chapter 17

when using antidepressants in patients with bipolar disorder, this should be done with care bc

it can trigger mania but bringing the patient up to fast

drug of choice for bipolar disorder

lithium

if a patient can tolerate this med, what can be used to treat bipolar disorder with no further episodes

lithium

An alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, and accelerated thinking and speaking.

mania

bipolar 1

manic episodes and depressive episodes

cyclothymic disorder compared to BP 1 or 2 is more

"mild" elevated mood thats not to hypomania, depressed mood thats not to a major depressive episode

therapeutic range of lithium for maintenance

0.6-1.2 mEq/L

therapeutic range of lithium for ACUTE mania

1.0-1.5 mEq/L

ECT is often given

3 times a week for 10 weeks, then will stretch treatments out

the recovery model

A concept of healing and transformation enabling a person with mental illness to live a meaningful life in the community while striving to achieve his or her full potential --> have patient set goals based on their own idea of meaning of life, helping pt to take control of their disorder

what has shown to be an effective method in reducing relapses and increasing medication adherence in bipolar pts>

FFT: family focused treatment

drugs used for bipolar disorders

LITHIUM -can also use: anticonvulsants, calcium channel blockers, antipsychotics,

electroconvulsive therapy (ECT)

Patient is sedated with muscle relaxants, anxiolytics, etc. then patient is given a short burst of a shock for a few seconds The effect is immediate and stabilizes the patient, this treatment frequency is dictated by the patient and their disease process

the external, observable emotional reaction associated with an experiance

affect

bipolar disorder can also be due to

another medical condition ex: brain tumor

why give antipsychotics to a patient experiencing mania?

because mania involves a break in reality, such as in psychosis

a combination of predisposing factors + environmental triggers --> chemical imbalances in the brain this is the common theory of

bipolar disorder

mood disorder characterized by cycles of depression and mania

bipolar disorder

A least two years involving numerous periods of elevated mood that do not meet the criteria for a hypomanic episode and numerous periods of depressed mood of insufficient severity or duration to meet the criteria for major depressive episode. The individual is never without the symptoms for more than 2 months

cyclothymic disorder: a chronic mood disorder

how often do lithium levels need to be checked?

every 6 weeks

bipolar 2

hypomania and depression

a pervasive and sustained emotion that may have a major influence on a person's perception of the world ex) depression, joy, elation, anger, anxiety

mood

3 MAJOR reportable s/s patients taking lithium need to report

n/v, diarrhea, tremors

the direct result of physiological effects r/t the alteration of neurotransmitters by a substance (either withdraw or ingestion)

substance-induced bipolar disorder

a patient on lithium can have an increased risk of lithium toxicity if they are

vomiting or have diarrhea bc this can cause a sodium loss

when should electroconvulsive therapy (ECT) be used for patients in an acute manic episode?

when showing signs of aggression