Bipolar Disorder

types of BPD

-BP 1

BP 2

Cyclothymic Disorder

what is BP 1

• most serious. one manic episode every 7 days

what is BP 2

at least one hypomania episode and one major depressive episode

cyclothymic disorder

not serious enough to be BP. the patient alternates between mild to moderate depression for at least 2 years

manic phase signs and symptoms

-       self importance

-       extreme energy

excessive talking with pressured speech

types of manic speech - pressured

more talkative and urgent and incoherent

circumstantial:

unnecessary details given when trying to get to the point

tangential

unnecessary details AND they never get to the point

loose associations

ideas not connected

flight of ideas

rapidly changing subjects to random other topics that only make sense in their mind

clang associations

rhyming words

treatment for BPD: drugs

antipsychotics:

• lithium carbonate

Anticonvulsants

• valproic acid

• carbamazepine

• Lamotrigine

therapies for BPD

CBT

family therapy

interpersonal and social rhythm therapy

procedures for BPD

• electroconvulsive therapy

• trans-cranial magnetic stimulation

• vagal nerve stimulation

safe lithium level

0.8-1.2

toxicity level for lithium

over 1.5

side effects of lithium

N/V

diarrhea

tremors

thirst

electrolyte imbalances

causes goiter, weight gain and hypothyroidism

electrolyte imbalances

renal toxicity

bradydysrhythmias

tiredness

lithium toxicity

drowsy, seizures, muscle weakness, coma, death

lithium education

take with food or milk

2-3x a day

monitor blood levels every 2-3 days and then 1-3 months

how long does lithium take to ‘work’

around a week

valproic acid side effects

stomach: weight gain, N/V

liver: toxic to liver: anorexia, fatigue, pain, jaundice

pancreatitis

thrombocytopenia - reduces blood count

carbemazepine side effects

Brain: double vision, cross eyes, staggering gait

Blood dycrasias: leukopenia, anemia, thrombocytopenia

Skin: rash

Lamotrigine side effects

Rash

Diplopia

N/V

blurred vision