Unit 5 Bipolar and Related Disorders Chapter 13

Question 1

How many Bipolar Disorders are there?

Answer 1

BIPOLAR I
BIPOLAR 2
CYCLOTHYMIC DISORDER

Question 2

Which of the following Bipolar Disorders is the most severe?

A. BIPOLAR I
B.BIPOLAR 2
C.CYCLOTHYMIC DISORDER
D.Rapid Cycling

Answer 2

A. BIPOLAR I

WHY: They experience Mania and Major depressive disorder

Question 3

S/s of Mania

Answer 3

Increased Energy ( decrease need for
sleep, rapid speech, hyperactivity)
* Feel euphoric (Happy, Positive, Tx
resistant)
* Engage in hazardous activities (Push
limits)
* May become psychotic w/ hallucinations,
delusions and/or disturbed thoughts (flight
of ideas, Bizarre thought process)
* Euphoria gives way to agitation and
irritability Utter exhaustion happens
* No aspirations are too high. No distance is too great
* Distractibility is hallmark sign of Mania
-cannot hold a job
* Grandiose – Self worth, clothing, makeup (bright, over the top, bizarre colorful, over done

Question 4

What is a hallmark sign of Bipolar Disorder 1

Answer 4

Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed

Question 5

How long does mania occur?

Answer 5

Mania is a period of intense mood distur- bance with persistent elevation, expansiveness, irritability, and extreme goal-directed activity or energy. These periods last at least 1 week for most of the day, every day. Symptoms of mania are so severe that this state is a psychiatric emergency.

Question 6

Which statement is a correct indication of Bipolar 1 disorder?

A. Mania, Major depressive disorder
B. Hypomania, low depression
C.Hypomania, Major depression
D. Mania, low depression

Answer 6

A. Mania, Major depressive disorder

Question 7

According to Maslow’s, which phsiological need is interrupted for a patient experiencing Mania?

A. Sleep
B. Relationships
C. Self esteem
D. Jon security

Answer 7

A. Sleep

They eat and sleep little, if at all, and are in perpetual motion. Because they feel so important and powerful, they take horrific chances and engage in hazardous activities.
*Unfortunately, the person with mania does not recognize the behaviors as being problematic and resists treatment.

Question 8

What is the definition of anosognosia

Answer 8

anosognosia-inability to recognize the illness is due to the illness itself and is referred to as anosognosia

-occurs often with patients with bipolar disorder
-occurs often with patients with schizophrenia

Question 9

When would a patient usually seek treatment, during manic episodes or major depressive episodes?

A. manic episodes
B. major depressive episodes

Answer 9

B. major depressive episodes

Question 10

What is bipolar 2

Answer 10

Individuals with bipolar II disorder have experienced at least one hypomanic episode and at least one major depressive episode.

Question 11

Which statement is a correct indication of Bipolar 2 disorder?

A. Mania, Major depressive disorder
B. Hypomania, low depression
C.Hypomania, Major depression
D. Mania, low depression

Answer 11

C.Hypomania, Major depression

Question 12

Hypomania S/S

Answer 12

• Excessive activity and energy
• Psychosis is never present (may be present in severe depressive episode that follows)
• Not severe enough to cause serious impairment in social or occupational
  functioning.
• Big appetite for social interaction (life of the party), spending (debt), activity and
  indiscriminate sex.
• May pursue elaborate schemes to get rich.
• Not usually hospitalized

For example, an individual may be much more talkative and distractible than usual. However, hypomania is not usually severe enough to cause serious impairment in occupational or social functioning.

Question 13

Is psychosis present in Bipolar 2?

A. Yes
B.No

Answer 13

B.No

Unlike mania, psychosis is never present with hypomania. Psychotic symptoms may, however, accompany the depressive side of the disorder.

Question 14

Which statement is a correct indication of Cyclothymic Disorder?

A. Mania, Major depressive disorder
B. Hypomania, depression
C.Hypomania, Major depression
D. Mania, low depression

Answer 14

B. Hypomania, depression

Question 15

What is Cyclothmic Disorder?

Answer 15

• In cyclothymic disorder, symptoms of hypomania alternate with symptoms of mild to moderate depression for at least 2 years in adults and 1 year in children.
• Hypomania alternating
  with mild-moderate
  Depression
• Major Risk Factor – 1st
  degree relative with
  Bipolar I

Question 16

Thought Content for pts with Bipolar

Answer 16

Thought Content
– Grandiose Delusions
examples:
unfounded beliefs that one has special powers, wealth, mission, or identity
“I am God , I am Beyonce”

– Persecutory Delusions
examples:
believe someone or something is mistreating, spying on or attempting to harm them (or someone close to them).

“someone is out to get me”

Question 17

Thought Process- (MANIA) Bipolar

Answer 17

hought Process/Speech Patterns
– Pressured speech
– Circumstantial speech
– Tangential speech
– Loose associations
– Flight of ideas
– Clang association

Question 18

Thought Process- (MANIA) Bipolar, Flight of Ideas

Answer 18

Flight of ideas is a continuous flow of accelerated speech with abrupt changes from topic to topic. The speech is usually based on understandable associations or plays on words. At times, the attentive listener can keep up with the flow of words, even though direction changes from moment to moment. Speech is rapid, verbose, and circumstantial. When the condition is severe, speech may be disorganized and incoherent. The inces- sant talking often includes joking, puns, and teasing:
How are you doing, kid, no kidding around, I’m going home … home sweet home … home is where the heart is, the heart of the matter is I want out and that ain’t hay … hey, Doc … get me out of this place.

Question 19

Behavior of Mania

Answer 19

Being manic means being busy during all hours of the day and night, furthering grandiose plans and wild schemes. To the person experiencing mania, no aspirations are too high and no distances are too far.
In the manic state, people often give away money, prized pos- sessions, and expensive gifts.

While out, they may spend money freely on friends and strangers alike—“I’ll buy the next round for every- one!” This excessive spending, use of credit cards, and high liv- ing continue even in the face of seriously depleted resources. The individual often needs intervention to prevent financial ruin.

Question 20

Interventions for Mania

Answer 20

• Communication
  – Calm
  – Use short, firm, concise statements
  – Be consistent
• Structure in a Safe Mileu
  – Low level of stimuli
  – Structure
  – Provide frequent high-calorie fluids
  – Redirect aggressive behavior
  – Free of harmful objects
• Self-Care Needs (Nutrition)
  – Monitor intake, output and Vital signs
  – Frequent high-calorie protein drinks
  and finger foods
  Sleep
  – Encourage frequent rest periods
  – Low Stimuli
  – Promote sleep/relaxation
• (warm bath, soothing music, medications if needed, avoid caffeine)
• Hygiene
  – Bathing
  – Appropriate clothing choices
• Elimination
  – Offer fluids and foods high in fiber

Example: “John, do not yell at or hit Peter. If you cannot control yourself, we will help you.” Or “The seclusion room will help you feel less out of control and prevent harm to yourself and others

Question 21

What is the drug of choice for a patient with Bipolar Disorder?

Answer 21

Lithium

can be used interchangebly for both acute and maintenance treatment

Question 22

Why is lithium the first line of treatment for bipolar disorder

Answer 22

-neuroprotective
-reduces suicidal ideation

Question 23

What is important to know as a nurse with a patient with Bipolar disorder

*hint , should antidepressants be solely used for these patient?
if not what drug should be added to their regimen to prevent the risk of mania?

Answer 23

NEVER ONLY USE ANTIDEPRESSANTS WITH BD PATIENT ALONE. ADD MOOD STABLIZER TO DECREASE THE RISK OF INDUCED MANIA.

Question 24

Your patient with bipolar is prescribed lithium. On change of sift the nurse giving report that the patients kidney function has declined by 50%. As a nurse what is the priority action.

Answer 24

Call the doctor , ask for another med

Contraindications. Lithium therapy is generally contraindicated in patients with cardiovascular disease, brain damage, renal disease, thyroid disease, or myasthenia gravis. Whenever possible, lithium is not given to women who are pregnant because it may harm the fetus. Lithium use is also contraindicated in mothers who are breast-feeding and in children younger than 12 years of age.

Question 25

Lithium family and patient teaching

Answer 25

Mood stabilizer, not addicted, continue even after symptoms have stop
* Na+ intake can affect Lithium levels.
– Na+ high = Lithium Low
– Na+ low = Lithium High
* Maintain current Na+ and H2O intake
*STOP if experiencing and contact Dr.:
– Excessive diarrhea, vomiting or sweating
– Lead to dehydration and
* Take with food to avoid stomach irritation

Question 26

Which of the following drugs can also be used as mood stabilizer?SELECT ALL THAT APPLY

A. Paroxetine
B. Amtriptiline
C. Lamotrigine
D. Phenelize
E.Carbamazepine
F. Valproate

Answer 26

C. Lamotrigine
E.Carbamazepine
F. Valproate

Question 27

What is the priority nursing intervention before prescribing anticonvulsants to women of child bearing age?

Answer 27

PREGNANCY TEST (12-51YO ) TO PREVENT TRETRAGENIC

Question 28

What organ does Valproate alter significantly , and labs must be monitored?
A. Lungs
B. Heart
C. Pancreas
D. Liver

Answer 28

D. Liver

Monitor liver function test , AND PLATELTET

PLT- 150,000-400,000

ALT 4-36
AST-35

Question 29

Effects that valproate has on pregnant patients

Answer 29

The FDA has a black box warning against valproate use in pregnancy due to teratogenicity. Patients should be screened for pregnancy and use birth control during therapy with this drug. These risks may apply to other anticonvulsants as well but are higher with valproate. Valproate can affect how the baby develops and may result in birth defects. Defects associ- ated with this drug include malformations such as small fin- gers and toes, and major malformations such as spina bifida or cleft palate. Autism is more common after use during preg- nancy. As the child grows, a condition sometimes known as fetal anticonvulsant syndrome may become evident. This syn- drome is characterized by developmental and learning prob- lems, such as delayed walking and talking, poor speech and language skills, memory deficits, and decreased intelligence.

Question 30

Your patient who has been prescribed carbamezpine. Reports feeling right upper quadrant pain. What do you as a nurse suspect is occurring

A. anticholinergic effect
B. liver inflammation
C. Onset sign of mani
D.sign of Stevens Johnson syndrome

Answer 30

B. liver inflammation

Question 31

Carbamzepine

Answer 31

Carbamazepine (Tegretol)
– Rapid cycling, severely paranoid or angry mania
– LFT’s, CBC
– Risk - Bone Marrow suppression, Liver inflammation and damage, leukopenia, aplastic anemia
– Contraindicated in those of Asian Decent (Stephen Johnson’s Syndrome)

Question 32

What should doctors prescribe prior to administering Carbamezpine to an asian patient?

Answer 32

GENETIC TESTING

CAN CAUSE STEVEN JOHNSON SYNDROME

Carbamazepine carries a black box warning for seri- ous dermatologic reactions. These include toxic epidermal necrolysis and Stevens-Johnson syndrome. Patients of Asian ancestry have a 10 times greater risk for toxic epidermal necrolysis and should be genetically tested prior to using this drug.

Question 33

Lamotrigine

Answer 33

Lamotrigine (Lamictal)
– Risk for Stephen Johnson’s Syndrome – decreased if started on low dose and increased
very slowly.

Question 34

If you notice a rash appears on your patient that is taking Lamotrigine, What is the nurses priority action?

Answer 34

DC MEDICATION-do not administer next dose (hold medication), contact doctor

*In about 10% of people taking lamotrigine, a rash appears within 8 weeks of starting treatment. However, about 1% of peo- ple progress to toxic epidermal necrolysis or Stevens-Johnson syndrome. The risk is greater in children aged 2 to 16 years. These skin conditions are more common with co-administration of valproate, rapid dose increases, and doses exceeding the rec- ommended upper limit. Since it is impossible to tell if a benign rash will become dangerous, it is essential to discontinue this drug if a rash appears.

Question 35

Seclusion and restraint guidelines

Answer 35

Seclusion and Restraint
– LAST RESORT – When patient is
dangerously out of control
– Not ordered as an intervention
– Danger to self or others
(Emergency)
– Least restrictive tried first
– NEVER for punishment or
convenience
– Safety

Question 36

Benefits of CBT

Answer 36

CBT is typically used as an adjunct to pharmacotherapy in many psychiatric disorders. It involves identifying maladaptive thoughts (“I am always going to be a loser”) and behaviors (“I might as well drink”) that may be barriers to a person’s recovery and ongoing mood stability.
CBT focuses on adherence to the medication regimen, early detection and intervention for manic or depressive episodes, stress and lifestyle management, and the treatment of depres- sion and comorbid conditions. Some research demonstrates that patients treated with cognitive therapy are more likely to take their medications as prescribed than are patients who do not participate in therapy, and psychotherapy results in greater adherence to the lithium regimen.