Bipolar education
• Chronic disorder that requires long-term pharmacological and psychological support • Benefits of psychotherapy and support groups to prevent relapse • Indications of impending relapse and ways to manage the crisis • Precipitating factors of relapse (sleep disturbance, use of alcohol or caffeine) • Importance of maintaining a regular sleep, meal, and activity pattern • Medication administration and adherence
What is the education needed for bipolar disorder?
Used for treatment-resistant bipolar disorder and for severe symptoms • Involves sending a carefully controlled electrical impulse through the brain • 6-12 treatments considered a typical course • Requires informed consent
What is electroconvulsive therapy (ECT)?
• Neurologic: Course tremor, slurred speech, ataxia, seizures, stupor, coma • Gastrointestinal: severe nausea, vomiting, and diarrhea • Cardiac: hypotension, bradycardia, electrocardiogram abnormalities, peripheral circulatory collapse • Renal: renal failure • May progress rapidly and can be lethal
What are the s/s for lithium toxicity?
• First-generation: chlorpromazine and loxapine • Second-generation: olanzapine, risperidone, lurasidone, quetiapine
What are antipsychotics?
• Flat, blunted, labile affect • Feelings of hopelessness and sadness; Tearfulness, crying • Feelings of worthlessness and inappropriate guilt • Lack of energy • Anhedonia: loss of pleasure and lack of interest in activities, hobbies, sexual activity • Physical reports of discomfort/pain
What are depressive characteristics?
Abnormally elevated mood, which can also be described as expansive or irritable; usually requires hospitalization. Manic episodes last at least one week.
What is mania?
*behavior shown in bipolar disorder
Mood stabilizer • First line treatment for bipolar disorder • Exact mechanism of action unknown • 3 to 6 weeks to show full therapeutic response • Requires close monitoring of serum levels→ narrow range from therapeutic to toxic levels
What is lithium?
Stop lithium and facilitate excretion: emetic; gastric lavage; urea, mannitol, and aminophylline • Hemodialysis in severe cases
What are the interventions for lithium toxicity?
• SSRIs (such as fluoxetine) to manage major depressive episodes; use caution because SSRIs may trigger manic episodes
What are antidepressants?
• Labile mood with euphoria and elation or irritability and anger • Poor judgment, impulsive, high-risk behavior (grand shopping sprees, drug and alcohol misuse, sexual promiscuity) • Decreased sleep • Increase in talking and activity, restlessness • Flight of ideas: rapid, continuous speech with sudden and frequent topic change • Pressured speech • Clang associations • Grandiose view of self and abilities (grandiosity) • Dislike of interference and intolerance of criticism
What are mania characteristics?
• Therapeutic range for acute mania: 0.5 to 1.2 mEq/L
• Maintenance range: 0.6 to 1.0 mEq/L
• Toxic range: greater than 1.5 mEq/L
• Life threatening emergency: levels of 2 mEq/L or greater
• Serum lithium levels affected by fluid and electrolyte imbalances (specifically sodium levels)
What are the ranges of lithium?
• Presents with recent severe and prolonged periods of depression that alternate with brief periods of hypomanic episode(s). • Hypomania is essentially a less severe and less intense form of mania and may only last two (2) to four (4) days in most cases. • *Never experience a full manic episode.* • Typically seek treatment during a depressive episode • More severe depressive symptoms and more time spent in depressive state • Psychosis IS NOT present in Bipolar II Disorder. • Work and social functioning impairment are present
What is bipolar 2 disorder?
Presents with milder hypomanic episodes alternating with persistent milder depressive episodes (dysthymia) for at least two (2) years in adults and one (1) year in children. •Mood shifts are not as extreme
What is cyclothymic disorder?
Clonazepam & Lorazepam helpful in managing psychomotor agitation seen in acute mania; short -term use
What are anxiolytics?
• Difficulty concentrating, focusing, problem-solving, decision making • Self-destructive behavior, including suicidal ideation, thoughts of death • Decrease in personal hygiene • Inability to sleep or sleeping too much • Changes in appetite and weight • Psychomotor retardation or agitation
What are depressive characteristics?
Less severe episode of mania that lasts at least four days accompanied by three or more manifestations of mania. Hospitalization is not required and the client is less impaired. Can progress to mania.
What is hypomania?
*behaviors shown in bipolar disorder
Four or more episodes of hypomania or acute mania within one year and associated with increased recurrence rate and resistance to treatment
What is rapid cycling?
*behaviors shown in bipolar disorder
Genetics: Having an immediate family member who has a bipolar disorder
• Physiological: Neurobiologic and neuroendocrine disorders
• Environmental: Increased stress in the environment can trigger mania and depression and increase risk for severe manifestations in genetically-susceptible children.
What are risk factors for bipolar disorder?
• Lithium carbonate • Anticonvulsants (acting as mood stabilizers) • Valproic Acid: First line treatment for bipolar mania or hypomania • Lamotrigine: First line treatment for bipolar depression
What are mood stabilizers?
Nutrition: • Monitor intake, output, and vital signs • Offer frequent high-calorie protein drinks, milkshakes, and finger foods • Frequently remind patient to eat
• Sleep/Rest: • Encourage frequent rest periods during the day • Keep patient in areas of low stimulation • At night, provide warm baths, soothing music, and medication when indicated • Avoid giving patient caffeine
What are nursing interventions to maintain physical health in bipolar disorder?
• At least one episode of “persistent or elevated, expansive or irritable mood” (mania) and at least one clearly recognizable episode of major depression with marked impairment in social and occupational functioning. • Psychosis may accompany the manic episode or the depressive episode • Hospitalization potentially warranted. • Significantimpairment in social and occupational functioning
What is BIPOLAR I DISORDER ?
Use of substances (alcohol, cocaine, caffeine) • Sleep disturbances • Psychological stressors
What are risk factors for relapse of mania?
substance Use Disorder • Anxiety Disorders • Borderline Personality Disorder • Oppositional Defiant Disorder • Social Phobia and Specific Phobias • Seasonal Affective Disorder • Attention Deficit Hyperactivity Disorder • Migraines • Metabolic Syndrome
What are common comorbidities of bipolar disorder?
• Demanding and manipulative behavior • Highly distractible, poor ability to concentrate, decreased attention span • Attention-seeking behavior: flashy dress and makeup, inappropriate behavior, sexually explicit speech and behavior • Impairment in social and occupational functioning • Neglect of ADLs, including nutrition and hydration • Possible presence of paranoid delusions and hallucinations • Denial of illness
What are mania characteristics?
Hygiene: • Supervise choice of clothes; minimize flamboyant and bizarre clothing (unmatched colors or sexually provocative clothing) • Give simple, step-by-step reminders for hygiene and dress
Elimination: • Monitor bowel habits; offer fluids and foods that are high in fiver • Evaluate need for laxative • Encourage patient to go to the bathroom
What are nursing interventions to maintain physical health?