Bipolar disorder

BIpolar 1

includes mania, major or minor depressive episodes

Bipolar 2

or “bipolar depression” includes hypomania-no mania episodes, some people with bipolar 2 will be pushed into mania with the incorrect medication regimen

both bipolar 1 and 2

are rated on a severity scale (mild,moderate,severe) based in number if symptom criteria met

depressive episode

same as with MDD, with the distinction of having had a manic episode or psychotic disorder

elevated episode

inflated self esteem or grandiosity

decreased need for sleep

increased takativeness, goal-directed activity, psychomotor agitation

distracted easily

engaging in risky activities ex. excessive spending

behaviors that are significantly different from the pt behavior

mania

meet 3-4 criteria of elevated episode

elevated, expansive, or irritable mood must be present most every day, or nearly every day for 7 days

delusions of grandeur, psychotic symptoms

needs hospitalization to prevent harm

marked impairment in social or occupational functioning

psychotic symptoms

Person’s reality/perception does not match our charred reality/perception. Symptoms include: delusions, catatonic behavior

delusions

altered belief or thought hallucinations, altered experience on one or more of the senses

catatonic behaviors

proposed to be overactive/hyperactive brain

hypomania

meet 3-4 criteria of elevated episode

elevated, expansive, or irritable mood must b present every day for 4 consecutive days

no need for hospitalization

no psychotic features

cause

A lot is still unknown about bipolar disorder, believed to be a chemical imbalance of neurotransmitters in the brain. could be due to stress or substance abuse

family history

Strong genetic predisposition, 30-70% with identical twins, 75% likelihood if both parents have diagnosis

psychotherapy

effective outside of manic episode or severe depressive episodes, psycho-educational and support, acute hospitalization, residential treatment

encourage

 proper sleep  hygiene, balanced diet, and moderate exercise 

lithium

a salt, inverse relationship with sodium ↑NA ↓ lithium, can work quickly state reached at about 2 weeks, can be nephotoxic, contraindicated with NSAIDS, diuretics, and pregnancy  

acute mania lithium

1.0-1.5 mEq/L, blood levels are drawn at least 1-2 times per week until stable

maintenance lithium

0.6-1.2 mEq/L, blood levels are drawn between every 1-6 months depending on individual 

lithium toxicity

at serum levels of 1.5 to 2.0, blurred vision, ataxia, tinnitus, nausea, vomiting, severe diarrhea

lithium side effects

 hand tremors, disruptions in memory or cognition, headache, dry mouth, increased thirst, urination, dizziness or drowsiness

lithium toxicity levels 2.0 to 3.5

excessive urine output of siluted urine, increasing tremors, muscle irritability, psychomotor retardation, mental confusion, giddiness

lithium toxicity serum levels above 3.5

impaired consciousness, seizure, coma, oliguria/anuria, MI, cardiovascular collapse

mood stabilizers

divalproex sodium (depatoke ER), valproic acid (depakote), carbamazepine (tegretol), lamotrigine (lamictal)

mood stabilizers side effects

 dizziness, drowsiness, fatigue, nausea, tremor, rash weight gain

mood stabilizers considerations

pregnancy, depakote can cause heart defects, cleft lip, neural tube defects, tegretol: spina bifida, avoid grapefruit with tegatol, lamictal has been associated with rash disorder, do not stop medication abruptly

atypical antipsychotics

• Cariprazine (vraylar)

• Lurasidone (latuda) only approved for bipolar II

• Risperidone (risperdal)

• Quetiapine (seroquel)

• Aripriprazole (abilify)

nursing care

frequent assessment of suicidal ideation, promote safety, promote medication adherence, med and therapy education, provide small portable meals, nutritious snacks, and monitor I&Os, evaluate effectiveness of treatment

outcomes

no manic symptoms

no longer a threat to self or others

less or no hypomanic symptoms

can participate in activities of daily living