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Flashcards in Quiz #2: Bipolar Disorders Deck (41)
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1

Bipolar Disorder Statistics

-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

Bipolar Disorder Etiology

Multiple independent factors
1. Biological**
2. Psychological
3. Environmental

3

Etiology of Bipolar Disorder: Biological

-Genetic – strong heredity
-Neurobiological: Serotonin, Norepinephrine, and Dopamine
-Neuroendocrine (rule out hyperthyroidism)

4

Etiology of Bipolar Disorder: Psychological

May play a role in precipitating manic episodes

5

Etiology of Bipolar Disorder: Environmental

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

Describe Bipolar I Disorder

-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

Bipolar I Disorder: Mania

-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

Describe Bipolar II Disorder

-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

Hypomania (Low Level Mania)

-Tends to be euphoric and often increases functioning
-Psychosis is never present with this

10

Flight of Ideas

-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

Clang Associations

-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

Grandiosity

-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

Bipolar Disorder: Moods Include

-Euphoria
-Joyous mood out of proportion with reality
-Boundless enthusiasm
-Labile

14

Bipolar Disorder: Behaviors Include

-Nonstop Physical Activity
-Starts a lot of projects
-Excessive spending or giving away money
-Poor Concentration
-Highly distractible
-Dress outlandishly
-Sexual indiscretion

15

Bipolar Disorder: Though Process And Speech Patterns Include

-Flight of ideas
-Rapid Speech
-Circumstantial
-Speech can be incoherent or disorganized
-Sexually explicit or inappropriate content
-Loud or screaming

16

Bipolar Disorder: Assessment Guidelines

-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

Assessing whether the patient is a danger to self and others

-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

Assessing medical status in patients with Bipolar Disorder

-May be secondary to medical condition (hyperthyroidism, dementia, ADHD, certain anxiety disorders)
-May be substance-induced (amphetamines)

19

Outcomes during the acute phase of Bipolar Disorder

-Safety
-Physiological

20

Outcomes during the continuation phase of bipolar disorder

-Knowledge of Disease and Medications
-Knowledge of early signs and symptoms of relapse

21

Outcomes during the maintenance phase in bipolar disorder

-Prevention of relapse
-Ongoing supportive therapy

22

What is the nurses priority in planning care for a patient with bipolar disorder?

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

Planning: Acute Phase

-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

Planning: Continuation Phase

-Adherence to medication regimen and prevention of relapse

25

Planning: Maintenance Phase

Preventing relapse and limiting severity and duration of future episodes

26

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)

27

Medications for Bipolar Disorder Include

-Lithium
-Anticonvulsants
-Antipsychotics and Benzodiazepines

28

Lithium

-Reduces elation, grandiosity, flight of ideas, irritability, anxiety
-Gold standard

29

Lithium Therapeutic Range

-0.8-1.4 mEq/L
-Therapeutic range can take 7 – 14 days

30

Anticonvulsants

-Valproate (Depakote), Carbamazepine (Tegretol), Lamotigrine (Lamictal)
-Beneficial in controlling mania and depression