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NUR 114
Bipolar disorder
| Question | Answer |
|---|---|
| Why is Bipolar difficult to diagnose? | mimics other disorders and has comorbidities |
| when are pts with bipolar likely to seek treatment? | when severely depressed; it is more debilitating and their manic episodes can be enjoyable to them/ they see it as a non-issue |
| what may children initially present with? | ADHD, oppositional defiance disorder, or anxiety |
| what co-occuring disorder do many people diagnosed with bipolar disorder have? | substance use disorder |
| what are the 2 causes of bipolar disorder? | genetic predisposition and a stressor |
| Disorders that have mood changes that should be ruled out before diagnosis of bipolar (5 of them :P ) | thyroid disorder (espc hyperthyroidism) seizure disorder multiple sclerosis serious infection drug-induced disorders |
| characteristics of mania | extremely happy/ energized fast/ pressured speech irritable/cranky/ disrespectful grandiosity/ risky behavior decreases need for sleep |
| characteristics of depression | feeling worthless appetite/ weight changes extreme sadness suicidal thoughts |
| basic definition bipolar 1 disorder | an individual will experience full-blown mania and may have psychotic symptoms (with depressive episodes ofc) |
| basic definition bipolar 2 disorder | individual will experience hypomania with no full mania or mixed manic episodes (with depressive episodes) |
| average age onset for bipolar 1 and bipolar 2 | BP 1 = 18 y/o BP 2 = 20 y/o |
| DSM-V requirements to diagnose bipolar 1 disorder | -1 or more full-blown manic episodes -minor or major depressive episodes -may experience psychotic symptoms |
| what is the difference between adults and children with bipolar 1 disorder? | adults have episodic mania with elevated mood/energy and children have chronic mania making them anxious or irritable |
| what is a mixed episode? | both mania and depression can occur on the same day, or symptoms can overlap |
| DSM-V requirements for bipolar 2 disorder | -oat least 1 HYPOMANIC episode -one or more major depressive episode - NO full mania or mixed mania episodes NO PSYCHOSIS |
| What is cyclothymia? | chronic, less severe form of bipolar with short depressions and short hypomanic episodes |
| DSM-V requirements for cyclothymia | -a single episode of hypomania is sufficient -each episode of either depression or hypomania is separated by a period of normalcy |
| when should you exclude the cyclothymia diagnosis | if the pt has experiences a full manic episode or a major depressive episode |
| DSM-V manic episode criteria | -Lasts at least one week -3 or more DIGFAST symptoms -distinct period of abnormally elevated mood |
| D in DIGFAST | Distractable |
| I in DIGFAST | increased activity/ psychomotor agitation |
| G in DIGFAST | Grandiosity (super-hero mentality) |
| F in DIGFAST | Flight of ideas (racing thoughts) |
| A in DIGFAST | Activities that are dangerous |
| S in DIGFAST | Sleep decreased |
| T in DIGFAST | Talkative/ pressured speech |
| what is the bipolar depressive triad? | overeating, oversleeping, and excessive physical fatigue |
| What is rapid-cycling specifier per DSM-V? | -BP 1 or BP 2 -four or more mood episodes per 12 months (i.e major depressive, manic, hypomanic, mixed) -episodes must be separated by a period of full remission or a switch to opposite polarity |
| Priority treatment of symptoms | FIRST treat mania/ psychosis SECOND treat depression THIRD treat ADHD/ anxiety |
| what are the medication classes used to treat Bipolar Disorder? | Mood stabilizers: lithium and anticonvulsants |
| therapeutic range of lithium maintenance dose | 0.6-1.2 mEq/L |
| therapeutic range of lithium for acute mania | 1.0-1.5 mEq/L |
| How often should a pt blood lvls be monitored while on lithium? | 1-2x weekly until levels are stable, then monthly blood draws |
| What is the black box warning on lithium? | narrow therapeutic range |
| What kind of things will affect/increase lithium levels? | anything that will decrease renal function: vomiting/diarrhea, diuretics, low sodium intake |
| S/S of Lithium toxicity (1.5-3.5 mEq/L) | hand tremors, blurred vision, tinnitus, n/v/d, muscle irritability, psychomotor retardation, mental confusion, giddiness |
| S/S of Lithium toxicity if serum levels are over 3.5 mEq/L | impaired consciousness, seizures, coma, scant urine output, MI, cardiovascular collapse |
| what side effect is related to noncompliance to lithium dose? | disruptions in memory/ cognition |
| how is lithium excreted? | through the kidneys unchanged --NOT METABOLIZED |
| how long after after oral admin of lithium is it at peak? | 3 hrs |
| how long after after oral admin of lithium is it completely absorbed? | 8 hrs |
| which anticonvulsant is also used for pain management? | Neurontin (Gabapentin) |
| which anticonvulsant is also used for migraines? | Topamax (Topiramate) |
| how do anticonvulsants work? | they calm hyperactivity in the brain |
| considerations for a female on an anticonvulsant | pregnancy should be avoided while on an anticonvulsant as it may increase the risk of birth defects |
| what other med is sometimes used in conjunction with a mood stabilizer? | atypical antipsychotics |
| which atypical antipsychotic can help with depression, mania, and psychosis? | Olanzapine (Zyprexa) |
| which atypical antipsychotic can help calm an agitated pt? | Ziprasidone (Geodon) |
Created by:
ginnyfoscue
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