Bipolar Disorders Redux

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Bipolar 1

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must be having or have history of manic episode

must have episodes of depression

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psychotic or catatonic features may be present in

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bipolar I

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Bipolar II criteria

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recurrent bouts of MDD with episodic occurrence of hypomania.

must have never had a full mania episode

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May have psychotic or catatonic features in depressive MDD

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Bipolar II

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if someone is having 1st mania watch for

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depressive episode

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in cyclothymic disorder you must

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chronic mood disturbance of at least 2 year duration which has that meet cyclothymic disorder criteria

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cyclothymic #1: Numerous periods of elevated moods that do not meed criteria for

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hypomanic episodes and numerous periods of depressed mood of sufficient severity or duration to meet the criteria for mdd

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Cyclothymic #2: in cyclothymic disorder they are never without

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symptoms for more than 2 months

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cyclothymic #3: no

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physiological reason

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cyclothymic #4: symptoms must cause

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significant distress or impairment of social or occupation functioning

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bipolar II is more

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depressive

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substance medication-induced bipolar disorder

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direct result of physiological effects of a substance

Sig. distress or impairment in social or occupational functioning

associated with intoxication or withdrawal of substance

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in substance medication-induced bipolar you must know

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what their social history is.. drug relation

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drugs for substance medication-induced bipolar substance can be

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alcohol, cocaine, amphetamines, opioids, inhalents

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bipolar due to other medical conditions

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abnormal and persistent elevated, expansive or irritable mood.

excessive energy or activity

due to medical or physiologic reason

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ADHD can be a

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comorbidity of bipolar

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predisposing factors for bipolar: biological: evidence show strong

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underlying genetic vunerability

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predisposing factors for bipolar: deficiency of

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norepinephrine and dopamine with the depressive part

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predisposing factors for bipolar: excess of

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norepinephrine and dopamine with mania

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f in find

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frequency of symptoms occur most day in a week

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I in find

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intensity symptoms are severe enough to cause extreme disturbances in one or more domains

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n-in find

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number: symptoms occur 3 or 4 times a day

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d-in find

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duration: symptoms occur 4 or more hours daily

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bipolar is difficult to

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assess in children and may be comorbidly present in ADHD and conduct disorders

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mania in children and adolescence they have euphoric

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expansive mood: extremely happy, silly or giddy

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mania in children: irritable mood

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hostility and rage over what is often trivial matters. may be followed by aggressive or self-injury behaviors

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mania in children they will have vision of

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grandeur

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mania in children they will have

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decreased need for sleep

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mania in children increased goal

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directed activity/

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mania in children Impulsive activity

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jumping of the top of the slide over and over again. steal while in store

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bipolar disoder

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chronic recurrent illness that must be carefully managed throughout a persons life.

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bipolar affects

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mood, energy and ability to function

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bipolar disorder mortality rate

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25-60%-attempted suicide at least once in their life

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mania dx criteria

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a distinct period of persistent elevated, expansive or irritable mood.

persistent increased goal-directed activity or energy lasting at least 1 week

Marked impairment in social and occupational function

no physiological reason

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in mania must have inflated

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self esteem or grandiosity

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mania you have a decreased need for

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sleep

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mania- pressure to keep

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talking, more talkative than usual

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mania flight of

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ideas, racing thoughts, distractibility

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mania increased goal directed

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activites

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mania excessive in involvement in activites that have a

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high potential for pain consequences: trash can drinking, impulsive sex, drug use, spending all you money on a shopping

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hypomania dx criteria

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less pronounced than mania, episodes are not sever enough to cause marked impairment in social or occupational function-little manic don't have to hit 3. may be 4 days or shorter

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mania in children they could have

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psychosis including hallucinations and delusions.

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mania in children-can have suicidality

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risk for ideation, intent, plans and attempts

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pharmacological in mania is to

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stabilize mood

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In lithium you have to watch for

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toxicity

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anticonvulsants for bipolar

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valporic acid or Depakote, lamictal, neurotin, tegretol

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atypical anti-psychotics for bipolar are

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zyprexia, abilify and seroquel

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med for bipolar

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lispiradol-new lithium

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pharmacological tx in bipolar: principals Mood stabilizer are

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the first-line drugs, bring depressive and manic cycles within a more normal range

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in bipolar: use of antidepressant without a

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mood stabilizer should be avoided

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tapering antidepressants in limiting

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the risk for affective cycling to hypomania, mania and rapid cycling depression

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lithium action

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alteration of ion transport in muscle and nerve cells; increased receptor sensitivity to serotonin

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therapeutic blood levels of lithium

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0.8-1.4 meq/l

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maintenance blood level of lithium

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0.4-1.3 mEq/l

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toxic blood levels of lithium

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1.5-2.0 mEq/L

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lithium increases sensitivity to

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serotonin

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lithium can be used to to and prevent

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recurrences of mania and depression

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lithium has potential adverse effect on

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thyroid, kidneys an nervous systems

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in lithium therapeutic levels are close to the

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toxic level

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another therapeutic level in slides for lithium is

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0.6-1.2 meq/l

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to show lithium levels blood samples should be

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drawn in the morning, immediately prior to next dose or 8-12 hours after prior dose

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low sodium levels may

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predispose to toxicity

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lithium, adequate fluid

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intake is essential

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lithium takes up to two weeks

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to have effects on mood

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lithium intoxication symptoms

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fever, decreased urine output, decreased blood pressure, irregular pulse, ECG changes, altered level of consciousness, seizures, coma , death

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Lithium warning signs of toxicity

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anorexia, nausea and vomiting, hand tremor, muscle twitching, hyperactive deep tendon reflexes, ataxia, tachycardia, bradycardia, tinnitus, vertigo, weakness, drowsiness, swollen painful joints

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lithium exact action

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remains unknown, but thought to alter cation transport in nerve and muscle, influences reuptake of neurotransmitters

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abilify

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mood stabilizer and antipsychotic

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abilify decreases

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mania in bipolar 1 disorder,

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abilify acts on

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dopamine and serotonin

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avoid taking tegretol with

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abilify

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avoid use of abilify with

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elderly with dementia

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abilify causes

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sedation and eps (wtf is eps????)

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abilify comes in

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tablets, orally disintegrating tablets, oral solution or IM

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anti convulsants

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divolprox (Depakote)

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Depakote is

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rapidly replacing lithium as first line tx for bipolar

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possible allergic drug reactions with anticonvulsants

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steven Johnson syndrome, toxic epidermal necrolysis,

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therapeutic level of tegretol

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6-10 micrograms/ml

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therapeutic valproic acid levels

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50-100 micrograms/ml

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toxic epidermal necroslysis

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rare life threatening dermatological condition that is characterized by the detachment of the top layer of skin from the lower layers of the skin all over the body

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assessment

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monitor mood and behavior, thought processes (are they altered?), speech pattern (fast) cognitive function (can they answer questions, appropriately?) non-stop talking

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assessment on a manic patient

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manipulative, aggressively demanding, splitting

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assessment check

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staff members actions, frequent staff meetings to deal with patient behavior and staff response,

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assessment set

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limits consistenly

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other tx

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ect, mileu management, support groups, health teaching and health promotion

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nursing dx for bipolar

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risk for injury (r/t impulsive sex, drugs, jumping off slide) risk for violence, imbalanced nutrition (manic don't eat or drink) insomnia,

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advanced practice interventions

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psychotherapy, cognitive-behavioral therapy, interpersonal and social rhythm therapy (taught to track moods everyday and identify routines)

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watch for

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cycling season change, dayshift/night shift ect..