Bipolar

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Author:
hvledger1
ID:
295781
Filename:
Bipolar
Updated:
2015-02-17 12:07:03
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psych
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psych
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psych
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  1. Bipolar
    recurrent episodes of depression/mania
  2. Bipolar
    emerge in late adolescence/early adulthood, or school-age

    (children more difficult to dx: bc it mimics ADHD)
  3. Bipolar
    psychotic, paranoid, and or bizarre behavior during mania periods
  4. Acute bipolar phase
    • acute mania
    • hospitalization required
    • reduction of mania and safety:goals
    • risk of harm to self/others determined
    • 1:1 supervision maybe
  5. Continuation bipolar phase
    • remission of clinical manifestations
    • treatment 4-9months
    • relapse prevention through ed., med, and psychotherapy
  6. Maintenance bipolar phase
    • increased ability to function
    • treatment continues through client's lifetime
    • prevention of future manic episodes
  7. Mania
    abnormally elevated mood, expansive or irritable; usually requires hospitalization
  8. Hypomania
    • less severe manic episode 
    • at least 4 days
    • accompained by 3-4 findings of mania
    • hospitalization not required
  9. Mixed episode
    manic episode and episode of major depression experienced by client simultaneously 

    • marked impairment in functioning
    • may require admission to acute care facility
  10. Rapid cycling
    4 or more episodes of acute mania in 1 year
  11. bipolar 1 disorder
    at least one episode of mania alternating with major depression
  12. bipolar 2 disorder
    one or more hypomanic manifestations alternating with major depressive episodes
  13. cyclothymia
    at least 2 years of repeated hypomanic manifestations that do not meet criteria for hypomanic episodes alternating with minor depressive episodes
  14. Comorbidities with bipolar
    • substance abuse (more rapid cycling of mania)
    • anxiety disorders
    • eating disorders
    • ADHD
  15. Risks for bipolar
    • genetics, immediate family member
    • psychological, stressful events or major life changes
    • physiological, neuroendocrine or neurobio problems
    • substance abuse, alcohol or cocaine
  16. Relapse of bipolar
    • alcohol, cocaine, caffeine can lead to mania
    • sleep disturbances may come before, associated with, or be brought on by mania
    • psychological stressors can trigger mania
  17. Manic characteristics
    • labile mood with euphoria 
    • agitation and irritability
    • restlessness
    • dislike of interference/ intolerance of criticism 
    • increase talking/activity
    • flight of ideas-rapid, cont. speech with suddent and frequent topic change
  18. Manic characteristics
    • grandiose view of self and abilities
    • impulsivity: spending money, giving away money or possessions 
    • demanding/manipulative behavior
    • distracted/decreased attention
  19. Manic characteristics
    • poor judgement 
    • attention seeking-flashy dress or makeup
    • impairment in social functioning
    • decreased sleep
    • neglect of ADLs
    • delusions/hallucinations
    • denial of illness
  20. Depressive characteristics of bipolar
    • flat, blunted, labile effect
    • tearfulness, crying
    • lack of energy
    • anhedonia: loss of pleasure 
    • physical reports of discomfort/pain
    • difficulty concentrating/focusing/problem-solving
  21. Depressive characteristics of bipolar
    • self-destructive behavior, suicidal ideation 
    • decrease in personal hygiene
    • loss or increase in appetite/sleep
    • psychomotor retardation or agitiation
  22. Tool to screen bipolar
    • Mood Disorder Questionnaire 
    • places mood progression on continuum for hypomania (euphoria) to acute mania (extreme irritaiblity and hyperactivity) to delirium (completely out of touch with reality)
    • not definitive diagnostic test
  23. Bipolar medications
    Lithium carbonate (Lithobid)-mood stabilizer
  24. Anticonvulsants for bipolar
    valproic acid, clonzepam, lamotrigine, gabapentin, and topiramate
  25. Bipolar med
    • Benzo
    • lorzapam
    • short term basis for sleep impairment r/t mania
  26. bipolar therapy
    • electroconvulsive therapy (ECT)
    • extreme manic behavior 
    • clients who are sucidal or rapid cycling
  27. Relapse signs
    • difficulty sleeping
    • ahedonia
  28. lithium
    • SE receptor blockade
    • decreases neuronal atrophy 
    • increases neuronal growth
    • controls episodes of mania
    • prevent return of mania/depression
    • decreases incidence of suicide
  29. lithium side effects
    • GI distress: usually transient, take with meals or milk
    • hand tremors: administer beta-adrenergic blocking agents such as propranolol, use lowest dose, report increase which could mean toxicitiy
    • polyuria, mild thirst: K-sparing diuretic, spironolactone, at least 2-3 L/day
    • weight gain
    • renal toxicity
    • goiter and hypothyroidism 
    • bradydysrhthmias, hypotension, electrolyte imbalance
  30. people with mania
    • most happiest, excited, and optimistic people
    • don't eat or sleep
    • euphoric and energized 
    • talk constantly
    • take horrific chances/ do foolish things
  31. as mania progresses...
    intensifies to psychosis, person may begin to hear voices
  32. bipolar disorder
    • shifts in mood
    • energy
    • ability to function
  33. bipolar during remission
    may still exp. chronic interpersonal or occupational difficulites
  34. suicide attempt in bipolar
    25-60%
  35. bipolar I
    • at least 1 week-long manic episode that results in excessive energy and activity 
    • difficulty maintaining social connections and employment
  36. during manic episodes in bipolar I
    • pyschosis
    • hallucinations 
    • delusions
    • disturbed thoughts
  37. during manic episodes
    • three of theses behaviors:
    • extreme drive and energy
    • inflated sense of self-importance
    • drastically reduced sleep
    • excessive talking, pressured speech
    • personal feeling of racing thoughts
    • unusually obsessed with goals
    • purposeless arousal and movement
    • dangerous activities indiscrimate spending, reckless sexual encounters, risky investments
  38. euphoric mania
    • wonderful in beginning 
    • turns scary and dark 
    • progresses toward loss of control/confusion
  39. dysphoric mania
    mixed state or agitated depression, with depressive symptoms along with mania
  40. dysphoric mania
    • irritable
    • angry
    • sucidial
    • hypersexual
    • panic attacks
    • pressured speech
    • agitiation 
    • severe insomnia
    • persecutory delusions and confusion
  41. bipolar 2
    • low levels of mania 
    • alternates with profound depression 
    • *hypomania
  42. hypomania
    • elevated mood with symptoms less sever than those of mania
    • person does NOT experience impairment in reality testing, nor do they symptoms markedly impair the person's social, occupational, or interpersonal function
  43. hypomania
    • euphoric and increases functioning 
    • excessive activity and energy for at least 4 days
    • involves 3 traits of mania 
    • psychosis never present
    • except in depressive side of disorder
  44. bipolar 2
    • not usually hospitalized 
    • suicide risk because of depressive symptoms
  45. cyclyothymic disorder
    symptoms of hypomania alternate with symptoms of mild to moderate depression for at least 2 years in adults or 1 in children
  46. cyclyothymic disorder
    irritable hypomanic episodes

    in children: irritability/sleep disturbed
  47. rapid cycling
    • at least 4 mood episodes in 12 month perio
    • can also occur within a course of month or even a 24 hour period 
    • poorer global functioning
    • high recurrence risk
    • resistance to conventional somatic tx
  48. depression
    • common
    • may exist with another condition
    • severity on continuum
    • may be expressed directly, based on culture, age
    • think "painful, debilitating, affecting physical well being/medical dx, interfering with one's life
  49. stats of bipolar
    • I onset: 18 yr
    • II onset: 20 yr
    • I begins with depressive episode-75% of time in women / men 67%
  50. women who have severe postpartum psychosis within 2 weeks of birth
    4x greater chance of subsequent conversion to bipolar disorder

    birth maybe a trigger for 1st symptoms of bipolar
  51. bipolar 2
    • clinicans downplay this one
    • may be milder version 
    • underdiagnosed for depression or personality disoder
  52. substance abuse and bipolar
    • more common in bipolar I
    • should be treated at the same time
  53. childhood or teens with bipolar
    • early-onset bipolar disoder
    • more severe than forms that appear later
  54. bipolar has a strong
    heritability
  55. polygenic disease
    • bipolar
    • number of genes contribute to its expression
  56. Lithium
    • first-line therapy for bipolar
    • DGKH enzyme linked
  57. rapid cyclers circadian rhythm
    • looks different
    • CRY2 associated
    • superfast biological clock
    • insomnia
  58. schizo and bioplar
    irregularity on chromosomes 13 and 15
  59. NE, dopamine, and serotonin
    • too few: depression
    • oversupply: mania 
    • could be receptor site insensitivity
  60. patho of bipolar
    • subregions of prefrontal cortex
    • medial temporal lobe 
    • early stages: prefrontal cortical changes 
    • repeated episodes or mania/depression: lateral ventricle abnormalities 
    • *also differences in anterior limbic regions (emotion, motivation, memory, fear)
  61. rapid cycling
    seen with hypothyroidism
  62. treatment-resistant bipolar disorder
    high-dose thyroxine
  63. Positive screening for bipolar
    • Yes to 7 questions
    • Yes to question 2
    • Yes to moderate/severe problem
  64. flight of ideas
    nearly continuous flow of accelerated speech wit abrupt changes from topic to topic that are usually base don understandable associations or plays on words
  65. Clang associations
    stringing together of words because of their rhyming sounds, without regard to their meaning
  66. grandiosity
    inflated self-regard
  67. mania
    • sensory perceptions altered
    • hallucinations
  68. not present in hypomania
    delusions/hallucinations
  69. cognitive impairments are greater in
    bipolar I
  70. limit setting
    • lights out after 11 pm
    • main theme in treating mania
  71. effective limit setting
    CONSISTENCY
  72. bipolar dx
    RISK FOR INJURY
  73. acute phase bipolar outcome
    injury prevention
  74. continuation phase bipolar outcome
    • 4-9 months
    • relapse prevention
    • ..education, support groups
    • medication adherance
  75. maintenance phase bipolar outcome
    prevention of relapse and limitation of severity and duration of future episodes
  76. acute phase of bipolar
    • hospital-safest environment
    • ensure 4-6 hours sleep
    • ECT or seclusion may be required
  77. bipolar disorder
    • some deny disease
    • reluctant to give up increased energy, euphoria
  78. bipolar communication
    • firm calm approach
    • short and concise explanations
    • remain neutral 
    • be consistent
  79. safe milieu for bipolar
    • low levels of stimuli
    • structued solitary play
    • high calorie diet
    • frequent rest periods
  80. acute mania intervetion
    • phenothiazines 
    • seclusion
  81. lithium
    • bipolar I and recurrent manic/depressive
    • less effective in mixed mania, rapid cycle
    • or atypical features
  82. lithium takes how many days to reach therapeutic level
    • 7-14 or longer
    • use benzodiazepine until reaches level
  83. lithium
    • do not exceed 1.5
    • 2-2.5: emergency
    • gastric lavage, treatment with urea, mannitol, aminophylline, hemodiaylsis
  84. two major long term risks of lithium
    • hypothyroidism 
    • impairment of kidney to excrete urine
  85. do not use lithium in
    • pregnant
    • breastfeeding
    • children under 12
  86. valproate
    • lithium nonresponders
    • rapid cyclers
    • dysphoric mania
    • not responded to carbamazepine
  87. monitor what in valproate
    • liver function
    • platelet count
  88. Lamotrigine can cause
    serious but rare dermatological rash
  89. clonazepam and lorazepam
    • acute mania
    • psychomotor agitation tx
  90. seclusion protocol
    proper reporting procedure through the chain of command when a patient is to be scheduled
  91. restraint require
    • physician written order q 24 hours
    • must include type of restraint
  92. only in emergency a charge nurse can
    • restrain or seclude a patient 
    • obtain physician's order in 15-30 min
  93. DBSA
    depression and bipolar support alliance
  94. mood stabilizers
    can cause weight gain

    altered metabolism of lipids and glucose
  95. side effects of therapeutic lithium levels
    • fine hand tremors
    • polyuria
    • mild thirst/nausea 
    • general discomfort
    • wt gain
  96. therapeutic level of lithium
    0.4-1.0
  97. early signs of toxicity of lithium
    • N/V/D
    • thirst
    • polyuria
    • lethargy 
    • slurred speech
    • muscle weakness 
    • fine hand tremor
  98. early level of toxicity in lithium
    1.5
  99. advanced signs of toxicity of lithium
    • coarse hand tremor
    • persistant GI upset
    • mental confusion
    • muscle hyperirritibility
    • electroencephalographic changes
    • incoordination
    • sedation
  100. advanced level of toxicity in lithium
    1.5-2
  101. severe toxicity signs of lithium
    • ataxia
    • giddiness
    • serious electroencephalographic changes
    • blurred vision
    • clonic movements
    • stupor
    • severe HYPOtension
    • coma
  102. severe toxicity level in lithium
    2-2.5
  103. >2.5 signs of lithium
    • convulsions
    • oliguira
    • death
    • may require dialysis
  104. severe toxicity 2-2.5 interventions
    • hospitalized
    • stop drug
    • if patient alert:give emetic
  105. early signs 1.5 of toxicity interventions
    • medication withheld
    • blood levels measured
    • dose reevaluate
  106. take lithium with
    meals
  107. gradually taper
    lithium to prevent relapse
  108. lithium decreases
    sodium reabsorption in kidneys
  109. a low sodium intake could lead to
    increase in lithium retention: toxicity

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