Term
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Definition
| Chronic, lifelong, severe, biologic illness. Characterized by recurrent mood fluctuations that increase in frequency over time. |
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Term
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Definition
| Normally adolescence-early adulthood. (can occur earlier or later) |
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Term
| Categories of Bipolar Disorder |
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Definition
Bipolar I- Episodes of manic or mixed + depressive
Bipolar II-Episodes of hypomania or depressive but not manic or mixed |
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Term
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Definition
Pure manic (euphoria mania)
Hypomanic
Major depressive
Mixed episode |
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Term
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Definition
Persistant heightened, expansive or irritable mood. -Assoc w/hyperactivity,excessive enthusiasm, flight of ideas.-overactive @ work & play.-decrease need for sleep.-excessive sociability & talkativeness. -extreme self-confidence, grandiose ideas, delusions of self-importance.-high-risk activities (business deals, reckless driving, gambling, sexual indiscretions) w/o though to consequences.
When severe mimick schizophrenia (hallucinations, delusion, bizarre) |
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Term
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Definition
Mild mania
-elevated, expansive, irritable mood. -not severe enough to impair social/occupational function.-no psychotic symptoms |
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Term
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Definition
| -Depressed moos & loss pleasure/interest in all usual activities.-disruption in sleep, eat, concentration.-feeling guilt, worthless, helpless.-suicidal |
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Term
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Definition
-High energy.-HIGH RISK SUICIDE.
-irritable/agitated.-feel worthless & depressed |
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Term
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Definition
Individual variance
Days, weeks, months, >year
Mania without tx las a few months
Depression without tx last at least 6mths.
Average 4 episodes in first 10yrs of illness.
Some are rapid cyclers |
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Term
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Definition
| Unknown. Theories-imbalance of neurotransmitters. Disruption of neuronal growth & survival |
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Term
Bipolar Disorder
Drug therapy |
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Definition
Mood stabilizers-relieve symptoms during mania & depression. Prevent reoccurance.Do not worsen episodes.
Antipsychotics-Severe manic episodes in combo w/mood stabilizer
Antidepressants- ALWAYS combo w/mood stabilizer |
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Term
| Initial tx of first manic episode |
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Definition
Euphoric-monotx mood stabilizer
Dysphoric/mixed-monotx mood stabilizer
Mania w/psychosis-mood stabilizer + SGA
Rapid cycle-monotx mood stabilizer |
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Term
Bipolar Disorder
Drug selection |
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Definition
Valproate preferred in all episodes but euphoric(lithium). If unresponsive to one use both valproate & lithium. 2wks or more for max response. Never monotx of antidepressant in depressive episode.
Adjunct-benzos (mild mania) SGA (severe w/symptoms) |
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Term
Bipolar Disorder
promoting adherence in drug tx |
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Definition
| Collaboration with family. SHort term hospitalizations, monitor that drugs are being taken. Barriers: pt fails to see anything is wrong, mania is not unpleasant. |
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Term
Bipolar Disorder
Non-drug tx |
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Definition
| Education and psychotherapy.-early signs of mood changes.-therapy to reduce stressors.-maintain stable sleep pattern.-maintain regular activity pattern.-avoid alcohol & street drugs.-Enlist help from family and friends.-reduce stress at work as possible.-keep mood chart.-ECT |
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Term
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Definition
| bipolar drug of choice in euphoric mania, alcoholism, bullimia, schizophrenia, glucocorticoid-induced psychosis, hyperthyroidism, cluster HA, migraine, SIADH, raise neutrophil in AZT pts |
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Term
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Definition
| (?)Alter glutamate uptake & release, block binding serotonin inhibit glycogen synthase kinase-3beta |
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Term
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Definition
| Low therapeutic index. Starts to work in 5-7 days, 2-3 wks for full effect. short 1/2 life rapid renal excretion, daily divided dose, Na levels effect renal excretion. If Na low lithium can be toxic |
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Term
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Definition
Na, Kidney function baseline & annual, T3,T4,TSH baseline & annual, CBC baseline & annual
lithium <1.5mEq/L
Labs q2-3 days to start. Draw in morning 12h after eve dose. Check q3-6 mths after stabilized. |
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Term
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Definition
| Do not go on a low Na diet, no diuretics, watch out for diarrhea and dehydration (hot weather/exercise). Take w/food or milk to avoid GI discomfort. |
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Term
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Definition
| Early tx-N/D, abdominal bloat, anorexia(subside). Transient fatigue, muscle weakness, HA, confusion, memory impairment. Persistent polyuria & thirst. Fine hand tremor augmented by stress, fatigue, antidepressants, antipsychotics, caffeine. Renal toxicity with chronic use. Goiters & hypothyroidism.Leukosytosis,dermotologic reactions. Teratogensis-especially in 1st trimester, crosses breast milk |
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Term
| How to minimize/tx side effects |
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Definition
| -Teach that Abdominal discomforts usually subside. -fine hand tremor w/BB or decrease dose, divide dose, or SR formulas). -Drink 8-12 glasses fluid/day, tx w/amiloride K sparing diuretic.Hypothyroidism-levothyroxine or dc lithium |
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Term
Lithium
toxicity side effects |
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Definition
mild <1.5 Fine hand tremor, muscle weakness, slurred speech, lethargy, polyuria, thirst, N/V/D
Mod 1.5-2 Persistent GI upset, coarse hand tremor, confusion, hyper irritability muscles, EKG changes, sedation, incoordination
Severe 2-2.5 Ataxia, giddy, SIADH, serious EKG changes, tinnutus, blurred vision, clonic movements, seizures, stupor, severe hypotension, coma, death
>2.5 Symptoms progress to convulsions, oliguria, death |
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Term
| Treating Lithium toxicity |
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Definition
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Term
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Definition
| diuretics, NSAIDs (compete renally-use ASA), anticholinergics |
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Term
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Definition
| Benefits are from neurotrophic and neuroprotective effects. |
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Term
| Valproate compared to lithium |
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Definition
Valproate works faster, higher therapeutic index, fewer side effects.
Lithium is better at reducing suicide risk and preventing relapse. |
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Term
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Definition
| Thrombocytopenia, pancreatitis, liver failure. Teratogenic. |
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Term
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Definition
| N/V/D, dyspepsia, indigestion, weight gain |
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Term
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Definition
| Early-visual disturbances, ataxia, vertigo, unsteadiness, HA (resolve). Leukopenia, anemia, thrombocytopenia, aplastic anemia uncommon but severe. |
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Term
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Definition
| CBC w/platelets at baseline and periodic. Tegretol plasma levels 4-12mcg/ml |
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Term
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Definition
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Term
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Definition
| HA, dizzy, double vision, rare Stephen Johnson. Minimize rash risk with low initial dose-taper up. |
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Term
Tegretol
indication in Bipolar |
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Definition
| Mixed mania or rapid cycle |
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Term
Lamictal
indication in Bipolar |
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Definition
| long-term maintenance or prevent/delay relapse |
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Term
| Preferred antipsychotics in Bipolar |
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Definition
SGA-due to lower risk EPS
Acute-Zyprexa, Seroquel, Riperdal, Abilify, Geodon.
Long-term-Abilify, Zyprexa,Geodon |
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