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Mania or hypomania
alternating with depression
Bipolar I (major depressive, manic, or
mixed episodes)
Bipolar II (major depression and
hypomania)
Cyclothymic disorder (hypomania and
depressive episodes not meeting full
criteria for major depressive episode)
BPD Definitions
Mood
Incidence and
Prevalence of BPD
Lifetime
bipolar II
Symptoms before age 25 years
No gender differences in incidence
Female patients at greater risk for depression
and rapid cycling than male patients
Male patients at greater risk for manic
episodes
Common comorbid conditions: anxiety
disorders (most prevalent: panic disorder and
social phobia) and substance use
Earlier
Bipolar I Disorder
Classic
BPD vs Unipolar
BPD:
DSM: 3 or >
Inflated
10
Bipolar, manic: sy
Euphoria
& elation
Labile mood; flight of ideas
Paranoid & grandiose delusions
Sexually uninhibited; inexhaustable
energy
Disorganized, flamboyant or bizarre
dress
Excessive psychomotor activity
Diminished sleep
3 most common sy @ onset: elated
mood, increased activity, reduced sleep
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Behaviors associated
w/BPD
Distractability
Insomnia
Grandiosity
Flight
of ideas
Activities
Speech
Thoughtlessness
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Question
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Answer
False.
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Understanding Biologic
Foundations
Physical Findings on Dx
studies
Brain
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Mania theories:
psychosocial
Psychoanalytic-mania
is denial
of depression, reactivation of
infantile state
Family-early life-loving,
nurturing--as gets older
increasing independence and
nurturing is withdrawn before the
child has object constancy--cant
incorporate good/bad19
ambivalence
Nursing DXs
Risk
for violence
Risk for Other-Directed Violence
Ineffective coping
Disturbed thought processes
Disturbed self-esteem
Impaired social interaction
SCD
Disturbed Sleep Pattern
Altered family processes
Imbalanced nutrition; FVD
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Ed Support Groups
Cognitive therapy
Nursing interventions
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Rapid Cycling
BPD: Chemo
Mood
stabilizers
lithium or depakote-1st line for acute mania,
Anticonvulsants used as mood stabilizers:
carbamazepine (tegretol)gabapentin (neurontin),
lamotrigine(lamictal)
Antidepressants: SSRIs, bupropion(wellbutrin),
venlafaxine(effexor), mirtazapine(remeron),
nefazodone(serzone)
Antipsychotics: atypical-olanzapine(zyprexa),
quetiapine(seroquel), risperidone(risperdol),
ziprasidone (geodan)clozapine(clozaril)-mood
stabilizing properties; most common side effectsdrowsiness & wt gain; clozaril not 1st choice
because of agranulocytosis
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Lithium: indications
1st
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Lithium therapy
Contraindications-
pregnancy/breast-feeding,
cardiac, renal, thyroid disease,
myasthenia gravis, (kids under
12 y/o)
Baseline- thyroid function, T3, T4,
TSH, renal-bun/cret, EKG
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Lithium
Expected
Lithium: toxicity
Levels
mEq/L;
Early-n/v/d, thirst, polyuria, slurred
speech, muscle weakness (above 1.5
mEq/L)
Advan.-Coarse hand tremors,
confusion, gi upset, muscle
hyperirritability, EEG changes
incoordination (1.5-2.0 mEq/L)
Severe-ataxia, seizures, coma,
hypotension, arrhythmias (2.0-2.5
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slow
speech, inhibit aggression,
decrease psychomotor activity,
exhaustion & death; risperidone,
flupenthixol
Anticonvulsants-control mania,
pvn mania, relieve psychotic s/s,
dampen mood swings, decrease
impulsive & aggressive behavior
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Anxiolytics, Benzodiazepines
Lorazepam:
short acting
Clonazepam: long-acting
Class Summary: By binding to
specific receptor sites,
benzodiazepines appear to potentiate
the effects of gamma-aminobutyric
acid (GABA) and facilitate inhibitory
GABA neurotransmission and the
action of other inhibitory transmitters.
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Anticonvulsants
Carbamazepin
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Anticonvulsants
Carbamazepine
BPD: Hospitalization
Acute
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Impulse self-control
Aggression self-control
Self-care status
Concentration
Compliance behavior
Mood
management
Nursing Intervention
Self-esteem
Classification (NIC)
(R/T Mania)
enhancement
Active
listening
Behavior
management:
overactivity
Behavior
management: sexual
Cognitive
restructuring
Coping
enhancement
Guilt
work facilitation
Limit
setting
Simple
guided
imagery
Simple
relaxation
therapy
Socialization
enhancement
Spiritual
support
Teaching:
process
disease
an expert on condition-read
Maintain stable sleep pattern
Maintain regular exercise program
Do not use ETOH or illicit drugs
Enlist support of family & friends
Try to reduce stress at work
Learn to recognize warning signs of new
mood episode
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or violent feelings
Changes in mood, sleep or energy
Changes in medication side effects
A need to use over-the-counter
medications such as cold meds or pain
meds
Acute general medical illness or need
for surgery, extensive dental care, or
changes in meds
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cyclothymic vs dysthymic
Cyclothymia-chronic
mood
disturbance of 2 or >yrs; alternating
hypomania & depression, no
psychosis or dysthymia &
hypomania; not severe enough to be
bpd
Dysthymia- depressive neurosis,
milder than mdd, no psychosis,
**chronic depressed mood most
days & >2 yrs, w/kids irritable mood
1yr or>
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Question
Which agent would most commonly be
prescribed for a patient with bipolar I
disorder?
A.
Lamotrigine
B.
Lithium
C.
Carbamazepine
D.
Divalproex
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Answer
B. Lithium
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Question
Is the following statement true or false?
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Answer
True.
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WEB Sites
National
Institute of Mental
Health
www.nimh.nih.gov
National Alliance on Mental
Illness
www.nami.org
Bipolar Support Alliance
dbsalliance.org
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