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Flashcards in psych Deck (39):
1

Bipolar disorder was formerly called

manic depressive illness

2

what are the two opposite poles that characterizes Bipolar disorder 


–Euphoria
–Depression
 

3

bipolar disorder is 


•Chronic, recurring, life-threatening illness
–Individuals experience interpersonal, occupational difficulties even during remission
–Associated with highest lifetime suicide rate among psychiatric disorders
 

4

Bipolar I


–At least one episode of mania alternating with major depression
–Psychosis may accompany manic episode
could see psychosis, or hallucinations

5

Bipolar II


–Hypomanic episode(s) alternating with major depression
–Not accompanied by psychosis
when they drop down to major depression they may have delusions.

6

cyclothymia


–Hypomanic episodes alternating with minor depressive episodes
 

7


•Specifier from DSM-IV-TR
 


–Rapid cycling (four or more episodes in 12-month period)
 

8

prevelance of bipolar disorder 


–Lifetime prevalence in U.S. estimated at 3.9%
–First episode commonly occurs between ages 18 and 30
 

9

comorbidity bipolar disorder


–Substance use disorders, personality disorders, anxiety disorders, attention deficit hyperactivity disorder
–Medical conditions: cardiovascular, cerebrovascular, metabolic disorders
 

10

Bipolar Genetics


–Twin, family, and adoptive studies support strong genetic component
–Specific genes identified on chromosome 13 associated with bipolar disorder
 

11

cycling

moving up and down between moods.  The faster someone moves between mania and depression, the more acutley ill the person is.  

12

neurobiological factors bipolar


–Hypothalamic-pituitary-thyroid-adrenal axis dysfunction implicated
 

13

neuroanatomical factors bipolar


–Dysregulation in prefrontal cortex and medial temporal lobe implicated 
 

14

psychological influences


–Stressful life events
–Families characterized by high expressed emotion most associated with relapse
 

15

cultural considerations


–More prevalent in higher socioeconomic classes
–Higher rates noted among creative writers, artists, highly educated men and women
 

16

bipolar periods


•Periods of abnormal and persistently elevated mood for at leas:
–4 days for hypomania
–1 week for mania
 

17

hypomania


–Episode associated with decreased function
–Hospitalization not required
 

18

mania


–Episode associated with marked impairment in function
–Hospitalization necessary
 

19

common symptoms of mania


–Unstable euphoric mood, intense feeling of well-being, mood may change to irritation and anger when thwarted
 

20

behavioral symptoms of mania


– Excessive hyperactivity, involved in pleasurable activities with painful consequences, sexual indiscretion, excessive spending of money, mode of dress/makeup may be outlandish, bizarre
 

21

physical symptoms of mania


– Nonstop activity, minimal food intake, little or no sleep
–Can lead to exhaustion and even death
 

22

cognitive suymptoms of mania


–Poor concentration, problems with verbal memory, sustained attention and executive functioning (may persist even in remission)
–Flight of ideas: continuous flow of accelerated speech with abrupt changes from topic to topic usually based on understandable associations

–Disorganized and incoherent speech with content often sexually explicit and grossly inappropriate
–Clang associations: stringing together of words because of rhyming sounds
–Grandiose persecutory delusions
 

23

assessment for bipolar disorder 


•Determine if patient dangerous to self or others
–Presence of physical exhaustion
–Poor impulse control
–Uncontrolled spending of money
•Determine medical symptoms
–Dehydration, infections

•Determine presence of other medical/psychiatric conditions
•Determine if hospitalization is necessary
•Determine patient’s and family’s understanding of disorder, treatment, medications, support groups

 

24

common nursing diagnosis for bipolar


–Risk for injury, Risk for self- or other-directed violence, Risk for suicide, Ineffective coping, Disturbed thought processes, Interrupted family processes, Impaired verbal communication, Imbalanced nutrition: less than body requirements
 

25

outcomes of bipolar disorder 


–Acute phase: goal is prevention of physical injury and decrease in symptoms manifested
–Continuation of treatment phase: goal is relapse prevention
–Maintenance phase: goal is relapse prevention and limiting severity of future episodes
 

26

planning bipolar 

Geared toward particular phase of mania as well as other co-occurring issues (e.g., risk of suicide, risk of violence, family/legal crisis, substance abuse, risk-taking behaviors, medical compliance

27

implementation bipolar 


–Directed toward establishing therapeutic alliance
–Acute phase implementations related to safety in hospital environment, establishment of controls and medical stabilization
 

28

clang associations (billy madison)

rhyming words

crunch you, munch you , punch you

29

communication guidlines bipolar 


•Use firm, calm approach
•Use short, concise statements
•Remain neutral; avoid power struggles
•Be consistent
–Important with firm limit setting
•Hear and act on legitimate complaints
•Firmly redirect energy into appropriate channels
 

30

milieu treatment bipolar 


•Seclusion and restraints may be used if patient becomes dangerously out of control and other least restrictive measures failed
–Purposes: reduces overwhelming stimuli, protects patient and others from injury, prevents destruction of property

•Use of seclusion/restraint associated with complex legal, ethical, and therapeutic issues
–Follow well-established institutional protocols for use of these measures
 

31

mood stabilizer treatment bipolar 


•Used for lifetime maintenance therapy
•Lithium carbonate: first-line treatment for mania
–Therapeutic blood level must be reached for drug to be effective (usually takes 7-14 days)
•Maintenance/therapeutic blood levels between 0.4 and 1.3 mEq/L
–Used in combination with antipsychotics or antianxiety medications in initial acute mania
 

32

lithium carbonate

first-line treatment for mania
–Therapeutic blood level must be reached for drug to be effective (usually takes 7-14 days)
•Maintenance/therapeutic blood levels between 0.4 and 1.3 mEq/L
–Used in combination with antipsychotics or antianxiety medications in initial acute mania
•Adverse reactions
–Related to lithium toxicity—fine line between therapeutic and toxic levels
–Lithium toxicity ranges from mild to moderate and severe symptoms depending on blood level
•Severe symptoms include ataxia, ECG changes, clonic movements, seizures, coma, and death


–Major long-term risks include hypothyroidism and kidney impairment
•Necessity for periodic thyroid and renal function tests 


•Patient and family teaching important
–Continue drug therapy to prevent relapse
–Maintenance of normal diet with normal salt and fluid intake (1500-3000 mL/day)
•Lithium decreases sodium absorption and low sodium levels/dehydration cause lithium toxicity
–Stop taking lithium and call physician if symptoms of dehydration develop from sweating and/or nausea, vomiting, diarrhea
 

33

antiepileptic medications bipolar 


•Adjunct to lithium as well as treatment for patients not responsive to lithium
•Commonly used drugs
–Carbamazepine (Tegretol), divalproex (Depakote), lamotrigine (Lamictal)
•Adverse effects of individual antiepileptic drugs vary but include such problems as sedation, agranulocytosis, hepatitis, life-threatening rash
 

34

ECT


•Can be used to subdue severe manic behavior in patients who are treatment resistant to usual medications
•May also be used in patients who are suicidal
 

35

pyschotherapy bipolar 


•Cognitive-behavioral therapy
–Cognitive restructuring effective in decreasing affective symptoms, increasing social functioning, and reducing relapse
•Interpersonal and social rhythm therapy (IPSRT)
–Focuses on resolution of interpersonal problems and prevention of further disputes

•Family-focused therapy
–Treatment approach focusing on communication within family, communication skills, and education to prevent relapse
 

36

evaluation bipolar 


•Short-term and intermediate evaluation focused on goal attainment such as:
–Are patient’s vital signs stable?
–Is patient well hydrated ?
–Is patient able to control behavior or respond to external controls?
–Does patient sleep at least 5 hours per night?
–Does family have understanding of illness and treatment?

•Long-term evaluation focused on goal attainment such as compliance with medication regimen, resumption of functioning in community, and family
 

37

therapeutic range of lithium

Therapeutic blood level must be reached for drug to be effective (usually takes 7-14 days)
•Maintenance/therapeutic blood levels between 0.4 and 1.3 mEq/L

38

lithium toxicity 

•Severe symptoms include ataxia, ECG changes, clonic movements, seizures, coma, and death

39

major side effects of Lamictal 

steven johnson's syndrome