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Bipolar Spectrum Disorder
Terms in this set (46)
How is bipolar spectrum disorder characterized?
-by moods that are at two opposite poles: depression and mania
-the range goes from depressed -> normal-> hypomania ->acute mania -> delirious mania
-can have mixed episode which depressive symptoms occur during a manic attack
-an exaggerated, elevated, expansive, or irritable mood accompanied by a persistent increase in activity
-can be euphoric or irritable
-adds to morbidity
Bipolar Disorder Manic Episode DSM-5 criteria
-Abnormally and persistently elevated, expansive or irritable mood lasting at least 1 wk
-Impairment in occupational functioning or in social activities or relationships
With 3 or more of the following:
-Inflated self-esteem or grandiosity
-Hyperverbal & pressured speech
-Flight of ideas or racing thoughts
-Decreased need for sleep (rested after 3 hrs)
-Increased goal directed activity or psychomotor agitation
-Excessive involvement in pleasurable activities that have a high potential for painful consequences
Mood disorder questionnaire
-screening device for assessment purposes
-Has there ever been a period of time when you ere not your usual self and you felt so good or so hyper that other people thought you were not your normal self or you got in trouble?
-you were so irritable that you started a fight?
-you were more self confident than usual?
-you got less sleep and didn't miss is?
-thought raced through your head?
-more active than usual?
-more social than usual?
-spending money that go you in trouble?
2. If you answered yes to more than 1, have several of these happened during the same period of time?
3. How much of a problem did these cause you? (unable to work, having family, money or legal problems, or getting into altercations)
4. Have any of your blood relative had manic depression of bipolar?
5. Has a HCP ever told you that you have manic depressive illness or bipolar disorder?
Bipolar I disorder
-requires a had a full blown mania either currently or in the clients hx**
-at least one episode of persistent or elevated expansive or irritable mood (mania) and at least one clearly recognizable episode of major depression.
-marked impairment in social and occupational functioning
-psychosis may accompany the manic episode
-traits such as anxious distress, mixed feature, rapid cycling, melancholic feature, atyptical features, and peripartum onset.
Bipolar II disorder
- is when the client has had a hypomania but no full blown mania **
-recent severe and prolonged period of depression that alternate with brief periods of hypomanic episode
-less sever and less intense than mania and only lasts 2-4 days
-specified by anxious to distress, mixed features, rapid cycling, mood congruent or mood in-congruent, with peripartum onset, with catatonia.
-psychosis not present
-hypomanic episode is euphoric
-at great risk for suicide because of the depressive symptoms
Rapid cycling features
-two or more distinct episodes of alternating episodes of both mania and depression (depression-mania-depression-mania) in a 12 month period
-usually indicates more severe symptoms such as proper global functioning, higher recurrent risks, and greater resistance to treatments
-present hypomanic episodes alternating with persistent depressive episodes for at least 2 years in adults and 1 year in children
-irritable hypomanic episodes
bipolar disorder unspecified
-do not meet criteria for specified disorders
-can cause distress but are not a distinct bipolar disorder and are noted as "other specified"
Mania or hypomania with mixed features
-in a full bipolar mania or hypomanic mood but display depressive symptoms at the same time
-significant suicide risk
-pessimism and worry
-decreased need for sleep
how to distinguish between hypomania, acute mania, extreme delirious mania
Communication, affect and thinking, physical behavior
-"life of the party", gets upset when not the center of attention
-treats everyones with familiarity and borders crude
-talk is goes from one topic to another and marked by pressure of speech
hypomania: affect and thinking
-persistent elevated, expansive, irritable mood
-full of pep and humor
-writes letters and calls to famous people
-decreased attention span
Hypomania: physical behavior
-overactive and distractable
-voracious appetite, eat on the run
-go without sleeping
-shopping sprees but will return stuff later
Acute mania: communication
-labile, goes from happy to sad
-demands attention inappropriately
-profanity and crude
-flight of ideas
Acute mania: affect and thinking
-abnormally persistent elevated, expansive, or irritable mood
-good humor, to increased irritability and hostility and rage
-intense attention span deficit
acute mania: physical behavior
-extremely restless and chaotic, outbursts
-no time for sex
-no time to eat
-no time for sleep
-extreme shopping sprees
extreme delirious mania: communicaation
-totally out of touch with reality
extreme delirious mania: affect and thinking
-may become destructive or aggressive: totally out of control
-may experience undenied hallucinations and delirium
extreme delirious mania: physical behavior
-dangerous state, hyperactive, aimless
-no time for sex, eating, sleep
-too disorganized to do anything
Unipolar depression v. Bipolar depression
-women more than men and appears later in life
-general insomnia, loss of appetite, depressive episodes last longer
-affects men more than women and is usually much younger
-hypersomnia, changes in appetite, psychomotor retardation
-at higher risk for drug abuse
What causes bipolar disorder?
-Psychological influences: stressful life and abuse as a child
-Physiological safety: hydration, cardiac status, sleep exhaustion, determine whether mania is primary or secondary (drugs)
-Danger to self/others: inappropriate sexual activity, uncontrolled spending/giving
-Assist in assessment to rule out other disorders
-Knowledge of disorder, meds, support groups and organizations
Acute phase (Phase I)
-first 2 months
-medically stabilizing the patient
-decrease physical activity
-increase food and fluid intake
-ensure 4-6 hours of sleep
-eliminate and bowel or bladder problems
-no self harm attempts
-stable cardiac status
Continuation phase (Phase II)
-maintaining compliance to medications
-interventions planned in accordance to assessments data of clients interpersonal and stress reduction skills, cognitive function, employment status, substance-related problems, and support systems.
-psycho-educational training for patient and family
-referrals given for community programs, groups, and support for co-occurring disorders or problems
-psychotherapy (CBT, Interpersonal and social rhythm therapy (IPSRT), family focused therapy (FFT))
-communication and problem solving skills training
-Pt teaching on knowledge on disease, medications, early S/S of relapse, and effects of substance abuse on relapse
Maintenance phase (phase II)
-6 months and on
-preventing relapse and limiting the severity and duration of episodes
-support and educational groups
-regular evaluations with a HCP
Interventions during the acute phase
-teamwork and collaboration
-biological therapy: nutrition, sleep, hygiene, elimination
-consistent setting and followed by all of the staff
-the ability to contain or diminish unacceptable or inappropriate behavior in a positive, professional manner. An interpersonal skill that maintains the self-esteem of all parties and establishes personal boundaries.
-Skills requires are: assertive communication techniques, detached concern, consistency with behavioral expectations and consequences.
-Avoid:Setting limits out of proportion to the situation, colluding with splitting
-Display a firm, calm approach. Good for structure and control. ("Come with me and eat this sandwhich")
-Express short, concise explanations or statements. Good because they have short attention spans)
-Remain neutral. Avoid power struggles.
-Maintain consistency. Minimizes manipulation.
-Conduct frequent staff meetings to agree on approach and limit setting.
-Hear and act upon legitimate complaint to minimize feelings of helplessness.
-Firmly redirect energy through distraction.
interventions for a safe and structured milieu
-maintain a low level of stimuli to decrease the patients anxiety: no joking and being loud
-provide structure solitary activities with a nurse or aide for security and focus
-provide frequent high calorie fluids
-promote rest periods
-redirect physical behavior through exercise
-when warranted, use seclusion and and antipsychotics to minimize harm
-protect the patients from money and valuables
-First-line agent for bipolar disorder along with Depakote
-Mechanism of action is unknown. Acts like a salt
-Requires continuous treatment to prevent both manic and depressive episodes
-Narrow therapeutic window = narrow range for symptom relief without toxicity
-Higher doses during acute mania,
lower maintenance dose
-Good for acute treatment of mainia and depressive episodes
-Less effective for people with mixed mania
Blood levels for lithium
-Therapeutic blood level: 0.6 to 1.2 mEq/L
-Maintenance blood level: 0.4 to 1.0 mEq/L
-Toxic blood level: 1.5 to 2.0 mEq/L
Side effects and adverse reactions of lithium
L: leukocytosis- benign side effect
I: Insipidus (Diabetic) = Large output of dilute urine- toxic; irritability of muscles (toxic)
T: Tinnitus (toxic); tremor (fine=side effect; course = toxic)
H: Hypotension (severe) -toxic
I: Increased weight(side effect), incoordination (toxic)
U: Vomiting (substitute V for U), nausea & diarrhea -early toxicity
M: Miscellaneous - EEG changes, Ataxia, nystagmus, blurred vision, confusion (all toxic)
Also look at 16-5
Long term risks of lithium therapy
-impairment of the kidneys ability to concentrate urine AKA Nephrogenic diabetes insipidus
Contradictions to lithium therapy
-Renal, thyroid or neurological disorders
-Pregnancy and Breast feeding
Lithium drug interactions
Any drug that affects sodium levels may interact with lithium:
Teaching for patients taking lithium
-Adequate fluid intake (3L/d)
-Awareness of heavy sweating & need to replace fluids & electrolytes
-Take with food or milk
-Don't change salt intake
-If fine tremor, eliminate caffeine. PCP may try beta blocker
-Moderately restrict calories if weight gain problematic
-Symptoms of toxicity
-Not to suddenly stop medication
-if patient doesn't respond to lithium
-beneficial in controlling mania (within 3 weeks or longer)
-superior is dyphoric mania
-superior in rapid cycling
-drug of choice for bipolar depression
-more effective when no family history
Example: divalproex (Depakote), carbamazepine (Tegretol), lamotrigine (Lamictal)
AKA Valproic Acid
-good for patients with acute mania, rapid cycles, dysphoric mania, respond to carbamezepine
-Black Box Warning for Hepatitis and Pancreatitis
-good for patients with rapid cycling, severely paranoid and angry patients with mania, mixed bipolar
-blood levels should be drawn for the first 8 weeks because it can suppress the liver
-can cause bone marrow supression
-first line treatment for people who have bipolar depression but also approved for acute maintenance and therapy
-can cause Steven's Johnson syndrome and Aseptic Meningitis (both rare but serious)
-used for acute mania and treatment resistant mania, and patients with psychomotor agitation
-contraindicated in someone with substance abuse
-Old Airplanes Lunge Right As they Zip Past Quiet Clouds
-used for sedative properties in patients with acute mania
Of Mood Stabilizers:
-1-3 weeks for effect in mania
-4-6 weeks for effect in depression
-Must know patient's target symptoms.
THIS SET IS OFTEN IN FOLDERS WITH...
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