Transcript Chapter_13_-_Bipolar_and_Related_Disorders

Bipolar and Related
Disorders
Copyright © 2014, 2010, 2006 by
Saunders, an imprint of Elsevier Inc.
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Assess a patient with mania for (a) mood, (b)
behavior, and (c) thought processes, and be alert to
possible dysfunction.
Explain the rationales behind five methods of
communication that may be used with a patient
experiencing mania.
Distinguish between signs of early and severe lithium
toxicity
Compare and contrast basic clinical conditions that
may respond better to anticonvulsant therapy with
those that may respond better to lithium therapy.
Evaluate specific indications for the use of seclusion
for a patient experiencing mania
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Acute Phase – page 234
Bipolar disorder, p. 228
Bipolar disorder, p. 228
Clang Associations, p. 233
Cyclothymic disorder, p. 228
Euphoric Mania, p. 228
Dysphoric Mania, p. 228
Flight of ideas, p. 233
Grandiosity, p. 233
Hypomania, p.228
Lithium Carbonate, p. 239
Maintenance Phase, p. 234
Mania, p. 245
Rapid Cycling, p. 228
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These are mood disorders with recurrent
episodes of depression and mania.
They are usually emerge in late adolescence
or early adulthood but have been diagnosed
in school-age children.
The clinical manifestations of bipolar disorder
can mimic the expected finings of attention
deficit hyperactivity disorder (ADHD), children
are more difficult to assess and diagnose.
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There are periods of normal functioning
which alternate with periods of illness.
Psychotic, paranoid and/or bizarre behavior
may be seen during periods of mania.
Care will depend on the state the patient is
experiencing at the time when seen.
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Biological factors
◦ Genetic
◦ Neurobiological
◦ Neuroendocrine
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Psychological factors
Environmental factors
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Bipolar I disorder
Bipolar II disorder
Cyclothymia
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Lifetime prevalence of bipolar disorder in the
United States is 5.1%
Bipolar I – more common in males
Bipolar II – more common in females
Cyclothymia – usually begins in adolescence
or early adulthood
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Mood
Behavior
Thought processes and speech patterns
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Cognitive functioning
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Flight of ideas - A continuous flow of speech
in which the person jumps rapidly from one
topic to another.
 Example: How are you doing, kid, no kidding around, I’m going
home….home sweet home…where the heart is.
◦ Clang associations - The meaningless rhyming of
words, often in a forceful manner.
 Cinema I and II, last row. Row, row, row your boat. Don’t be a
cutthroat. Cut your throat. Get your goat. Go out and vote.
◦ Grandiosity - Exaggerated belief in or claims about
one’s importance or identity
 Glad to meet you, I am the President of Leadville, glad to have
you visit my country. Be careful with the FBI may shoot you
while you’re here.
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Manic patient
◦ Manipulative
◦ Demanding
◦ Splitting
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Staff member actions
◦ Frequent staff meetings to deal with patient
behavior and staff response
◦ Set limits consistently
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Danger to self or others
Need for protection from uninhibited
behaviors
Need for hospitalization
Medical status
Coexisting medical conditions
Family’s understanding
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Risk for injury
Risk for violence
◦ Other-directed
◦ Self-directed
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Ineffective coping
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Acute phase
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Prevent injury
Hospitalization may be required
Risk of harm to self or others is determined
One to one supervision may be indicated.
Continuation phase
◦ Relapse prevention
◦ Treatment is generally 4 to 9 months in duration
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Maintenance phase
◦ Limit severity and duration of future episodes
◦ Requires lifetime treatment
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Acute phase
◦ Medical stabilization
◦ Maintaining safety
◦ Self-care needs
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Continuation phase
◦ Maintain medication adherence
◦ Psychoeducational teaching
◦ Referrals
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Maintenance phase
◦ Prevent relapse
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Acute phase
◦ Depressive episodes
◦ Manic episodes
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Continuation phase
◦ Prevent relapse with follow-up care
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Maintenance phase
◦ Prevent recurrence
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Lithium carbonate
◦ Indications
◦ Therapeutic and toxic levels
 Therapeutic blood level: 0.8 to 1.4 mEq/L
 Maintenance blood level: 0.4 to 1.3 mEq/L
 Toxic blood level: 1.5 mEq/L and above
◦ Maintenance therapy
◦ Side/Adverse Effects
◦ Contraindication – Pregnancy Risk Category D –
teratogenic during the first trimester. If
breastfeeding it should be discouraged and if they
have renal dysfunction, heart disease, dehydration
it should not be used.
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Valproate (Depakote)
Carbamazepine (Tegretol)
Lamotrigine (Lamictal)
Contraindications which are important:
◦ They are Pregnancy Risk Category D and can result
in birth defects
◦ Carbamazepine cannot be used in clients with bone
marrow suppression or bleeding disorders.
◦ Valproic acid cannot be used in clients with liver
disorders.
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Clonazepam (Klonopin)
Lorazepam (Ativan)
Atypical antipsychotics
Olanzapine (Zyprexa)
Risperidone (Risperdal)
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Electroconvulsive therapy (ECT)
Teamwork and safety
Support groups
Health teaching and health promotion
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Physical exhaustion and possible death
◦ A client in a true manic state usually will not stop
moving and does not eat, drink or sleep. This can
become a medical emergency
◦ Nursing Actions:
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Prevent self-harm
Decrease client’s physical activity
Ensure adequate fluid and food intake
Promote adequate sleep each night
Assist the client with self-care needs
Management medications
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Evaluate outcome criteria
Reassess care plan
Revise care plan if indicated
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1. Which anticonvulsant medication might be
prescribed for a patient with bipolar
disorder?
A. Divalproex sodium (Depakote)
B. Clonazepam (Klonopin)
C. Olanzapine (Zyprexa)
D.Lithium (Lithobid)
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