Mood Disorders - Bipolar Flashcards
Van Gogh painting Old Man in Sorrow was painted shortly after his
1890 died AFTER D/C from an asylum
from self-inlficted GSW
Bipolar 1 Disorder consists of
At least one episode of “persistent or elevated, expansive or irritable mood” (mania), accompanied by changes in activity or energy.
A major depressive disorder episode is frequently included.
- social and work functioning is impaired
- psychosis accompany both
Bipolar 2 Disorder consists of
Includes at least one period of hypomania alternating with one or more periods of depression.
- no full mania episodes
- tx during depressive
Hypomania episodes requires
requires less sleep, inflated self-esteem, increased energy or activity, is distracted, may overspend, sexual indiscretions and impulsivity
Bipolar 2 has more
depressive s/s AND SPEND MORE TIME IN DEPRESSIVE STATE
Bipolar Specifiers
rapid cycling (4+ episodes in 12-month period)
mania- depression x4
Melancholic
Atypical
Peripartum
Seasonal
Psychotic and catatonic features
Melancoholic
depressive episodes with inability to feel pleasure
Atypical
depressive features that are not typical for the individual
Psychotic features in Bipolar
hallucinations
paranoia
delusions
Catatonic features for bipolar
extremes of physical activity or not moving at all
- Randy
Manic episode s/s (3+ for bipolar)
- inflated self-esteem or grandiosity (jesus, devil, president)
- decreased need for sleep (3 hours is good for them)
- more talkative and pressure to keep talking
- flight of ideas or racing thoughts
- distractibility (irrelevant)
- increase in goal-directed activities or psychomotor agitation
- excessive involvement in high potential painful consequences (shopping, sexual indiscretions, or investments)
The bipolar mood disturbances is sufficiently
severe to cause marked impairment in social or occupational functioning
If the manic episode continues for a long time, what issues could arise?
cardiac
Hypomanic criteria
4+ days
- unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
- not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization
Delirious mania
rapid onset of delirium and mania
possible psychosis
Hyperactive catatonia - prominent
DO NOT STOP TO EAT AND ACUTE CONFUSION
Delirious mania is tx with
high doses of benzodiazepines and or ECT
Unipolar depression
affects women more
later in life
no appetite, no interest to eat
sleep with insomnia, problems staying asleep and falling asleep
lesser risk of drug abuse and suicide than bipolar
Bipolar Depression
men and women equal
younger
Binge eating- depressed; anorexia -mania
Hypersomnia and diff to wake in the morning
Greater isk of abuse and suicide
Cyclothymic Disorder
Hypomanic episodes alternating with persistent depressive episodes for at least 2 years or 1 year in children.
- irritable episodes
mood extemes severe than bipolar
stable mood periods
Initial presentation for male;females is
mania, and depression for females.
What other disorders could be accompanying bipolar cyclothymia?
anxiety
Impulse control, attention-deficit/hyperactivity and substance use disorders occur in over half of those with bipolar disorder.
Bipolar spectrum disorder has a higher rate of these medical comorbidity
especially cardiovascular and metabolic diseases, endocrine disorders, type 2 diabetes, and obesity.
Genetic Theory of BSD
First degree relatives of a person with bipolar disorder are 7-10 times more likely to develop bipolar disorder
both then 50%
Strongest predictor of later development of BSD is
displays premorbid symptoms of anxiety/depression, affective lability and low-level manic symptoms
Neurobiological Factors of BSD
in mania
HIGH dopamine, norepinephrine, and glutamate
Neurobiological Factors of BSD
in bipolar depression
low dopamine and norepinephrine
If serotonin is too low in BSD depression episode this can cause
agitation
poor impulse control in manic phase
GABA in BSD is
blunted
Meltonin is altered in
BSD leads to poor sleep
Neuroendocrine Factors in Bipolar as associated with
stress abnormalities in HPA axis
- high levels of ADH and cortisol
Premenstraul syndrome
- late onset with menopause
Neuroanatomical Factor’s of BSD
Development or degenerative
MRIs subtle deficits in gray matter vol with mood
- disorganization
Environmental and Psychological Influences in BSD
Dysregulation
Hyperresponsiveness may result in mania.
Depressive symptoms result from the deactivation of BAS.
Environment and Psychological Factors in BSD
Social Rhythm Theory states that our disruptions of our circadian rhythm and sleep deprivation may provoke or exacerbate the symptoms.
Stress can trigger acute episodes of BPD
migraine, childhood trauma, genes, poor cognitive ability,
excited neurons
BSD S/S
mania abrupt
recurrence is likely
- few days -months
FOLLOW depressive episodes
- remorse and increasing risk for suicide
T/F: Suicide can only occur in BSD depression episodes.
false, it can occur in both phases but most common in depressive
Appearance and Behavior in BSD
Unstable, unpredictable
Constant activity
Constantly pushes limits
Impulsive/excessive: spending $$, phone calls, writing, giving away items
Religious preoccupation
Extreme makeup and clothing
Sexual indiscretion
Self care issues: Lack of sleep/proper nutrition, may lead to physical exhaustion/death
Thoughts of BSD patients include
Pranoid delusions
grandiousity
hallucinations
pressured speech
flight of ideas
circumstantial speech
cland associations
Paranoid delusions
– everyone is out to get them
Fixed beliefs that appear real with fear and loss of ability to teal what is real and unreal
Grandiosity
inflated self regard
Hallucinations
Sensory perceptions become altered
Pressured speech
Nonstop, loud, hard to interrupt.
Flight of ideas
Disconnected rambling from subject to subject
Circumstantial speech
Unnecessary details. Rate and rhythm can be rapid.
Clang Associations
Stringing words together, rhyming
Tx for BSD in cognitive functions
pharmacotherpay and psychoedu
Tx depressive s/s
control comorbidity
implenet remediation
promote aerobic and execise
healthy habits
The mood and affect of a person on BSD
Unstable, labile
May change from euphoria to belligerence to crying
Easily angered
Hostile, irritable, paranoid
What assessment tool is used for BSD?
MOOD DISORDER QUESTIONAIRE
Nursing Process for BSD
hospilze for stabilization
Medical exam for dehydration, cardiac status, and poor sleep
Safety - danger for others/self, poor impulse/judgment, inappropriate sexual, uncontrolled spending
When the patient is stabile, what does the nurse need to ensure the family understands
assess their understanding of BSD
Nursing Dx for BSD
Impaired Sleep
Self Care Deficits
Safety Risk Towards Others
Lack of Insight
Nonadherence to Medication Regime
Impaired Mood Regulation and Labile
During acute mania, the nurse needs to
Prevent injury and maintain safety
Be well hydrated with 24 hours
Maintain stable cardiac status
Get sufficient sleep
Demonstrate self control
Have them attempt at self control
Phase 2 (continue) and Phase 3 (maintenance), the nurse needs to
Patient and family will attend psychoeducational classes
Support groups
Therapies – cognitive-behavior, interpersonal and social rhythm therapy, family-focused therapy
Communication and problem-solving skills training
What can the nurse implement during the acute mania phase of BSD?
Decreasing physical activity
Adequate food and fluid
Ensuring 4-6 hours of sleep
Alleviate bowel or bladder problems (more fluids or healthy diet)
Intervening to ensure self-care
Medication management
Close observation, seclusion or ECT
What can the nurse implement during the PHASES 2 AND 3 phase of BSD?
Stress reduction
Employment and legal issues
Relapse prevention
Communication implemented in the BSD patients behavior ad a nurse
setting limits in a firm nonthreatening, and neutral manner
Early intervention in escalating behavior
Avoid power struggle, but set limits for safety
Verbal de-escalation for agitation or aggressive behavior
Seclusion may be necessary to prevent harm to self or others if de-escalation attempts do not work
Hyperactive Therapy Milieu needs to be
decreased stimulation
Seclusion for Bipolar is only after
all other approaches have not worked
involuntary and solitary confinement
Seclusion may provide
comfort and relief with no longer control of their behavior
- considered restraint
requires documentation that less restrictive interventions were attempted and requires an order from a physician
Pharmacological therapies for mood stabilization in BSD IS USED IN
mania
hypomania
depression
- continue indefinitly
What is the 1st choice for Bipolar 1 acute mania?
Lithium carbonate
- alters excitatory neurotransmitters
Lithium side effects
Mild hand tremor, polyuria & thirst, mild nausea, wt gain. Long term risk of hypothyroidism & kidney impairment. Monitor thyroid and renal functions
- Contraindicated in pregnancy
All medications used in Bipolar Disorders
lithium
anxiolytics
mood stabilizers (antconvulsant and antiepileptic)
antipsychotics
antidepressants
ECT - CATATONIC S/S
Antidepressants are not given by themselves if used in BSD, what is also given with it?
mood stabilizers
- if not can cause mania
Patient teachings for Lithium
blood levels, thyrois and kidneys
- toxic effects
with adequate salt and fluid intake *1500-3000mL/day
STOP if excessive vomiting, diarrhea, sweating since dehydration causes lithium levels to increase
With lithium do not give
diuretics
OTC
Avoid __________ if using lithium
pregnancy
Mood stabilizers patho
Depresses CNS by ↑ GABA (used for rapid-cyclers)
Mood stabilizers medication names
*Divalproex, valproate, or valproic acid (Depakote**
Depakene, Depacon, Stavzor)
Carbamazepine (Tegretol)
Lamotrigine (Lamictal) (report rash)
Gabapentin (Neurontin)
Topiramate (Topamax)
Oxcarbazepine (Trileptal)
ECT is used on bipolar with
catatonic s/s
resistant manic and sepressed s/s
rapid control symptoms
severe suicide, agitation, or violent
- severe depression or mania during pregancy
What needs to be done during the maintenance phase of Bipolar?
Psychoeducation
Information
Emotional Discharge
Support medication and other treatment adherence
Use self help strategies
Problem-solving training
Cgonitive Behavior Therapy
IPSRT
Family therapy
telepsych
support gorups
A prevention plan of ___________ needs to be established in maintenace.
relapse and early warning signs
Bipolar patients need to decrease
cafeeine and avoid alcohol and drugs
