Module 4: Suicide Prevention, Bipolar Disorder, & Anti-Manic Agents Flashcards
List some suicide risk factors.
- Medical and mental illnesses
- Trauma
- Previous attempts
- Recent psychiatric hospitalization
- Access to lethal means
- Social losses
- Hopelessness
- Family history of suicide
- Local epidemics
- COVID?
List some population groups that have a higher risk for suicide.
- 10th leading cause of death
- 2nd leading cause of death age 10-34
- Suicide peaks during middle age – 2nd peak age 75 and older
- Male suicide completion 4X than females
- White middle-aged male 45 – 65 years of age 70%
- Veterans
- American Indian and Alaska Native highest
- Use of firearms most prominent
- High risk groups
- Older adults
- LGBTQIA+
- Black youth
Describe risk assessment for suicide.
Suicide assessment is always a priority
- Identification of suicidal ideation
- Elicitation of a plan
- Determination of the severity of intent
- Evaluation of availability of means
Nursing intervention to reduce imminent risk of suicide?
- Ensuring safety
- Reconnecting the patient to other people and instilling hope
- Restoring emotional stability and reducing suicidal behavior
Nursing interventions to reduce intermediate and long-term risk of suicide?
- Expect setbacks
- Understand triggers, develop coping and goals
- Continuous engagement with healthcare services (Inpatient →Outpatient)
Bipolar I Disorder diagnostic criteria?
- At least 1 Manic Episode
- Mania and other mood symptoms cannot be better explained by another diagnosis
- Major depressive episodes are common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder.
Mania diagnostic criteria?
- Marked impairment in functioning
- Elevated, expansive, or irritable mood and increased activity/energy for at least 1 week (or less if hospitalization required)
Mania symptoms?
Distractibility ↑
Irresponsibility
Grandiosity ↑
Flight of Ideas
Activity ↑
Sleep ↓
Talkativeness ↑
DIGFAST
Define hypomania.
Elevated, expansive, or irritable mood and increased activity/energy for at least 4 days
Bipolar II Disorder diagnostic criteria?
- At least one hypomanic episode + a major depressive episode (required)
- Less “marked impairment” yet observable and unusual
Bipolar II Disorder diagnostic criteria also includes 3 of the following:
- Decreased need for sleep
- Increased self-esteem
- More talkative or pressured speech
- Distractibility
- Increased goal directed activity or psychomotor agitation
- Racing thoughts
- Risky Activities/ Excessive spending
Cyclothymia diagnostic criteria?
Chronic fluctuating mood:
- For at least 2 years, for at least 50% of the time, there have been multiple:
- Hypomanic symptoms without meeting full criteria
- Depressive episodes without meeting full criteria
List some Antimanic Drugs.
- Lithium
- Valproic Acid (Depakote)
- Carbamazepine (Tegretol)
- Lamotrigine (Lamictal)
Lithium MOA?
unknown
Lithium drug interactions?
Diuretics, NSAIDS, TCAs all cause lithium accumulation (TOXICITY RISK!)
Lithium therapeutic range?
12-hour trough serum level of 0.6 to 1.2 mEq/L (narrow therapeutic range!)
Lithium nursing consideration & patient education?
- Monitor at least 5 days after dose changes, then every 1-3 months while in maintenance (Lithium level, BUN, Creatinine)
- Thyroid must be assessed annually!
Lithium mnemonic?
Levels (0.6-1.2 mEq/L)
Increased urination (polyuria)/ Insipidus
Tremors/Thirst
Hypothyroidism
Interactions (NSAIDS, ACE-Is, Diuretic, etc.)
Upset stomach
Muscle weakness/ Miscellaneous- EKG changes)
Valproic Acid (Divalproex Sodium) MOA?
- Blockade of Na+, possibly Ca++ and K+ channels
- Simulates ADH release
Valproic Acid (Divalproex Sodium) common adverse effects?
- Sedation
- Tremor
- Thrombocytopenia
- Anorexia
- N/V
Valproic Acid (Divalproex Sodium) black box?
- Hepatotoxic
- Pancreatitis
- Teratogenic
Valproic Acid (Divalproex Sodium) nursing considerations?
- Traditional AEDs cause CNS effects, educate patients about drowsiness, sedation and depression (what about driving!)
- Monitor for S/S of toxicity (nystagmus, diplopia)
- Hepatotoxicty + Pancreatitis: Monitor LFTs + amylase periodically, patient should also monitor for N/V, jaundice, abdominal pain
- Rarely Thrombocytopenia: Monitor platelets, educate patient to notify prescriber of bruising
Carbamazepine MOA?
- Increases dopamine availability
- Works on GABA
Carbamazepine common adverse effects?
- Nystagmus
- Blurred vision
- Dizziness
- Drowsiness
- N/V
Carbamazepine black box?
- Stevens-Johnson syndrome
- Bone marrow suppression leading to anemia and agranulocytosis
Carbamazepine nursing considerations?
CNS effects:
- Use caution when driving
- The visual disturbances should decrease over time
Due to SJS/TEN:
- Protect skin from sun exposure
- Report skin rash/mouth sores
Due to bone marrow suppression:
- Periodic checks of CBC
- Report fever/sore throat
Fluid Retention:
- Check BMP (Na, BUN)
Administration:
- Give with food (can cause GI symptoms)
- Can give at bedtime, if possible, to sleep through symptoms
SJS nursing consideration?
- Fever, Rash
- Early catching and discontinuation of the offending drug is essential.
Lamotrigine MOA?
Weak inhibitory effect on the serotonin 5-HT3 receptor
Lamotrigine common adverse effects?
- Diplopia
- Dizziness
- Headache
- N/V
Lamotrigine black box?
Stevens-Johnson syndrome
Lamotrigine nursing considerations?
Due to SJS/TEN:
- Protect skin from sun exposure
- Report skin rash/mouth sores
CNS effects:
- Use caution when driving
- The visual disturbances should decrease over time
