Bipolar and Related Disorders

Question 1

examples of anticonvulsant mood stabilizers

Answer 1

–sodium valproate/divalproex sodium/valproic acid
–carbamazepine
–lamotrigine
–gabapentin

Question 2

examples of antipsychotics

Answer 2

–olanzapine
–risperidone
–aripiprazole
–quetiapine

Question 3

examples of benzos

Answer 3

–diazepam
–lorazepam

Question 4

who is more likely to experience bipolar I?

Answer 4

males

Question 5

who is more likely to have bipolar II?

Answer 5

females

Question 6

when does cyclothymia start?

Answer 6

usually begins in adolescence or early adulthood

Question 7

when can bipolar start?

Answer 7

onset can begin at any age

Question 8

neurotransmitters connected with bipolar disorder

Answer 8

–norepi
–dopamine
–serotonin

Question 9

neurobiological factors of bipolar disorder

Answer 9

–prefrontal cortical region
–hippocampus
–amygdala

Question 10

neuroendocrine of bipolar disorder

Answer 10

hypothalamic-pituitary-thyroid-adrenal (HPTA) axis

Question 11

clinical picture of bipolar I

Answer 11

–most severe form
–highest mortality rate of the three
–at least 1 manic episode

Question 12

clinical picture of bipolar II

Answer 12

–at least 1 hypomanic episode
–at least 1 major depressive episode

Question 13

clinical picture of cyclothymic disorder

Answer 13

–alternate with symptoms of mild to moderate depression for at least 2 years
–rapid cycling possible

Question 14

diagnostic criteria for bipolar I

Answer 14

–abnormally and persistently elevated, expansive, or irritable mood and goal directed activity or energy, for a duration of 1 week
–three or more of symptoms:
(1) inflated self-esteem or grandiosity
(2) decreased need for sleep
(3) more talkative than usual or pressure to keep talking
(4) flight of ideas or subjective experience that thoughts are racing
(5) distractibility
(6) increase in goal-directed activity or psychomotor agitation
(7) excess involvement in pleasurable activities with high potential for painful consequences
marked impairment in social or occupational functioning

Question 15

characteristics of bipolar I disorder

Answer 15

–at least one manic episode
–symptoms of alternating manic episodes with MDE and/or hypomanic episodes
–psychotic episode or MDE may be absent over the lifetime of the person, but would be unusual
–the more manic episodes that occur the more intense they are
–highs mirror the lows in depth and intensity

Question 16

DIG FAST (mania)

Answer 16

D-distractibility
I- indiscretion
G-grandiosity
F-flight of ideas
A-activity increase
S-sleep deficit
T-talkativeness

Question 17

mood lability

Answer 17

rapid extreme mood swings with irritability or sudden outburst of misplaced rage

Question 18

behaviors of mania

Answer 18

–mood lability
–quick to anger/feels misunderstood/low frustration tolerance
–pacing
–uses jokes, puns
–flamboyant or sexually suggestive dress

Question 19

characteristics of bipolar II

Answer 19

–presence or history of at least one major depressive episode
–presence or history of at least one hypomanic episode
–never had a manic episode
–impairment in functioning in at least one area
–no psychosis with hypomania but may have during the depressive phase

Question 20

mixed features

Answer 20

symptoms of both depression and mania occur at the same time

Question 21

with rapid cycling

Answer 21

–four or more manic episodes for at least 2 weeks in 12 months
–partial or full remission for 2 months at a time or switch to opposite episode
–high risk of recurrence
–resistant to drug therapy
–greater severity of illness
–depressive symptoms predominate

Question 22

hypomanic episode criteria

Answer 22

same for manic except…
–associated with a definite noticeable change in functioning uncharacteristic for the individual
–NOT severe enough to cause a marked impairment in social or occupational functioning or hospitalization
–no psychotic features in this phase
–elevated, expansive, or irritable mood for at least 4 days

Question 23

specifics of cyclothymic disorder

Answer 23

–presence for at least 2 years in adults
–multiple hypomanic symptoms but not hypomanic episode
–depressive symptoms but no MDE, manic, and mixed episodes
–symptoms present more than half the time; has not been without symptoms for more than 2 months at a time
–fluctuating hypomanic and depressive symptoms
–rapid cycling possible

Question 24

mood cues for bipolar

Answer 24

–mania
–hypomania
–depression
–lability

Question 25

behavior cues for bipolar

Answer 25

--agitated --manipulative --restless --pacing

Question 26

thought process cues for bipolar disorders

Answer 26

--loose --tangential --flight of ideas

Question 27

thought content cues for bipolar

Answer 27

--grandiose --paranoid --persecutory delusions

Question 28

speech pattern cues for bipolar

Answer 28

--pressured --circumstantial --clang

Question 29

cognitive functioning cues for bipolar

Answer 29

deficits possible

Question 30

primary outcome goal for the manic phase

Answer 30

injury prevention

Question 31

nursing care for acute mania

Answer 31

--managing meds --decreasing physical activity --increasing food and fluid intake --ensuring at least 4-6 hours of sleep per night --intervening for self-care needs and setting limits on behavior

Question 32

patient/family teaching for bipolar disorder

Answer 32

--chronic and episodic nature --treatment requires one or more mood stabilizing agents taken a long time --expected side effects or toxic effects of med --s/s of relapse that may "come out of the blue" --role of family members and others in preventing a full relapse --phone numbers of emergency contacts --no drugs, alcohol, or caffeine --good sleep hygiene --coping strategies --group and individual therapy

Question 33

examples of mood stabilizers

Answer 33

--lithium plus an antipsychotic --divalproex/valproate plus antipsychotic

Question 34

examples of atypical antipsychotics

Answer 34

--risperidone --quetiapine --aripiprazole --olanzapine --ziprasidone

Question 35

examples of benzos

Answer 35

--diazepam --lorazepam --clonazepam

Question 36

indications for lithium carbonate

Answer 36

acute mania and maintenance treatment

Question 37

contraindications for lithium

Answer 37

--CV disease --renal disease --brain damage --thyroid disease --pregnant or breast feeding mothers

Question 38

onset for lithium

Answer 38

5-7 days, may take as long as 2 weeks

Question 39

action of lithium

Answer 39

--uncertain --crosses cell membranes --alters sodium transport --not protein-bound

Question 40

lab measurement with lithium

Answer 40

initial labs 1-2x per week then... --CR, thyroid, and CBC q 6 months --kidney damage a risk --thyroid function may decrease (6-18 months) -- dry skin, hair loss, constipation, bradycardia, cold intolerance

Question 41

teaching points for lithium

Answer 41

--risk of SI when Li+ discontinued --do not restrict sodium --hydrate (if ill and cannot take in, contact MD) --intermittent blood tests required

Question 42

teaching for valproate/divalproex

Answer 42

--check serum levels --broader spectrum of efficacy --longer periods of mood stabilization

Question 43

teaching for carbamazepine

Answer 43

--risk of low WBCs --check hepatic and renal function --effective in pts who have no response to lithium or with secondary mania --rash may be life threatening

Question 44

teaching for lamotrigine

Answer 44

--for rapid cycling and depressed phase of bipolar --rash may be life threatening --used as add-on therapy in refractory mood disorders

Question 45

gabapentin use

Answer 45

may be effective for acute mania, mood stabilization, and rapid cycling

Question 46

warnings about lamictal rash

Answer 46

--stop med immediately --can advance to Steven Johnson Syndrome --flu like symptoms --sore throat, fever, chills, blisters, burning eyes --allergic reaction --can further advance to toxic epidermal necrosis

Question 47

ECT usage

Answer 47

--used to subdue severe manic behavior --useful with treatment-resistant mania and patients with rapid cycling --more effective than drug-based therapy for treatment-resistant bipolar depression --depressive episodes