Test 2 (case study quiz) - Chapter 26 - Bipolar and related disorders Flashcards
Bipolar disorders is characerized by….
mood swings from profound depression to extreme euphoria (mania)
delusions or hallucinations may be present
onset of symptoms reflect a seasonal pattern.
What is the difference between mania and hypomania?
hypomania does not impair social or occupational functioning or require hospitalization like mania does
Bipolar dx can be labeled as I or II. What is the difference between the two?
(UPDATE AFTER LECTURE)
Bipolar I includes at least one MANIA or mixed episode + major depressive episodes
Bipolar II includes at least one major depressive episode + at least 1 hypomanic episode with normal moods in between.
What is a manic episode like?
Distinct period of persistently elevated, expansive or irritable mood and abnormally focused/persistent goal directed activity or energy last at least 1 week.
Inflated self esteem/grandiosity
decreased need for sleep.
more talkative
flight of ideas (racing thoughts)
distractibility
engaged in reckless behavior (buying srees, sexual
indiscretion, foolish investments, etc)
mood distrubance that severely impairs socially/occupationally
What is a HYPOmanic episode like?
exactly like above EXCEPT mood disturbance DOES NOT impair the person socially/occupationally
Degrees of mania
See slide for more details
hypomania, acute, delirious
This disorder is a chronic mood disturbance of at least 2 years’ duration. The elevated period does not meed hypomania criteria and the depressed mood is not as severe as bipolar. What is the DO?
cyclothymic disorder
the individual is never without the symptoms for more than 2 months.
A person gets intoxicated on drugs, alcohol or medications which cause mood disturbances. This is known as
substance/medication induced bipolar disorder
How can bipolar be caused by another medical condition?
deficiency (depression) or increase (mania) in DA and NE (5ht remains low in both)
right sided lesions in limbic system is another example
see page 502 in ch 26
Medication for bipolar
_______ is antimanic, mood stabilizer. It requires an ekg and intake of salt and water. It is used to treat mania.
Lithium (considered the gold standard)
Remember to check the blood lithium levels daily!
T or F: The calcium channel blocker Verapamil can be used to treat Bipolar depression.
True
_________ is an anticonvulsant used to treat bipolar disease. it is good for rapid cyclers.
Carbamazpine (Tegretol, Equetro)
Know TEGRETOL acronym
T - Trigeminal neurolgia = tonic clonic seizures (do not stop abruptly)
E - Evaluate for UE: anorexia, nausea, dizziness, sedation, heart attack, sore throat, blood dyscrasias.
G - Give with food, milk to reduce GI upset
R - Review levels, maintain between 4-12
E - Evaluate hepatic and renal function (and for anorexia - sign for toxicity)
T - Tablet = chewable, do not swallow whole! Or take extended release
O - Open and mis with food (extended release)
L - Look for many drug/drug interactions (toxic with lithium)
T or F: 2nd and 3rd generation antipsychotics and atypicals may be used to treat bipolar disorder.
true.
approved for mania and may also be effective against depressive symptoms. Most atypicals can lead to weight gain and increase the incidence of type II diabetes.
________ ( ______ ) works well in patients with bipolar 2.
aripiprazole (Abilify)
Two i’s - bipolar 2
Hip hip hurray, I have the ability 2 feel better
Paroxetine (Paxil) is what type of med? How does it effect bipolar disorder patients?
SSRI
Works well, decreases switching to other antidepressants.
Which group of antidepressants should be avoided in bipolar treatment?
TCAs
There are three stages of mania ranging from hypomania to delirious mania. explain MOOD we expect to see in each stage.
Stage I: Hypomania - Cheerful and expansive (with underlying irritability that surfaces rapidly when desires unfulfilled); volatile and fluctuating.
Stage II: Acute Mania - characterized by euphoria and elation. Appears to be on continuous high. Always subject to frequent variation.
Stage III: Delirious Mania - very labile. Might go from despair to urestrained merriment and ectasy. Might be irritable or indifferent. Panic anxiety may be evident.
There are three stages of mania ranging from hypomania to delirious mania. explain COGNITION AND PERCEPTION we expect to see in each stage.
Stage I: Hypomania - perception of self is exalted. Easily distracted by irrelevant stimuli.
Stage II: Acute Mania - flight of ideas (fragmented, psychotic, disjointed); abrupt topic changes.
Stage III: Delirious Mania - clouding of consciousness + confusion, disorientation and sometimes stupor.
There are three stages of mania ranging from hypomania to delirious mania. explain ACTIVITY AND BEHAVIOR we expect to see in each stage.
Stage I: Hypomania - extroverted, sociable, talk loudly and inappropriately. increased libido.
Stage II: Acute Mania - xcessive activity. excessive spending poor impulse control. manipulate others. energy seems inexhaustible. no need for sleep. Dress may be disorganized, flamboyant, bizarre and excessive.
Stage III: Delirious Mania - purposeless movements, frenzied, agitated. Intervention or death.
T or F: bipolar persons should be treated by someone of the same sex
True. Consistent person of same sex.
What type of foods should you have available to bipolar DO pts?
things that can be eaten on the run; finger foods.
A person in the manic phase will have a short attention span. What can we do to communicate?
Walk and talk with patient.
Reduce stimuli
SECLUSION (away from nurses station - too much noise)
Use short simple sentences
T or F: You should be strict with rules when it comes to bipolar patients.
True. no special favors or privileges. Patient may try to charm you to fulfill their own desires.
Patient may try to make sexual advances - set boundaries verbally and physically (ask colleague to help. Do not go “off-site” for sessions). redefine your role as a reminder!
