Week 5: Bipolar, Suicide, Self Injury

bipolar 1 disorder

criteria - 1 manic episode. most severe form, highest mortality rate.

bipolar 2 disorder

criteria - 1 hypomanic and 1 major depressive episode

cyclothymic disorder

recurring symptoms of mild-moderate depression for at least 2 years, dx in adults.

bipolar risk factors

genetic, neurobiological, neuroendocrine, peripheral inflammation, environmental, psychological/cognitive

bipolar assessment

labile mood/affect, grandiose/persecutory delusions, flight of ideas, clang associations, pressured speech, tangential/circumstantial (excessive detail) speech, changes in behavior + cognitive functioning. mania - manipulation, demanding, splitting.

bipolar planning/tx

safety, seclusion, restraints, ECTs, manage self care. maintain med adherence, psychoeducational teaching. acute phase - prioritize safety during depressive/manic episodes. maintenance - prevent relapse + recurrence w/ follow up care.

bipolar patient teaching + health promotion

info, warning signs of episodes, emphasize regular routines - sleep, meals, exercise, etc. group/individual therapy

lithium carbonate

first line mood stabilizer. requires monitoring. contraindications - kidney disease, significant cardiovascular disease, hypothyroidism, dehydration/hyponatremia creates toxicity risk. avoid in first trimester and during breastfeeding. levels increased by diuretics, ACEis, ARBs, NSAIDs.

lithium ranges

0.8-1.2 mEq/L therapeutic, 0.4-0.8 mEq/L maintenance, 1.5-2.5 mEq/L toxic

anticonvulsants for bipolar

valproate acid/divalproex sodium, lamotrigine, carbamazepine, gabapentin, oxcarbazepine, topiramate

second gen antipsychotics for bipolar

aripiprazole, olanzapine, paliperidone, ziprasidone, asenapine, clozapine, lurasidone (latuda), cariprazine, quetiapine (seroquel). zuprexa/prozac (symbyax) - bipolar depression and tx resistant depression

non pharm bipolar tx

ECT, CBT, interpersonal/social rhythm therapy, family focused therapy, seclusion protocols, support groups, milieu

suicide attempt definition

potentially injurious behavior with intent to die

suicidal ideation

thinking about, considering, planning suicide

suicide risk factors + comorbidities

existing mental illness dx, family hx, low SKA2 gene. freud theory - aggression turned inward. menninger - 3 parts (wish to kill, be killed, die). aaron beck - hopelessness. diathesis-stress. copycat suicides. low parental monitoring, sociocultural factors.

social factors (descending order) that increase risk for suicide

relationship problems, recent/imminent crises, substance use, health problems, financial problems, legal problems, loss of housing

suicide assessment

overt/covert/nonverbal cues, hx attempts, lethality of plan (definite plans - high risk), family hx, sudden happiness, social supports.

overt statement examples

“I can’t take it anymore” “Life isn’t worth living” “I wish I were dead” “Everyone would be better off if I died”

covert statement examples

“Everything will be okay soon.” “Things will never work out.” “I won’t be a problem much longer.” “Nothing feels good to me anymore and probably never will.” “How can I give my body to medical science?”

primary suicide intervention

activities that provide support, information, and education. ex. 988 hotline.

secondary suicide intervention

treatment of actual suicidal crisis - preventing harm

tertiary suicide intervention

postventions with survivors to reduce traumatic afereffects

suicide risk environmental safety guidelines

use and count plastic utensils, 1

non-suicidal self-injury (NSSI) definition

self injury to induce relief from a negative feeling/cognitive state without suicidal intent

NSSI assessment

look for triggers and transference