Quiz #2: Bipolar Disorders Flashcards
1
Q
Bipolar Disorder Statistics
A
- Less common than MDD
- Associated with increased premature mortality secondary to general medical illnesses
- As many as 60 – 70% of individuals with bipolar disorder meet diagnostic criteria for a lifetime history of substance abuse or dependence
- Risk for alcohol or drug abuse is 6 – 7 x greater among people with bipolar disorder
2
Q
Bipolar Disorder Etiology
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Multiple independent factors
- Biological**
- Psychological
- Environmental
3
Q
Etiology of Bipolar Disorder: Biological
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- Genetic – strong heredity
- Neurobiological: Serotonin, Norepinephrine, and Dopamine
- Neuroendocrine (rule out hyperthyroidism)
4
Q
Etiology of Bipolar Disorder: Psychological
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May play a role in precipitating manic episodes
5
Q
Etiology of Bipolar Disorder: Environmental
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More prevalent in upper socioeconomic classes; Those who achieve higher levels of education and higher occupational status; Children w/ stressful family environments and adverse life events may increase vulnerability toward bipolar
6
Q
Describe Bipolar I Disorder
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- Characterized by at least one week-long manic episode
- Manic episodes may alternate with depression or a mixed state of agitation and depression
- Severe disorder that the person tends to have difficulty maintaining social connections and employment
- Psychosis (hallucinations, delusions, and disturbed thoughts) may occur during manic episodes
7
Q
Bipolar I Disorder: Mania
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- Extreme drive and energy
- Inflated sense of self-importance
- Drastically reduced sleep requirements
- Excessive talking combined with pressured speech
- Personal feeling of racing thoughts
- Distraction by environmental events
- Usually obsessed with and over-focused on goals
- Purposeless arousal and movement
- Dangerous activities such as indiscriminate spending, reckless sexual encounters, or risky investments
8
Q
Describe Bipolar II Disorder
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- Low-level mania (hypomania) alternates with profound depression
- Disorder is usually not severe enough to cause serious impairment in occupational or social functioning
- Hospitalization is rare; however, depressive symptoms tend to put them at particular risk for suicide
9
Q
Hypomania (Low Level Mania)
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- Tends to be euphoric and often increases functioning
- Psychosis is never present with this
10
Q
Flight of Ideas
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- Nearly continuous flow of accelerated speech with abrupt changes from topic to topic that are usually based on understandable associations or plays on words
- Example: “How are you doing, kid, no kidding around, I’m going home … home sweet home … home is where the heart is, the hart of the matter is I want out and that ain’t hay … hey, doc, … get me out of this place.”
11
Q
Clang Associations
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- Stringing together of words because of rhyming sounds, without regard to their meaning
- Example: “Cinema I and II, last row. Row, row, row your boat. Don’t be a cutthroat. Cut your throat. Get your goat. Go out and vote. And so I wrote.”
12
Q
Grandiosity
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- Inflated self-regard – exaggerate their achievements or importance, state that they know famous people, or believe they have great powers.
- Ex: God is speaking to them or that the FBI is out to stop them from saving the world
13
Q
Bipolar Disorder: Moods Include
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- Euphoria
- Joyous mood out of proportion with reality
- Boundless enthusiasm
- Labile
14
Q
Bipolar Disorder: Behaviors Include
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- Nonstop Physical Activity
- Starts a lot of projects
- Excessive spending or giving away money
- Poor Concentration
- Highly distractible
- Dress outlandishly
- Sexual indiscretion
15
Q
Bipolar Disorder: Though Process And Speech Patterns Include
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- Flight of ideas
- Rapid Speech
- Circumstantial
- Speech can be incoherent or disorganized
- Sexually explicit or inappropriate content
- Loud or screaming
16
Q
Bipolar Disorder: Assessment Guidelines
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- Assess whether patient is a danger to self and others
- Assess need for protection from uninhibited behaviors. External control may be needed to protect patient from bankruptcy
- Assess the need for hospitalization to safeguard and stabilize
- Assess medical status – need thorough medical examination. Is mania primary or secondary to another condition.
17
Q
Assessing whether the patient is a danger to self and others
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- Patients can exhaust themselves to the point of death
- May not eat or sleep for days
- Poor impulse control may result in harm to others or self
- Uncontrolled spending
18
Q
Assessing medical status in patients with Bipolar Disorder
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- May be secondary to medical condition (hyperthyroidism, dementia, ADHD, certain anxiety disorders)
- May be substance-induced (amphetamines)
19
Q
Outcomes during the acute phase of Bipolar Disorder
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- Safety
- Physiological
20
Q
Outcomes during the continuation phase of bipolar disorder
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- Knowledge of Disease and Medications
- Knowledge of early signs and symptoms of relapse
21
Q
Outcomes during the maintenance phase in bipolar disorder
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- Prevention of relapse
- Ongoing supportive therapy
22
Q
What is the nurses priority in planning care for a patient with bipolar disorder?
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Geared toward particular phase of the mania the patient is in as well as any other co-occurring issues identified in the assessment (i.e risk of suicide, risk of violence to person or property, family crisis, legal cries, substance abuse, risk-taking behaviors.)
23
Q
Planning: Acute Phase
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- Medically stabilize patient while maintaining safety (the hospital is usually the safest environment for accomplishing this)
- Geared toward managing medications, decreasing physical activity, increasing food and fluid intake, ensuring adequate sleep, alleviating bowel or bladder problems and ensuring self-needs are met.
24
Q
Planning: Continuation Phase
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-Adherence to medication regimen and prevention of relapse
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Planning: Maintenance Phase
Preventing relapse and limiting severity and duration of future episodes
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Bipolar Disorder: Implementation
- High priority on potential for harm toward others
- Impose controls on destructive behaviors and provide medication stabilization
- Continuously set limits
- Provide frequent high-calorie food and frequent rest periods
- Provide structured solitary activities with staff (avoid group activities if possible)
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Medications for Bipolar Disorder Include
- Lithium
- Anticonvulsants
- Antipsychotics and Benzodiazepines
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Lithium
- Reduces elation, grandiosity, flight of ideas, irritability, anxiety
- Gold standard
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Lithium Therapeutic Range
- 0.8-1.4 mEq/L
| - Therapeutic range can take 7 – 14 days
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Anticonvulsants
- Valproate (Depakote), Carbamazepine (Tegretol), Lamotigrine (Lamictal)
- Beneficial in controlling mania and depression
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Antipsychotics and Benzodiazepines
- Can be used while lithium is reaching therapeutic levels to prevent exhaustion
- Antipsychotics act promptly to slow speech, inhibit aggression, and decrease psychomotor activity
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How does lithium help treat bipolar disorder?
- Interacts with a # of neurotransmitters and receptors, decreasing norepinephrine and increasing serotonin synthesis
- Specific biochemical mechanism of lithium action in mania is unknown
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Lithium and its relationship with water and sodium
- Regular serum level tests because lithium interferes with sodium and water levels in body
- Risk for dehydration
- Need to stay hydrated because if dehydration occurs, lithium levels increase (think of hypo and hypernatremia)
- Dehydration is due to lithium inhibition of the antidiuretic hormone which normally enables the kidney to reabsorb water from urine
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Side effects of Lithium
- Increased WBC
- Polyuria and polydipsia
- Dry mouth
- Confusion
- Muscle Weakness
- ECG Changes
- Muscle twitching
- Vertigo
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Symptoms of Lithium Toxicity
- Asthenia (weakness)
| - Ataxia(dysfunction in coordination of muscle movements)
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Lithium Side Effects based on levels of lithium in the blood: Expected Side Effects (0.4-1.0)
- Fine hand tremors, polyuria, and mild thirst
| - N/V
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Early signs of lithium toxicity (1.5)
- Thirst, polyuria
- Slurred speech
- Muscle weakness, fine hand tremor
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Advanced signs of lithium toxicity (1.5-2)
- Coarse hand tremor
- Mental confusion, sedation
- Muscle hyperirritability, incoordination
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Severe symptoms of lithium toxicity (2-2.5)
- Serious EEG changes, seizures
- Blurred vision
- Severe hypotension; large output of dilute urine
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If lithium levels are above 2.5, what symptoms may occur?
- Convulsions
- Oliguria
- Death
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Electroconvulsive Therapy for Bipolar Disorder
- Especially useful in treatment-resistant mania and patients with rapid cycling
- Teamwork and safety
- Support groups
- Health teaching and health promotion
- Psychotherapy
