Card Set Information
lccc psy nursing
exam 3 psych
What are the 3 types of Bipolar disorders?
: More common in males
: More common is females
: usually begins in adolescence or early adulthood
What is the suicide rate in bipolar? What is the most common morbidity with bipolar? What is the median number of manic episodes?
suicide rate is 15%
Alcohol abuse (or substance abuse) is big comorbidity
median # of episodes is 9
What are the key points of bipolar disorder? wat is it defined by?
costly, common and treatable
Defined by recurrent episodes of mania or hypomania and depression
*it is often misdiagnosed
What is the difference between bipolar and depression?
: earlier age of onset, more fears
: more cognitive/somatic symptoms
What is the dsm-5 criteria for bipolar disorder?
Distinct period of abnormally and persistent elevated, expamsive or irritable mood for at least *four days for hypomania *1 week for mania
During mood disturbance, at least 3 of the following symptoms:
increased activity level
sexual or psychomotor agitation
unusual talkativeness (pressured speech [you won't get a word in, they just keep talking])
flight of ideas
inflated self esteem, grandiosity
Why is bipolar often mis or undiagnosed? What is the most common misdiagnosis?
35-60% have depression first
Depression is far more prevalent than mania
May have many depressive episodes prior to mania
Many will not report mania/hypomania
May progress to psychosis
Lag between symptom onset and first treatment with mood stabilizer
most common misdiagnosis
The lag between symptom onset and first treatment with mood stabilizer is dangerous, why?
(average lag time is 9.8 years)
the greater the lag the worse social functioning, more hospitalizations, higher suicide rates
What are the differences among the three types of bipolar (for diagnosis)?
: At least one episode of mania, alternating wit major depression
: hypomanic episode(s) alternating with major depression
: hypomanic episodes alternating wit minor depressive episodes (2 years)
What are clues to the diagnosis for bipolar disorder?
history of mania
family history of bipolar
earlier age onset of symptoms
elevated or irritable mood
school truancy or failure
multiple failed relationships
abrupt onset and termination of depressive episodes
Worsening with antidepressant treatment
severe anhedonia(inability to feel pleasure)
What is the biggest comorbidity in childhood?
*beware of stimulant use without mood stabilizer
What are the different types of mixed states?
Bipolar mixed states
: depression and mania co-occurring
Depressive mixed states
: core of depression, but with racing thoughts
What is the mnemonic for the diagnostic criteria for bipolar?
: indiscretions (excessive pleasure activities)
: flight of ideas
: activity increase
: sleep deficits
What are the other common comorbidities with bipolar?
substance use disorders-highest
*Risk for suicide
personality disorders- non med compliant
describe substance abuse and bipolar disorder
bipolar d/o is the highest axis 1 disorder comorbid/concurrent with substance abuse
bipolar disorder is second to antisocial personality disorder in terms of concurrent substance abuse
Substance use adversely effects medication, produces earlier onset of symptoms and often leads to hospitalizati
How much do genetics play in BP D/O
28% likely with one parent
3x the risk with both parents
What is hyperthymic temperament or soft bipolarity?
exuberant, upbeat, over energetic, overconfident
verbally aggressive, self assured
Strong willed, self employed, risk taking, sensation seeking
history of legal problems
What is soft bipolarity?
3 or more
major depressive episodes with failed drug trials
1st degree relatives with affective illness
What are the 3 stages of manic states?
What are the characteristics of mania?
Thought processes and cognitive function:
What is stage 1 for hypomania-assessment?
: fluctuating, cheerful to irritable, hostile nature of person=volatile
: extroverted, sociable, inappropriate, easily distracted
: rapid flow of ideas, flighty, exalted sense of self
What are the questions for detecting hypomania?
Do you have days of energy or ideas that come and go abruptly?
On those days of energy, are you productive? creative? feel unconquerable? convinced your self worth, talents, abilities? Positive about the future? talkative? distinctly social? irritable?
On those days of energy, do your thoughts feel as if thy're racing?
What is stage 2? assessment for stage 2?
: unstable- euphoric to irritation/anger continuous high
: psychomotor hyperactivity/nonstop activity; constitutes an emergency
: flight of ideas
What is stage 3?
totally out of touch with reality
requires chemical/physical restraints
What should you assess in mania? Why?
assess danger to self and others
because death can occur from exhaustion, not eating or sleeping
poor impulse control can lead to self harm or harm of others
suicide is 20 times higher
protect from giving away
Assess medical status
mania secondary to medical condition or drugs/meds
because stroke, hyperthyroidism, traumatic brain injury can occur
assess for substance use and anxiety disorders
(have exceptionally co-morbidity)
how should you communicate with clients with Bipolar?
firm, calm approach
sort, concise explanations
be neutral; avoid power struggles, do not join in joking
consistent approach and expectations
convey limits, consequences
act on legitimate complaints redirect energy
How should the nurse structure the environment?
Maintain low level of stimuli
structured solitary activities with staff
redirect violent behavior
minimize physical harm
observe for medication side effects/toxicity
protect from consequences of behavior, such as giving way money or possessions
What are the goals for treatment?
reduce presenting symptoms
improve quality of life
What are the nursing interventions?
maintain adequate hydration/nutrition
decrease psychomotor agitation
encourage appropriate social interactions
What nutrition care should you do for bipolar?
monitor I&O and vitals
offer frequent high-calorie protein drinks
provide finger foods
remind client to eat
walk or sit with client to encourage eating
What elimination care is needed?
monitor bowel elimination
offer high fiber foods
evaluate need for laxative
encourage client to go to bathroom
What should you do to promote sleep?
encourage rest periods during day
use sleep inducing interventions
What hygiene care needs are necessary?
supervise bathing as necessary
minimize choices of clothing give simple step by step reminders
What medication is big for bipolar?
: 24 hours
: 8-12 hours after last dose
Therapeutic and toxic levels
: 0.5-1.5 mEq/L
: .8-1.2 mEq/L and above
What is mild toxicity of lithium? Wat will you see?
coarse hand tremors, confusion
hyperirritability of muscles
drowsiness, lack of coordination
persistent GI upset
Salivary gland swelling
What is moderate toxicity? What will you see?
large output of dilute urine
What is severe toxicity?what will you see?
greater than 2.5mEq/L
complex involvement of multiple organ systems
irreversible organ damage
What are the interventions for lithium toxicity?
obtain lithium level
: electrolytes, BUN, creatinine, UA, CBC
consider emetic if awake
What medications besides lithium are used?
nvalproic Acid ( Depakote)
What antianxiety meds are used for Bipolar?
Orally or IM for agitation or psychosis
What antipsychotics are used for bipolar?
aripiprazole (abilify) IM or PO
Olanzapine (zyprexa) IM
risperidone (riperadal) Consta IM every 2 weeks
Haloperidol (haldol) IM
What are the advantages and disadvantages of lamictal?
: bipolar depression, rapid-cycling, propylaxis, bipolar I and II, unipolar depressions; very well tolerated, no weight gain, no labs, no sedation, no cognitive dulling
: slow dosage titration limits acute utility, skin issues, high rate of benign skin rashes, fear of Steven Johnson's, increased risk of SJS with aggressive dosing
Valproate will double lamictal serum levels
What education is needed for clients on lamictal for ski rash safety?
warn clients not to change soaps, laundry detergents, OTC products, unusual foods during first 6 weeks of lamotrigine titration
Assess rash (severity, location and feautures)
: rash os severe, painful, or rapidly evolving. any blistering, systemic symptoms, mucous membrane involvement
How can you help to maintain compliance?
Assist client to overcom denial and promote compliance by
: establishing a therapeutic alliance
maintai regular appointments/visits
involve family in care
educate client about side effects
risperdal consta IM
What are common triggers for mania?
exposure to light
lack of structure
driving in traffic
every day obligations