Bipolar Disorders Study Notes

Describe three different types of bipolar disorders.
Describe factors that make bipolar disorder difficult to diagnose.
Describe nursing interventions for behaviors associated with mania.
List three medications useful in treatment of bipolar disorders and the potential side effects of each.
Describe two teaching points for bipolar patients on mood stabilizers.

A disorder characterized by mood swings from profound depression to extreme euphoria with intervening periods of normalcy.

Cyclothymic:
- Characterized by chronic mood disturbance involving numerous episodes of hypomania and depressed mood with less intensity.
Hypomania:
- A mild form of mania, characterized by relatively elevated mood but without the significant impairment seen in full manic episodes.
Mania:
- Predominant mood that is elevated, expansive, or irritable, often accompanied by frenzied motor activity. Also known as manic episodes.

Bipolar I:
- The classic image of bipolar disorder with manic symptoms and most likely depressive episodes.
Bipolar II:
- Recurrent bouts of major depression with episodic occurrence of hypomania; may never experience a full episode of mania.
Cyclothymic:
- A chronic mood disturbance lasting at least 2 years, involving numerous episodes of hypomania and depressed mood of lesser intensity.

Biochemical Factors:
- Altered levels of neurotransmitters such as serotonin, dopamine, and/or norepinephrine affect mood; increased in manic episodes and decreased in depressive episodes.
Genetics:
- Results from twin studies indicating a hereditary component.
Environmental Triggers:
- A combination of genetic and biochemical factors plus environmental stressors can create a comprehensive understanding of the disorder.
Medical Conditions and Medications:
- Can trigger an episode in individuals already predisposed to bipolar disorder.

Prevalence:
- Approximately 4.4% of the American population will experience bipolar disorder at some point in their lifetime.
Gender Distribution:
- Affects males and females at approximately the same rate.
Depressive Association:
- Episodes may or may not be associated with periods of depression.
Average Age of Onset:
- The average age of onset is 25.
Recurrence Risk:
- High risk of recurrence after the first episode; can have periodic episodes separated by years or more frequent cycles.
Postpartum Psychosis:
- Most common cause of postpartum psychosis.

Manic Phase:
- Can last from days to months and result in marked disruption of occupational and social functioning; psychotic features may be included.
Depressed Phase:
- Symptoms are similar to those described in major depressive disorders.

Very elevated mood.
Excess activity (hyperactivity).
Increased energy.
Racing thoughts and flight of ideas.
Frequently talking.
Very high self-esteem (false beliefs about self or abilities).
Easily distracted.
Little need for sleep; may feel rested after only 3 hours of sleep.
Poor temper control; easily agitated and irritable.
Reckless behavior and lack of self-control, which can include:
- Drinking and/or drug use, binge eating.
- Poor judgment.
- Sexual promiscuity.
- Spending sprees.
Transition of Manic Episode:
- Early stages may show engaging and outgoing behavior with high achievement, but as mania escalates, behavior can become frenzied and out of control, leading to impaired decision-making and potentially hazardous actions.

Mood Stabilizer Medications:
- Primary treatment option for managing the disorder.
Psychotherapy:
- Provides support and helps in medication compliance.

Lithium:
Anticonvulsants:
- Includes carbamazepine (Tegretol), gabapentin (Neurontin), valproic acid (Depakene), and lamotrigine (Lamictal).
Additional Medications:
- Antianxiety and antipsychotic drugs may be used in some patients.

Blood Monitoring:
- Requires close monitoring of blood levels.
- Therapeutic levels are between 0.5–1.2 milliequivalents per liter for most patients (1.0–1.5 in acute mania).
Risk Factors for Toxicity:
- Elevated blood levels can occur due to dehydration, profuse sweating, and chronic diarrhea.
Symptoms of Toxicity:
- Includes tremors, confusion, seizures, coma, and potentially death.
Early Warning Signs of Toxicity:
- Nausea, vomiting, and sedation.

What is the therapeutic lithium blood level in a stable patient?
- A. 1.0–1.5 milliequivalents per liter (Correct Answer)
- B. 10–15 milliequivalents per liter
- C. 0.5–1.2 milliequivalents per liter
- D. 0.05–0.1 milliequivalents per liter
Which response is the most accurate list of signs of lithium toxicity?
- A. Nausea, tremors, confusion (Correct Answer)
- B. Increased manic symptoms
- C. Increased urine output, excessive thirst
- D. Nausea, agitation, hypertension
Which statement demonstrates the best approach to promote compliance with mood stabilizers?
- A. Patient knows he can stop these meds when manic symptoms decrease
- B. Patient and his family are educated on side effects (Correct Answer)
- C. If taking lithium, blood tests are only required the first 6 months of treatment
- D. Psychotherapy is not recommended once the manic state resolves