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Module 6 > UNIT 2- BIPOLOR DISORDER > Flashcards

UNIT 2- BIPOLOR DISORDER Flashcards

1
Q

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What is bipolor 1 disorder?

A

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 occupational functioning are impaired
- psychosis may accompany either

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2
Q

What is bipolor II disorder?

A
  1. Includes at least one period of hypomania alternating with one or more periods of depression.
  2. Full manic episode doesn’t occur
  3. Treatment is usually sought during depressive period
  4. Hypomanic episode requires less sleep, inflated self-esteem, increased energy or activity, is distracted, may overspend, sexual indiscretions and impusiity
  5. Risks and consequencses are less severe and less likely to cause impairment in functioning
  6. ** more depressive symptoms** and spend more time in depressive state
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3
Q

Bipolor specifers…

A
  1. Rapid cycling: 4 or more episodes in a 12 month period (mania/dep, mainia/dep, mania/dep, mania/dep)
  2. melanchoic- depressive episode with inability to feel pleasure
  3. atypical-depressive features that are not typical
  4. Peripartum onset
  5. Seasonal pattern
  6. Psychotic features- hullcinations, paranoia, delusions
  7. Catatonic features- extremes of physical activity
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4
Q

What should we know about delirious mania?

A
  1. Rapid onset of delirum and mania
  2. May include psychosis
  3. Hyperactive catatonia is often a promient feature
  4. can be life threatening
  5. Treated with high doses of benzodiazepine and or ECT
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5
Q

What should we know about unipolor depression?

A
  1. Affects women more than men
  2. Appears later in life
  3. Loss of appetitie; no interest in eating
  4. lesser risk of drug abuse and suicide than bipolar depression
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6
Q

What should we know about bipolor depression?

A
  1. Affects women & men equally
  2. Onsert younger age
  3. Alt binge eating (carbs esp.) anorexia
  4. Hypersomnia and difficulty in morning walking
  5. Greater risk of drug abuse and suicide than unipolor
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7
Q

What is cyclothymic disorder and what should we know about it

A
  1. Hypomanic eipisodes alternating with persistent depressive episodes for at least 2 year or 1 year in children
  2. Irritable hypomanic episodes
  3. mood extermes less severe then bipolor
  4. There may be periods of stable moods
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8
Q

Pediatric bipolor disorder is characterized by?

1

A
  1. eleated or irritability mood, cycling mood episodes, rage, grandiosity or inflated self esteem, hypersexual behavior, decreased need for sleep and poor insight
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9
Q

True or false: Higher levels of dopamine, norepinephrine and glutamate result in manic phases and lower levels of dopamine and norepinephrine lead to bipolor depression

A

True

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10
Q

What should we know about the theory of bipolor disorder and neurobiological factors

A
  1. Neurobiolgical factor
  2. Serotonin can be too low in depression phase or can cause agression and poor impulse control in mania phase
  3. GABA is blunted
  4. Melatonin is altered contributing to poor lseep
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11
Q

What should we know about neuroendocrine factors w/bipolor disorder?

A
  1. Abnormalities with stress related molecular pathways of the ypothalamic-pituitary-adrenal (HPA) axis
  2. Disease is associated with higher levels of adrenocoticotropic hormone (ADH) and cortisol, but no corticotropin releasing hormone (CRH)
  3. Hormones play a role in the severity of the disease in women during premenstrual syndrome. Late onset biopolor disorder associated with menopause
  4. Inflammatory factors interact with the HPA axis. THe autonomic nervous system, an and neurotransmitters. studies in patients with bipolor disorder have confirmed the presense of a chronic inflammatory state
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12
Q

What should we know about the neuroanatomical factors thearpy with bipolor

A
  1. neurodevelopmental and neurodegeneratrive processes can contribute to bipolor disease
  2. MRIs demostrate subtle deficits in gray-matter volume especially in brain areas that regulate mood. There is alos white matter disorganization in tracts connecting brain regions
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13
Q

What should we know about environmental and psychological influences on bipolor disorder

A
  1. Social rhythm theory states that our disruptions of our circadian rhythm and sleep deprivation may provoke or exacerbate the symptoms
  2. Stress can trigger acute episodes of BPD
  3. Migranes are more common with BPD
  4. Higher incidence of childhood trauma
  5. Two genes increase susceptibility
  6. Cognitive abilities (memory, executive functioning and motor skills) were poorer in those with BPD
  7. Key features of speech patterns were found to be predictive of mood states
  8. Neurons were more excitable.
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14
Q

What is the “clinical picture” with mania?

A
  1. Mania may begin gradually, but is more typical with abrupt onset
  2. Prognosis of any single manic episode is good; however reoccurance is likely
  3. Manic episode may last for a few days to months and may follow with depressive episode
  4. During depressive episode, there may be remorse increasing risk for suicide
  5. Suicide can occur with either mania or depressive state but more common in depressive state
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15
Q

What is the general appearance of someone in a manic state?

A
  1. Unstable, unpredictable
  2. Constant activity
  3. COnstantly pushes limits
  4. Impulsive/exccessive: spending $$, phone calls, writing, giving away items
  5. Religious preoccupation
  6. Extreme makeup and clothing
  7. Sexual indiscretion
  8. Self care issues: lack of sleep/proper nutrition, may lead to physical exhaustion/death
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16
Q

What is paranoid delsusions?

A
  1. Fixed beliefs that appear rea with fear and loss of ability to tell what is real and unreal
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17
Q

What is grandiosity?

A

Inflated self regard

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18
Q

What is hallucinations?

A
  1. Sensory perceptions become altered
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19
Q

What is pressured speech?

A
  1. Nonstop, loud, hard to interrupt
20
Q

What is flight of ideas?

A

Disconnected rambling from subject to subject

21
Q

What is circumstantial speech

A

Unnecessary details. Rate and rhythem can be rapid

22
Q

What is clang associations

A

Stringing words together, rhyming

23
Q

What is cognitive function like with a patient with bipolor disorder?

A
  1. Onset may be preceded with high cognitive function
  2. Associative with creative and high achievement
  3. 1/3 significant and persistent cognitive difficultuies
  4. Problems with verbal memory, sustained attention and executive function
24
Q

Treatment for cognitive function includes?

A
  1. pharmacotherapy
  2. psychoeducation
  3. treat depressive symptoms
  4. control comorbidity
  5. implement cognitive remediation
  6. promote aerobic exercise and healthy habits
25
Q

What should we know about the mood and affect of a patient with bipolor disorder?

A
  1. unstable, labile
  2. may change from euphoria to to belligerence to crying
  3. easily angered
  4. Hostile, irritable, paranoid
26
Q

What safety issues might a bipolor patient face?

A
  1. Danger to self
  2. Danger to others
  3. Poor impulse control
  4. Poor judgement
  5. Inappropriate sexual activity
  6. Uncontrolled spending
27
Q

When should you assess a patient and families understanding of BPD?

A

When stable

28
Q

What 3 physiological things are we assesing for with bioplor patients?

poorly worded

A
  1. dehydration
  2. cardiac status
  3. poor sleep
29
Q

What might our nursing diagnosis/problem be for a patient with bipolor disorder?

A
  1. Impaired sleep
  2. Self care deficits
  3. safety risk towards others
  4. lack of insight
  5. nonadherence to medication regime
  6. impaired mood regulation and labile
30
Q

What are our desired outcomes during acute mania?

A
  1. Prevent injury and maintain safety
  2. Be well hydrated with 24 hours
  3. Maintain stable cardiac status
  4. Get sufficent sleep
  5. Demonstrate self control
  6. Make no attempt at self control
31
Q

During phase II and Phase III (continuation and maintenance) what are our desired outcomes?

A
  1. Patient and family will attend psychoeducational classes
  2. Support groups
  3. Therapies-cognitive-behavior, interpersonal and social rythem therapy, family-focused therapy
  4. communication and problem solving skills training
32
Q

During the acute phase how do we implement our nursing plans for BPD?

A
  1. Decrease physical activity
  2. Adequate food and fluid
  3. Ensuring 4-6 hours of sleep
  4. Alleviate bowel or bladder problems
  5. Intervening to ensure self-care
  6. Medication management
  7. close observation, seclusion or ECT
33
Q

During the continuation and maintenance phase how do we implement our nursing plans for BPD?

A
  1. Stress reduction
  2. Employment and legal issues
  3. Relapse prevention
34
Q

What should we keep in mind regarding communication in the implementation phase?

A

Communication-setting limits in a firm nonthreatening and neutral manner
1. Early intervention in escalating behavior
2. avoid power struggle, bet set limits for safety
3. verbal de-escalation for agitiation or agressive behavior
4. Seclusion may be necessary to prevent harm to self or other if descalation attempts do not work
5.

35
Q

What should we know about seclusion and BPD patients?

A
  1. May provide comfort and relief to a patient who is no longer in control of his or her behavior
  2. Warrented when documented data reflect it
  3. Restraints-physical and chemical
    • restraints should only be used in extreme situations
  4. Seclusion and or restraints are associated with complex therapeutic and ethical, and legal issues
    • protocol requires documentation that less restrictive interventions were attempted and requires an order from a physcian
36
Q

What should we know about the pharmaceutical therapies with BPD?

A
  1. Mood stablization for mania, hypomania or depression
  2. May need to be continued indefinately
  3. Lithium Carbonate: (Lithoid, Eskalith) 1st choice of treatment for bipolor 1, acute mania
37
Q

Lithium carbonate: Lithobid, Eskalisth is the 1st choice of treatment for what…

A

Bipolor I disorder, acute mania

38
Q

What is the MOA of lithium carbonate?

A
  1. Alters excitory neurotransmitters & neuronal activity
39
Q

What is the maintenace level for lithium carbonate (Lithobid, Eskalith)

A
  1. 0.4-1 mEq/L effects begin in 5-7 days but may take 3-6 weeks for full effect. Monitor blood levels to prevent toxicity
40
Q

What are the side effects of lithium carbonate?

A
  1. mild hand tremor
  2. polyuria & thirst
  3. mild nausea,
  4. weight gain
  5. long term risk of hypothryoidsim and kidney impairment

Important to monitor thyroid and renal functions
DO NOT TAKE IF PREGNANT

41
Q

What pharmaceuticals can be used to treat BPD?

A
  1. Lithium
  2. mood stabilizers: antiepileptic or anticonsulants drugs
  3. Antipsychotics
  4. anxiolytics
  5. Antidepressants
42
Q

Patient teaching for lithium usage should include?

A
  1. monitor lithium blood levels, thyroid and kidney levels closely
  2. Teach side effects and toxic effects
  3. Eat a normal diet with adequate salt and fluid intake (1500-3000ml/day)
  4. Stop taking your lithium and notify your doctor immediately if you have excessive v/d sweating since dehydration causes lithium levels to increase
  5. Do not take diuretics, OTC meds while taking lithium
  6. Avoid pregnancy
  7. Take lithium with meals
  8. Do not stop taking abruptly
43
Q

What mood stabilizers might we see given to a patient with BPD?

A
  1. Divalproex, valproate, or valproic acid (depakote, depakene, depacon)
  2. Carbamazepine (tegretol)
  3. Lamotrigine (lamicital) (report rash)
  4. Gabapentin (neurotin)
  5. Toprimate (topamax)
  6. Oxcarbazepine (trileptal)
44
Q

What should we know about Electroconvulsive therapy?

A
  1. Catatonic symptoms
  2. Treatment resistant manic and depressed symptoms
  3. Need for rapid control symptoms
  4. Severe suicidal behavior, agitation or violent behavior
  5. Severe depression or mania during pregnancy
45
Q
A

Module 6 (19 decks)

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