bipolar disorder
what episode is required for a dx of bd
manic
what episode usually occurs first for man and women? what can occur first for men?
depressive. manic
definition of manic
characterized by elevated expansive or irritable mood ad are fundamental to the dx of bd 1
hypomaniac episodes
similar to manic episode but denotes a less severe level of impairment.
meds used
mood stabilizers, atypical antipsychotic, anticonvulsants
electroconvulsive therapy and benzos
what are other name in hx for bd
manic-depressive disorder and bipolar affective disorder
bd1
major depression to manic
dx criteria for bd 1
mania must persist for atleast 1 week (unless hosp). can last days to months
dx of hypomaniac
length of episode atleast 4 days but not severe enough for hospitalization.
3 of these:increased self esteem or grandiosity, decreased sleep, increased talkativeness, subjective thoughts are racing, distractability, increase in goal directed activity, excessive involvement in pleasureable activities
whats important to know about lithium
there therapeutic index is narrow and blood draws are important. 0.6-q.0meq/l stanrdard
dose-400-1200mg/day
median age of onset of bd
25. onset is usually early 20s
bd2
major depression to hypomanic
medical conditions that cause mania
anoxia, hyperthyroidism, hemodialysis, lyme disease. hypercalcemia, aids, stroke, brain tumor, ms, normal pressurw hydrocephalus, other neuro disorders
depressive episode
causes more suffering and is more disabling than manic or hypomanic
most valueable anticonvulsant
valproates- divalproex sodium ( depakote)
prescribed twice as much as lithium
% of elderly with bd
25%
difficulties treating bd
50% patient non complaince
29% determinging the best meds
21% distinguishing bd from depression
signs of excessive ness
spending sprees, sexual indiscretions, loud clothing, and excessive make up
unipolar disorder
major depressive disorder
milieu management
SAFETY
consistency among staff
reduction of environment stimuli
dealing with patients who are escalating
reinforcement of appropriate hygiene and dress
nutrition and sleep issues
routines
what % have bd 1 over the course of 1 yr?
0.6%
what med do they not recommend to give to people with bd
antidepressants. starts manic
relapse acronym
r- rhythm disturbance.
e-ending treatment
l-life change
a-additional drugs
p-physical health changes
s-substance use and withdrawal
e-end of drug response
cyclothymic disorder
dysthymia to hypomanic
mdq questionaire
answer yes to atleast 7 of the number q's.
yes to 2
and moderate to serious problem for 3