chapter 14 bipolar disorders Flashcards
acute phase of bipolar disorder
the overall outcome of the acute phase is injury prevention. the patient will:
- be well hydrated
- maintain stable cardiac status
- maintain/obtain tissue integrity
- get sufficient sleep and rest
- demonstrate thought self-control
- make no attempt at self harm
anticonvulsant drugs
suppress the rapid and excessive firing of neurons; mood stabilizers
anticonvulsants drugs are thought to be:
- superior for continuously cycling patients
- more effective when there is no family history of bipolar disease
- beneficial in controlling mania(within 2 wks) and depression(within 3 wks or longer)
- depakote for lithium nonresponders
- tegretol combined with lithium
- lamictal(life-threatening rash)
bipolar I disorder
at least one episode of mania alternates with major depression. Psychosis may accompany the manic episode
bipolar II disorder
Hypomanic episodes alternate with major depression. Psychosis is not present. The hypomania of bipolar II tends to be euphoric and often increases functioning, and the depression tends to put people at particular risk for suicide
clang associations
the stringing together of words because of their rhyming sounds, often meaningless
“Cinema I and II, last row. Row, row, row your boat. Don’t be a cutthroat. Cut your throat. get your goat. Go out and vote. And so I wrote”
continuation phase of bipolar disorder
it lasts for 4 to 9 months. Although the overall outcome is relapse prevention, may other outcomes must be accomplished to achieve relapse prevention. these outcomes include
- psychoeducational classes for patient and family
- support groups or therapy(cognitive-behavioral, interpersonal)
- communication and problem-solving skills training
cyclothymia
hypomanic episodes alternate with minor depressive episodes(at least 2 yrs in duration). Individuals with cyclothymia tend to have irritable hypomanic episodes
flight of ideas
a nearly continuous flow of accelerated speech with abrupt changes from topic to topic that are usually based on understandable associations or plays on words
“how are you doing, kid, no kidding around, I’m going home, home sweet home, home is where the heart is, the heart of the matter is I want out and that ain’t hay, hey doc, get me out of this place”
grandiosity
inflated self-regard.
hypomania
an elevated mood with symptoms less severe than those of mania. A person in hypomania does not experience impairment in reality testing, nor do the symptoms markedly impair the person’s social, occupational, or interpersonal functions
lithium carbonate
it is effective in the treatment of bipolar I acute and recurrent manic and depressive episodes. It is less effective in people with mixed mania, those with rapid cycling, and those with atypical features
expected side effects <0.4-1.0 mEq/L
- fine hand tremor, polyuria, mild thirst, mild nausea, generla discomfort,weight gain
maintenance phase of bipolar disorder
the overall outcomes of this phase continue to focus on prevention of relapse and limitation of the severity and duration of future episodes. Additional outcomes include:
participation in learning interpersonal strategies related to work, interpersonal and family problems.
participation in psychotherapy group or other ongoing supportive therapy modality
mania
unstable elevated mood in which delusion, poor judgment, and other signs of impaired reality testing are evident. During a manic episode, pts have marked impairment of social, occupational and interpersonal functioning
mood stabilizers
lithium and anticonvulsants.
may cause weight gain, altered metabolism of lipids and glucose which increases the risk for diabetes, high blood pressure, cardiac problems
rapid cycling
4 or more mood episodes in a 12-month period
