Bipolar and Related Disorders, Ch 17
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Questions and Answers

What is the correct rationale for diagnosing a client with bipolar 1 disorder rather than major depressive disorder?

  • The physician does not believe the client is suffering from major depression.
  • There is no history of major depression in the client’s family.
  • The client has experienced a manic episode in the past. (correct)
  • The client does not exhibit psychotic symptoms.

    • During an acute manic episode, what should be the priority nursing diagnosis for the client?

  • Disturbed sleep pattern related to manic hyperactivity
  • Imbalanced nutrition, less than body requirements, related to inadequate intake
  • Risk for injury related to excessive hyperactivity (correct)
  • Situational low self-esteem related to embarrassment secondary to high-risk behaviors

    • Which of the following should be included in medication education for a client on lithium?

  • Lithium should be taken on a PRN basis.
  • Major changes in sodium level can cause toxicity. (correct)
  • Serum lithium levels will need to be checked throughout treatment. (correct)
  • Weight loss is a common side effect.

    • What important dietary information should a nurse teach a client being discharged on lithium carbonate?

    <p>Do not skimp on dietary sodium intake.</p> Signup and view all the answers

    Which symptoms should a nurse recognize as indicative of lithium toxicity?

    <p>Severe mental confusion, ataxia, tremors, severe diarrhea</p> Signup and view all the answers

    What is the main focus of the Recovery Model for bipolar disorder?

    <p>Learning to prevent and minimize symptoms while coping</p> Signup and view all the answers

    Which food type is recommended for clients with imbalanced nutrition due to bipolar disorder?

    <p>High-protein, high-calorie foods</p> Signup and view all the answers

    What role does the clinician play in the recovery process for bipolar disorder?

    <p>Serves as a support person in goal achievement</p> Signup and view all the answers

    What technique should be avoided when interacting with clients displaying manipulative behaviors?

    <p>Arguing or bargaining with the client</p> Signup and view all the answers

    Which scenario would warrant the use of Electroconvulsive Therapy (ECT) in a bipolar patient?

    <p>Patient's life is threatened by dangerous behavior</p> Signup and view all the answers

    Which of the following is NOT a part of patient and family education regarding bipolar disorder?

    <p>History of medication use</p> Signup and view all the answers

    What is a critical component to monitor in patients regarding their nutritional status?

    <p>Accurate record of intake and output</p> Signup and view all the answers

    What should be done if restraint is deemed necessary for a patient?

    <p>Ensure sufficient staff are present to assist</p> Signup and view all the answers

    What is a significant risk associated with lithium therapy?

    <p>Narrow therapeutic range</p> Signup and view all the answers

    Which of the following symptoms can indicate lithium toxicity?

    <p>Persistent nausea and vomiting</p> Signup and view all the answers

    What should a patient taking lithium be cautious of regarding their sodium intake?

    <p>Normal sodium intake is encouraged.</p> Signup and view all the answers

    Which medication is known to potentially cause sodium depletion while increasing lithium receptor sites?

    <p>NSAIDs</p> Signup and view all the answers

    What should patients on anticonvulsants avoid without physician approval?

    <p>Discontinuing the medication abruptly</p> Signup and view all the answers

    Which of the following is a precaution for patients taking second-generation atypical antipsychotics?

    <p>Rise slowly from a sitting or lying position.</p> Signup and view all the answers

    What precaution should be taken when a patient is prescribed Verapamil?

    <p>Do not stop taking the medication abruptly.</p> Signup and view all the answers

    Which condition warrants immediate reporting by a patient taking anticonvulsants?

    <p>Skin rash</p> Signup and view all the answers

    Which dietary recommendation is important for patients taking lithium?

    <p>Drink six to eight glasses of water daily.</p> Signup and view all the answers

    What should patients taking second-generation atypical antipsychotics report to their physician?

    <p>Excessive thirst or hunger.</p> Signup and view all the answers

    What best characterizes Bipolar 1 Disorder?

    <p>At least one episode of mania alternating with major depression.</p> Signup and view all the answers

    Which of the following symptoms is associated with acute mania?

    <p>Elation and excessive motor activity.</p> Signup and view all the answers

    What is a criterion for diagnosing Cyclothymic Disorder?

    <p>Chronic mood disturbance lasting at least 2 years.</p> Signup and view all the answers

    Which of the following is a risk related to mania?

    <p>Decreased need for sleep and increased agitation.</p> Signup and view all the answers

    What is a common comorbidity associated with childhood bipolar disorders?

    <p>Attention-Deficit/Hyperactivity Disorder.</p> Signup and view all the answers

    What neurotransmitters are often implicated in bipolar disorders?

    <p>Norepinephrine and serotonin.</p> Signup and view all the answers

    Which symptom is not characteristic of hypomania?

    <p>Marked impairment in functioning.</p> Signup and view all the answers

    Which nursing diagnosis is specifically related to extreme hyperactivity in mania?

    <p>Risk for injury.</p> Signup and view all the answers

    What defines a manic episode?

    <p>Presence of hallucinations and delusions.</p> Signup and view all the answers

    What is a critical factor in the treatment of pediatric bipolar disorder?

    <p>Education about medication adherence.</p> Signup and view all the answers

    What is a common characteristic of bipolar 2 disorder?

    <p>One or more hypomanic episodes with major depression.</p> Signup and view all the answers

    Which of the following behaviors is indicative of delirious mania?

    <p>Severe clouding of consciousness.</p> Signup and view all the answers

    Which symptom denotes a potential manic episode in an individual?

    <p>Increased libido and talkativeness.</p> Signup and view all the answers

    What is a key reason for diagnosing a client with bipolar 1 disorder rather than major depressive disorder?

    <p>The client has experienced a manic episode in the past.</p> Signup and view all the answers

    What should the nurse prioritize as a nursing diagnosis for a client experiencing an acute manic episode?

    <p>Risk for injury related to excessive hyperactivity.</p> Signup and view all the answers

    Which statement about lithium therapy is true and should be included in medication education?

    <p>Serum lithium levels will need to be checked throughout treatment.</p> Signup and view all the answers

    What dietary information should be taught to a client who is being discharged on lithium carbonate?

    <p>Maintain regular sodium intake to stabilize lithium levels.</p> Signup and view all the answers

    Which symptom might indicate lithium toxicity that the nurse should educate the client about?

    <p>Severe mental confusion and tremors.</p> Signup and view all the answers

    Which action should a patient taking lithium avoid to minimize the risk of toxicity?

    <p>Reduce sodium intake</p> Signup and view all the answers

    What is the recommended frequency for checking serum lithium levels after stabilization of treatment?

    <p>Every 1-3 months</p> Signup and view all the answers

    Which of the following anticonvulsant side effects should be reported to a physician immediately?

    <p>Skin rash</p> Signup and view all the answers

    What is an important dietary instruction for a patient prescribed lithium?

    <p>Drink six to eight glasses of water daily</p> Signup and view all the answers

    Which symptom should be watched closely for in a patient on antipsychotic medications?

    <p>Sore throat and fever</p> Signup and view all the answers

    Which precaution is essential while taking second-generation atypical antipsychotics?

    <p>Use sunblock when outdoors</p> Signup and view all the answers

    What should be avoided when a patient is taking anticonvulsants?

    <p>Alcohol and OTC medications</p> Signup and view all the answers

    In which situation should a patient on Verapamil seek immediate medical attention?

    <p>Having irregular heartbeat</p> Signup and view all the answers

    Which of the following is a common side effect of anticonvulsant medications?

    <p>Unusual bleeding</p> Signup and view all the answers

    What should a patient taking lithium do if they experience persistent nausea and vomiting?

    <p>Notify their physician</p> Signup and view all the answers

    What should be included in patient education about the nature of bipolar disorder?

    <p>The cyclic nature of the illness</p> Signup and view all the answers

    Which of the following strategies is effective for managing manipulative behaviors in clients?

    <p>Setting limits on the behaviors</p> Signup and view all the answers

    What type of foods should be provided to clients experiencing imbalanced nutrition due to bipolar disorder?

    <p>High-protein, high-calorie foods</p> Signup and view all the answers

    Which aspect of the Recovery Model emphasizes the patient's role in managing bipolar disorder?

    <p>Clients should identify their own goals</p> Signup and view all the answers

    What is a critical consideration when using Electroconvulsive Therapy (ECT) for treating bipolar disorder?

    <p>Informed consent must be obtained</p> Signup and view all the answers

    What monitoring is essential to ensure the effectiveness of nutritional interventions in bipolar disorder patients?

    <p>Recording intake and output</p> Signup and view all the answers

    Which factor may indicate that a manic episode requires Electroconvulsive Therapy (ECT)?

    <p>The patient is failing to respond to medication</p> Signup and view all the answers

    When education about support services for bipolar disorder is provided, what should be emphasized?

    <p>Support groups can offer communal understanding and resources</p> Signup and view all the answers

    What distinguishes Bipolar 1 Disorder from Bipolar 2 Disorder?

    <p>It requires hospitalization more often.</p> Signup and view all the answers

    Which symptom is NOT characteristic of hypomania?

    <p>Severe clouding of consciousness</p> Signup and view all the answers

    What is a common characteristic of Cyclothymic Disorder?

    <p>Chronic mood disturbance for at least 2 years</p> Signup and view all the answers

    Which factor is considered a physiological influence in the development of bipolar disorders?

    <p>Brain lesions</p> Signup and view all the answers

    During an acute manic episode, a patient may exhibit which of the following symptoms?

    <p>Flight of ideas</p> Signup and view all the answers

    What is a primary nursing diagnosis related to risk factors in mania?

    <p>Risk for violence related to manic excitement</p> Signup and view all the answers

    Which symptom is characteristic of delirious mania?

    <p>Labile mood and disorientation</p> Signup and view all the answers

    In the context of bipolar disorder, how is hypomania characterized?

    <p>Symptoms not severe enough to cause marked impairment</p> Signup and view all the answers

    What neurotransmitter imbalances are often associated with bipolar disorders?

    <p>Low norepinephrine and serotonin</p> Signup and view all the answers

    Which of the following statements is true regarding the treatment of pediatric bipolar disorder?

    <p>Family interventions can play a crucial role in management.</p> Signup and view all the answers

    Which nursing diagnosis is associated with weight loss in a manic patient?

    <p>Imbalanced nutrition less than body requirements</p> Signup and view all the answers

    What is a common comorbid condition associated with childhood bipolar disorders?

    <p>Attention Deficit Hyperactivity Disorder (ADHD)</p> Signup and view all the answers

    What is a critical factor in managing the nutritional status of a patient experiencing mania?

    <p>Maintaining a well-balanced diet</p> Signup and view all the answers

    Study Notes

    • Mood is a sustained, pervasive emotion that influences perception. Examples of mood: depression, joy, elation, anger, anxiety.
    • Affect is the emotional reaction associated with an experience.
    • Bipolar Disorders involve extreme mood swings with emotional highs and lows, interspersed with periods of normalcy.
    • Bipolar disorders differ based on the severity of the emotional highs and lows.

    Types of Bipolar Disorders

    • Bipolar 1 Disorder often requires hospitalization.
      • Involves at least one manic episode alternating with major depression.
      • Mania is a key feature of bipolar 1 disorder, characterized by:
        • Elation, inflated self-esteem, grandiosity, hyperactivity, agitation, racing thoughts, and accelerated speech.
      • May also include episodes of depression.
      • Speech: Loud, rambling, clanging, vulgar, poor judgment.
      • Issues with weight loss, distraction, hyperactivity, decreased need for sleep, inappropriate dress.
    • Bipolar 2 Disorder is less severe.
      • Characterized by bouts of major depression with episodic occurrences of hypomania.
      • Feelings of worthlessness, increased anger, decreased pleasure, negative view, insomnia, suicidal ideation.
      • Never meets the criteria for a full manic episode.
    • Cyclothymic Disorder involves chronic mood disturbance.
      • At least 2 years of repeated hypomanic manifestations (not meeting full criteria) alternating with minor depressive episodes.
      • Numerous episodes of hypomania and depressed mood, but not severe enough for Bipolar 1 or 2.

    Predisposing Factors

    • Genetics plays a role in bipolar disorder.
    • Physiological influences:
      • Brain lesions
      • Enlarged ventricles
      • Medication side effects
    • Biochemical influences:
      • Imbalance of several neurotransmitters, including low levels of norepinephrine and serotonin.
    • Psychosocial theories are less emphasized now, with bipolar disorder viewed as a brain disease.
    • A link between childhood trauma is being explored.

    Developmental Implications: Childhood & Adolescence

    • Lifetime prevalence of pediatric and adolescent bipolar disorders is around 1%.
    • Disruptive Mood Dysregulation Disorder (DMDD): Non-discrete mood episodes, chronic irritability, and temper tantrums in children.
    • ADHD is a common comorbid condition.
    • Treatment strategies:
      • Monotherapy (atypical antipsychotic or mood stabilizer).
      • ADHD stimulant agents may worsen mania.
      • Family interventions (educate about medication adherence).
      • Psychoeducation about bipolar disorder.
      • Communication and problem-solving skills training.

    Nursing Process/Assessment

    • Symptoms can be categorized by severity.
    • Hypomania: Specific to Bipolar 2, not causing significant impairment or hospitalization. Symptoms include:
      • Cheerful mood.
      • Rapid flow of ideas, heightened perception (rapid speech).
      • Increased motor activity.
    • Acute Mania: Marked impairment in functioning, often requiring hospitalization. Symptoms include:
      • Elation and euphoria, fluctuating to irritability, anger, sadness, and crying.
      • Flight of ideas, accelerated, pressured speech (loquaciousness).
      • Hallucinations and delusions.
      • Excessive motor activity.
      • Social and sexual inhibition.
      • Minimal need for sleep.
    • Delirious Mania: Serious form, severe clouding of consciousness. Symptoms include:
      • Labile mood, panic anxiety.
      • Clouded consciousness, disorientation.
      • Frenzied psychomotor activity.
      • Exhaustion, potentially fatal without intervention.

    Clinical Manifestations of Mania: "DIGFAST"

    • Distractibility and easy frustration.
    • Irresponsibility and erratic, uninhibited behavior.
    • Grandiosity.
    • Flight of ideas.
    • Activity increased with weight loss and increased libido.
    • Sleep is decreased.
    • Talkativeness.

    Nursing Diagnoses

    • Risk for injury: Related to hyperactivity, agitation, and lack of control over movements.
    • Risk for violence (self or others): Related to manic excitement, delusional thinking, hallucinations, and impulsivity.
    • Imbalanced nutrition (less than body requirements): Related to inability to sit still to eat, leading to weight loss and amenorrhea.
    • Disturbed thought processes: Related to biochemical alterations in the brain, evidenced by delusions of grandeur and persecution, and inaccurate interpretation of the environment.
    • Disturbed sensory perception: Related to biochemical alterations and sleep deprivation, evidenced by auditory and visual hallucinations.
    • Impaired social interaction: Related to egocentric and narcissistic behavior.
    • Insomnia: Related to excessive hyperactivity and agitation.

    Criteria for Measuring Outcomes

    • The patient:
      • Exhibits no evidence of physical injury.
      • Has not harmed self or others.
      • No longer exhibits physical agitation.
      • Eats a well-balanced diet to maintain nutrition.
      • Interprets the environment accurately.
      • Reports that hallucinatory activity has ceased and shows no outward signs of hallucinations.
      • Accepts responsibility for their behavior.
      • Does not manipulate others for personal gratification.
      • Interacts appropriately with others.
      • Falls asleep within 30 minutes of retiring.
      • Sleeps 6-8 hours per night.

    Planning & Implementation

    • Risk for Violence:
      • Remove dangerous objects.
      • Maintain a calm attitude.
      • Ensure sufficient staff for restraint if necessary, using it as a last resort.
    • Impaired Social Interaction:
      • Set limits on manipulative behaviors.
      • Do not argue, bargain, or reason with the patient.
      • Provide positive reinforcement.
    • Imbalanced Nutrition & Insomnia:
      • Provide high-protein, high-calorie foods.
      • Monitor intake, output, and calorie count.
      • Monitor sleep patterns.

    Patient & Family Education

    • Nature of the illness:
      • Causes of bipolar disorder.
      • Cyclic nature of the illness.
      • Symptoms of depression.
      • Symptoms of mania.
    • Management of the illness:
      • Medication management.
      • Assertive techniques.
      • Anger management.
    • Support services:
      • Crisis hotline.
      • Support groups.
      • Therapy.
      • Legal/financial assistance.

    Treatment Modalities for Bipolar Disorder

    • The Recovery Model:
      • Learning to live a safe, full, and self-determined life with the illness.
      • Recovery involves preventing and minimizing symptoms, and successfully coping with the effects of the illness.
      • It is a continuous process.
      • Client identifies goals.
      • Client and clinician develop a treatment plan.
      • Strategies are developed to help the client manage the illness.
      • Clinician acts as a support person.
    • Electroconvulsive therapy (ECT):
      • Requires informed consent.
      • Establishing IV for medication administration.
      • Monitoring with EEG.
      • Bag valve mask for extra oxygen.
      • Vital signs monitored.
      • Typically done in series (2-3 times per month).
      • Short-term memory loss possible.
      • ECT may be used for mania when:
        • Client does not tolerate medication.
        • Client does not respond to medication.
        • Client's life is threatened by dangerous behavior or exhaustion.
    • Mood-Stabilizing Agents:
      • Lithium: Works on the intracellular level. Narrow therapeutic range.
      • Anticonvulsant medications: Carbamazepine, valproic acid, lamotrigine, topiramate, oxcarbazepine. -Second-generation atypical antipsychotics: Olanzapine, aripiprazole, lurasidone, quetiapine. Lurasidone is particularly effective for bipolar depression.
      • Calcium channel blockers: Verapamil, diltiazem, nimodipine. Take with meals. Monitor BP and HR.

    Client/Family Education for Medications

    • Lithium:
      • Take medication regularly.
      • Avoid sodium depletion (don't exclude sodium from diet).
      • Drink 6-8 glasses of water daily.
      • Monitor serum lithium levels.
      • Report signs of toxicity (nausea, vomiting, diarrhea, ataxia, blurred vision, tinnitus, excessive urination, tremors, confusion).
    • Anticonvulsants:
      • Do not discontinue abruptly.
      • Avoid alcohol and over-the-counter medications.
      • Report skin rash, bleeding, bruising, sore throat, fever, malaise, dark urine, yellow skin or eyes.
    • Antipsychotics:
      • Do not discontinue abruptly.
      • Use sunblock outdoors.
      • Rise slowly from sitting or lying.
      • Avoid alcohol and over-the-counter medications.
      • Report sore throat, fever, malaise, bleeding, bruising, rash, nausea, vomiting, severe headache, rapid heart rate, difficulty urinating, muscle twitching, tremors, dark urine, pale stools, yellow skin or eyes, excessive thirst or hunger, muscle weakness.
    • Verapamil:
      • Do not discontinue abruptly.
      • Rise slowly from sitting or lying.
      • Report irregular heartbeat, chest pain, shortness of breath, dizziness, swelling of hands and feet, mood swings, persistent headaches.

    Clicker Question Answers

    • Question 1: B. The client has experienced a manic episode in the past.
    • Question 2: A. Risk for injury related to excessive hyperactivity.
    • Question 3: A. Major changes in sodium level can cause toxicity.
    • C. Serum lithium levels will need to be checked throughout treatment.*
    • E. Severe mental confusion, ataxia, tremors, severe diarrhea are symptoms of toxicity.*
    • Question 4: A. Do not skimp on dietary sodium intake.

    Mood vs. Affect

    • Mood is a sustained emotion that influences perception
    • Affect is the emotional reaction to an experience

    Bipolar Disorders

    • Characterized by extreme mood swings: highs, lows, and periods of normalcy
    • Severity of highs and lows varies based on specific disorder

    Types of Bipolar Disorders

    • Bipolar 1 Disorder
      • At least one manic episode alternating with major depression
      • Full syndrome of manic symptoms present
      • Mania is specific to Bipolar 1
        • Elation, inflated self-esteem, grandiosity, hyperactivity, agitation, racing thoughts, pressured speech
      • May also have experienced depressive episodes
      • Speech: loud, rambling, clanging, vulgar, poor judgment
      • Weight loss, distraction, hyperactivity, decreased sleep, inappropriate dress
    • Bipolar 2 Disorder
      • One or more hypomanic episodes alternating with major depressive episodes
      • Characterized by major depression with episodic hypomania
      • Feelings of worthlessness, increased anger, decreased pleasure, negative view, insomnia, suicidal ideation
      • Never met criteria for full manic episode
    • Cyclothymic Disorder
      • At least 2 years of repeated hypomanic manifestations (not meeting full criteria) alternating with minor depressive episodes
      • Chronic mood disturbance lasting at least 2 years
      • Numerous episodes of hypomania and depression, but not severe enough for Bipolar 1 or 2

    Predisposing Factors

    • Genetics
    • Physiological Influences
      • Brain lesions
      • Enlarged ventricles
      • Medication side effects
    • Biochemical Influences
      • Imbalance of neurotransmitters (low norepinephrine and serotonin)
    • Psychosocial Theories
      • Credibility declined in recent years
      • Bipolar disorder considered a brain disease
      • Link to childhood trauma

    Developmental Implications: Childhood and Adolescence

    • Lifetime prevalence of pediatric and adolescent bipolar disorders is about 1%
    • Disruptive Mood Dysregulation Disorder (DMDD)
      • Non-discrete mood episodes, chronic irritability, temper tantrums
    • Most common comorbid condition is ADHD

    Treatment Strategies (Children and Adolescents)

    • Monotherapy with atypical antipsychotics or mood stabilizers
    • ADHD stimulant agents may exacerbate mania
    • Family interventions (educate about not abruptly stopping medications)
    • Psychoeducation about bipolar disorder
    • Communication training
    • Problem-solving skills training

    Stages of Mania

    • Hypomania: Not severe enough to cause significant impairment or require hospitalization
      • Cheerful mood
      • Rapid flow of ideas, heightened perception (rapid speech)
      • Increased motor activity
      • Specific to Bipolar 2 Disorder
    • Acute Mania: Marked impairment in functioning, usually requires hospitalization
      • Elation and euphoria, easily shifts to irritability, anger, sadness, crying
      • Flight of ideas, accelerated, pressured speech (loquaciousness)
      • Hallucinations and delusions
      • Excessive motor activity
      • Social and sexual inhibition
      • Little need for sleep
    • Delirious Mania: Severe clouding of consciousness, intensification of acute mania symptoms
      • Labile mood, panic anxiety
      • Clouding of consciousness, disorientation
      • Frenzied psychomotor activity
      • Exhaustion and possible death without intervention

    Clinical Manifestations of Mania (DIGFAST)

    • Distractibility and easy frustration
    • Irresponsibility and erratic uninhibited behavior
    • Grandiosity
    • Flight of ideas
    • Activity increased with weight loss and increased libido
    • Sleep is decreased
    • Talkativeness

    Nursing Diagnosis

    • Risk for Injury
      • Extreme hyperactivity, agitation, lack of control over movements
    • Risk for Violence (self or others)
      • Manic excitement
      • Delusional thinking
      • Hallucinations
      • Impulsivity
    • Imbalanced Nutrition: Less than Body Requirements
      • Inability to sit still to eat, evidenced by weight loss and amenorrhea
    • Disturbed Thought Processes
      • Biochemical brain alterations, evidenced by delusions of grandeur and persecution, misinterpretation of environment
    • Disturbed Sensory Perception
      • Biochemical brain alterations and sleep deprivation, evidenced by auditory and visual hallucinations
    • Impaired Social Interaction
      • Egocentric and narcissistic behavior
    • Insomnia
      • Excessive hyperactivity and agitation

    Criteria for Measuring Outcomes

    • Patient exhibits no evidence of physical injury
    • Patient has not harmed self or others
    • Patient is no longer exhibiting physical agitation
    • Patient eats a well-balanced diet to prevent weight loss
    • Patient verbalizes accurate interpretation of the environment
    • Patient verbalizes that hallucinations have ceased and shows no outward behavior indicating hallucinations
    • Patient accepts responsibility for their behaviors
    • Patient does not manipulate others for personal gratification
    • Patient interacts appropriately with others
    • Patient is able to fall asleep within 30 minutes of retiring
    • Patient is able to sleep 6-8 hours per night

    Planning and Implementation

    • Risk for Violence
      • Remove dangerous objects
      • Maintain a calm attitude
      • Ensure sufficient staff for restraint if necessary
    • Impaired Social Interaction
      • Set limits on manipulative behaviors
      • Avoid arguing, bargaining, or reasoning with the client
      • Provide positive reinforcement
    • Imbalanced Nutrition and Insomnia
      • Provide high-protein, high-calorie foods
      • Maintain accurate intake, output, and calorie count
      • Monitor sleep patterns

    Patient and Family Education

    • Nature of the Illness
      • Causes of bipolar disorder
      • Cyclic nature of the illness
      • Symptoms of depression
      • Symptoms of mania
    • Management of the Illness
      • Medication management
      • Assertive techniques
      • Anger management
    • Support Services
      • Crisis hotline
      • Support groups
      • Therapy
      • Legal/financial assistance

    Treatment Modalities

    • Recovery Model
      • Living a safe, dignified, full, and self-determined life despite the disability associated with mental illness
      • No cure, but recovery is possible: preventing and minimizing symptoms, coping with effects
      • Recovery is a continuous process:
        • Client identifies goals
        • Treatment plan development
        • Strategies for managing bipolar illness
        • Clinician serves as support person
    • Electroconvulsive Therapy (ECT)
      • Informed consent, IV access, EEG monitor, bag valve mask for oxygen, VS monitoring
      • Typically done in series (2-3 times per month)
      • May cause short-term memory loss
      • Used for manic episodes when:
        • Client does not tolerate medication
        • Client fails to respond to medication
        • Client's life is threatened by dangerous behavior or exhaustion

    Mood-Stabilizing Agents

    • Lithium
      • Works on intracellular level
      • Narrow therapeutic range, risk of toxicity
    • Anticonvulsant Medications
      • Carbamazepine, valproic acid, lamotrigine, topiramate, oxcarbazepine
    • Second-generation Atypical Antipsychotics
      • Olanzapine, aripiprazole, lurasidone, quetiapine
      • Lurasidone is good for bipolar depression
    • Calcium Channel Blockers
      • Verapamil, diltiazem, nimodipine
      • Take with meals
      • Monitor BP and HR

    Client/Family Education: Lithium

    • Lithium is a sodium substitute
      • Sodium depletion increases risk of lithium toxicity (normal levels 0.6-1.2)
    • Take medication regularly
      • Many drug-drug interactions (NSAIDs)
    • Do not exclude sodium from diet
    • Drink 6-8 glasses of water daily
    • Have serum lithium levels checked
      • At initiation: every 2-3 days until stable, then every 1-3 months
    • Notify physician of:
      • Persistent nausea and vomiting
      • Severe diarrhea
      • Ataxia
      • Blurred vision
      • Tinnitus
      • Excessive urination
      • Increasing tremors
      • Mental confusion

    Client/Family Education: Anticonvulsants

    • Do not discontinue abruptly
    • Avoid alcohol and over-the-counter medications
    • Report: skin rash, unusual bleeding, bruising, sore throat, fever, malaise, dark urine, yellow skin/eyes

    Client/Family Education: Antipsychotics

    • Do not discontinue abruptly
    • Use sunblock outdoors
    • Rise slowly from sitting or lying position
    • Avoid alcohol and over-the-counter medications
    • Continue taking even if feeling well
    • Report:
      • Sore throat, fever, malaise, unusual bleeding, bruising, skin rash, persistent nausea/vomiting
      • Severe headache, rapid heart rate, difficulty urinating, muscle twitching, tremors
      • Dark urine, pale stools
      • Yellow skin/eyes
      • Excessive thirst/hunger
      • Muscular incoordination/weakness

    Client/Family Education: Verapamil

    • Do not discontinue abruptly
    • Rise slowly from sitting/lying position to prevent sudden drop in BP
    • Report:
      • Irregular heartbeat, chest pain
      • Shortness of breath, pronounced dizziness
      • Swelling of hands/feet
      • Profound mood swings
      • Severe and persistent headache

    Clicker Question 1

    • The correct answer is B. The client has experienced a manic episode in the past.
    • Bipolar 1 disorder requires a manic episode in the past, even if the current episode is depressed.

    Clicker Question 2

    • The correct answer is A. Risk for injury related to excessive hyperactivity
    • Priority in acute mania is safety due to the client's uncontrolled behavior.

    Clicker Question 3

    • The correct answers are:
      • A. Major changes in sodium level can cause toxicity. Lithium competes with sodium.
      • C. Serum lithium levels will need to be checked throughout treatment. Monitoring is essential to prevent toxicity.
      • E. Severe mental confusion, ataxia, tremors, severe diarrhea are symptoms of toxicity. These are signs of lithium toxicity.

    Clicker Question 4

    • The correct answer is A. Do not skimp on dietary sodium intake. Maintaining adequate sodium levels is crucial for lithium safety.

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    Test your knowledge about bipolar and related disorders, including definitions of mood and affect. Explore the types of bipolar disorders, particularly focusing on Bipolar 1 Disorder and its characteristics. This quiz will challenge your understanding of the emotional highs and lows associated with these conditions.

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