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Comprehensive Guide to Bipolar Disorder Management

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  1. Chapter 14 Bipolar Disorders

  2. Clinical Picture • Bipolar I Disorder • Bipolar II Disorder • Cyclothymia

  3. Epidemiology Lifetime prevalence of bipolar disorder in the United States is 3.9% • Bipolar I– more common in males • Bipolar II– more common in females • Cyclothymia – usually begins in adolescence or early adulthood

  4. Etiology • Biological factors • Genetic • Neurobiological • Neuroendocrine • Psychological factors • Environmental factors

  5. Assessment • Mood • Behavior • Thought processes and speech patterns • Flight of ideas • Clag associations • Grandiosity • Cognitive functioning

  6. Self-Assessment • Manic patient • Manipulative • Aggressively demanding • Splitting • Staff member actions • Frequent staff meetings to deal with patient behavior and staff response • Set limits consistently

  7. Assessment Guidelines Bipolar Disorder Danger to self or others Need for protection from uninhibited behaviors Need for hospitalization Medical status Coexisting medical conditions Family’s understanding

  8. Nursing Diagnosis • Risk for injury • Risk for violence • Other-directed • Self-directed • Risk for suicide

  9. Outcomes Identification • Acute phase • Prevent injury • Continuation phase • Relapse prevention • Maintenance phase

  10. Planning • Acute phase • Medical stabilization • Maintaining safety • Self-care needs • Continuation phase • Maintain medication adherence • Psychoeducational teaching • Referrals • Maintenance phase • Prevent relapse

  11. Implementation • Acute phase – highest priority is always safety • Depressive episodes • Manic episodes • Continuation phase • Prevent relapse with follow-up care • Maintenance phase

  12. Pharmacological Interventions • Lithium carbonate • Indications • Therapeutic and toxic levels • Therapeutic blood level 0.8 to 1.4 mEq/L • Maintenance blood level 0.4 to 1.3 mEq/L • Toxic blood level: 1.5 to 2.0 mEq/L • Maintenance therapy • Contraindications

  13. Anticonvulsant Drugs • Valproate (Depakote) • Carbamazepine (Tegretol) • Lamotrigine (Lamictal)

  14. Antianxiety Drugs • Clonazepam (Klonopin) • Lorazepam (Ativan) Atypical Antipsychotics • Olanzapine (Zyprexa) • Risperidone (Risperdal)

  15. Other Treatments • Electroconvulsive therapy (ECT) • Milieu management • Support groups • Health teaching and health promotion

  16. Advanced Practice Interventions • Psychotherapy • Cognitive-behavioral therapy (CBT) • Interpersonal and social rhythm therapy

  17. Evaluation Evaluate outcome criteria Care plan reassessed Care plan revised if indicated

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