Bipolar Disorder

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  1. What are the 3 types of Bipolar disorders?
    • Bipolar 1: More common in males
    • Bipolar 2: More common is females 
    • Cyclothymia: usually begins in adolescence or early adulthood
  2. What is the suicide rate in bipolar? What is the most common morbidity with bipolar? What is the median number of manic episodes?
    • suicide rate is 15%
    • Alcohol abuse (or substance abuse) is big comorbidity 
    • median # of episodes is 9
  3. What are the key points of bipolar disorder? wat is it defined by?
    • costly, common and treatable 
    • Defined by recurrent episodes of mania or hypomania and depression 
    • *it is often misdiagnosed
  4. What is the difference between bipolar and depression?
    • Bipolar: earlier age of onset, more fears
    • Unipolar: more cognitive/somatic symptoms
  5. What is the dsm-5 criteria for bipolar disorder?
    • Distinct period of abnormally and persistent elevated, expamsive or irritable mood for at least *four days for hypomania *1 week for mania 
    • During mood disturbance, at least 3 of the following symptoms:
    • increased activity level
    • sexual or psychomotor agitation 
    • unusual talkativeness (pressured speech [you won't get a word in, they just keep talking])
    • flight of ideas 
    • reduced sleep
    • inflated self esteem, grandiosity 
    • distractibility 
    • risky behavior
  6. Why is bipolar often mis or undiagnosed? What is the most common misdiagnosis?
    • 35-60% have depression first 
    • Depression is far more prevalent than mania
    • May have many depressive episodes prior to mania 
    • Many will not report mania/hypomania 
    • May progress to psychosis 
    • Lag between symptom onset and first treatment with mood stabilizer
    • most common misdiagnosis: depression
  7. The lag between symptom onset and first treatment with mood stabilizer is dangerous, why?
    • (average lag time is 9.8 years) 
    • the greater the lag the worse social functioning, more hospitalizations, higher suicide rates
  8. What are the differences among the three types of bipolar (for diagnosis)?
    • Bipolar 1: At least one episode of mania, alternating wit major depression 
    • Bipolar 2: hypomanic episode(s) alternating with major depression 
    • Cyclothymia: hypomanic episodes alternating wit minor depressive episodes (2 years)
  9. What are clues to the diagnosis for bipolar disorder?
    • history of mania
    • family history of bipolar 
    • earlier age onset of symptoms 
    • elevated or irritable mood 
    • school truancy or failure 
    • occupational failure 
    • multiple failed relationships 
    • female
    • multiple episodes 
    • abrupt onset and termination of depressive episodes 
    • Worsening with antidepressant treatment
    • hypersomnia
    • severe anhedonia(inability to feel pleasure)
  10. What is the biggest comorbidity in childhood?
    • ADHD 
    • *beware of stimulant use without mood stabilizer
  11. What are the different types of mixed states?
    • Bipolar mixed states: depression and mania co-occurring
    • Depressive mixed states: core of depression, but with racing thoughts
  12. What is the mnemonic for the diagnostic criteria for bipolar?
    • DIG FAST 
    • D: distractibility 
    • I: indiscretions (excessive pleasure activities) 
    • G:grandiosity 
    • F: flight of ideas
    • A: activity increase 
    • S: sleep deficits 
    • T:talkativeness
  13. What are the other common comorbidities with bipolar?
    • substance use disorders-highest 
    • *Risk for suicide 
    • personality disorders- non med compliant 
    • Eating disorders 
    • ADHD
  14. describe substance abuse and bipolar disorder
    • bipolar d/o is the highest axis 1 disorder comorbid/concurrent with substance abuse 
    • bipolar disorder is second to antisocial personality disorder in terms of concurrent substance abuse 
    • Substance use adversely effects medication, produces earlier onset of symptoms and often leads to hospitalizati
  15. How much do genetics play in BP D/O
    • 28% likely with one parent 
    • 3x the risk with both parents
  16. What is hyperthymic temperament or soft bipolarity?
    • exuberant, upbeat, over energetic, overconfident 
    • verbally aggressive, self assured 
    • Strong willed, self employed, risk taking, sensation seeking 
    • history of legal problems
  17. What is soft bipolarity?
    • 3 or more 
    • marriages 
    • major depressive episodes with failed drug trials 
    • distinct professions 
    • languages 
    • 1st degree relatives with affective illness
  18. What are the 3 stages of manic states?
    • hypomania 
    • acute mania 
    • delirious mania
  19. What are the characteristics of mania?
    • Mood: 
    • Behavior: 
    • Thought processes and cognitive function:
  20. What is stage 1 for hypomania-assessment?
    • Mood: fluctuating, cheerful to irritable, hostile nature of person=volatile 
    • Behavior: extroverted, sociable, inappropriate, easily distracted 
    • Cognition: rapid flow of ideas, flighty, exalted sense of self
  21. What are the questions for detecting hypomania?
    • Do you have days of energy or ideas that come and go abruptly? 
    • On those days of energy, are you productive? creative? feel unconquerable? convinced your self worth, talents, abilities? Positive about the future? talkative? distinctly social? irritable? 
    • On those days of energy, do your thoughts feel as if thy're racing?
  22. What is stage 2? assessment for stage 2?
    • stage 2-mania 
    • Mood: unstable- euphoric to irritation/anger continuous high 
    • Behavior: psychomotor hyperactivity/nonstop activity; constitutes an emergency 
    • thought process: flight of ideas 
    • clang associations 
    • pressured speech 
    • hallucinations/delusions
  23. What is stage 3?
    • Delirious mania 
    • totally out of touch with reality 
    • grandiosity 
    • clang associations 
    • totally disorganized 
    • experience hallucinations 
    • extremely dangerous 
    • requires chemical/physical restraints
  24. What should you assess in mania? Why?
    • assess danger to self and others
    • because death can occur from exhaustion, not eating or sleeping 
    • poor impulse control can lead to self harm or harm of others
    • suicide is 20 times higher 
    • uncontrolled spending 
    • protect from giving away
    • Assess medical status 
    • mania secondary to medical condition or drugs/meds 
    • because stroke, hyperthyroidism, traumatic brain injury can occur 
    • assess for substance use and anxiety disorders 
    • (have exceptionally co-morbidity)
  25. how should you communicate with clients with Bipolar?
    • firm, calm approach
    • sort, concise explanations 
    • be neutral; avoid power struggles, do not join in joking 
    • consistent approach and expectations 
    • convey limits, consequences 
    • act on legitimate complaints redirect energy
  26. How should the nurse structure the environment?
    • Maintain low level of stimuli 
    • structured solitary activities with staff 
    • redirect violent behavior 
    • minimize physical harm: medication/seclusion 
    • observe for medication side effects/toxicity 
    • protect from consequences of behavior, such as giving way money or possessions
  27. What are the goals for treatment?
    • safety*
    • reduce presenting symptoms 
    • stabilize mood 
    • improve functioning 
    • improve quality of life 
    • prevent relapse 
    • prevent consequences
  28. What are the nursing interventions?
    • Prevent injury 
    • prevent exhaustion
    • maintain adequate hydration/nutrition
    • decrease psychomotor agitation
    • encourage appropriate social interactions
    • limit setting
  29. What nutrition care should you do for bipolar?
    • monitor I&O and vitals 
    • offer frequent high-calorie protein drinks 
    • provide finger foods 
    • remind client to eat 
    • walk or sit with client to encourage eating
  30. What elimination care is needed?
    • monitor bowel elimination 
    • offer high fiber foods
    • evaluate need for laxative 
    • encourage client to go to bathroom
  31. What should you do to promote sleep?
    • encourage rest periods during day 
    • reduce stimulation 
    • avoid caffeine 
    • use sleep inducing interventions
  32. What hygiene care needs are necessary?
    • supervise bathing as necessary 
    • minimize choices of clothing give simple step by step reminders
  33. What medication is big for bipolar?
    • Lithium carbonate 
    • half life: 24 hours 
    • Labs: 8-12 hours after last dose 
    • Therapeutic and toxic levels 
    • therapeutic: 0.5-1.5 mEq/L 
    • Maintenance: .8-1.2 mEq/L and above
  34. What is mild toxicity of lithium? Wat will you see?
    • 1.5-2.0 
    • coarse hand tremors, confusion 
    • hyperirritability of muscles 
    • drowsiness, lack of coordination 
    • persistent GI upset 
    • Salivary gland swelling 
    • excessive salivation 
    • EKG changes
  35. What is moderate toxicity? What will you see?
    • 2.0-2.5 
    • Ataxia 
    • tinnitus 
    • blurred vision 
    • clonic movement/seizures 
    • stupor/coma 
    • large output of dilute urine
  36. What is severe toxicity?what will you see?
    • greater than 2.5mEq/L 
    • complex involvement of multiple organ systems 
    • irreversible organ damage 
    • death
  37. What are the interventions for lithium toxicity?
    • D/C immediately 
    • Notify MD 
    • Obtain vitals 
    • obtain lithium level 
    • Labs: electrolytes, BUN, creatinine, UA, CBC 
    • hydration
    • consider emetic if awake
    • hemodialysis
  38. What medications besides lithium are used?

    nvalproic Acid ( Depakote)

    ncarbamazepine (Tegretol)

    nlamotrigine (Lamictal)

    noxcarbazepine (Trileptal)

    ntopiramate (Topamax)

    ngabapentin (Neurontin)
  39. What antianxiety meds are used for Bipolar?
    • Clonazepam (Klonopin) 
    • Lorazepam (ativan
    • Orally or IM for agitation or psychosis
  40. What antipsychotics are used for bipolar?
    • aripiprazole (abilify) IM or PO 
    • Olanzapine (zyprexa) IM 
    • risperidone (riperadal) Consta IM every 2 weeks 
    • Haloperidol (haldol) IM
  41. What are the advantages and disadvantages of lamictal?
    • Advantages: bipolar depression, rapid-cycling, propylaxis, bipolar I and II, unipolar depressions; very well tolerated, no weight gain, no labs, no sedation, no cognitive dulling 
    • Disadvantages: slow dosage titration limits acute utility, skin issues, high rate of benign skin rashes, fear of Steven Johnson's, increased risk of SJS with aggressive dosing
    • Valproate will double lamictal serum levels
  42. What education is needed for clients on lamictal for ski rash safety?
    • warn clients not to change soaps, laundry detergents, OTC products, unusual foods during first 6 weeks of lamotrigine titration 
    • Assess rash (severity, location and feautures) 
    • discontinue if: rash os severe, painful, or rapidly evolving. any blistering, systemic symptoms, mucous membrane involvement
  43. How can you help to maintain compliance?
    • Assist client to overcom denial and promote compliance by: establishing a therapeutic alliance
    • maintai regular appointments/visits 
    • involve family in care 
    • educate client about side effects 
    • risperdal consta IM
  44. What are common triggers for mania?
    • Sleep deprivation
    • exposure to light 
    • stress
    • summer 
    • arguments 
    • time change 
    • social events 
    • shopping centers
    • lack of structure 
    • television 
    • driving in traffic 
    • overcommitting 
    • every day obligations 
    • holidays
Card Set
Bipolar Disorder
exam 3 psych
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