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Module 6 (Psych Mental Health) > Mood Disorders - Bipolar > Flashcards

Mood Disorders - Bipolar Flashcards

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1
Q

Van Gogh painting Old Man in Sorrow was painted shortly after his

A

1890 died AFTER D/C from an asylum
from self-inlficted GSW

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2
Q

Bipolar 1 Disorder consists of

A

At least one episode of “persistent or elevated, expansive or irritable mood” (mania), accompanied by changes in activity or energy.

A major depressive disorder episode is frequently included.
- social and work functioning is impaired
- psychosis accompany both

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3
Q

Bipolar 2 Disorder consists of

A

Includes at least one period of hypomania alternating with one or more periods of depression.
- no full mania episodes
- tx during depressive

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4
Q

Hypomania episodes requires

A

requires less sleep, inflated self-esteem, increased energy or activity, is distracted, may overspend, sexual indiscretions and impulsivity

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5
Q

Bipolar 2 has more

A

depressive s/s AND SPEND MORE TIME IN DEPRESSIVE STATE

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6
Q

Bipolar Specifiers

A

rapid cycling (4+ episodes in 12-month period)
mania- depression x4
Melancholic
Atypical
Peripartum
Seasonal
Psychotic and catatonic features

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7
Q

Melancoholic

A

depressive episodes with inability to feel pleasure

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8
Q

Atypical

A

depressive features that are not typical for the individual

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9
Q

Psychotic features in Bipolar

A

hallucinations
paranoia
delusions

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10
Q

Catatonic features for bipolar

A

extremes of physical activity or not moving at all

  • Randy
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11
Q

Manic episode s/s (3+ for bipolar)

A
  • inflated self-esteem or grandiosity (jesus, devil, president)
  • decreased need for sleep (3 hours is good for them)
  • more talkative and pressure to keep talking
  • flight of ideas or racing thoughts
  • distractibility (irrelevant)
  • increase in goal-directed activities or psychomotor agitation
  • excessive involvement in high potential painful consequences (shopping, sexual indiscretions, or investments)
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12
Q

The bipolar mood disturbances is sufficiently

A

severe to cause marked impairment in social or occupational functioning

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13
Q

If the manic episode continues for a long time, what issues could arise?

A

cardiac

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14
Q

Hypomanic criteria

A

4+ days
- unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
- not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization

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15
Q

Delirious mania

A

rapid onset of delirium and mania
possible psychosis
Hyperactive catatonia - prominent
DO NOT STOP TO EAT AND ACUTE CONFUSION

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16
Q

Delirious mania is tx with

A

high doses of benzodiazepines and or ECT

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17
Q

Unipolar depression

A

affects women more
later in life
no appetite, no interest to eat
sleep with insomnia, problems staying asleep and falling asleep
lesser risk of drug abuse and suicide than bipolar

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18
Q

Bipolar Depression

A

men and women equal
younger
Binge eating- depressed; anorexia -mania
Hypersomnia and diff to wake in the morning
Greater isk of abuse and suicide

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19
Q

Cyclothymic Disorder

A

Hypomanic episodes alternating with persistent depressive episodes for at least 2 years or 1 year in children.
- irritable episodes
mood extemes severe than bipolar
stable mood periods

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20
Q

Initial presentation for male;females is

A

mania, and depression for females.

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21
Q

What other disorders could be accompanying bipolar cyclothymia?

A

anxiety
Impulse control, attention-deficit/hyperactivity and substance use disorders occur in over half of those with bipolar disorder.

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22
Q

Bipolar spectrum disorder has a higher rate of these medical comorbidity

A

especially cardiovascular and metabolic diseases, endocrine disorders, type 2 diabetes, and obesity.

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23
Q

Genetic Theory of BSD

A

First degree relatives of a person with bipolar disorder are 7-10 times more likely to develop bipolar disorder
both then 50%

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24
Q

Strongest predictor of later development of BSD is

A

displays premorbid symptoms of anxiety/depression, affective lability and low-level manic symptoms

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25
Neurobiological Factors of BSD in mania
HIGH dopamine, norepinephrine, and glutamate
26
Neurobiological Factors of BSD in bipolar depression
low dopamine and norepinephrine
27
If serotonin is too low in BSD depression episode this can cause
agitation poor impulse control in manic phase
28
GABA in BSD is
blunted
29
Meltonin is altered in
BSD leads to poor sleep
30
Neuroendocrine Factors in Bipolar as associated with
stress abnormalities in HPA axis - high levels of ADH and cortisol **Premenstraul syndrome** - late onset with menopause
31
Neuroanatomical Factor's of BSD
Development or degenerative MRIs subtle deficits in gray matter vol with mood - disorganization
32
Environmental and Psychological Influences in BSD
Dysregulation Hyperresponsiveness may result in mania. Depressive symptoms result from the deactivation of BAS.
33
Environment and Psychological Factors in BSD
Social Rhythm Theory states that our disruptions of our circadian rhythm and sleep deprivation may provoke or exacerbate the symptoms. Stress can trigger acute episodes of BPD migraine, childhood trauma, genes, poor cognitive ability, excited neurons
34
BSD S/S
mania abrupt recurrence is likely - few days -months FOLLOW depressive episodes - remorse and increasing risk for suicide
35
T/F: Suicide can only occur in BSD depression episodes.
false, it can occur in both phases but most common in depressive
36
Appearance and Behavior in BSD
**Unstable**, unpredictable Constant activity Constantly **pushes limits** Impulsive/excessive: **spending $$**, phone calls, writing, giving away items **Religious** preoccupation **Extreme** makeup and clothing Sexual **indiscretion** **Self care issues**: Lack of sleep/proper nutrition, may lead to physical exhaustion/death
37
Thoughts of BSD patients include
Pranoid delusions grandiousity hallucinations pressured speech flight of ideas circumstantial speech cland associations
38
Paranoid delusions
– everyone is out to get them Fixed beliefs that appear real with fear and loss of ability to teal what is real and unreal
39
Grandiosity
inflated self regard
40
Hallucinations
Sensory perceptions become altered
41
Pressured speech
Nonstop, loud, hard to interrupt.
42
Flight of ideas
Disconnected rambling from subject to subject
43
Circumstantial speech
Unnecessary details. Rate and rhythm can be rapid.
44
Clang Associations
Stringing words together, rhyming
45
Tx for BSD in cognitive functions
pharmacotherpay and psychoedu Tx depressive s/s control comorbidity implenet remediation promote aerobic and execise healthy habits
46
The mood and affect of a person on BSD
Unstable, labile May change from euphoria to belligerence to crying Easily angered Hostile, irritable, paranoid
47
What assessment tool is used for BSD?
MOOD DISORDER QUESTIONAIRE
48
Nursing Process for BSD
hospilze for stabilization Medical exam for **dehydration, cardiac status, and poor sleep** Safety - **danger for others/self, poor impulse/judgment, inappropriate sexual, uncontrolled spending**
49
When the patient is stabile, what does the nurse need to ensure the family understands
assess their understanding of BSD
50
Nursing Dx for BSD
Impaired Sleep Self Care Deficits Safety Risk Towards Others Lack of Insight Nonadherence to Medication Regime Impaired Mood Regulation and Labile
51
During acute mania, the nurse needs to
Prevent injury and maintain safety Be well hydrated with 24 hours Maintain stable cardiac status Get sufficient sleep Demonstrate self control Have them attempt at self control
52
Phase 2 (continue) and Phase 3 (maintenance), the nurse needs to
Patient and family will attend psychoeducational classes Support groups Therapies – cognitive-behavior, interpersonal and social rhythm therapy, family-focused therapy Communication and problem-solving skills training
53
What can the nurse implement during the acute mania phase of BSD?
Decreasing physical activity Adequate food and fluid Ensuring 4-6 hours of sleep Alleviate bowel or bladder problems (more fluids or healthy diet) Intervening to ensure self-care Medication management Close observation, seclusion or ECT
54
What can the nurse implement during the PHASES 2 AND 3 phase of BSD?
Stress reduction Employment and legal issues Relapse prevention
55
Communication implemented in the BSD patients behavior ad a nurse
**setting limits in a firm nonthreatening, and neutral manner** **Early intervention in escalating** behavior **Avoid power struggle**, but set limits for safety Verbal **de-escalation** for agitation or aggressive behavior **Seclusion** may be necessary to **prevent harm to self or others if de-escalation attempts do not work**
56
Hyperactive Therapy Milieu needs to be
decreased stimulation
57
Seclusion for Bipolar is only after
all other approaches have not worked involuntary and solitary confinement
58
Seclusion may provide
comfort and relief with no longer control of their behavior - considered restraint **requires documentation that less restrictive interventions were attempted and requires an order from a physician**
59
Pharmacological therapies for mood stabilization in BSD IS USED IN
mania hypomania depression - continue indefinitly
60
What is the 1st choice for Bipolar 1 acute mania?
Lithium carbonate - alters excitatory neurotransmitters
61
Lithium side effects
Mild hand tremor, polyuria & thirst, mild nausea, wt gain. Long term risk of hypothyroidism & kidney impairment. Monitor thyroid and renal functions - Contraindicated in pregnancy
62
All medications used in Bipolar Disorders
lithium anxiolytics mood stabilizers (antconvulsant and antiepileptic) antipsychotics antidepressants ECT - CATATONIC S/S
63
Antidepressants are not given by themselves if used in BSD, what is also given with it?
mood stabilizers - if not can cause mania
64
Patient teachings for Lithium
blood levels, thyrois and kidneys - toxic effects **with adequate salt and fluid intake *1500-3000mL/day** STOP if excessive vomiting, diarrhea, sweating since dehydration causes lithium levels to increase
65
With lithium do not give
diuretics OTC
66
Avoid __________ if using lithium
pregnancy
67
Mood stabilizers patho
Depresses CNS by ↑ GABA (used for rapid-cyclers)
68
Mood stabilizers medication names
*Divalproex, valproate, or valproic acid (Depakote** Depakene, Depacon, Stavzor) **Carbamazepine (Tegretol) Lamotrigine (Lamictal) (report rash)** Gabapentin (Neurontin) Topiramate (Topamax) Oxcarbazepine (Trileptal)
69
ECT is used on bipolar with
catatonic s/s resistant manic and sepressed s/s rapid control symptoms severe suicide, agitation, or violent - severe depression or mania during pregancy
70
What needs to be done during the maintenance phase of Bipolar?
Psychoeducation Information Emotional Discharge Support medication and other treatment adherence Use self help strategies Problem-solving training Cgonitive Behavior Therapy IPSRT Family therapy telepsych support gorups
71
A prevention plan of ___________ needs to be established in maintenace.
relapse and early warning signs
72
Bipolar patients need to decrease
cafeeine and avoid alcohol and drugs

Module 6 (Psych Mental Health) (12 decks)

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