Exam 2-Bipolar and Related disorders Flashcards
mania
an abnormally and persistently:
-elevated mood: euphoria or elation
-expansive mood: lack of restraints in expression; overvalued self importance
-irritable mood: easily annoyed and provoked to anger
manic episode: distinct period of mania
mood lability: rapid shifts in mood with little or no change in external events.
bipolar disorder
mania or hypomania alternating with depression
-bipolar 1
-bipolar 2
-cyclothymic disorder
bipolar 1
a chronic multisystemic cyclic disorder: major depressive, manic, or mixed episode
-class manic-depressive disorder with mood swings alternating from depressed to manic
-mania: a distinct period (of at least 1 week or less if hospitalized) of abnormally and persistently elevated, expansive, or irritable mood with abnormally increased goal-directed behavior or energy
-depression can be 2+ weeks
-earlier onset results in more frequent episodes than persons who develop later in life
-progressive condition with prodromal, symptomatic, and residual states
-can be arrested with early diagnosis, proper treatment, and individual management
-an early onset and family history of illness are associated with multiple episodes or continuous symptoms
-symptoms of the illness can be unpredictable and variable
-can lead to severe functional impairment such as alienation from family, friends, and coworkers, indebtedness, job loss, other problems of living
-presences of mood lability and rapid cycling
-diagnosis reliant upon occurrence of at least one manic episode or mixed episode and a depressive episode.
bipolar 2
major depression and hypomania
-hypomania: mania is slightly less high/mild form of mania (characteristic)
-primarily depressed with brief periods of elevated, expansive, or irritable moods
cyclothymic disorder
hypomania and depressive episodes not meeting full criteria for major depressive episode.
-less severe hypomanic symptoms alternating with numerous periods of depression
-can be triggered by drug use, prescription meds, and some medical conditions.
bipolar 1 in children and adolescents
-depression usually occurs first, marked by intense rage
-symptoms reflective of developmental level of the child
bipolar 1 in older adults
-greater neurologic abnormalities and cognitive disturbances
-incidence of mania decreased with age
epidemiology and risk factors
-1-4% effected in lifetime
-symptom onset: ages 14-21, fewer cases after 40
-no gender differences
-female patients at greater risk for depression and rapid cycling
-male patients at greater risk for manic episodes
-need more studies for ethnic and culture links
-common comorbid conditions: anxiety disorders (panic disorder, social phobia), substance use
etiology of bipolar
-biologic theories: chronobiologic theories, genetic factors, chronic stress, inflammation, and kindling
-psychological and social theories: focus on reducing environmental stress and trauma in genetically vulnerable individuals
recovery oriented care for bipolar
-teamwork/collaboration to work toward recovery
-goals of treatment: minimize and prevent either manic or depressive episodes, manage stress, med adherence, maintain social rhythms
-help patient and family learn about the disorder and manage throughout lifetime
primary treatment modalities
-medications: GOLD STANDARD IS LITHIUM
-psychotherapy
-education
-support
priority care issues with bipolar
-safety
-suicide
-injury
-poor judgement, impulsivity
EBP nursing care for bipolar
physical health:
-changes in activity, eating, and sleep
-diet and body weight
-lab tests: thyroid function
-changes in sexual practices
-pharmacologic assessment: previous antidepressant use, discontinuation of mood stabilizers
therapeutic relationship
-provide refocusing
-remain calm and avoid power struggles
-avoid confrontations
-respect personal space
-meet with client “where they are”
-vital to prevent relapse!!
mental health nursing interventions
recovery and wellness goals
-periods of stable mental health are perfect times to focus on: stress reduction, illness management, relapse prevention
physical care rest: adequate hydration and nutrition, reestablishment of physical well-being
wellness challenges
pharmacological treatment
goals= rapid control of symptoms and prevention of future episodes or at least reduction in severity and frequency
-mood stabilizers: LITHIUM (most widely used mood stabilizer), divalproex sodium, carbamazepine, lamotrigine
-antipsychotics: quetapine, olanzapine, apirpiprzole
other somatic therapies
-electroconvulsive therapy
-transcranial magnetic stimulation
psychosocial interventions
-therapeutic interactions
-enhancing cognitive and behavioral functioning: individual CBT, individual interpersonal therapy, adjunctive therapies
-psychoeducation
-teaching strategies
-teaching about symptoms: wellness strategies and social skills training
psychosocial interventions for bipolar
-providing family education
-promoting safety
-implementing milieu therapy
-support groups
-developing recovery- oriented rehab strategies
-evaluation and treatment outcomes
lithium
-side effects: tremors, weight gain, metallic taste in mouth, edema
-lithium toxicity: confusion, tinnitus, blurred vision, slurred speech, metallic taste, coma and convulsions
-triggers of toxicity: dehydration, hyponatremia, old age (kidney metabolism may be impaired)
-NEED CONSISTENT SALT INTAKE!
-suggest high dense calorie finger foods during manic episodes to ensure no weight loss
