Bipolar Disorder Slides

pathophysiology of Bipolar disorder

Neurotransmitter dysregulation, Neural circuitry, Structural changes, HPA involvement, Genetics

pathophysiology of Bipolar disorder: Neurotransmitter dysregulation

dopamine, serotonin, glutamate imbalances

pathophysiology of Bipolar disorder: Neural circuitry

overactivity in amygdala, underactivity in PFC

pathophysiology of Bipolar disorder: structural changes

enlarged ventricles, altered hippocampal and prefrontal regions

pathophysiology of Bipolar disorder: HPA involvement

stress hormone dysregulation

pathophysiology of Bipolar disorder: Genetics

strong heredity component

Types of bipolar disorders

Bipolar I, Bipolar II, cyclothymia, Rapid cycling

Types of bipolar disorders: Bipolar I

at least one full manic episode +/- (w/ or w/o) depression

Types of bipolar disorders: Bipolar II

Hypomania + major depressive episode

Types of bipolar disorders: cyclothymia

2+ years of hypomanic & depressive symptoms (not full episodes)

Types of bipolar disorders: Rapid cycling

≥4 mood episodes in 12 months

• Elevated or irritable mood

• Grandiosity, inflated self-esteem

• decreased need for sleep

• pressured speech, flight of ideas

• Impulsive/risky behaviors

s/s of mania

less severe than mania, no psychosis, not as impairing

s/s of hypomania

sadness, anhedonia, fatigue, sleep/appetite changes, suicidal ideation

s/s of depression

______ is the gold standard treatment for bipolar disorder

lithium

_____ is a mood stabilizer drug

lithium

__-__ mEq/L is the therapeutic range of lithium

0.6-1.2

Toxicity signs of lithium include ______, _______, ________, ________.

coarse tremors, confusion, seizure, coma

Toxicity signs of lithium signifies a medical _________

emergency

side effects of lithium include _____, ______, ________, _______, __________, _________

tremor, GI upset, polyuria, weight gain, hypothyroidism, renal impairment

labs to monitor while pt. is on Lithium _____, ______, ______, ________

Lithium levels, renal function, thyroid function, electrolytes

mood stabilizers: Anticonvulsants drugs

Valproate (Depakote), Carbamazepine, Lamotrigine

side effects of Valproate (Depakote)

sedation, tremor, GI upset, weight gain, hepatotoxicity, pancreatitis

labs to monitor when pt. is on Valproate (Depakote)

LFTs

side effects of Carbamazepine

sedation, dizziness, agranulocytosis, aplastic anemia, rash (SJS)

labs to monitor when pt. is on Carbamazepine

CBC, LFTs

medication used to treat bipolar depression

Lamotrigine

side effects of Lamotrigine

SJS (rash)

Types Antipsychotic drugs

Quetiapine (seroquel), Olanzapine (zyprexa), Risperidone (riperdal), Aripiprazole (Abilify), Lurasidone (Latuda)

What is Lurasidone (Latuda) used to treat?

bipolar depression

what side effect happen when taking Aripiprazole (Abilify)?

less weight gain

What is Aripiprazole (Abilify) used to treat?

maintenance of Bipolar disorder

What is Risperidone (Riperdal) used to treat?

mania/mixed states

What is a side effect of taking Olanzapine (zyprexa)? (reason why some pt. might stop taking med)

weight gain

What is Olanzapine (zyprexa) used to treat?

mania

What is Quetiapine (seroquel) used to treat?

mania & depression

What are the side effects for antipsychotics?

Metabolic syndrome, EPS, Tardive dyskinesia, NMS

What are the risks of NMS?

rigidity, fever, confusion, vital sign instability, diaphoresis, elevated CPK, leukocytosis, metabolic acidosis

What action is taken when NMS occurs?

medical emergency

What are the risks of Tardive dyskinesia?

long term risk

What are the risk of EPS?

tremor, rigidity, akathisia

What is monitored when a metabolic syndrome occurs?

BMI, glucose, lipids

What are the risk of metabolic syndrome?

weight gain, hyperglycemia, dyslipidemia

What are the nonpharmacological therapies?

Psychotherapy, lifestyle intervention, Neuromodulation, Support systems

types of psychotherapies used for Bipolar disorder

CBT, interpersonal & social rhythm therapy, family-focused therapy, psychoeducation for pt. & family

types of Lifestyle intervention used for Bipolar disorder

• sleep hygiene, exercise, stress management

• Avoid triggers (substances, irregular routine)

types of neuromodulation for bipolar disorder

• ECT for severe/refractory cases

• TMS, emergency therapy

types of support systems for bipolar disorder

peer support, community programs, case management

step 1 to nursing interventions: mania

ensure safety, set limits, redirect impulses

step 2 to nursing interventions: mania

reduce stimulation, structured environment

step 3 to nursing interventions: mania

promote rest/sleep

step 4 to nursing interventions: mania

encourage fluid & nutrition intake

Types of nursing intervention- medications for Bipolar Disorder

Adherence educatzion, monitor labs, teach lifestyle needs, educate family

Types of nursing intervention- medications for Bipolar Disorder: educate family

recognize early relapse signs

Types of nursing intervention- medications for Bipolar Disorder: teach lifestyle needs

hydration & salt consistency with lithium

Types of nursing intervention- medications for Bipolar Disorder: monitor labs

lithium, CBC, LFTs, metabolic labs

Types of nursing intervention- medications for Bipolar Disorder: Adherence education

importance of consistency

Components of whole person care

mind, body, spirit

Components of whole person care: mind

psychotherapy, education, thought reframing

Components of whole person care: body

medication adherence, exercise, sleep, nutrition

Components of whole person care: spirit

prayer, faith community, hope rooted in God’s promises

In whole person care, it’s important to emphasize ______, _______, & _______

compassion, dignity, holistic healing