N138 Study material | complete Study Guide for
final Exams Prep, with Solutions
Stress and Bipolar Disorder
Stress causes mania and/or depression
Risk Factors for Bipolar Disorder
Genetics (80%)
Physiological (biological disorders)
Environmental (stress)
Expected Findings of Manic Episodes (BD)
Labile mood with euphoria
Agitation, irritability, restlessness
Decreased need for sleep
Dislike criticism
Flight of ideas
Neglect ADLs
Increased energy levels
Grandiose views of self and abilities
Impulsive, poor judgement (risky behaviors)
Demanding and manipulative
Denial of illness
Possible psychosis
Noticeably talking more
Increased sex drive
Expected Findings of Depressive Episodes (BD)
Flat, blunted, labile affect
Tearfulness, crying
Lack of energy
Anhedonia
Decreased personal hygiene
Physical reports of discomfort/pain
Difficulty concentrating/focusing/problem solving
Self-destructive behaviors (including SI)
,Loss or increase in appetite
Disturbed sleep
Psychomotor retardation/agitation
Comorbidities of BD
Anxiety disorders
Substance-use
BPD
ODD
CD
Specific/social phobias
ADHD
Physical distress
Phases of BD
Acute
Continuation
Maintenance
Acute Phase of BD
Gravely disabled
Most often hospitalized
Goal of Acute Phase of BD
Reduction of mania and safety
Continuation Phase of BD
Relapse prevention
Goal of Continuation Phase of BD
Education and therapy
Maintenance Phase of BD
Lasts throughout life
Goal of Maintenance Phase of BD
Prevention
,What causes relapse for BD?
Substance use
Sleep disturbances
Psychological stressors
Pharm Tx for BD
1. Lithium (mood stabilizer)
2. Antipsychotics (2nd gen more than 1st gen)
3. Anticonvulsants
4. Antidepressants (very extreme and controversial)
5. Anxiolytics
6. Benzos
Antipsychotics for BD
Haloperidol (Haldol)
Olanzapine (Zyprexa)
Risperidone (Risperdal)
Quetiapine (Seroquel)
Ziprasidone (Geodan)
Anticonvulsants for BD
Valproate (Depakote)
Lamotrigine (Lamictal)
Carbamazepine (Tegretol)
What is the gold standard tx for mania?
Lithium
Lithium
Narrow therapeutic index (0.8-1.0)
Baseline and ongoing labs for thyroid and kidney fxn
Can lead to permanent structural changes in kidneys
Best Range for Lithium
0.8-1.2 mEq/L
Toxicity of Lithium
, 2 mEq/L
Sxs manifest at 1.5 mEq/L
What can increase Lithium levels?
Dehydration
Hyponatremia
What can decrease Lithium levels?
Caffeine
S&S of Lithium Toxicity
Early: vomiting, diarrhea, muscle twitching
Late: lethargy, ataxia, slowed speech, coma
Nonpharm Tx for BD
IPT
CBT
Dynamic psychotherapy
Group therapy
Fam-focused psychotherapy
Social rhythm therapy
Nursing Dx and Interventions for BD
Risk for injury/violence: remove dangerous objects, maintain calm presence
Imbalanced nutrition: provide high-protein, high cal foods, maintain I&Os, cal count
Impaired social interaction: provide positive reinforcement, limit behaviors, don't
argue/bargain, use TC
Labs for Lithium
Labs weekly until stable, then monthly
CMP, TSH, and Li level
Personality Disorders
Reality distortions (self and others)
Inability to see how their behaviors affect others
Manipulative
final Exams Prep, with Solutions
Stress and Bipolar Disorder
Stress causes mania and/or depression
Risk Factors for Bipolar Disorder
Genetics (80%)
Physiological (biological disorders)
Environmental (stress)
Expected Findings of Manic Episodes (BD)
Labile mood with euphoria
Agitation, irritability, restlessness
Decreased need for sleep
Dislike criticism
Flight of ideas
Neglect ADLs
Increased energy levels
Grandiose views of self and abilities
Impulsive, poor judgement (risky behaviors)
Demanding and manipulative
Denial of illness
Possible psychosis
Noticeably talking more
Increased sex drive
Expected Findings of Depressive Episodes (BD)
Flat, blunted, labile affect
Tearfulness, crying
Lack of energy
Anhedonia
Decreased personal hygiene
Physical reports of discomfort/pain
Difficulty concentrating/focusing/problem solving
Self-destructive behaviors (including SI)
,Loss or increase in appetite
Disturbed sleep
Psychomotor retardation/agitation
Comorbidities of BD
Anxiety disorders
Substance-use
BPD
ODD
CD
Specific/social phobias
ADHD
Physical distress
Phases of BD
Acute
Continuation
Maintenance
Acute Phase of BD
Gravely disabled
Most often hospitalized
Goal of Acute Phase of BD
Reduction of mania and safety
Continuation Phase of BD
Relapse prevention
Goal of Continuation Phase of BD
Education and therapy
Maintenance Phase of BD
Lasts throughout life
Goal of Maintenance Phase of BD
Prevention
,What causes relapse for BD?
Substance use
Sleep disturbances
Psychological stressors
Pharm Tx for BD
1. Lithium (mood stabilizer)
2. Antipsychotics (2nd gen more than 1st gen)
3. Anticonvulsants
4. Antidepressants (very extreme and controversial)
5. Anxiolytics
6. Benzos
Antipsychotics for BD
Haloperidol (Haldol)
Olanzapine (Zyprexa)
Risperidone (Risperdal)
Quetiapine (Seroquel)
Ziprasidone (Geodan)
Anticonvulsants for BD
Valproate (Depakote)
Lamotrigine (Lamictal)
Carbamazepine (Tegretol)
What is the gold standard tx for mania?
Lithium
Lithium
Narrow therapeutic index (0.8-1.0)
Baseline and ongoing labs for thyroid and kidney fxn
Can lead to permanent structural changes in kidneys
Best Range for Lithium
0.8-1.2 mEq/L
Toxicity of Lithium
, 2 mEq/L
Sxs manifest at 1.5 mEq/L
What can increase Lithium levels?
Dehydration
Hyponatremia
What can decrease Lithium levels?
Caffeine
S&S of Lithium Toxicity
Early: vomiting, diarrhea, muscle twitching
Late: lethargy, ataxia, slowed speech, coma
Nonpharm Tx for BD
IPT
CBT
Dynamic psychotherapy
Group therapy
Fam-focused psychotherapy
Social rhythm therapy
Nursing Dx and Interventions for BD
Risk for injury/violence: remove dangerous objects, maintain calm presence
Imbalanced nutrition: provide high-protein, high cal foods, maintain I&Os, cal count
Impaired social interaction: provide positive reinforcement, limit behaviors, don't
argue/bargain, use TC
Labs for Lithium
Labs weekly until stable, then monthly
CMP, TSH, and Li level
Personality Disorders
Reality distortions (self and others)
Inability to see how their behaviors affect others
Manipulative
