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52 Cards in this Set
- Front
- Back
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What is Bipolar disorder?
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a disease characterized by severe pathologic mood swings from hyperactivity & euphoria (manic) to sadness & depression
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Do bipolar spend more time in manic phase or a depressive phase?
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They spend 3 times more time in a depressive phase
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What is the lifetime suicide rate for bipolar people vs unipolar depression
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Bipolar have a 25-50% chance of commiting suicide vs unipolar which is 15% |
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S/s of mania
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- Elevated mood, state of euphoriaBehaviour - impulsive, constant activityThought processes - reduced attention & concentration, easily distractible, flight of ideas |
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s/s of depression
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- Feelings of sadness or hopelessness - Lost of interest in pleasurable - Changes in sleeping - Difficulty concentrating - Neglecting duties - Decrease in physical activity - Reduced self-care - Suicidal ideation |
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What is the usual age by which a person with bipolar will be diagnosed
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usually before the age of 30
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What is the range of bipolar?
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Mania Hypomania Normal/balanced Mild/moderate depression Moderate to severe depression |
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Manic episode
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Manic symptoms & presence of abnormally elevated, expansive (excessive enthusiasm or friendliness) mood lasting at least 1 week.
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Hypomanic episode
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Elevated mood and other classic symptoms that define mania but are not accompanied by delusional beliefs, hallucinations and not severe enough to require hospitalization or impair social/occupational functioning.
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Mixed episode
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Full criteria for both a manic and a depressive episode met within a 1-week period.
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Major depressive episode
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5 out 9 depressive symptoms (must included depressed mood or loss of interest in pleasure) for at least 2 weeks.
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Bipolar 1 disorder
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- Most serious - Intense depression & mania |
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Bipolar 2 disorder
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- Constant, low-grade depression with occasional milder episodes of mania (hypomania). - Bipolar II patients are often misdiagnosed with depression, since this is the symptom they feel most of the time. - Doesn’t disrupt the patient’s ability to function as significantly as bipolar I disorder. |
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Cyclothymia
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Fluctuating low-level depression along with periods of hypomania. |
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Rapid-Cycling Bipolar Disorder
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Severe form of bipolar disorder, occurring when a person has at least four episodes of major depression, mania, hypomania, or mixed states within a year.
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For how long must symptoms of cyclothymia be present for before a diagnosis can be made?
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2 years
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To be considered cyclothymia, what is the max timeframe for an individual to be symptom free?
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2 months
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Are men or women effected more in rapid cycling disorder?
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Women
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What is the typical age of onset for bipolara?
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21-30
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Who is more pron to manic episodes?
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Men
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Who is more prone to depressive episodes?
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Women
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What happens if bipolar is left untreated?
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increased frequency, severity of episodes
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What is a biological cause of bipolar?
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Genetics
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What is a biochemical cause of bipolar?
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excess of norepinephrine, serotonin, and/or dopamine
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What are physiological causes of bipolar?
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brain lesions, medication side effects (steroids, amphetamines, antidepressants, and high doses of anticonvulsants during manic episodes)
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What is a neurologial cause of bipolar?
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suspect problem with neuronal growth & survival
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What is a chronobiologic cause of bipolar?
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Impact of sleep disturbances
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What are treatment goals for bipolar disorder?
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- Monitoring psychiatric status/safety - Providing education regarding bipolar disorder - Enhancing treatment compliance - Promoting regular patterns of activity and sleep - Anticipating stressors - Early identification of a new episode - Minimizing functional impairments - Assisting client to define and test reality - Meeting client’s self-care needs |
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What are non-drug therapies for bipolar disorder?
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- Self care - Education - Psychotherapy (individual, family, CBT) - Electroconvulsive therapy |
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What are the 4 drug classes used to treat bipolar?
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1. Mood stabilizers 2. Antipsychotics 3. Anticonvulsants 4. Antidepressants |
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What is lithium used for?
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Often used with antipsychotics in the acute phase of bipolar
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How does lithium work?
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Alters sodium transport in nerve & muscle cells, increases norepinephrine uptake & serotonin receptor sensitivity
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How can sodium effect lithium?
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Higher the body’s sodium levels, the lower the lithium levels (and thus mood stabilizing effects) & vice versa
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What kind of theraputic index does lithium have?
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Limited
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What are predictors that lithium will work?
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- Absence of rapid cycling, personality disorder, comorbidity, psychotic symptoms. - Previous use/ Family response to Lithium |
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s/s of lithium toxicity greater then 1.5 mEq/L
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- metallic taste in mouth, - fine hand tremor, - nausea, - polyuria, - polydipsia, - diarrhea, - muscle weakness, - memory impairments. |
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s/s of lithium toxicity of 1.5-2.5 mEq/L
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- severe diarrhea, - incoordination, - ataxia, - slurred speech, - blurred vision, - muscle irritability |
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s/s of lithium toxicity of greater then 2.5 mEq/L
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- cardiac arrhythmias, - blackouts, - nystagmus, - course tremours, - visual/tactile hallucinations, - oliguria/renal failure, - peripheral vascular collapse, - confusion, - seizures, - COMA & DEATH |
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How often should lithium blood serum levels be checked?
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Monitor levels every 2 to 3 days at initiation of therapy and then every 3 to 6 months
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What are drug interactions for lithium?
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- ACE Inhibitors( increase serum lithium) - Diuretics - Nonsteroidal anti-inflammatory drugs - Anticholinergic drugs - Tricyclic antidepressants - OTC's |
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What are important patient teaching points with lithium?
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- Avoid alcohol or other CNS depressants - Birth control (pregnancy, breastfeeding) - Many many drug interactions, notify prescriber of all OTC, supplements - May impair judgment, thinking, motor skills - Do not abruptly discontinue |
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What are antipsychotic drugs used for in treatment of bipolar?
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- Short term -- control symptoms during manic episodes - Long term -- stabilize mood |
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What are examples of antipsychotics used for treatment of bipolar?
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- Haloperidol (Haldol), - Olanzapine [Zyprexa], - quetiapine [Seroquel], - risperidone [Risperdal], - aripiprazole [Abilify], - ziprasidone [Geodon] |
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What are examples of antieplieptics that are used to treat bipolar?
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- divalproex (valproate), - carbemazepine, - lamotrigine |
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What must be checked regularly with antiepileptic medication?
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Liver function tests and CBC for serum levels
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How is divalproex different from lithium?
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- Easier to tolerate than lithium - Less effective than lithium in treatment/prevention of depressive episodes - Less effective than lithium in preventing relapse- More suicide risk associated with valproate than lithium |
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What is Carbemazepineused for?
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Treatment/prevention of manic episodes
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How does Carbmazepine differ from lithium?
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Less effective than lithium in treatment/prevention of depressive episodes
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What are the common drug class combination used to treat bipolar?
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antidepressants and a mood stabilizer
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What can happen if only antidepressants are used to treat bipolar?
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It may induce mania
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What are nursing interventions that can be used to help a person in a manic episode?
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- Assist with personal care, encourage responsibility for self-care (rest, hydration, nutrition, re-establish physical well-being) - Protect from over-stimulation (decreases agitation *& promotes sleep) - Set realistic goals and limits for the patient’s behaviour - Provide diversions suited for a short attention span - Reorient to reality - Avoid power struggles - Safety measures/risk assessment |
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What are nursing interventions for a patient experiencing a depressive episode?
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- Avoid overwhelming expectations - Allow increased time for activities and responses - Provide structured routine - Promote interaction with others - Encourage verbalization, provide support - Safety measures/risk assessment - Encourage physical activity |
