Flashcards in Bipolar Disorder Deck (40):
3 Kinds of Bipolar Disorders?
Bipolar I disorder
Bipolar II disorder
A period of abnormality and persistently elevated, expansive, or irritable mood for at least: one week and present for the most of the day?
Bipolar I disorder
During the period of mood disturbance for Bipolar I disorder, three or more of the following symptoms occur?
- Inflated self esteem or grandiosity.
- Decrease need for sleep (3 hours only).
- Pressure of talk. Flight of ideas. Distractibility.
- Psychomotor agitation or increase in goal directed activity.
- Excessive involvement in pleasurable activities*
A period of abnormality and persistently elevated, expansive, or irritable mood for at least: four consecutive days and present for the most of the day, nearly every day?
Bipolar II disorder
During the period of mood disturbance for Bipolar II disorder, three or more of the following symptoms occur?
Inflated self esteem or grandiosity.
Decrease need for sleep (3 hours only).
Pressure of talk. Flight of ideas. Distractibility.
Psychomotor agitation or increase in goal directed activity.
Excessive involvement in pleasurable activities
S/S of Mania?
- Impairment in occupational, social activities and relationship.
- Symptoms are severe.
- Hospitalization is needed
S/S of Hypomania?
- Absence of marked impairment in social or occupational functioning.
- Symptoms are less severe.
- Hospitalization is not indicated.
Most severe type of bipolar disorder?
hypomanic episodes which alternate with minor depressive episodes of at least 2 yrs in duration?
Factors causing bipolar disorder?
- Biological factors
- Genetic factors
- Neurobiological factors
- Neuroendocrine factors:
- Hypothyroidism (rapid cycling).
Most common concurrent disorders seen in bipolar disorders?
Rapid mood shifts are called
a rapid flow of thought, manifested by accelerated speech with abrupt changes from topic to topic?
Flight of ideas
Thought processing during mania episodes?
- Flight of ideas
- Pressure of speech
- Talking often includes joking, playing on words and teasing
- Clang association
Ex. Cut your throat, get your goat
- Highly distractible
- Delusion of grandeur and persecution
- Hallucination may occur
For acute mania, focus should be on what?
prevention of exhaustion and death from cardiac collapse
Planning during the Acute Phase?
- medically stabilizing the client while maintaining safety.
- Seclusion and ECT may be required.
Planning during the continuation phase?
- Compliance with the medication regimen and prevent relapse.
- Specific psychotherapy is needed to address clients interpersonal problems.
Planning during the Continuation phase duration?
Planning during the maintenance phase?
- Preventing relapse.
- Psychotherapy, support/psycho-educational groups, and periodic evaluation.
Interventions during the Acute Phase?
- Redirect energy into more constructive channels
- Be consistent in approach and expectations
- Maintain low level of stimuli
First choice of tx for acute mania?
Lithium is particularly effective in reducing the following:
Elation and grandiosity
Flight of ideas.
Irritability and anxiety
To a lesser extent, lithium controls:
Threatening or assaultive behavior
Tx of Acute Mania
- Start with antipsychotic or benzodiazepine to help calm manic symptoms.
- Lithium must reach therapeutic blood level to be effective
How long does it take for Lithium to reach therapeutic levels?
> 7 or more days.
Lithium level should not exceed?
Lithium effective range?
0.6 to 0.8 mEq/L
S/S of Lithium toxicity
Nausea, vomiting, diarrhea, thirst, polyuria, slurred speech, muscle weakness.
Intervention(s) for early signs of Lithium Toxicity?
- Medication should be withheld.
- Blood level lithium measured.
- Dosage reevaluated.3
Early signs of Lithium toxicity can occur at what range?
Severe Lithium Toxicity occurs at what range?
2.0 - 2.5 mEq/L
Intervention(s) for severe Lithium Toxicity?
- There is no specific antidote for lithium poisoning.
- drug is stopped and the excretion is hastened.
- If alert, an emetic.
- If not, gastric lavage and treatment with urea, mannitol, aminophylline to hasten lithium excretion.
How often are blood levels of Lithium initially measured?
weekly and biweekly
After six months to a year of stability while taking Lithium, measure blood levels?
every three months.
How long after Lithium dosing should the blood be drawn?
8 to 12 hours after the last dose of lithium is taken.
How long are bipolar patients on Lithium?
9-12 moths or used for life long maintenance
Patient and family teaching for Lithium Therapy?
- Monitor lithium blood levels very closely, more frequently at first, then once every several months after that.
- Normal diet with normal salt and fluid intake (1500-3000 mL/day or six 12 oz glasses of fluid).*
- You should stop taking lithium if you have diarrhea, vomiting, or sweating.**
- Avoid taking diuretics while you are taking lithium
- Kidney and thyroid check periodically.
I- f you gain a lot of weight, contact your doctor
Contraindications for Lithium Therapy?
- cardiovascular disease.
- brain damage, renal disease, thyroid disease.
- Women who are pregnant.
- Mothers who are breastfeeding.
- Children younger than 12 years of age.
ECT used for?
- treatment resistant mania/depression
- instances of rapid cycling
- mania during pregnancy
- suicidal patients