Mood Disorders ppt Flashcards
Epidemiology of Bipolar Disorder?
No gender differences
Females are at greater risk for depression
Males are at greater risk for manic episodes
Symptoms before age 25
Etiology of Bipolar Disorders
A strong association with genetics
Psychosocial stress
Two categories of Bipolar Disorder
Bipolar I
Bipolar II
Bipolar I
Bipolar I disorder is the classic manic-depressive disorder with mood swings alternating from depressed to manic.
Manic Episode of Bipolar Disorder- What is the pneumonic?
DIGFAST:
Distractability
Irritability
Grandiosity
Flight of ideas or racing thoughts
Activity (increase in goal directed activities)
Sleep deficit
Talktativeness
Diagnostic Criteria of a Manic Episode
Duration of at least 1 week of (DIG FAST): Three or more s/s (4 if only irritable) lasting 1 week
To be diagnosed with Bipolar I, what must occur?
To be diagnosed with bipolar I disorder, at least one manic episode or mixed episode and a depressive episode have to occur.
What does mixed episode mean?
The term mixed episode is used when mania and depression occur at the same time, which leads to extreme anxiety, agitation, and irritability.
Bipolar II
Depressive episode and hypomania (less severe mania)*
Hypomania - able to continue with day-to-day responsibilities
The elevated mood is not so severe that the person requires hospitalization or experiences significant disruption at home or work*
Hypomania:
Hypomania, a mild form of mania, is characteristic of bipolar II disorder.
Bipolar Disorders Across the Life-Span: Children and Teens
Depression usually occurs first in children
The hallmark of childhood bipolar disorder is intense rage.
These children often have other psychiatric disorders, such as attention-deficit hyperactivity disorder or conduct disorder
Nursing Process: Assessment
History
General appearance and motor behavior (clothes reflecting elevated mood)
Mood and affect (periods of euphoria, grandiosity)
Thought process and content (circumstantiality, tangentiality)
Sensorium and intellectual processes (disoriented to time)
Nursing Process: Assessment continued
Judgment and insight- does symptoms impact day to day and do they realize it?
Self-concept (exaggerated self-esteem)
Roles and relationships (in manic phase can rarely fulfill role responsibilities)
Physiological and self-care considerations
Outcome identification examples of bipolar disorder
No injury to self or others
Balance of rest, sleep, and activity
Socially appropriate behavior
What is part of nurse management for Bipolar
During mania, patients usually violate others’ boundaries, and they may miss the cues indicating anger and aggression from others.
Priority* protecting the patient from self-harm as well as harm from others
What is the first line treatment for mania/suicidal thoughts?
Lithium
Lithium
Mood stabilizer
What is medication is contraindicated with mania?
Antidepressants
When is lithium contraindicated?
Impaired kidneys
Impaired Thyroid
What should you assess before and while taking Lithium?
Renal function/creatinine functions
Normal Creatinine for men
0.74 to 1.35 mg/dL
65.4 to 119.3 micromoles/L
Normal Creatinine for adult women
For adult women, 0.59 to 1.04 mg/dL
(52.2 to 91.9 micromoles/L)
What does litium do to thyroid
Can reduce thyroid secretion which can result in hypothyroid.
What does TSH mean?
Thyroid Stimulating Hormone
from the pituitary gland
How does hypothyroidism show up in a test?
Elevated TSH is not making enough thyroid hormone = hypo
Normal TSH test range for an adult
Normal TSH Normal test range for an adult:0.40 - 4.50 mIU/mL(milli-international units per liter of blood).
When taking Lithium, what should you do?
Maintain salt intake.
Maintain adequate fluid intake
Assess therapeutic blood levels 0.6 to 1.2.
Blood tests 12 hours after last dose. Monitor serum plasma concentration every 4-6 days after initiation and 2-3 months for the first 6 months
Why do you need to maintain salt intake while taking Lithium?
A decrease can lead to toxicity. Assess sodium levels. A normal blood sodium level isbetween 135 and 145 milliequivalents per liter(mEq/L).
A normal blood sodium level is
A normal blood sodium level isbetween 135 and 145 milliequivalents per liter(mEq/L).
What is therapeutic blood levels of Lithium
Assess therapeutic blood levels 0.6 to 1.2.
What serum Lithium level is considered toxic?
Toxicity 1.5 and above.
Notable Effects of Lithium Toxicity
Tremor, ataxia, diarrhea, vomiting and sedation. STOP Lithium immediately.
Push fluids
What should you avoid when taking Lithium?
Avoid diuretics that contribute to sodium loss & can contribute to toxicity.
Avoid nonsteroidal anti-inflammatory as it can increase Lithium concentration. Avoid naproxen & ibuprofen
What does Lithium put you at an increased for?
Increased risk of Major Birth Defects such as cardiac abnormalities (Ebstein’s anomaly)*
What are the medications involved in Bipolar Disorder?
Lithium (gold standard)
Divalproex sodium
Carbamazepine (second line agent)
Lamotrigine
Antipsychotic drugs
What is Divalproex sodium (Valproate)?
Mood stabilizer & Anticonvulsant
Divalproex sodium (Valproate)- what is it contraindicated in?
Processed via the liver and contraindicated with liver impairment
What is the difference between lithium and Divalproex sodium (Valproate)?
Not as effective as lithium for reducing suicidal tendencies*
More effective than lithium for depressive symptoms*
Normal Liver function test results
Normal Liver function test results range between7-56 units/litre for ALT and 10-40 got AST
Serum blood levels while taking Depakote?
Serum blood levelsbetween 50 and 125 g/mL.
Notable Side Effects of Depakote
Thrombocytopenia platelet count below the lower limit of normal, below 150000/microliter
- If experiencing bruising discontinue
Weight gain
-Increases appetite and subsequent weight
-Hair loss
Second Line drug for Bipolar Disorder?
Carbamazepine
Carbamazepine
Antiepileptic
Serves as protection against recurrence of mania and depression
Serum blood level of Carbamazepine
Serum plasma level: 4 to 12 mcg/mL
Notable Side Effects of Carbamazepine
Transient vertigo
Headache
N & V and diarrhea
Benign leukopenia (low white blood count) A countless than 4,000 cells per microliter is below normal
What drug is approved for maintenance treatment of Bipolar Disorder?
Lamotrigine
Lamotrigine
Mood-stabilizing anticonvulsant
Side Effects of Lamotrigine?
Steven John Syndrome: Skin:rashes, blister, peeling, rash of small purplish spots, red spots, or small bump Whole body:fever or malaise.
Be mindful that Depakote can increase Lamictal levels. Need to lower Lamictal dose.
Serious as death occurs in 10% of the cases.
Antipsychotic drugs- how are they used?
Can be used in conjunction with mood stabilizers during acute mania & long term for its mood stabilization properties
Common Atypical Antipsychotics Utilized
Risperidone (Risperdal)
Aripiprazole (Abilify)
Ziprasidone (Geodon)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Lurasidone (Latuda)
