Chapter 13: Bipolar And Related Disorders

Question 1

Is bipolar disease mostly classified as severe

Answer 1

Yes

Question 2

Mortality rate for bipolar

Answer 2

60% attempted

2nd to schizophrenias

Question 3

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

Answer 3

3

Question 4

Dysphoric mania is…

Answer 4

Depressive sx with mania

Question 5

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

Answer 5

Bipolar II

Question 6

Cyclothymia

Hypomania and mild to moderate depression

How long does it last for….

Answer 6

2 years or more adults
1 year children

Question 7

Rapid cycling of Bipolar

At least ___ swings in a 12 month period

Can also be seen in which mental illness

Answer 7

4

Borderline Personality Disorders

Question 8

Does bipolar disease have a chance at heritability?

Answer 8

80 - 90% Yes

Question 9

Will there be inflammation with mania & depression…

Answer 9

Yes, HPTA

Question 10

Mood disorder questionnaire MDQ

Altman Self-Rating Mania Scale

Are used for…

Answer 10

Assessing Bipolar

Question 11

Biggest risk for bipolar…

Answer 11

Cardiac risk.

Nonstop physical activity

Question 12

Distractability
Indiscretion
Grandiosity
Flight of ideas
Activity increases
Sleep deficit
Talkativeness

Answer 12

MNEMONIC FOR BIPOLAR

DIGFAST

Question 13

First priority in acute phase of Bipolar

Answer 13

Medical Stabilization
Maintaining Safety

Question 14

Phase of bipolar treatment

Answer 14

Acute Medical stability
Continuation maintenance of adherence
Maintenance prevent relapse

Question 15

During which phase of bipolar may the patient be overgenerous & poor boundaries

May not be able to attend group

Answer 15

Manic

Question 16

Manic phase

Diarrhea or Constipation

Answer 16

Constipation due to dehydration

Question 17

How long for Lithium to be effective in bipolar

Answer 17

10 - 21 days

Question 18

When to measure levels of Lithium after starting

Answer 18

5 days

8 - 12 hrs after last dose

Question 19

Contradictions to lithium

Answer 19

CV diseases, thyroid diseases, preggers, breast feeding

Question 20

Maintenance therapy for Lithium

Monitor (how often)

Risk: hypothyroidism & kidney disease

Answer 20

Monthly

Question 21

Which Lithium Level will cause

Fine hand tremors
Polyuria
Mild thirst / nausea
Weight gain

And these Sx don’t go away

Answer 21

0.8 - 1.4 therapeutic range

These Sx are normal

Question 22

Lithium Sx

Lethargy
Slurred speech
Muscle weakness
Fine hand tremors
Headache

Describe level

Interventions

Answer 22

Early Toxicity

1.5

Interventions

Hold Lithium
Measure Lithium blood level
Renal function
VS

Question 23

Describe Lithium Level

Coarse hand tremors
Persistent gi upset
Confused
Muscle hyperittitabulity
Uncoordinated
Sedation

Interventions

Answer 23

More advanced Toxicity 1.5 - 2

Interventions

Hold Lithium
Measure levels
VS
START IV 0.9 NS

Question 24

Describe Lithium Level

Ataxia ( Muscle uncoordinated)
Blurred vision, clonic movement (twitch), polyuria, seizures, Low BP, coma / death

Interventions….

Answer 24

Severe Toxicity 2 - 2.5

Interventions
Hospital: Force excretion (Aminophylline, Mannitol, urea, emetics, gastric lavage)

Question 25

Lithium Level > 2.5 = convulsions , oligurua & death

What is the Intervention

Answer 25

Haemodialysis

Question 26

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

Answer 26

Anticonvulsants

Valproate, Lamotrigine, Carbamazepine (2nd line)

Question 27

Why might Anticonvulsant drugs be given to a bipolar with or without Lithium

Valproate 50 - 125
Lamotrigine 3 - 14
Carbamazepine 4 - 12

Answer 27

Rapid cyclers
No family history of bipolar
Schizoaffective mood swings
ETOH/BZD withdrawal
Faster therapeutic response to maintain
Lessened impulsiveness & aggressiveness

Question 28

This anticonvulsant

Liver and platelets monitoring
Fatal 800 - 1000

Hold if RR <12

Answer 28

Valproate (Depakote)

Question 29

This anticonvulsant medication

Stevens-Johnson Syndrome
Borderline personality

Answer 29

Lamotrigine 3 - 14

Question 30

This anticonvulsant

Drowsiness common Sx
OH
Liver & Platelets monitoring
Bone marrow suppression
Blood level 4 - 12

Not recommended for….

Answer 30

<18
Asians

Nystagmus, Dystonia, respiratory depression

Question 31

Bipolar may also recieve these types of medications…..

Answer 31

Atypical antipsychotics (2nd gen)

Antianxiety: Clonzepam & Lorazepam

Question 32

Written orders for Seculsion Protocol
Renewed ……

No PRN seclusion orders

Answer 32

24 hrs

Question 33

RN can seclude for up to….., then must obtain a physician order

Measure VS ….

Answer 33

30 minutes

Q15min

Question 34

Documentation needed for seclusion

Answer 34

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