Bipolar Disorders

distinct period (1 wk or less) of abnormally and persistently elevated, expansive, or irritable mood with abnormally increased goal-directed behavior or energy

mania

less severe episode of mania that lasts at least 4 days, most of the day, everyday functioning is not impaired, no psychosis, do not need hospitalization

hypomania

distinct period of mania

manic episode

rapid shifts in mood with no change in external events

mood lability

extreme form of mood lability that can occur in bipolar disorders

continuous cycling between threshold mania/depression or hypomania/depression

rapid cycling

classic manic-depressive disorder with mood swings alternating from depressed to manic

bipolar I disorder

major depression and hypomania

bipolar II disorder

what type of bipolar is more severe

bipolar I disorder

Hypomania and depressive episodes not meeting criteria or MDD episode

cyclothymic disorder

what does bipolar I look like in kids

depression first, marked by intense rage

symptoms reflective of childs developmental level

what does bipolar I look like in older adults

LOC changes

mania incidinces decrease with age

what are common comorbid conditions associated with bipolar

anxiety disorder

substance use

when do you focus on stress reduction, illness management, relapse prevention

periods of stable mental health

what is the nursing care for acute mania

monitor patient for escalating behavior hyperactivity

assess for poor appetite and little sleep

saftey

assess for SI

decrease stimulation without isolation

what are the goal of using mood stabilizers

rapid control of symptoms and prevention/reduction of future episodes

what is the gold standard mood stabilizer for bipolar disorder

lithium

how long does it take for lithium to kick in

5 days - 2 weeks

lithium is excreted by the

kidneys so we must monitor renal function

what mood stabilizer has a narrow therapeutic index

lithium

what are the S/S of lithium toxicity

N/V/D

ataxia

blurred vision

tinnitus

polyuria

increasing tremors

LOC changes

what is the therapeutic level of lithium

0.6-1.2 mEq/L

what are the anticonvulsants being used as mood stabilizers

valproic acid

carbamazepine

lamotrigine

when taking valproic acid, we must monitor

LFTs - risk of hepatotoxicity

valproic acid blood levels

what is the main risk of carbamazepine

aplastic anemia

what lab are we monitoring when the patient is on carbamazepine

CBC w diff

what is the main risk of lamotrigine

stevens johnson syndrome

what is the dosing schedule for lamotrigine

start low and titrate slow

monitor closely within first 7 days for rash

what are the atypical antipsychotics used in bipolar

risperidone

olanzapine

lurasidone

Lurasidone is not ideal for

use in acute mania

lurasidone is indicared in

bipolar depression