Mood and Affect Pt 2 Flashcards
is mood objective or subjective
subjective
is affect objective or subjective
objective
how is bipolar characteriszed
mood swings from profound
depression to extreme
euphoria (mania), with
intervening periods of
normalcy.
what is mania
An alteration in mood that may be expressed by feelings of
elation, inflated self-esteem, grandiosity, hyperactivity, agitation,
racing thoughts, and accelerated speech
what is hypomania
Symptoms not sufficiently severe to cause
marked impairment in social or occupational
functioning or to require hospitalization
* Cheerful mood
* Rapid flow of ideas; heightened perception
* Increased motor activity
what is acute mania
Marked impairment in functioning; usually requires
hospitalization
* Elation and euphoria; a continuous “high”
* Flight of ideas; accelerated, pressured speech
* Hallucinations and delusions may be present
* Excessive motor activity
* Social and sexual inhibition
* Little need for sleep (may go days without sleeping)
what is delerious mania
A grave form of the disorder characterized by
an intensification of the symptoms associated with
acute mania.
* The condition is rare because the advent of
antipsychotic medication.
* Labile (unstable) mood; panic anxiety
* Clouding of consciousness; disorientation
* Frenzied psychomotor activity
* Exhaustion and possibly death without
intervention
what is bipolar 1
Individual has experienced at least one full manic episode usually
followed by a depressed state
* May also experience hypomania
* May experience mixed episodes (mania/depression) lasting at least one-
week, anxious distress, or rapid cycling causing marked impairment in life.
* Psychotic or catatonic features may also be present
* Mania can be precipitated by medications to treat depression (SSRI,
SNRIs, TCAs)
what is bipoalr 2
- History of at least one hypomania episode
- History of at least one episode of depression
- No history of full mania
- Characterized by recurrent bouts of depression with episodic occurrence
of hypomania - Not severe enough to cause marked impairment in social/occupational
functioning or require hospitalization - No psychosis in hypomania
what is cyclothymic disorder
A chronic mood disturbance of at least 2 years’ duration
not as extreme as bipolar
what is lithium
Helps control acute mania associated with bipolar disorder
Used prophylactically to prevent recurrence of mania or depression
The primary and preferred drug for treating mania associated with
bipolar disorder
Not entirely clear how lithium regulates the mood
Makes changes to the transport of sodium ions in nerve cells which
alters the metabolism of catecholamines (fight-or-flight hormones
released in response to stress)
A sudden decrease in Na intake can increase lithium levels, while an
increase in NA may decrease lithium levels
Decreases mania
adverse reactions of lithium
At therapeutic blood levels: Gastrointestinal symptoms may occur, but often
subside with time (take with milk or meals)
A third of people taking lithium experience transient
Fatigue
Headache
Confusion
Muscle weakness
Memory impairment
Polyuria (antagonizing effect lithium has on ADH )
Decrease secretion of thyroid hormone, may cause goiter or hypothyroidism
(monitor for lethargy, low heart rate, decreased body temperature)
Fine hand tremor may develop and is exacerbated by stress or fatigue
therapeutic blood levels of lithium
.4-1 mEq/L
toxic level of lithium
> 1.5 mEq/L
how much h20 to drink per day
8-12 glasses or 2-3L
when are labs drawn
1-2 months post hosptial
12 hours after dose
what else do we monitor foe when on lithium
Monitor BUN/Creatinine (danger of renal failure with toxicity) thyroid function, &
pregnancy (teratogenic – fetal heart defects)
what else to know about lithium
Those who are dehydrated, have low sodium levels, low sodium diets, and
taking diuretics should not take lithium
May cause sodium depletion until consistent blood levels are achieved,
increases lithium levels, risk for toxicity
Hx of angioedema from ACE inhibitors should not take lithium (risk for
toxicity)
Drug interactions: NSAIDs (exception of aspirin), tetracycline (antibiotic),
diuretics, methyldopa (cardiac med for HTN), probenecid (med for gout)
Weight gain is a common side effect
s/s of lithium toxicity
Low sodium diet can
decrease lithium elimination
leading to increased lithium
levels
Persistent nausea and
vomiting, Severe diarrhea,
Ataxia (impaired
coordination), Blurred vision,
Tinnitus, Excessive output of
urine, Increasing tremors,
Mental confusion
Severe Nausea/Vomiting/Diarrhea Severe hand tremors
Confusion Vision Changes
examples of anticonvulsants
valproate/valproic acid/divalproex: Therapeutic Level: 50-100 mcg/ml
lamotrigine, carbamazepine and oxcarbamazepine
risks w/ valproate/valproic acid/divalproex
risk for thrombocytopenia: Check CBC, INR
- Risk of hepatotoxicity: Check LFTs
- Common side effects: GI upset, weight gain, alopecia
risks w/ lamotrigine, carbamazepine, and oxcarbamazepine
Risk of life-threatening rash (Steven’s Johnson Syndrome)
* Risk of blood dyscrasias
* Blood disorders, i.e., anemia, clotting, bleeding
* Monitor CBC w/ diff
* Risk of eosinophilia (allergic response to medication)
* Inflammation of tissues, i.e., heart, lungs, skin, and nervous system
most affected
* Monitor white blood cells, specifically eosinophil count
* Risk of hepatotoxicity; monitor LFT
* GI upset
what do you monitor for anticonvulsants in general
Monitor for skin rash, unusual bleeding, spontaneous bruising, signs of
hemorrhage, sore throat, fever, back pain, dark urine, and yellow skin
is recovery model pt centered or illness centered
pt centered
