Bipolar & Related Disorders Flashcards
Epidemiology & predisposing factors
Bipolar disorder - episodes of profound depression to extreme euphoria or mania
> Evidence from family, twin, & adoption studies
> Serotonin is believed to remain low in depression & mania
> Excess of norepinephrine & dopamine in mania
> Acetylcholine is believed to be r/t sx’s of bipolar
> Excess levels of glutamate, an excitatory neurotransmitter, has also been assoc w/ bipolar disorder
> Neuroanatomical changes correlated w/dysfunction in the prefrontal cortex, basal ganglia, temporal & frontal lobes of the forebrain, & parts of the limbic system
DSM 5 - Manic Episode
DSM 5 - Hypomanic Episode
In ____, there’s an alteration in mood that may be expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, racing thoughts, & accelerated speech
> It can occur as part of a psychiatric disorder as well as some other medical conditions or in response to some substances
mania
A manic phase is characterized by euphoria & other sx’s that might include overconfidence, hyperverbal speech, irritability, poor judgment, hypersexuality, physical aggression, & diminished sleep/appetite
A depressive phase may include feelings of worthlessness, anhedonia, & helplessness
A somewhat mild degree of this clinical symptom picture is called ____
> This isn’t severe enough to cause that marked impairment in social or occupational function or to require hospitalization. It doesn’t include psychotic features
hypomania
Terms to Review
?
is a normal mood; a stable mood
Euthymia
Rapid thoughts, or racing thoughts, are thoughts that come faster than can be articulated
Rapid cycling – is 4 or more mood swings or episodes in a 12-month period & can include mania, mixed sx’s, & depression
?
is a rapid flow of thoughts manifested by accelerated speech, w/abrupt changes from topic to topic
Flight of ideas
Pressured speech is the pressure to keep talking w/o regard to other’s wishes to speak
?
is an experience of perceiving objects or events that do have an external source, such as hearing one’s name called & that no one else seems to hear
Hallucinations
?
is a rigid system of beliefs w/which the person is preoccupied, & the person firmly holds
Delusion(s)
Types of Bipolar Disorders
- Bipolar I Disorder / Bipolar II Disorder
- In order for a client to be diagnosed w/Bipolar II disorder, they must never have experienced a full manic episode
> Pt won’t have psychotic symptoms in bipolar II, but the reality is that if the patient has a major depressive ep happening in bipolar II, they can in fact have some psychotic or catatonic features. But these sx’s have nothing to do w/their mania. If they’re having a hypomanic phase, they’re not going to experience psychotic sx’s
- Cyclothymic Disorder
- Substance/Medication-Induced Bipolar Disorder
- Bipolar Disorder d/t Another Medical Condition
Which bipolar disorder classification is this?
bipolar II disorder
Which bipolar disorder classification is this?
bipolar I disorder
?
This is a chronic mood disturbance of @ least 2 yrs in duration. The individual is never without the sx’s for more than 2 mos
Cyclothymic disorder
? Stage
! This is a grave form of the disorder
> There’s a severe clouding of consciousness or mental fog
> It’s rare d/t the use of anti-psychotic rx’s
> Delusions of persecution
Stage 3: Delirious Mania
? Stage
> Doesn’t usually involve hospitalization
Has an exalted self-perception that can incl buying huge amounts of purchases & using credit cards w/o having the resources to pay
Stage 1: Hypomania
? Stage
> Involves progression of the sx’s
These individuals have a marked impairment in function & often require hospitalization
Stage 2: Acute Mania
Nursing diagnoses
Outcomes & evaluation
Interventions for Mania
Treatment Modalities
> Group therapy isn’t really appropriate until the acute phase of the illness has stabilized
Lithium
> Drink 6-8 glasses of water/day & avoid excessive caffeine intake
This is a medication that needs to be tapered down if it’s ever discontinued; if discontinued, there could be a re-emergence of sx’s
Contraindicated in pts w/cardiac & renal disease as well as brain damage
> It’s been known to cause birth defects
Be cautious w/thyroid disorders, diabetes, urinary retention, seizures in the elderly
Ensure adequate sodium intake
Anticonvulsants
- Antiepileptic or anticonvulsant rx’s play a key role in treating bipolar disorder
- Valproic acid stabilizes mood just as effectively as lithium but does have adverse effects like blood dyscrasia and wt gain
> Carbamazepine, lamotrigine, & topiramate are all anticonvulsants & are prescribed for symptoms of mania & depression
Valproic acid and carbamazepine require regular blood work to ensure their levels are within a therapeutic range
Valproic acid for pts w/rapid cycling bipolar [usually need a level of 50-100 mcg/mL]
- All these rx’s are metabolized in the liver so routine liver monitoring is important
> These drugs can incr the risk of suicidal thoughts & behaviors
Use of anticonvulsants in bipolar is an off-label use
