Mood disorders: suicide and bipolar spectrum disorders

  1. The most common method of suicides for men is ___ and for women is ___
    • Men: firearms
    • Women: poisoning
  2. The top four suicide risk factors
    • suicidal ideation with intent
    • lethal suicide plan
    • hx of suicide attempt
    • family hx of suicide
  3. Up to 50% of suicides have this factor in common
    • EtOH in their blood
    • Gives emotional blunting before suicide
  4. What is the "flight into health" phenomenon?
    • When there is rapid improvement of a hospitalized patient, not associate with actual recovery but used as a means to leave care in order to complete suicide
    • symptoms: unexpected calmness, nurse has uneasy feeling about pt, pt insists upon leaving or going off the unit alone
    • change in behavior patterns
  5. Why must suicide patients need close monitoring when starting antidepressants?
    • They will recover energy prior to their depression being alleviated
    • they will have the energy needed to commit suicide
  6. What is the most important question to ask someone who has suicide ideation in the past or currently?
    • What stopped you from acting upon them?
    • Allows us to focus on their reason for living
    • Example: love of family
  7. Hierarchy of needs for suicide patients
    • SAFETY
    • biological and physical needs
    • social interaction/doing
    • self-esteem/self-worth
  8. Intervention approach for suicide ideation
    • protect from harm: remove obvious means of self-harm, develop a "contracting approach"
    • watch for "flight into health"
    • work with the side of the person that wants to live
    • Activate social support
    • provide structure to day to reduce rumination
    • provide statements of hope - important
  9. What is the "contracting approach" for patients with suicide ideation?
    • Have patient agree to let you know if they are feeling out of control or ready to act on suicide plan.
    • Do not exclusively depend on this approach
  10. The three bipolar spectrum disorders discussed in class
    • Bipolar I
    • Bipolar II
    • Cyclothymic disorder
  11. Define a manic episode
    • acute psychotic process associated with positive symptoms of psychosis (hallucinations, delusions)
    • persistently elevated, expansive or irritable mood with increased goal-directed activity and energy lasting at least 1 week
  12. A dx of bipolar I requires criteria for a ___ episode
    • manic (1 week)
    • psychotic
  13. During the manic or hypomanic period, at least 3 of the following symptoms must be met (or 4 if the mood is just irritable).
    • inflated self-esteem or grandiosity
    • decreased need for sleep
    • more talkative
    • flight of ideas or racing thoughts
    • distractibility
    • increase in goal-directed activity [or psychomotor agitation (hallucinations) for bipolar I]
    • excessive involvement in activities that have a high potential for self-harm
  14. During a manic period, patients will have a massive load of this NT, which will ____ the body
    • Dopamine
    • EXHAUST = safety issue!
  15. It is very common for type I bipolar pt to use this to self-medicate during the manic stage.
    • EtOH
    • May require CIWA scoring
  16. For pts with bipolar disorder I, illicit drugs can trigger this
    ACUTE manic episode
  17. Requirements for a dx of bipolar II
    • Hypomanic episode: distinct period of abnormally and persistently elevated, expansive or irritable mood and increased goal-directed activity and energy, lasting at least 4 consecutive days.
    • Absence of an acute psychotic process (no positive symptoms of psychosis).
  18. Length of time for dx of bipolar I versus bipolar II
    • Bipolar I: manic for at least 1 week
    • Bipolar II: hypomanic for at least 4 consecutive days
  19. The differences between bipolar I and bipolar II
    • bipolar I involves psychotic episodes (hallucinations)
    • bipolar II hypomanic episodes are not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization
  20. Requirements for a dx of cyclothymic disorder
    • at least 2  years (1 year in children) with numerous periods with hypomanic symptoms (not severe enough to call an episode) and depressive symptoms.
    • Can be challenging to differentiate from bipolar II
  21. Define rapid cycling
    4 or more episodes of mania, mixed mania, hypomania, or depression, or any combination of these in a 12-month period
  22. Bipolar disorder is a leading cause of ___ worldwide
  23. Suicide risk for pts with bipolar disorders
    • 25-50% attempt
    • 15% complete
  24. Medications (general) used for bipolar treatment
    • lithium
    • anticonvulsants
    • atypical anticonvulsants
  25. Lithium is the most powerful medication for these effects
    • anti-manic
    • mood stabilizer
  26. Therapeutic levels for lithium
    0.6 to 1.0 mEq/L
  27. Toxic level of lithium
    • 1.5 mEq/L or greater
    • VERY NARROW window, requies regular blood draws
  28. Symptoms of lithium toxicity
    • severe N/V
    • diarrhea
    • ataxia
    • tinnitus
    • vertigo
    • muscle weakness
    • blurred vision
    • seizure
    • arrhythmia
    • stupor
    • coma
  29. Any conditions causing ___ or ___ can cause lithium toxicity
    • dehydration
    • shift of electrolytes
  30. For bipolar disorder, anticonvulsants have this effect
    • primarily controls mania
    • has some preventative antidepressant effect
  31. For bipolar disorder, atypical antipsychotics have this effect
    • mood stabilization
    • some efficacy in treatment-resistant bipolar disorder (3rd line choice)
  32. Nursing interventions for bipolar disorder
    • maintain a safe environment
    • medication administration, assessment and monitoring
    • substance abuse withdrawal regimen and education (if needed)
    • teaching monitoring and coping strategies
    • social skills and support training
  33. Top two target behaviors for nursing interventions, bipolar disorder
    • irritability
    • impulsiveness
  34. Interventions for acute mania
    • KISS - structured, short 1-to-1 activities
    • firm, calm approach
    • short, concise statements
    • avoid power struggle
    • have a consistent approach and expectations
    • communicate with team
    • redirect excessive energy
    • reduce environmental stimuli
    • frequent high-calorie protein and finger foods that patients can eat on the go
    • avoid caffeine
    • supervise ADLs
    • monitor I & O
    • frequent rest periods
Card Set
Mood disorders: suicide and bipolar spectrum disorders
suicide; bipolar spectrum disorders