Ch 13 - Bipolar and Related Disorders Study Guide

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Ch. 13 – Bipolar and Related Disorders Study Guide Ch. 13 - Bipolar and Related Disorders Study Guide Know the definitions for the following terms.  Circumstantial speech  Clang Association  Flight of Ideas  Loose Associations  Pressured Speech  Rapid Cycling  Tangential Speech Answer the following questions. 1. What is the difference between Bipolar I and Bipolar II? Bipolar I disorder is the most severe bipolar disorder. It is marked by shifts in mood, energy, and ability to function. Periods of normal functioning may alternate with periods of illness (highs, lows, or a combination of both). Many individuals continue to experience chronic interpersonal or occupational difficulties even during remission. Individuals with bipolar II disorder have experienced at least one hypomanic episode and at least one major depressive episode. Hypomania refers to a low-level and less dramatic mania. The hypomania of bipolar II disorder tends to be euphoric and often increases functioning. Like mania, hypomania is accompanied by excessive activity and energy for at least 4 days and involves at least three of the behaviors listed under Criterion B in the DSM-5. Unlike mania, psychosis is never present with hypomania. Psychotic symptoms may, however, accompany the depressive side of the disorder. 2. What characteristics seen when having a manic episode in Bipolar I? A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary). 3. What characteristics are seen when having a manic episode in Bipolar II? The hypomania of bipolar II disorder tends to be euphoric and often increases functioning. Like mania, hypomania is accompanied by excessive activity and energy for at least 4 days and involves at least three of the behaviors listed under Criterion B in the DSM-5. Unlike mania, psychosis is never present with hypomania. Psychotic symptoms may, however, accompany the depressive side of the disorder. 4. When is the risk of suicide attempts greater in a patient with the cyclothymic disorder? Some people with bipolar I or II will experience rapid cycling and may have at least four mood episodes in a 12-month period. These mood episodes can be major depressive, manic, or hypomanic. Cycling can also occur within the course of a month or even a 24-hour period. Rapid cycling is associated with more severe symptoms, such as poorer global functioning, high recurrence risk, and resistance to conventional somatic treatments. 1

Ch. 13 – Bipolar and Related Disorders Study Guide 5. What is the risk factor that increases the risk of bipolar disorder up to 10 times in an individual? 6. As nurse what signs might be seen when one has suicidal ideations? The euphoric mood associated with mania is unstable. During this euphoric period, patients may experience intense feelings of well-being, being “cheerful in a beautiful world,” or are becoming “one with God.” The overly joyous mood may seem out of proportion to what is going on, and cheerfulness may be inappropriate for the circumstances, considering that patients are full of energy with little or no sleep. People experiencing a manic state may laugh, joke, and talk in a continuous stream with uninhibited familiarity. They often demonstrate boundless enthusiasm, treat others with confidential friendliness, and incorporate everyone into their plans and activities. They know no strangers, and energy and self- confidence seem boundless. The euphoric mood associated with mania is unstable because this mood may change quickly to irritation and anger when the person is frustrated. The irritability and belligerence may be short-lived, or it may become the prominent feature of the manic phase of bipolar disorder. 7. What is hypomania? The distinguishing symptoms of these disorder include unusual shifts from highs (mania and hypomania) 8. What comorbidities might be seen with Bipolar Disorders? Nearly all the anxiety disorders are associated with bipolar I, affecting about 75% of people with this disorder. Individuals may experience panic attacks, social anxiety disorder, and specific phobias. Other challenging disorders may complicate the clinical presentation and management of the often- dramatic bipolar I. They include attention-deficit/hyperactivity disorder and all the disruptive, impulse- control, or conduct disorders. A substance use disorder is present in more than half of individuals with bipolar I, perhaps in an attempt to self-medicate. More than 50% of individuals have an alcohol use disorder—a problem associated with an increased risk for suicide. Further complicating the picture is a higher-than-normal rate of serious medical conditions. Migraines are more common. Metabolic syndrome—a cluster of problems such as high blood pressure, high blood glucose, excess body fat around the waist, and abnormal cholesterol levels—may lead to premature death due to heart disease, stroke, and diabetes. 9. List treatment goals for caring for a person with bipolar disorders: Treatment of bipolar with a common antidepressant alone increases the risk of bringing on a manic episode (Viktorin et al., 2014). This risk vanishes when combining the antidepressant with a mood stabilizer. Specific medications are indicated for bipolar depression. The second-generation antipsychotics lurasidone (Latuda), quetiapine (Seroquel), and cariprazine (Vraylar) have FDA approval for the treatment of bipolar depression. Symbyax is another drug with approval for this type of depression. It is made up of the second-generation antipsychotic olanzapine (Zyprexa) and the selective serotonin reuptake inhibitor antidepressant fluoxetine (Prozac). 2

Ch. 13 – Bipolar and Related Disorders Study Guide 10. What is the goal of the acute phase when treating a patient with Bipolar? Anticonvulsant drugs (also known as antiepileptics) were developed to treat seizures associated with epilepsy. The FDA approves them for use in acute mania, acute bipolar depression, and/or bipolar maintenance: • Superior for continuously cycling patients • More effective when there is no family history of bipolar disease • Effective at diminishing impulsive and aggressive behavior in some nonpsychotic patients • Helpful in cases of alcohol and benzodiazepine withdrawal • Beneficial in controlling mania (within 2 weeks) and depression (within 3 weeks or longer) 11. What type of interventions will be provided to a patient who is in the acute phase of Bipolar? Like other advanced practice psychiatric professionals, psychiatric-mental health advanced practice registered nurses (PMH-APRNs) are usually able to diagnose and prescribe medications for treating bipolar disorder. In addition, they may use psychotherapy to help the patient cope more adaptively to stresses in the environment and decrease the risk of relapse. Specific approaches to psychotherapy include cognitive behavioral therapy (CBT), interpersonal and social rhythm therapy, and family-focused therapy. 12. What is the purpose of the maintenance phase for a patient with Bipolar? During this phase, interventions are geared toward the prevention of relapse. Medication adherence is essential, as is regular and adequate hours of sleep, healthy nutrition, and community support. Individuals at this stage will likely be engaged with community resources and be using outpatient facilities such as community mental health centers, outpatient clinics, and psychiatric home care. In addition to medication management, outpatient services provide structure, a decrease in social isolation, and a channel for their time and energy. 13. A patient has been prescribed lithium to treat his bipolar disorder. What symptoms might Lithium help to control? Lithium is particularly effective in reducing the following: • Elation, grandiosity, and expansiveness • Flight of ideas • Irritability and manipulation • Anxiety • Self-injurious behavior To a lesser extent, lithium controls the following: • Insomnia • Psychomotor agitation • Threatening or assaultive behavior • Distractibility • Hypersexuality • Paranoia 3

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Ch. 13 – Bipolar and Related Disorders Study Guide 14. What are the potential side effects, nursing interventions when using Lithium to treat a patient with Bipolar? Lithium therapy is generally contraindicated in patients with cardiovascular disease, brain damage, renal disease, thyroid disease, or myasthenia gravis. Whenever possible, lithium is not given to women who are pregnant because it may harm the fetus. Lithium use is also contraindicated in mothers who are breast-feeding and in children younger than 12 years of age 15. What are the signs and symptoms related Lithium toxicity? Nausea, vomiting, diarrhea, thirst, polyuria (producing too much urine), lethargy, sedation, and fine hand tremor Renal toxicity, goiter, and hypothyroidism may occur with long-term use 16. What are the long-term risk of lithium therapy. Talk to your prescriber about having your thyroid, parathyroid, and renal function checked periodically due to risk for hypothyroidism, hyperthyroidism, hyperparathyroidism, and decreased kidney function. 17. How does the use of electroconvulsive therapy (ECT) help to reduce severe manic behavior? One major advantage of ECT is that it works more quickly than medication in improving depressive symptoms—usually within a week. 18. What goals are appropriate for the patient with bipolar disorder? he goals are symptom reduction and achieving remission from the episode. Nursing care centers around supporting these goals while supporting injury prevention and physiological integrity 19. What medications might be prescribed to patients with Bipolar Disorders? Individuals with bipolar disorder may be on multiple medications. For severe agitation, lithium (Eskalith, Lithobid) or divalproex (Depakote) and a second-generation antipsychotic such as olanzapine (Zyprexa) or risperidone (Risperdal) are recommended. Individuals experiencing less severe symptoms may be given only one of these. There may be times when a benzodiazepine antianxiety agent can help reduce agitation or anxiety. Due to concern of dependency, use of benzodiazepines is usually short term until the mania subsides. The high-potency antianxiety benzodiazepines clonazepam (Klonopin) and lorazepam (Ativan) are useful in the treatment of acute mania. They may calm agitation and reduce insomnia, aggression, and panic. 20. What communications techniques are important to use with this diagnosis? Communication with a patient in seclusion is concrete, direct, and empathetic. Patients need reassurance that seclusion is only a temporary measure and that they will be returned to the unit when they demonstrate the ability to safely be around others. Restraints and seclusion are never for punishment or for the convenience of the staff. Refer to Chapter 6 for a more detailed discussion of the legal implications of seclusion and restraints. 21. What complication in Bipolar I could cause patient to develop physical exhaustion and possible death? Give 2 examples of nursing actions 4

Ch. 13 – Bipolar and Related Disorders Study Guide Metabolic syndrome—a cluster of problems such as high blood pressure, high blood glucose, excess body fat around the waist, and abnormal cholesterol levels—may lead to premature death due to heart disease, stroke, and diabetes 5

Ch 13 - Bipolar and Related Disorders Study Guide

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