bipolar and related disorders

Question 1

bipolar 1 disorder

Answer 1

• Most severe form
• Highest mortality rate of the three
• At least 1 manic episode
• big shifts
• admiited for severe mania

Question 2

bipolar 2 disorder

Answer 2

• at least 1 hypomanic episode- less severe scale
• at least 1 major depressive episode
• productive at work, trying to do a lot of things at once

Question 3

cyclothymic disorder

Answer 3

• Alternate with symptoms of mild to moderate depression for at least 2 years (adults)
• Rapid cycling possible- at least four mood episodes in a 12-month period
• hypomania

Question 4

assessment of mania

Answer 4

mood
behavior 
thought processes and speech patterns
thought content
cognitive functioning

Question 5

mood assessment for mania

Answer 5

mania: expansive mood, elevated,
and unrestrained emotional expressiveness,
euphoric, irritability, labile

Question 6

behavior assessment for mania

Answer 6

• Hypomania: love social engagement, spending,
  And activity, and indiscriminate sexual activity,
  May not sleep for several days (first indication something wrong), less severe
• Mania: give away money, prized possessions,
  And expensive gifts, distractibility, grandiose (larger then life),
  manipulative

Question 7

thought content assessment for mania

Answer 7

• Grandiose delusions: highly inflated self-regard

- Persecutory delusions: believing that one is being singled out for harm

Question 8

pressured speech

Answer 8

fast, ranging from rapid to frantic that conveys an inappropriate sense of urgency.

Question 9

circumstantial speech

Answer 9

adding unnecessary details when communicating with others. The person eventually gets to the point

Question 10

tangential speech

Answer 10

similar to circumstantial speech, main difference is that the person loses their point that they were trying to make and never find it again.

Question 11

loose associations

Answer 11

thoughts are only loosely connected to each other in the person’s conversation.

Question 12

flight of ideas

Answer 12

continuous flow of accelerated speech with abrupt changes from topic to topic.

Question 13

clang associations

Answer 13

stringing together of words because of their rhyming sounds, without regard to their meaning.

Question 14

assessment: depressive state

Answer 14

• Mood: depressed mood, anhedonia
• Affect: flat, blunted, constricted
• Behavior: anergia, vegetative signs of depression
• Thought processes: difficulty with problem solving, difficulty thinking clearly, poor judgement, indecisiveness, poor memory and concentration,
• Cognitive changes: helplessness, difficulty completing simple tasks, hopelessness, suicidal ideation, anger, irritability, low self-esteem, worthlessness

Question 15

manic patient

self assessment

Answer 15

Manic patient

• Manipulative
• Demanding
• Splitting

Staff member actions
- Frequent staff meetings to deal with patient behavior and staff response
Set limits consistently

Question 16

assessment guidelines for bipolar disorder

Answer 16

Danger to self or others
Need for protection from uninhibited behaviors
Need for hospitalization
Medical status
Coexisting medical conditions
Family’s understanding

Question 17

nursing diagnosis

Answer 17

Risk for injury

Risk for violence

• Other-directed
• Self-directed

Ineffective coping

Question 18

outcomes identification

Answer 18

Acute phase
- Prevent injury- make sure pt. is safe

Continuation phase
- Relapse prevention- minimize s/s

Maintenance phase
- Limit severity and duration of future episodes

• treatting psychotherapy meds
• manoa: high protein snacks and sleeping
• monitor vitals
• no self harm behaviors

Question 19

planning

Answer 19

Medical stabilization
Maintaining safety
Nursing care

Question 20

planning manic phase

Answer 20

• Managing medications
• decreasing physical activity
• increasing food and fluid intake
• ensuring at least 4 to 6 hours of sleep per night
• intervening so that self-care needs are met
• Seclusion, restraint, or electroconvulsive therapy (ECT) may be considered during the acute phase.

Question 21

planning during depressive phase

Answer 21

• Reduction of depressive symptoms
• restoration of psychosocial and work function
• hospitalization may be required
• medication or biological treatments
• prevention of relapse
• prevention of further episodes of depression

Question 22

implementation depressive episodes

Answer 22

• Hospitalization for suicidal, psychotic, or catatonic signs
• Medication concerns about bringing on a manic phase

Question 23

manic episodes implementation

Answer 23

• Hospitalization for acute mania (bipolar I disorder)
• Communicating challenges and strategies
• be direct with limits

Question 24

lithium carbonate use

Answer 24

mood stabilizer

Question 25

lithium therapeutic level

maintenance blood level

Answer 25

Therapeutic blood level: 0.8 to 1.4 mEq/L

Maintenance blood level: 0.4 to 1.3 mEq/L

Question 26

lithium toxic level

Answer 26

Toxic blood level: 1.5 mEq/L and above

• need blood test every 5d

Question 27

lithium contraindications

Answer 27

• assess renal function and thyroid status
• cardiovascular disease
• pregnant women
• breast feeding mothers

Question 28

Anticonvulsant Mood Stabilizers

Answer 28

Valproate (Depakote)

• better than lithium
• used for acute mania and maintain depression, rapid cycling
• monitor platelets & lsts

Carbamazepine (Tegretol)
Lamotrigine (Lamictal)

Question 29

Second-Generation Antipsychotics

Answer 29

Olanzapine (Zyprexa)
Risperidone (Risperdal)

with lithium for severe agitation

Question 30

Medications for Bipolar Depression

Answer 30

• Treatment of bipolar with a common antidepressant alone increases the risk of bringing on a manic episode, risk vanishes with a combination of an antidepressant and mood stabilizer
• Second-generation antipsychotics: lurasidone (Latuda) and quetiapine (Seroquel)
• Symbyax: made up of the second- generation antipsychotic olanzapine (Zyprexa) and SSRI fluoxetine (Prozac)
• antidepressant and mood stabilizer due to being manic from anti