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Mental Health Exam 4 > Week 9: Bipolar Disorder > Flashcards

Week 9: Bipolar Disorder Flashcards

1
Q

Mania***

A

An abnormally elevated and persistently

  • elevated mood
  • expansive mood
  • irritable mood
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2
Q

Expansive mood

A

Lack of restrains in expression, overvalued self importance

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3
Q

Manic episode*

A

Distinct period of abnormally and persistently elevated, expansive, or irritable mood with abnormally increased goal-directed behavior or energy

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4
Q

Mood lability*

A

Rapid shifts in mood with little or no change in external events (rapid cycling)

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5
Q

Rapid cycling*

A

In bipolar disorder, the occurrence of 4 or more mood episodes that meet criteria for manic, mixed, hypomanic, or depressive episode during the previous 12 months

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6
Q

Bipolar Disorders (3 types)

A

BP I
BP II
Cyclothymic

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7
Q

BP I

A

Manic episode that may be followed by or preceded by a depressive or hypomanic state

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8
Q

BP II

A

Lifetime experience of at least one episode of major depression and one hypomanic episode

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9
Q

Cyclothymic disorder

A

Hypomanic and depressive periods for at least 2 years (children, 1 year) without meeting criteria of bipolar I or II disorder

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10
Q

Key signs of mania* (5)

A 
Cognitive changes
Elevated self-esteem
Pressured speech
Flight of ideas
Distractibility increase
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11
Q

Mania vs Hypomania***

Manic episode

Hypomanic episode

A
  • lasting at least one week of abnormally elevated, expansive, or irritable mood AND increased activity/energy PLUS 3 of the classic mania symptoms
  • hospitalization common
  • significantly impairs function
  • may be accompanied by psychotic symptoms
  • Distinct period lasting a minimum of 4 days of abnormally elevated, expansive or irritable mood AND increased activity/energy PLUS 3 of the classic mania symptoms
  • NO hospitalization
  • does NOT significancy impact function
  • NO psychotic features
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12
Q

Classic mania symptoms

A 
Inflated self-esteem
Pressured speech
Decreased need for sleep
Flight of ideas
Distractibility
Psychomotor agitation
Increased risk taking
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13
Q

Manic episode dx***

A

A. Distinct period during which there is an abnormally, persistently elevated, expansive, or irritable mood and persistently increased activity or energy that is present for most of the day, nearly every day, for a period of at least 1 week, accompanied by at least 2 additional symptoms from criterion B (if mood is irritable rather than elevated or expansive, at least 4 must be present)

B. Symptoms

  1. Inflated self-esteem or grandiosity
  2. Decreased need for sleep
  3. More talkative than usual or pressure to keep talking
  4. Flight of ideas or subjective experience that thoughts are racing
  5. Distractibility
  6. Increase in goal-directed activity, psychomotor agitation
  7. Excessive involvement in high risk activity
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14
Q

DIGFAST***

A 
Distractibility
Indiscretion and impulsivity
Grandiosity or inflated self-esteem
Flight of ideas
Activity increase 
Sleep deficit
Talkativeness
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15
Q

BP disorder: epidemiology

A

Symptoms often appear before age 25

No gender differences

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16
Q

BP female patients risk

A

Female patients at greater risk for depression and rapid cycling

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17
Q

BP male paitents riks

A

Manic episodes

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18
Q

Common comorbidity of BP

A

Anxiety (panic, and social phobia) and substance use

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19
Q

Lifespan considerations

Children and adolescents

A

Depression usually first – marked by intense rage

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20
Q

Lifespan considerations

Older adults

A

Greater neuro abnormalities and cog disturbances

Incidence of mania decreased with age

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21
Q

Biologic theories of BP (3)

A

Chronobiologic theories
Genetic factors***
Chronic stress and kindling theory

22
Q

Genetic aspect of BP***

A

One of the mental disorders with the strongest and most clearly established genetic heritability

23
Q

Kindling theory

A

Genetically predisposed individuals experience repetitive subthreshold stressors at vulnerable times

  • closely related to allostatic lode
  • mood symptoms of increasing intensity and duration occur
  • each episode leaves a trace and increases the person’s vulnerability or sensitizes the person to have another episode
  • later episodes: little or no stress may precipitate
  • over time, time between episodes decreases and episodes intensify
24
Q

Nursing assessment

Biologic Domain

A

Physical assessment

  • changes in activity, eating, and sleep***
  • diet and body weight
  • lab testing (thyroid)
  • changes in sexual practices/risk taking***
  • pharm assessment
  • -previous use of antidep
  • -use of alcohol and other substances***
25
Q

Lithium

SE

A 
Weight gain*
Thirst*
Fine head tremor*
Drowsiness*
Mild diarrhea
Metallic taste
Increased urinary freq
26
Q

Lithium considerations (4)

A

Risk for cardiac malformations when takin in pregnancy*
Avoid alcohol and CNS depressants*
Maintain hydration level*
Low sodium intake increases lithium levels*

27
Q

Lithium Drug interactions***

A

NSAIDS – double lithium levels*
Thiazide and loop diuretics – increase lithium levels*
ACE inhibitors – increase lithium levels*

Osmotic diuretics – decrease lithium
Sodium chloride – high sodium intake decreases lithium levels, low sodium may increase
TCAs – increase tremor

28
Q

Lithium blood levels***

A

<1.5 mild side effects
1.5 – 2.5 moderate tox
>2.5 severe tox

29
Q

lithum: Mild SE***

A

Fine hand tremor
Diarrhea or loose stools
Muscular weakness or fatigue

30
Q

lithium: Moderate tox***

A 
N/V
Mild-moderate ataxia
Incoordination
Dizziness, sluggishness, giddiness, vertigo
Muscle irritability or twitching
31
Q

lithium: Severe tox***

A

Cardiac arrhythmias
Nystagmus
Seizures
Coma and death

32
Q

Divalporex sodium***

Indication

A

Effective for acute mania, first line treatment for patients with rapid cycling or mixed states

33
Q

1st line treatme for rapid cyclin or mixed states

A

divalporex sodium

34
Q

Divalporex sodium***

SE

A

Very sedating***
Tremor
GI upset

35
Q

Divalporex soidum

onsiderations

A

Avoid CNS depressants
Hepatotoxic
Teratogenic – leads to neural tube defects

36
Q

Signs of hepatotoxicity

A 
Malaise
Weakness
Lethargy
Anorexia
vomiting
37
Q

Carbamazepine***

class

A

Anticonvulsant

38
Q

Carbamazepine

SE (5)

A 
Dizziness
Drowsiness
N/v
Aplastic anemia
Agranulocytosis
39
Q

Carbamazepine

Considerations

A

Increasd risk for birth defectse
Monitor CBC and liver function
Requires monthly blood level until patient is on stable dosage
Many drug interactions (increase carb, decrease carb, decrease other drug level)

40
Q

Carbamazepine stable range

A

8-12 ng/mL

41
Q

Antipsychotic various uses

A

in conjunction with lithium and Divalporex in management of acute mania

  • as adjunctive therapy for maintenance
  • a few are approved to use as monotherapy for maintenance in pregnant women with BP who cannot take lithium or anticonvulsants***
  • for acute mania***
42
Q

Which antipsychotics for acute mania (3)

A

Asenapine
Olanzapine
Ziprasidone

43
Q

BP disorder: Psychological Domain

Nursing Assessment

A
  • mood (assess for mania – Young Mania Rating Scale)
  • Cognition
  • Thought disturbances
  • stress and coping
  • insight and judgement
  • risk assessment
  • strength assessment
44
Q

Interacting w/ person w/ mania***

A
  • calm non-threatening approach
  • be direct and use simple commands
  • avoid open-ended sentences
  • redirect conversation if flight of ideas occur
  • avoid confrontation and arguments
  • limit interaction time and recognize patient’s need for space and movement
  • Do not place excessive demands on patient
45
Q

Psychoeducation checklist: BP I

A 
Psychopharmacologic agents
Medication regimen adherence
Recovery plan*
Wellness plan*
Crisis plan*
Relapse prevention
Strategies to decrease agitation and restlessness
Safety measures*
Self-care management*
Follow-up laboratory testing*
Support services
46
Q

BP disorder: Social domain

Nursing assessment

A

Cultural views of mental illness*
Social and occupation impact of disorder*
Any changes resulting from a manic or depressive epsiode*
Relationship conflicts: changes in social circle and impact on behaviors and self-concept*

47
Q

BP Emergencey plan (CRISIS PLAN)

A 
List of emergency contacts (PCP family)
List of meds (w/ dosages)
Info about health problems
Symptoms that indicate others need to take responsibility for care
Treatment preferences

Should be simple and clear
Include
-personal info
-what person is like when feeling well
-list of useful coping strategies (wellness toolbox)
-list of signs that person is no longer able to care for self
-what crisis looks like for person
-how person feels when in crisis
-possible triggers***
-any useful “code words”
-preferred and unwanted treatments, facilities, and medications
-list of people to contact/NOT contact
-safety plan for safety of client and dependent children or pets

48
Q

Intensive outpatient care

A

ACT teams (assertive community treatment)

  • partial hospitalization
  • day hospitalization
49
Q

BP II dx

A

Similar dx to BPD 1

1 hypomanic episode plus at least 1 depressive episode

50
Q

Cyclothymic disorder patho

A

Cyclothymic disorder patho Chronic fluctuating mood with symptoms similar to BPD but less severe
-dysthymic episodes and elevated mood episodes don’t meet criteria for depressive, manic, or hypomanic episodes

Mental Health Exam 4 (3 decks)

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