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Psychiatric Mental Health Nursing > Bipolar/Mania > Flashcards

Bipolar/Mania Flashcards

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1
Q

what was the old name for bipolar/mania?

A

manic depression

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2
Q

what is criteria for manic episode?

A

intense alteration in mood- expressed by feelings of elevated, expansive, irritable, persistently increased goal-directed activity or energy, boundless self-confidence, can change quickly to irritation and anger, creates many plans/goals, but are unable to fulfill them

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3
Q

how long does a manic episode need to last for it to fit the criteria?

A

lasting at least 1 week, most of the day, and nearly every day

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4
Q

what needs to be ruled out for a manic episode to fit criteria?

A

not due to medications, such as corticosteroids, stimulants, and methamphatamines, substances, and other diseases

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5
Q

what are the side effects of mania?

A

needs to have at least 3 of the following symptoms to meet the criteria

inflated self-esteem on grandiosity (no filter)- grandiose delusion and persecutory delusions
decreased need for sleep can be some sleep or no sleep)- usually won’t take time to eat well, so it can lead to unintentional weight loss/malnourished
more talkative-usually pressured speech; often circumstantial and tangential
flight of ideas, racing thoughts- loose associations/clang association
distractibility
increase in goal-directed activity (work, school, sexual)/psychomotor agitation- unable to stop moving
excessive involvement in activities that have high potential for painful consequences- can cause financial difficulties (maxing out credit cards), unprotected sex, drugs, and risky behavior

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6
Q

what is hypomania?

A

euphoric- increased functioning; excessive activity- energy for at least 4 days/at least 3 of criteria of mania met
episode is change for person and is observable by others
episode is not severe enough to impair functioning or require hospitalization
no psychosis with manic portion
not attributable to substance use
criteria for bipolar disorder 2

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7
Q

what are bipolar disorders?

A

mood swings from profound depression to extreme euphoria (mania), with intervening periods of normalcy
impair occupational functioning or usual social activities or relationships- may require hospitalization to prevent harm to self/others

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8
Q

what are three types of bipolar disorders specturm?

A
  1. bipolar 1
  2. bipolar 2
  3. cyclothymic
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9
Q

what is bipolar 1 disorder?

A

full syndrome of manic symptoms- risk for exhaustion
usually alternate with episodes of depression/anxiety and agitation
psychosis is possible- auditory hallucinations are most common
high risk for suicide d/t impulsivity; do not think about their actions and have poor insight

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10
Q

what are some comorbidities of bipolar 1 disorder?

A

anxiety disorder
ADHD
impulse control
conduct disorder
substance abuse disorder >50%
higher medical issues

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11
Q

what is bipolar 2 disorder?

A

major depression with episodic occurrence of hypomania (less severe/dramatic than mania episode)
has never met criteria for full manic episode
does not have psychosis unless they develop depression

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12
Q

what are comorbidities with bipolar 2 disorder?

A

anxiety disorders
eating disorders (binge eating)
substance use disorders

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13
Q

what is cyclothymic disorder?

A

symptoms of hypomania alternating with mild to moderate depression for at least 2 years (adults)
do not meet criteria for other types- yet disturbing enough to affect functioning

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14
Q

what are the comorbidities of cyclothymic disorder?

A

substance use disorder
sleep disorder
ADHD

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15
Q

what is bipolar disorder with rapid cycling?

A

at least 4 episodes in 12 month period
more severe symptoms- resistant to treatment

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16
Q

what changed to disruptive mood dysregulation disorder?

A

childhood bipolar

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17
Q

if a child/teen has true bipolar, then what are they at risk for?

A

high risk for suicide

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18
Q

what are the developmental implications for childhood bipolar?

A

frequency- symptoms occur most days in a week
intensity- symptoms are sever enough to cause extreme disturbances
number- symptoms occur 3 to 4 times a day
duration- symptoms occur 4 or more hours a day

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19
Q

what are the risk factors for bipolar disorder (mania)?

A

genetic- strong hereditary implications (if parents have it, then a person has a 20% chance of developing it), ANK3 and CACNA1C

biochemical influences- excess of norepinephrine and dopamine; low serotonin; acetylcholine (too much in depression, not enough in mania)

electrolyte imbalance

brain structure and function- grey matter loss causing dysfunction in the prefrontal cortex region, hippocampus, and amygdala; neuroendocrine causing a dysfunction in hypothalamic, pituitary-thyroid adrenal axis, and inflammation activation

psychosocial theories- credibility of psychosocial theories has declined in recent years; disease of brain; psychosocial issues play a role in triggering episodes, but not causative factor

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20
Q

what are some potential bipolar triggers?

A

stressful experiences
physical illnesses
seasonal changes in weather
some medicines
recreational drugs

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21
Q

what are treatments for bipolar disorder (mania)?

A

psychopharmacology medications first

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22
Q

what are examples of mood stabilizing medication/antimanic medications?

A

lithium carbonate (Lithium, Lithobid, Eskalith CR)

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23
Q

what is the mechanism of action of lithium?

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A

it is mostly unknown, but it enhances the reuptake of norepinephrine and dopamine, which causes lowering levels in the body to decrease the hyperactivity

it is neuroprotective, which means the person will have a decreased of suicide

24
Q

how long does it take for lithium to start working?

25
what are contraindications of lithium?
cardiac or renal disease dehydration sodium depletion pregnancy or lactation
26
what are some cautions when taking lithium?
thyroid problems diabetes urinary retention history of seizures elderl
27
what are some baseline labs that need to be checked when taking lithium?
renal function thyroid profile electrolytes, including Mg+
28
what are the side effects of lithium?
side effects are dose related expected side effects- subside during treatment: drowsiness dizziness headache dry mouth thirst GI upset N/V/D fine hand tremors polyuria dehydration weight gain
29
what is lithium's therapeutic range?
0.6-1.2 mEq/L
30
when does lithium toxicity begin to appear?
levels around 1.5 mEq/L
31
what are the early symptoms of lithium toxicity when range is 1.5-2.0 mEq/L?
ataxia tinnitus persistent N/V severe diarrhea thirst confusion coarse hand tremor
32
what are the symptoms of lithium toxicity when the range is 2.0-2.5 mEq/L?
blurred vision ataxia giddiness seizures excessive dilute urine output stupor hypotension patient will need hospitalization
33
what are the symptoms of lithium toxicity when the lithium level is severe > 2.5 mEq/L?
impaired consciousness seizures coma oliguria/anuria dysrhythmia MI/cardiovascular collapse death the patient will likely need hemodialysis
34
what is a tremor?
involuntary muscle contraction/twitching- usually in hands
35
what are fine tremors?
expected when taking lithium/antimanic medication usually in the hands usually symmetric can improve spontaneously
36
what are coarse tremors?
signs of toxicity more irregular and severe more widespread (affecting other body parts) associated with other symptoms of toxicity
37
what is the treatment of tremors?
reducing caffeine keep lithium levels in low-medium range propranolol vitamin B6
38
what is the patient/family teaching and education for lithium?
must get levels drawn monthly need consistent sodium intake- 2 grams a day- if sodium intake is reduced or the body depletes sodium (excessive sweating, fever) lithium is reabsorbed by kidneys, increasing chances of toxicity patients need to have adequate sodium and fluid intake- 1500-3000 mL/day- avoid dehydrating fluids and call the doctor if V/D occur take with food/monitor intake, output, and weight daily contraception needed female/sperm affect male no NSAIDs/interacts with many medication/alcohol need to carry ID card
39
what are examples of anticonvulsants as mood stabilizers?
Valproic Acid (depakene)/divalproex sodium (Depakote) lamotrigine (Lactimal) carbamazepine (tegretol) clonazepam (Klonopin) topiramate (Topamax) oxcarbazepine (Trileptal) Gabapentin (Neurontin)- high dose/off label 1200 mg
40
what is the mechanism of action of anticonvulsants as mood stabilizers?
unknown
41
what are the contraindications of anticonvulsant as mood stabilizers?
liver disease renal disease cardiac disease pregnancy and lactation
42
what are the side effects of anticonvulsants used as mood stabilizers?
blood dyscrasias liver failure decrease the effectiveness of birth control pills
43
what is the black box warning of anticonvulsants used as mood stabilizers?
increased risk for suicidal thoughts and behaviors
44
what is the mechanism of action for valproic acid?
decrease firing rate of high frequency neurons- stabilize membrane increase GABA
45
what are the therapeutic levels of valproic acid (depakote)?
50-100 mcg/mL
46
what is the black box warning for valproic acid?
hepatotoxicity
47
what are some common drug-to-drug interactions with valproic acid?
coumadin/aspirin antacids
48
what are good for rapid cycling and severally paranoid/angry patients?
carbamazepine (tegrtol/equetro)
49
what can cause a life-threatening rash and Steven-Johnson Syndrome?
Lamotrigine (Lamictal)
50
why are antipsychotics utilized?
used to help control behaviors and stabilize mood work faster than mood stabilizer so used initially until other drugs kick in used as adjunctive therpay
51
what are examples of atypical antipsychotics utilized for bipolar mania?
olanzapine (Zyprexa) risperidone (risperdal) aripiprazole (Abilify) cariparazine (Vraylar)- for acute mania lursaidone HCL (Latuda)- for depressive episodes quetiapine fumarate (Seroquel) ziprasidone (geodon) asenapine (Saphris)
52
what is the treatment for bipolar depression?
if treat with antidepressant alone, then it can increase the risk of mania must combine with a mood stabilizer
53
what are the mood stabilizers utilized for bipolar depression?
lurasidone HCl (Latuda) quetiapine fumarate (Seroquel) olanzapine (Zyprexa) plus fluoextine (Prozac) combo called Symbyax
54
what are other treatments for bipolar mania with the inclusion of medications?
ECT- electroconvulsive therapy integrative therapy- omega 3 fatty acids, fish oil, and DHA-EPA individual psychotherapy including group therapy and family therapy including support from NAMI cognitive behavioral therapy- focus on changing automatic thoughts such as personalizing, all or nothing, mind reading, discontinuing negatives
55
what is ECT?
used for mania especially if the client does not tolerate meds or when life-threatening dangerous behavior or exhaustion occurs depressive episodes with severe catatonic or treatment-resistant depression can be beneficial for those pregnant with mania that is not a high-risk pregnancy to avoid the teratogenic effects of the meds
56
what are nursing interventions/implementations with bipolar mania?
maintaining safety of clients and others maintain safe environment, free of dangerous objects maintain calm attitude monitor client behavior frequently restoring client nutritional status, sleep, rest, hygiene encouraging appropriate client interaction with others/communication- redirect aggressive behavior maintain low level of stimuli solitary activities- avoiding competitive games help client to identify positive things about self intervene at first sign of increased anxiety, agitation, aggressiveness have sufficient staff for show of strength if necessary use seclusion or restraint if client cannot be talked down recognize purpose of client's inappropriate behaviors (to reduce insecurities by increasing sense of power) set limits of manipulative behaviors do not argue, bargain, or try to reason with client give positive reinforcement for appropriate behaviors
57
what is client/family education for bipolar mania?
support services crisis hotline support groups, DBSA individual psychotherpay legal/financial assistance family support- NAMI

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