapid cycling of Bipolar
At least ___ swings in a 12 month period
Can also be seen in which mental illness
4
Borderline Personality Disorders
Does bipolar disease have a chance at heritability?
80 - 90% Yes
Will there be inflammation with mania & depression…
Yes, HPTA
Mood disorder questionnaire MDQ
Altman Self-Rating Mania Scale
Are used for…
Assessing Bipolar
Biggest risk for bipolar…
Cardiac risk.
Nonstop physical activity
Distractability
Indiscretion
Grandiosity
Flight of ideas
Activity increases
Sleep deficit
Talkativeness
MNEMONIC FOR BIPOLAR
DIGFAST
First priority in acute phase of Bipolar
Medical Stabilization
Maintaining Safety
Phase of bipolar treatment
Acute Medical stability
Continuation maintenance of adherence
Maintenance prevent relapse
During which phase of bipolar may the patient be overgenerous & poor boundaries
May not be able to attend group
Manic
Manic phase
Diarrhea or Constipation
Constipation due to dehydration
How long for Lithium to be effective in bipolar
10 - 21 days
When to measure levels of Lithium after starting
5 days
8 - 12 hrs after last dose
Contradictions to lithium
CV diseases, thyroid diseases, preggers, breast feeding
Maintenance therapy for Lithium
Monitor (how often)
Risk: hypothyroidism & kidney disease
Monthly
Which Lithium Level will cause
Fine hand tremors
Polyuria
Mild thirst / nausea
Weight gain
And these Sx don’t go away
0.8 - 1.4 therapeutic range
These Sx are normal
Lithium Sx
Lethargy
Slurred speech
Muscle weakness
Fine hand tremors
Headache
Describe level
Interventions
Early Toxicity
1.5
Interventions
Hold Lithium
Measure Lithium blood level
Renal function
VS
Describe Lithium Level
Coarse hand tremors
Persistent gi upset
Confused
Muscle hyperittitabulity
Uncoordinated
Sedation
Interventions
More advanced Toxicity 1.5 - 2
Interventions
Hold Lithium
Measure levels
VS
START IV 0.9 NS
Describe Lithium Level
Ataxia ( Muscle uncoordinated)
Blurred vision, clonic movement (twitch), polyuria, seizures, Low BP, coma / death
Interventions….
Severe Toxicity 2 - 2.5
Interventions
Hospital: Force excretion (Aminophylline, Mannitol, urea, emetics, gastric lavage)
Lithium Level > 2.5 = convulsions , oligurua & death
What is the Intervention
Haemodialysis
These types if meds may be given to bipolar alone or added with Lithium.
Indicated for
Rapid cyclers
No family history of bipolar
Schizoaffective mood swings
ETOH/BZD withdrawal
Faster therapeutic response to maintain
Lessened impulsiveness & aggressiveness
Anticonvulsants
Valproate, Lamotrigine, Carbamazepine (2nd line)
Why might Anticonvulsant drugs be given to a bipolar with or without Lithium
Valproate 50 - 125
Lamotrigine 3 - 14
Carbamazepine 4 - 12
Rapid cyclers
No family history of bipolar
Schizoaffective mood swings
ETOH/BZD withdrawal
Faster therapeutic response to maintain
Lessened impulsiveness & aggressiveness
This anticonvulsant
Liver and platelets monitoring
Fatal 800 - 1000
Hold if RR <12
Valproate (Depakote)
This anticonvulsant medication
Stevens-Johnson Syndrome
Borderline personality
Lamotrigine 3 - 14
This anticonvulsant
Drowsiness common Sx
OH
Liver & Platelets monitoring
Bone marrow suppression
Blood level 4 - 12
Not recommended for….
<18
Asians
Nystagmus, Dystonia, respiratory depression
Bipolar may also recieve these types of medications…..
Atypical antipsychotics (2nd gen)
Antianxiety: Clonzepam & Lorazepam
Written orders for Seculsion Protocol
Renewed ……
No PRN seclusion orders
24 hrs
RN can seclude for up to….., then must obtain a physician order
Measure VS ….
30 minutes
Q15min
Documentation needed for seclusion
Behavior warranted seclusion
Less restrictive actions taken
Time placed in seclusion
Assessments Q15min & Q1hr RN Assessment
1:1 in restraints
Time & Type of medication given
Effects on pt
