1. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. Chapter 14 Bipolar Disorders

2. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 2 Clinical Picture Bipolar I DisorderBipolar I Disorder Bipolar II DisorderBipolar II Disorder CyclothymiaCyclothymia

3. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 3 Epidemiology Lifetime prevalence of bipolar disorder in the United States is 3.9% Bipolar I – more common in malesBipolar I – more common in males Bipolar II – more common in femalesBipolar II – more common in females Cyclothymia – usually begins in adolescence or early adulthoodCyclothymia – usually begins in adolescence or early adulthood

4. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 4 Etiology Biological factorsBiological factors –Genetic –Neurobiological –Neuroendocrine Psychological factorsPsychological factors Environmental factorsEnvironmental factors

5. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 5 Assessment MoodMood BehaviorBehavior Thought processes and speech patternsThought processes and speech patterns –Flight of ideas –Clag associations –Grandiosity Cognitive functioningCognitive functioning

6. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 6 Self-Assessment Manic patientManic patient –Manipulative –Aggressively demanding –Splitting Staff member actionsStaff member actions –Frequent staff meetings to deal with patient behavior and staff response –Set limits consistently

7. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 7 Assessment Guidelines Bipolar Disorder Danger to self or othersDanger to self or others Need for protection from uninhibited behaviorsNeed for protection from uninhibited behaviors Need for hospitalizationNeed for hospitalization Medical statusMedical status Coexisting medical conditionsCoexisting medical conditions Family’s understandingFamily’s understanding

8. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 8 Nursing Diagnosis Risk for injuryRisk for injury Risk for violenceRisk for violence – Other-directed – Self-directed Risk for suicideRisk for suicide

9. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 9 Outcomes Identification Acute phaseAcute phase –Prevent injury Continuation phaseContinuation phase –Relapse prevention Maintenance phaseMaintenance phase

10. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 10 Planning Acute phaseAcute phase –Medical stabilization –Maintaining safety –Self-care needs Continuation phaseContinuation phase –Maintain medication adherence –Psychoeducational teaching –Referrals Maintenance phaseMaintenance phase –Prevent relapse

11. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 11 Implementation Acute phase – highest priority is always safetyAcute phase – highest priority is always safety –Depressive episodes –Manic episodes Continuation phaseContinuation phase –Prevent relapse with follow-up care Maintenance phaseMaintenance phase

12. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 12 Pharmacological Interventions Lithium carbonateLithium carbonate –Indications –Therapeutic and toxic levels Therapeutic blood level 0.8 to 1.4 mEq/LTherapeutic blood level 0.8 to 1.4 mEq/L Maintenance blood level 0.4 to 1.3 mEq/LMaintenance blood level 0.4 to 1.3 mEq/L Toxic blood level: 1.5 to 2.0 mEq/LToxic blood level: 1.5 to 2.0 mEq/L –Maintenance therapy –Contraindications

13. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 13 Anticonvulsant Drugs Valproate (Depakote)Valproate (Depakote) Carbamazepine (Tegretol)Carbamazepine (Tegretol) Lamotrigine (Lamictal)Lamotrigine (Lamictal)

14. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 14 Antianxiety Drugs Clonazepam (Klonopin)Clonazepam (Klonopin) Lorazepam (Ativan)Lorazepam (Ativan) Atypical Antipsychotics Olanzapine (Zyprexa)Olanzapine (Zyprexa) Risperidone (Risperdal)Risperidone (Risperdal)

15. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 15 Other Treatments Electroconvulsive therapy (ECT)Electroconvulsive therapy (ECT) Milieu managementMilieu management Support groupsSupport groups Health teaching and health promotionHealth teaching and health promotion

16. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 16 Advanced Practice Interventions PsychotherapyPsychotherapy –Cognitive-behavioral therapy (CBT) –Interpersonal and social rhythm therapy

17. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 17 Evaluation Evaluate outcome criteriaEvaluate outcome criteria Care plan reassessedCare plan reassessed Care plan revised if indicatedCare plan revised if indicated