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Flashcards in 5 Bipolar Disorder Deck (85):
1

Bipolar disorder is characterized by __ __ from profound __ to extreme __ with intervening periods of __.

mood swings
depression
euphoria
normalcy

2

Can delusions be present for someone with bipolar disorder?

YES

3

Onset of symptoms of bipolar disorder may have a __ __

seasonal pattern

4

What are the 5 bipolar disorder diagnoses?

1. Bipolar I
2. Bipolar II
3. Cyclothymic Disorder
4. Substance/Medication Induced Bipolar Disorder
5. Bipolar Disorder due to another Medical Condition

5

Bipolar disorder affects ~ __ million or __% of adults in the US

5.7
2.6

6

Is bipolar disorder more prevalent in women or men?

EQUALLY prevalent in both men and women

7

What is the average age of onset of bipolar disorder ?

early 20's

8

Bipolar disorder tends to be recurrent following __ _ ___

first manic episode

9

Etiology
Bipolar Disorder is ... (4)

1. genetic
2. biochemical
3. neuroanatomical factors
4. medication/drug induced

10

Genetic Factors Prevalence of bipolar disorder in the general population:

2.6%

11

Genetic Factors Prevalence of bipolar disorder in monozygotic twins:

60-80%

12

Genetic Factors Prevalence of bipolar disorder in dizygotic twins

10-20%

13

Genetic Factors Prevalence of bipolar disorder in child of 1 parent with bipolar disorder:

28%

14

Genetic Factors Prevalence of bipolar disorder in child of 2 parents with bipolar disorder

50-60%

15

Is there an excess or deficiency of DOPAMINE in:
A) Mania
B) Depression

A) Mania - EXCESS
B) Depression - DEFICIENCY

16

Is there an excess or deficiency of NOREPINEPHRINE in:
A) Mania
B) Depression

A) Mania - Excess
B) Depression - Deficiency

17

Is there an excessive or inadequate amount of CHOLINERGIC TRANSMISSION in:
A) Mania
B) Depression

A.) Mania - Inadequate
B.) Depression - Excessive

18

Neuroanatomical Factors for Bipolar Disorder:
__-sided lesions in: (4) areas

right

1. limbic system
2. temporobasal areas
3. basal ganglia
4. thalamus induced mania

19

Neuroanatomical Factors for Bipolar Disorder:
enlarged __ __

third ventricles

20

Neuroanatomical Factors for Bipolar Disorder:
__ __ __

subcortical white matter

21

Neuroanatomical Factors for Bipolar Disorder:
__ __

periventricular hyperintensities

22

Medications for bipolar disorder (4)

1. steroids
2. amphetamines
3. antidepressants
4. narcotics

23

Manic episode is defined as at least __ __ period of elevated, expansive or irritable mood

1 week

24

A manic episode causes __ __ , i.e. ____

marked impairment
hospitalization

25

manic episode is not attributable to __, ___, and __ __

substances
medications
medical conditions

26

What are 8 symptoms of a manic episode?

1. inflated self-esteem/grandiosity
2. decreased need for sleep
3. talkative/pressured speech
4. flight of ideas/racing thoughts
5. distractibility
6. increase in goal directed activity
7. excessive involvement in activities with high potential for painful consequences
8. agitation, irritability, aggression

27

A hypomanic episode is a __ day period of elevated, expansive, or irritable mood

4

28

A hypomanic episode is an episode where there is a __ in __

change in behavior

29

In a hypomanic episode, the disturbance in mood and change in functioning are...

observable by others

30

In a hypomanic episode, is it severe enough to cause marked impairment in functioning?

NO

31

A hypomanic episode is OR is not attributable to a substance/medication, medical condition?

IS NOT

32

Bipolar I and II Distinguishing Factors:

Manic Episode

A) Bipolar I
B) Bipolar II

A) Yes at least 1 week duration

B) NO

33

Bipolar I and II Distinguishing Factors:

Hypomanic Episode

A) Bipolar I
B) Bipolar II

A) n/a

B) Yes at least 4 days duration

34

Bipolar I and II Distinguishing Factors:

Major Depressive Episode

A) Bipolar I
B) Bipolar II

A) May be present and must be at least 2 weeks

B) Yes at least 2 weeks

35

Bipolar I and II Distinguishing Factors:

Marked impairment in functioning

A) Bipolar I
B) Bipolar II

A) Yes (i.e. hospitalization)

B) No (hospitalization)

36

Name this disorder.
Chronic, fluctuating mood disturbance of at least 2 years duration

Cyclothymic Disorder

37

Cyclothymic Disorder has numerous periods of __ __ (does not meet criteria for hypomanic episode)

elevated mood

38

Cyclothymic Disorder has numerous periods of __ __ (does not criteria to meet MDD)

depressed mood

39

In a client with Cyclothymic Disorder, there is never without symptoms for more than __ __

2 months

40

Substance/Medication-Induced Bipolar Disorder is a direct result of __ __ of a substance (__ or __)

physiological effects

ingestion; withdrawal

41

Substance/Medication-Induced Bipolar Disorder causes significant __ or __

distress
impairment

42

Bipolar disorder in children and adolescents is __ to diagnose

difficult

43

Bipolar disorder in children and adolescents may present with co-morbid __ __ or ___

co-morbid conduct disorders or
attention deficit/hyperactivity disorder (ADHD)

44

Children of __ parents at higher risk for bipolar disorder

bipolar

45

Lifetime risk of suicide in individuals with bipolar disorder is __ times that of the general population

15

46

If the person has a past history of __ __, increases suicide risk in bipolar disorder

suicide attempt

47

Bipolar I lifetime prevalence rates of suicide attempts

32.4%

48

Bipolar II lifetime prevalence rates of suicide attempts

36.3%

49

Nursing diagnoses for bipolar disorder (7)

1. risk for injury
2. risk for violence: self directed or other directed
3. imbalanced nutrition
4. disturbed through processes
5. disturbed sensory perception
6. impaired social interaction
7. insomnia

50

9 nursing interventions for bipolar disorder

1. ensure safety of self and others
2. reduce environmental stimuli
3. remove hazardous object
4. stay with client who is hyperactive and agitated (may need 1:1)
5. provide structure
6. limit group activities
7. administer tranquilizing medications as prescribed
8. limit setting
9. mechanical restraints or seclusion

51

seclusion and restraints are initiated only when ....

less restrictive measure have proven ineffective

52

seclusion and restrains are used when ...

behavior poses serious and imminent danger to the person, staff or others

53

There must be a face evaluation by a MD, NP, RN, PA within _ __ of restraint

1 hour

54

There must be a new order of seclusion/restraints made every __ __ for an adult and every __-__ __ for children and adolescents

4 hours

1-2 hours

55

There should be __ __ checks or a 1:1 for a person in seclusion or on restraints

15 minute checks

56

RN must at least monitor __ for someone on restraints/in seclusion

hourly

57

__ is done for someone on seclusion/restraints

debriefing

58

what are the treatments for bipolar disorder? (4)

1. psychopharmacology
2. psychotherapy
3. recovery model
4. ECT

59

What two drug classes are used to treat someone with bipolar disorder?

1. mood stabilizers
2. anticonvulsants

60

What mood stabilizer is used for someone with bipolar disorder ?

lithium carbonate (Eskalith, Lithobid)
(most commonly used)

61

What anticonvulsants are used for someone with bipolar disorder? (7)

1. Tegretol (Carbamazepine)
(most commonly used)
2. Klonipin (Clonazepam)
3. Depakene, Depakote (Valproic Acid) (most commonly used)
4. Lamictil (Lamotrigine) (most commonly used)
5. Neurontin (Gabapentin)
6. Topamax (Topiramate)
7. Trileptal (Oxcarbazepine)

62

Which antipsychotics are used for someone with bipolar disorder? (7)

1. Olanzapine (Zyprexa)
2. Chlorpromazine (Thorazine)
3. Quetiapine (Seroquel)
4. Risperdone (Risperdal)
5. Ziprasidone (Geodone)
6. Asenapine (Saphris)
7. Lurasidone (Latuda)

63

__ and the __ may take 1-3 weeks (more with __/__) to take effect

Lithium
anticonvulsants
Lamictil/Lamotrigine

64

Patient with mania started on a mood stabilizer needs __ treatment with an __ and/or a __ until symptoms start to resolve

adjunctive

antipsychotic

benzodiazepine

65

Lithium normal ranges:
1.) Acute mania
2.) Maintenance

1. 1.0-1.5 mEq/L
2. 0.6-1.2 mEq/L

66

What are the 8 Lithium side effects?

1. Drowsiness, dizziness, headache
2. Dry mouth, thirst
3. GI upset nausea/vomiting
4. Fine hand tremors
5. Polyuria, dehydration
6. Weight gain
7. Acne
8. Lithium toxicity

67

Lithium toxicity is __ __ and can cause:
1.)
2.)
3.)

life threatening
1.) renal impairment
2.) nephrogenic diabetes insipidus
3.) hypotension, arrhythmias, pulse irregularities

68

Symptoms when Lithium serum levels are between 1.5-2.0

1. blurred vision
2. persistent nausea
3. vomiting
4. severe diarrhea

69

Symptoms when Lithium serum levels are between 2.0-3.5

1. excessive output of dilute urine
2. increasing tremors
3. muscular irritability
4. psychomotor retardation
5. mental confusion
6. giddiness

70

Symptoms when Lithium serum levels are above 3.5

1. impaired consciousness
2. nystagmus
3. seizures
4. coma
5. oliguria/anuria
6. arrhythmias
7. MI
8. cardiovascular collapse

71

Lithium lab tests before initiation of treatment

1. kidney, thyroid function
2. ECG after 50
3. weight, BMI

72

Lithium lab tests during initiation of treatment

1. 1-2 weeks until stable
2. monthly first 6 months

73

Lithium lab tests during maintenance treatment

1. every 3-6 months
2. kidney function 1-2 times/year

74

Important side effects of Valproic Acid (Depakote)

1. sedation
2. weight gain
3. hepatotoxicity with liver failure
4. pancreatitis
5. prolonged bleeding time

75

Important side effect of Lamotrigine (Lamictil)

Steven Johnson's Syndrome

76

Important side effects of Carbamazepine (Tegretol)

1.) Steven Johnson's Syndrome
2.) Aplastic anemia
3.) hyponatremia

77

lab tests done for tegretol (Carbamazepine) during:
1. initiation
2. treatment

1. CBC, liver, kidney, thyroid function
2. CBC every 2 weeks for 2 months, then every 3-6 months, liver, kidney, and thyroid function every 6-12 months

78

lab tests done for depakote (valproic acid) during:
1. initiation
2.How often are these tests done?

1. Platelet count, liver function test, weight

2. every 6 months

79

Any lab tests done for Lamictil (Lamotrigine)?

NOPE

80

What should your teaching include about lithium treatment? (9)

1. sodium intake
2. exercise
3. adequate fluid intake: 2,500-3,000 ml/day
4. monitor weight
5. take lithium as prescribed
6. carry card or ID noting that he or she is taking Lithium
7. symptoms of toxicity
8. use caution with driving until stable
9. contraceptive use

81

What should you include when teaching about anticonvulsants?

1. do not stop medication abruptly
2. Report any: skin rash, unusual bleeding, bruising, sore throat, fever, malaise, dark urine, yellow skin or eyes
3. carry card identifying the name of medication
4. use caution with driving until stable
5. laboratory testing

82

What should you include when teaching about antipsychotics?

1. do not discontinue abruptly
2. use sunblock
3. orthostatic hypotension
4. stay hydrated
5. good oral care
6. avoid ETOH
7. contraceptives
8. carry card identifying med
9. caution driving
10. report if you experience symptoms (on separate flash card)

83

When should you report immediately when taking antipsychotics?

When you experience:
1. sore throat, fever, malaise
2. unusual bleeding, bruising
3. persistent n/v
4. severe headache
5. rapid HR
6. muscle twitching;tremors
7. dark colored urien
8. excessive hunger
9. pale stools
10. muscle uncoordination
11. skin rash
12. yellow skin or eyes

84

What types of psychotherapy are there for someone with bipolar disorder? (5)

1. interpersonal and social rhythm therapy (IPSRT)
2. family therapy
3. CBT
4. individual therapy
5. group therapy: the person is stable

85

What does the recovery model consist of for bipolar disorder? (7)

1. knowledge about bipolar disorder
2. take medications as prescribed
3. awareness of early symptoms
4. family awareness of early symptoms
5. develop emergency plan
6. identify and reduce stress
7. develop a personal support system