24. Bipolar Disorder Flashcards
(42 cards)
abnormally and persistently elevated mood, expansive mood, or irritable mood
mania
euphoria or elation
elevated mood
lack of restraints in expression; overvalue self-importance
expansive mood
easily annoyed and provoked to anger
irritable mood
sxs of manic episode
- a lot of energy
- constantly engaged in risky behaviors (regardless of consequences)
- accelerated thinking and pressured speech
- excessive involvement in pleasurable activities (gambling, shopping, sex)
disorder involving periods of severe mood episodes from mania to depression
bipolar I disorder
disorder with a milder form of mood elevation involving mild episodes of hypomania that alternated w/ severe depression
bipolar II disorder
disorder involving hypomania and depressive episodes that don’t meat full criteria for major depressive episode
cyclothymic disorder
how does bipolar manifest in children and adolescents
- depression usually occurs first marked by intense rage
- sxs reflective of developmental level of child
how does bipolar manifest in older adults
- greater neurologic abnormalities and cognitive disturbances
- incidence of mania decreased w/ age
epidemiology of bipolar
- sxs before age 25
- no gender differences
- female patient at greatest risk for depression and rapid cycling than male patients
- male patients at greatest risk for manic episodes
- common comorbid conditions: anxiety (panic disorder and social phobia) and substance use
biologic theories of bipolar
- chronobiologic theories (sleep disturbances common during manic phase; seasonal changes)
- genetic factors
- chronic stress and kindling (role of stress in cognitive impairment associated w/ disorder)
psychosocial theories of bipolar
focus on reducing environmental stress and trauma in genetically vulnerable individuals
biologic nursing assessment for bipolar
- changes in eating, sleeping, and activity
- diet and body weight
- thyroid function testing
- changes in sexual practice
- pharmacologic assessment (substances or previous treatment with antidepressants)
psychosocial nursing assessment for bipolar
- mood and cognition
- thought disturbances
- stress and coping
- risk assessment
- cultural views of mental illness
- social and occupational changes
- any changes resulting from a manic or depressive episode
strength assessment for bipolar
- healthy behaviors
- cues for manic or depressive episodes
- family, friends, and social support
- understanding of illness
- relaxation skills
- stress management skills
- medications
goals of tx for bipolar
- minimize and prevent manic or depressive episodes
- help pt and family learn about disorder and manage it throughout lifetime
priority care issue for bipolar
safety
how to establish therapeutic relationship w/ someone w/ bipolar
- use calm non-threatening approach
- be direct and use single commands
- avoid open-ended sentences; redirect if flight of ideas occur
- limit interaction time
- avoid excessive demands
psychosocial nursing interventions for bipolar
- identify risk factors
- teach about disorder
- relapse prevention (emergency plan)
- individual CBT
- individual interpersonal therapy
- adjunctive theapies
- psychotherapy
- support group
- family interventions (parenting skills, counseling and intensive family therapy)
- family psychoeducation
mental health promotion during periods of remission in bipolar
- teach stress management
- practice relaxation techniques
- develop plan for managing emerging sxs
spectrum of care for bipolar
- inpatient management
- intensive outpatient programs (partial hospitalization or day hospitalization)
biologic nursing interventions for bipolar
- protection from self-harm and harm from other patients
- education about physical care (sleep and nutrition)
- mood stabilizers
- antipsychotics (adjunct or monotherapy)
examples of mood stabilizers
- lithium: gold standard for tx
- anticonvulsants
- atypical antipsychotics
- ECT (severe mania)
