Bipolar Disorders

Bipolar 1 disorder

Mania alternates with major depression

Bipolar 2 disorder

Hypomania alternates with severe depression

Cyclothymic disorder

Hypomania alternates with mild to moderate depression

Bipolar 1 commonality

More common in males

Bipolar 2 commonality

more common in females

Hypomania mood

Cheerful with underlying irritability

Hypomania cognition and perception

Rapid flow of ideas, grandiose, easily distracted, goal directed activities are difficult.

Hypomania activity and behavior

increased motor activity, very extroverted and sociable, many friends, increased libido, loud and inappropriate laughter, may have increased appetite.

Mania mood

Euphoria, LABILE

Mania cognition and perception

Fragmented, flight of ideas, pressured speech, very distractible, paranoid and grandiose delusions.

Mania activity and behavior

Excessive psychomotor activity, too distracted for sex, excessive spending, very manipulative, diminished need for sleep and food. May neglect hygiene and dress bizarrely.

Bipolar 1 characteristics

At least 1 week-long manic episode which may alternate with depression or a mixed state of agitation.

Bipolar 2 characteristics

Low level mania alternates with profound depression.

Cyclothymic disorder symptoms

Mild to moderate depression for at least 2 years in adults (1 year in children). Often difficult to distinguish from bipolar 2.

Risk factors for Cyclothymic disorders

Genetic- tends to run in families. Neurotransmitters- norepinephrine, dopamine, serotonin. Brain structure. Neuroendocrine- reason many people also have hypothyroidism.

Assessment guidelines for Bipolar Disorder

Danger to self or others, need for protection from uninhibited behaviors, need for hospitalization, medical status, coexisting medical conditions, family’s understanding.

Nursing Diagnosis for bipolar disorder

Risk for injury, risk for other directed violence, sleep deprivation, altered thought process, ineffective health maintenance, self-care deficit, impaired social interaction, interrupted family processes, ineffective role performance.

Interventions for bipolar disorder

Communication, structure, safety, nutrition, sleep, hygiene.

Pharmacological interventions for bipolar disorder

Lithium carbonate (Eskalith, Lithobid)

Therapeutic level for lithium carbonate

0.8 to 1.4 mEq/L

Maintenance blood level for lithium carbonate

0.4 to 1.3 mEq/L

Toxic blood level for lithium carbonate

1.5 mEq/L

Early signs of Lithium toxicity

GI upset, coarse hand tremor, confusion, hyper irritability of muscles, EEG changes, sedations, incoordination

Advanced signs of lithium toxicity

Ataxia, giddiness, serious EEG changes, blurred vision, clonic movements, large urine output, seizures, stupor, severe hypotension, coma, death secondary to pulmonary complications.

Severe signs of lithium toxicity

Convulsions, no or small urine production, death.

Factors that increase serum lithium levels

Sodium deficiency, diarrhea, diuretics, dehydration, high fever, strenuous activity, poor renal functioning.

Factors that decrease serum lithium levels

High salt intake, high sodium bicarbonate intake, pregnancy, caffeine.

Carbamazepine (Tegretol, Equetro) therapeutic levels

6-8 mg/L

Valproate (Depakote) Valproic Acid (Depakene) therapeutic levels

50-100 mg/L

Anticonvulsant drugs

Carbamazepine (tegretol, equetro), valproate (depakote), valproic acid (depakene), lamotrigine (lamictal)

Antianxiety meds

Clonazepam (Klonopin), Lorazepam (Ativan)

Second Generation - Atypical antipsychotics

Olanzapine (Zyprexa), Risperidone (Risperdal)

Second Generation Antipsychotics

Lurasidone (Latuda), Quetipine (Seroquel)

Combo drug

Symbyax—> olanzapine and fluoxetine. Includes second-generation antipsychotics and SSRIs.

Lamictal

Takes four weeks to stabilize, not a good medication for newly diagnosed patients. Monitor patient for rash (discontinue drug).

Integrative Therapies

Cod liver oil, ECT, teamwork, seclusion and restraint, support groups, health teaching and promotion, advanced practice nursing interventions, CBT.