Bipolar Disorder, Mood Affect, and Suicide Review Flashcards

A comprehensive set of vocabulary flashcards covering types of bipolar disorder, pharmacological treatments (including Lithium and anticonvulsants), nursing considerations, and suicide risk assessment/terminology based on the lecture notes.

Bipolar I Disorder

The most severe form of bipolar disorder, characterized by full manic episodes that last at least a week and occur all day, every day, often requiring hospitalization.

Cyclothymic Disorder

A chronically unstable mood state involving persistent patterns of mood fluctuations lasting at least $2$ years.

Bipolar II Disorder

A type of bipolar disorder featuring hypomania and at least $1$ depressive episode per year.

Mixed Features

The simultaneous presentation of mania (usually cognitive) and depression occurring together concurrently.

Rapid Cycling

A mood cycling pattern defined by $4$ or more episodes of mania or depression within a single year.

Pressured speech

Rapid, urgent speech patterns commonly seen during manic episodes.

Flight of ideas

Racing thoughts characterized by jumping quickly between different ideas.

Hypomanic Episodes

A mood state involving increased energy and focus with a good mood, which is less extreme than mania and usually does not require hospitalization.

*easily irritated

Lithium (Lithobid)

Considered the gold standard mood stabilizer, it is used for manic and depressive episodes but requires regular monitoring due to a narrow therapeutic window.

Therapeutic Lithium Level

The safe therapeutic range for serum lithium levels, defined as $0.6-1.2\,mEq/L$.

Severe Lithium Toxicity

A dangerous level of lithium in the blood, reaching $2.0\,mEq/L$, which constitutes a medical emergency.

Lamotrigine (Lamictal)

An anticonvulsant mood stabilizer particularly effective for depressive episodes and generally the best tolerated in its class.

Stevens-Johnson Syndrome (SJS)

A rare and medical emergency involving a painful red or purplish rash that spreads and blisters, causing the skin to shed within days.

Atypical Antipsychotics

A class of medications, including Aripiprazole and Olanzapine, considered first-line treatment for acute manic episodes.

Tardive dyskinesia (TD)

A long-term complication of antipsychotic use involving involuntary, potentially irreversible muscle movements around the head, neck, and mouth.

Neuroleptic Malignant Syndrome (NMS)

A medical emergency associated with antipsychotic medication characterized by fever, confusion, muscle rigidity, and altered consciousness.

Suicide

The act of inflicting self-harm that results in death.

Suicidal Ideation

Thoughts about, consideration of, or plans for taking one's own life.

Non-suicidal Self-Injury (NSSI)

Self-directed injurious behavior performed without the intent to die.

SAD PERSONS

A mnemonic used for rapid suicide risk assessment, standing for Sex, Age, Depression, Previous attempts, Ethanol, Rational thinking loss, Social support lacking, Organized plan, No spouse, and Sickness.

IS PATH WARM

A mnemonic for suicide warning signs developed by the American Association of Suicidology: Ideation, Substance abuse, Purposelessness, Anxiety, Trapped, Hopelessness, Withdrawing, Anger, Recklessness, and Mood changes.

Passive death wish

A state of wanting to die but not actively pursuing or planning a method to kill oneself.

Contagion effect

The phenomenon where a suicide in media or peer groups may trigger similar suicidal behavior in others, particularly adolescents.

Valproate (Depakote)

An anticonvulsant mood stabilizer used primarily for managing bipolar disorder and effective in preventing manic and depressive episodes.

Carbamazepine (Tegretol)

An anticonvulsant used as a mood stabilizer, particularly effective in treating acute mania and rapid cycling patterns.

Nursing Consideration for Mood Stabilizers

Regular monitoring of blood levels, renal and liver function tests, and ensuring patient adherence to medication.

Patient Education for Mood Stabilizers

Inform patients about potential side effects, the importance of timely dosage, and not to stop medications abruptly without consulting a provider.

Cognitive Behavioral Therapy (CBT)

A type of psychotherapy that helps patients recognize and alter negative thought patterns and behaviors.

Active Listening

A therapeutic communication technique focusing on fully understanding and engaging with what the patient is expressing.

Empathy in Therapeutic Communication

The ability to understand and share the feelings of another, essential for building rapport with patients.

Validation

Acknowledging and affirming a patient's feelings and experiences to foster a safe communicative environment.

Intervention for Suicidal Ideation

Engaging in safety planning, providing resources, and mobilizing support systems to protect the patient.

Establishing Boundaries

Setting clear limits in therapeutic relationships to maintain a professional and safe environment for patients.

Antidepressants

Medications used to treat depressive disorders, which include SSRIs, SNRIs, and atypical antidepressants, and require monitoring for side effects and effectiveness.

Mood Stabilizers

Medications used to control mood swings, particularly in bipolar disorder, and include options like lithium, valproate, and carbamazepine.

SSRIs (Selective Serotonin Reuptake Inhibitors)

A class of antidepressants that increase serotonin levels to help improve mood and are usually the first-line treatment for depression.

SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

A class of antidepressants that affect both serotonin and norepinephrine neurotransmitters, used for depression and anxiety disorders.

Atypical Antidepressants

A diverse group of antidepressants that do not fit neatly into other categories, each with unique mechanisms and side effects.

Safety Monitoring for Antipsychotics

Regular evaluation for metabolic syndrome, extrapyramidal symptoms, and other adverse effects in patients taking antipsychotic medications.

Psychiatric Emergency Interventions

Immediate actions taken to ensure patient safety, including crisis intervention and coordinate with emergency services when needed.

Therapeutic Relationship

A trusting, respectful partnership between the healthcare provider and patient, essential for effective treatment and communication.

Crisis Intervention Techniques

Strategies used to support individuals in acute distress, focusing on de-escalation and finding immediate solutions to safety concerns.

Documentation in Therapeutic Communication

Accurate, thorough records of interactions with patients to ensure continuity of care and legal compliance.

Mindfulness in Therapeutic Communication

The practice of being present and fully engaged with the patient during interactions, fostering a deeper understanding and connection.

Assertiveness Training

Teaching patients to express their needs and feelings confidently and indirectly, promoting self-advocacy in mental health care.

Bipolar I Disorder

The most severe form of bipolar disorder, characterized by full manic episodes that last at least a week and require hospitalization in many cases.

Bipolar II Disorder

A type of bipolar disorder featuring at least one major depressive episode and at least one hypomanic episode per year.

Lithium (Lithobid)

The gold standard mood stabilizer used for both manic and depressive episodes, necessitating regular blood level monitoring due to its narrow therapeutic window.

Lamotrigine (Lamictal)

An anticonvulsant mood stabilizer

effective for depressive episodes

Valproate (Depakote)

anticonvulsant mood stabilizer

Carbamazepine (Tegretol)

An anticonvulsant that is effective for treating acute mania and rapid cycling patterns typical in bipolar disorder.

REQUIRES MONITORING FOR DRUG INTERACTIONS

Atypical Antipsychotics Meds

Aripripazole

Olanzapine

Quetiapine

Risperidone

Ziprasidone

Rapid Cycling

A mood cycling pattern defined by four or more episodes of mania or depression occurring within a single year, common in bipolar disorder.

Manic episode characteristics

Euphoria

Decreased need for sleep

Pressured speech

Flight of ideas

Distractibility

Risky behavior

Irritability

Risk for Development of Bipolar Disorder

Equal in men and womenbut women may experience more depressive episodes, while men tend to have more manic episodes.

Children & adolescents LC

onset @ 18

*important to differentiate from typical adolescent mood swings

Pregnant Women LC

20% symptom recurrence

may experience first manic/depressive episode while pregnant

IMPORTANT: Carbamazepine & Valproic acid require modification

Older adults LC

Must rule out medical conditions including substance use disorder before diagnosis

BPD diagnostic approach

Clinical manifestations + patient history

NO test

BPD Primary Treatment Goal

Increasing function & quality of life

BPD Safety

Environmental modifications

Monitor for self-harm and suicidal ideation

Structured activities to safely burn off NRG

Use seclusion room strategically for time out rather than punishment

BPD Behavioral Management

AVOID competitive activities

Provide structured physical activities

Allow safe outlets for excess NRG [eg: punching bag]

BPD Cognitive Support

Promote reality-based thinking with consistency & acceptance

Positively-reinforce reality based thoughts & statements

Gently challenge delusions & grandiose thinking

Lithium Mechanism of Action

Affects flow of sodium through body cells; sodium affects reuptake of neurotransmittersLi

Lithium therapeutic uses

Mood stabilizer

Maintenance therapy

PROVEN to reduce BPD suicide risk

Lithium Dosing

Once daily

BID

TID

Lithium Onset

1-3 weeks

Lithium Interactions

NSAIDS

Diuretics

Caffeine

Carbamazepine

Antithyroid agents

Sodium

Lithium Adverse Effects

Tremors and GI

Polyuria/polydipsia

Weight gain

Dizziness, muslcel weakness, fatigue

Sexual dysfunctionLit

Lithium & Pregnancy

AVOID —> crosses the placenta

Toxicity Management Protocol

Hold dose

Obtain lithium level

Hydrate with normal saline

Correct electrolyte abnormalities

GI decontamination, whole-bowel irrigation

Symptomatic supportive care

Hemodialysis

Blood Level Monitoring Schedule

First month: 2-3 times/week

After first month: weekly

Long term: 2-3 months

When to obtain blood levels

After initialTi dose

After each dosage increase

5 days after a dosage adjustment

Timing of Blood Draws

Obtain level in the morning

12-14 hrs after last dose, minimum 8 hrs

Lifestyle & Dietary Management

2L-3L of fluid to prevent dehydration

Eat diet with consistent sodium intake

Avoid excesive coffee, tea, cola

Avoid activities causing excessive sweating

Low calorie diet options —> weight gain may occur

Driving & safety

May cause drowsiness or dizziness

Caution to avoid driving or activities requiring alertness until response to medication is known

Anticonvulsants as Mood Stabilizers

Valproic acid & Carbamazepine: more effective in treating mania

Lamotrigine: stronger antidepressent effect; best tolerated

Anticonvulsant Mood Stabilizer Adverse Effects

Can cause liver or kidney damage:

drowsiness

dizziness

fatigue

anorexia

weight gain

AC NC

Monitor liver functions regularly

Hepatotoxicity signs: anorexia, nausea & vomitng, fatigue, abdominal pain, jaundice

SJS

Monitor for low platlet count, low WBC, bone marrow suppression

Client Education AC

Do not breast feed when taking anticonvulsants

Sun protection

Use additional form of contraceptive

Don’t drive until med response is known

Monitor for suicidal behaviorLa

Lab Monitoring

LFTs

Platelet counts

Serum levels

Watch for pancreatitis: abd pain, nausea, vomiting, anorexiaAt

Atypical Antipsychotics Baseline

Monitor BP

Obtain baseline ECG

Monitor weight, glucose levels, and lipid levels

Atypical Antipsychotics SE

Sexual dysfunction

Concurrent medications: avoid using anticholinergic meds [antihistamines]