Mood disorder bipolar order 8


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Mental Health Fall '12

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  • How about some others?
  • For acute mania: therapeutic level is 1-1.5 For maintenance: .6- 1.2 Not used in pregnancy.
  • Mood disorder bipolar order 8

    1. 1. Chapter 29
    2. 2.  A disorder which is characterized by mood swings from profound depression to extreme euphoria (Mania), this coexists with periods of normalcy. Mania: an alteration in mood that is expressed by feelings of elation, grandiosity, hyperactivity, agitation, and accelerated thinking and speaking.
    3. 3.  Mood Swings Chronic; recurring Delusions/ Hallucinations Seasonal pattern onset May require hospitalization Highest lifetime suicide rate
    4. 4.  High genetic relationship Imbalances in neurotransmitters Lesions or brain trauma in the limbic system Medications (steroids/seizure meds/antidepressants/ narcotics) Psychosocial- this theory is declining due to the evidence based research which acknowledges this disease as a biological disease of the brain.
    5. 5. Substance abusePersonality DisordersAnxiety DisordersEating DisordersADHD
    6. 6.  Milder clinical picture  No marked occupational/ social impairment  Cheerful and expanded personality  Does not require hospitalization  Rapid flow of ideas, hyperactivity, social butterfly  Does not include psychosis  Increased libido  Anorexia, weight loss, spending large amts without thinking of any repercussions
    7. 7.  Mood is elevated, expansive, irritable  Euphoric, on a huge “high”, that changes to anger or crying without any warning.  Impaired occupation/social functioning and relationships  May become psychotic, thoughts are disjointed, flight of ideas, pressured speech  Excessive/frenzied motor activity/no impulse control/ sexually manipulative
    8. 8.  Hallucinations/ delusions Inexhaustible/ no sleep/ no eat! Hygiene and grooming neglected Dress may by flamboyant/ excessive makeup/ bizarre You feel pressured and nervous talking to them and after your interview you are tired
    9. 9.  This is an emergency because the client can have a severe clouding of consciousness with the mania symptoms intensifying Confusion/ disorientation/panic Delusions of persecution/ grandeur/ religiosity Safety is at stake; they are so physically exhausted and have been overworking their cardiovascular system for days.
    10. 10.  Bipolar I Bipolar II Cyclothymic Rapid Cycling
    11. 11. Upper socioeconomic classEducational and Occupational status
    12. 12.  Level of mood  Elated mood ▪ (hypomania) ▪ VS  MANIA, EUPHORIC ▪ (manic)
    13. 13.  Assess Behavior Assess Thought Process  Flight of ideas, speech, communication,c lang associations, grandiosity Assess Cognitive Functions  Cognitive difficulties in psychosocial areas  Impairment core features
    14. 14.  Resists control Splitting Aggressively demanding Setting limits Shallow relationships
    15. 15. Danger to self and othersControlsHospitalizationMedical StatusCo-existing conditionPt/family education
    16. 16. See page 548 for excellent concept map on this!!!!
    17. 17.  The client will:  Exhibit no signs of physical injury  Not harm self or others  No longer exhibit physical anxiety/agitation  Eat a balanced diet  Accept responsibility for their behaviors  Will sleep 6-8 hours a night  Will not manipulate others for self gratification
    18. 18.  Any thoughts? I’ll start: ▪ Risk for violence: self directed or other directed ▪ Short term goal- client will recognize increasing anxiety and will report this to staff for assistance ▪ Longterm goal- client will not harm self or others
    19. 19.  Therapies once meds initiated Cognitive therapy ECT/TMS Basic interventions:  Reduce stimuli  Lower lights in room  Remove dangerous items from room/observe for safety per unit protocal  Provide finger foods/high calorie/ juice/ milk  Set limits on manipulative behavior/ remain calm
    20. 20. Mood Stabilizers/ Lithium Carbonate
    21. 21.  Initially mania treated with antipsychotics or Valproic Acid until Lithium level is therapeutic (7-10 days) Therapeutic level Maintenance level Normal side effects expected:  Drowsy, headache, thirst, pulse irregularities, polyuria, and weight gain ….look at Lithium as a causes similar effects
    22. 22.  Early Toxicity signs  Ataxia, severe diarrhea, blurred vision, N/V, tinnitis Advanced Toxicity signs  Excessive dilute urine, tremors, seizure, impaired consciousness, arrhythmias, coma, ..death* There is a very slim margin between therapeutic and TOXIC Levels must be checked weekly until therapeutic level reached, then monitored monthly during maintenance therapy.
    23. 23.  So what do we do if the client is experiencing toxicity? STOP THE LITHIUM  The monitor for arrythmias  Hydrate maintaining fluid and electrolyte balance
    24. 24.  Antiepileptics  Depakote/ Tegretol/ LamictalThese drugs are sometimes used while Lithium is reaching levels or may be used alone. It decreases the firing of neurons, therefore slowing down the client.
    25. 25.  Anxiolytics- Clonazepam and Lorazepam  Acute Mania / psychomotor agitation Antipsychotics ▪ Olanzapine ▪ Quetiapine ▪ Risperidone ▪ (These can be used alone or with lithium)
    26. 26.  Severe treatment resistant mania Rapid Cyclers Paranoid Acutely Suicidal Used when meds have failed. ECT creates a grand mal seizure which “reboots” the brain. TMS are more specific waves of electricity to specific nerve cells, this does not cause a grand mal. TMS is one of the newer technologies being used.
    27. 27.  Seclusion / Restraints (what is seclusion) Rationale Documented Justification Complex therapeutic, ethical and legal issues Restraint/ Seclusion policy/ Protocal NEVER USED AS PUNISHMENT/ STAFF CONVIENENCE
    28. 28.  Depression and Bipolar Support Alliance (DBSA) National Alliance for the Mentally Ill (NAMI) National Mental Health Association Manic-Depressive Association
    29. 29.  Drink??? Do drugs???? Why knowing their diagnosis do you think a bipolar client will become noncompliant with meds and then use substances?
    30. 30. MOVIE TIME!
    31. 31.  Mostly application questions, what will you say??? Remember restate for clarification, set limits Know the drugs and any client teaching ( ie MAOI, TCA etc). Meds that are used for EPS , anticholinergic effects, side effects Treatments : ECT (interventions and monitoring) , seclusion (removing stimuli) Documentation of care, planning care Client teaching for meds, resources, diet Nursing diagnosis priorities Chemical dependency, care of client, crisis intervention