• at least one episode of mania alternating with major depression
• more common in men
  

• hypomanic episodes alternating with major depression
• Manic-depressives - have highest rate of suicide of all psych illnesses
• more common in females
  

• mixed episodes - criteria for both manic and depressive episodes met
• hypomanic episode - same as manic but less than four days, do not impede the individual from functioning
• secondary mania - caused by medical disorders of treatment
• rapid cycling - four or more episodes within twelve months

• chronic cyclic disorder
• later episodes occur more frequently
• interpersonal/occupational fxning are affected
• patient has rapid clycling between mania, depression, and hypomania and depression.

• four or more mood episodes that occur within a 12 month period
• episodes must last a minumum of a few days and be distinct
• women have more episodes than men

• hypomanic episodes alternating with minor depressive episodes
• cycles between hypomania and dysthymia for at least two years
• no delusions, not usually hospitalized, doesn't impair social, occupation or interpersonal fxning

• lifetime prevalence of bipolar disorder in the US is 5.1%
• Bipolar I - more common in males
• Bipolar II - more common in females
• Cyclothymia - begins in adolescence or early adulthood

• 21-30 years, men and women affected equally
• 10-15% of adolescents with recurrent depressive episodes develop bipolar I
• tends to be comorbid to anxiety, substance and personality disorders

• mood is elevated, irritated
• speech is long and rapid, running, clanging and rhyming, vulgar
• wt. loss, delusions, decreased sleep, flight of ideas
• begins suddenly and escalates over period of a few days

• dysphoric, depressive and despairing mood
• no interest in please, negative thoughts, fatigue, loss of appetite, low libido
• may be agitated or have movement retardation

• hyperactivity - nonstop activity, no eating, no sleeping, can lead to exhaustion
• bizarre and colorful dress, highly distracted
• impulsive spending, run up credit cards
• increased energy - speech can't keep up with thoughts, clanging, rhyming words, nonsensical

• prevent exhaustion, injury
• quiet, calm environment
• solitary, noncompetitive activities
• 5-7 hours of sleep, high calorie and protein foods, keep hydrated
• medication compliance

• understanding distortions in thought and activity
• learn new ways to cope with illness

• focus on structured daily routines
• stabilizing sleep/wake cycles
• work out key relationship problems and issues

• only to be used as last resort option
• patient will exhibit severe manic behavior, rapid unctrollable cycling, paranoid and destructive features, acutely suicidal behavior

• used only in an emergency for clients when there is a clear risk of harm to client or others
• client's behavior has continued despite use of less restrictive methods to keep client and others safe
• shortest duration

• 80-90%
  
  

• a disease in which the number of genes contribute to its expression

• 13 and 15

• nearly continuous flow of accelerated speech with abrupt changes from topic to topic with play on words

• stringing together words because of their rhyming sounds with no meaning

• inflated self-regard
• exaggeration of behavior, importance or achievement

• Lithium
• lamotrigine (Lamictal)

• LiCO3, Li+
• effective for bipolar I acute and recurrent manic/depressive episodes
• inhibits 80% of episodes within 10-21 days
• less effective for mixed mania, rapid cycling and aytipical features

• hypothyroidism
• kidney impairment r/t ability to concentrate urine

• 0.4-1.0 mEq/ml (therapuetic range)
• hand tremors, polyuria, mild thirst
• weight gain

• 1.5 mEq/ml
• N/V, diarrhea, thirst, polyuria, slurred speech, muscle weakness

• 1.5-2.0 mEq/ml
• GI upset, mental confusion, muscler hyperirritability, sedation, incoordination

• 2.0-2.5 mEq/ml
• ataxia, blurried vision, large amounts of dilute urine, hypotension, coma, death

• convulsions, seizures, oliguria, death

• demonstrate efficacy in treatment of mood disorders
• helpful for cycling patients, schizoaffective patients, controlling mania and depression

• useful for non-lithium responders
• used for acute mania, rapid cyclers
• helps prevent future episodes
• monitor liver fxn and platelet count

• used for treatment-resistant bipolar disorder
• helpful with rapid cycling, paranoid manias, dysphoric mania
• check liver fxn and platelet count, blood levels every 8 wks

• first line treatment for bipolar depression and acute therapy
• monitor for rare, but life-threatening rash; seek medical attention immediately

• used to subdue severe manic behavior with treatment resistant mania and rapid cycling (four or more episodes of illness a year)

• Seclusion and Restraints

• documentation must be obtained in 15-30 minutes after seclusion
• document patient behavior every 15 minutes
• offer food and fluids every 30-60 minutes

toil the patient every 1-2 hrs

• substantial risk to self or others
• patient cannot control actions
• behavior excalates uncontrollably
• all other measures have failed

Problems of Mood Stabalizer

• can cause weight gain, altered metabolism
• put patients at risk for diabetes, HTN, dyslipidemia

• Verbosity

• Cardiac

• normal every day life, helps to perceive reality
• S/S - physical discomfort, restlessness, irritability, tension-relieving behaviors (foot tapping, nail biting)

• person sees, hears, and grasps less information
• selective inattention, only certain things are seen or heard
• S/S - pounding heartbeat, perspiration, tachypenia, headache, urinary urgency

• person only focuses on one detail or scattered details, don't notice surrounding environment
• Learning and problem solving are not possible; dazed and confused
• S/S - trembling, shaking, hyperventilation, sense of impending doom, N/V, dizzy, headache

• most extreme level of anxiety
• person is unable to process what is going on, can lose touch with reality
• S/S - hallucinations, false sensory perception, screaming/shouting, erratic, uncoordinated, impulsive
• can lead to exhaustion

• automatic coping styles to protect people from anxiety and maintain self-image by blockng feelings, conflicts, and memories

• anxiety to achieve goals

• frequency
• intensity
• duration

• development of inappriopriate levels of concern over being away from a significant other
• the fear that something horrible will appen to the other person
• anxiety is so intense it distracts from ADLs, sleep

• after significant stress (death of relative or pet)
• after illness
• physical or sexual assault

• avoidance
• worry/shyness
• fatigue
• uncertainty
• impairs social and occupational fxning

• the sudden onset of extreme apprehension or fear, r/t feelings of impending doom
• attacks seem to come out of nowhere, last ten minutes

• no normal fxning, misinterpretation of reality
• SOB, choking, chills, N/V
• may become avoidant of social situations, feelings of hopelessness, depressed mood

• intense, excessive anxiety and fear about being in places or situations from which escape might be difficult or not available

• persistent irriational fear of a specific object, activity or situation that leads to avoidance
• cause high levels of anxiety

• also called social phobia
• severe anxiety or fear of exposure to a social or performance situation
• can cause high levels of anxiety, avoid social situations

• excessive worry
• can cause restlessness, irritable, experience muscle tension, sleep disturbance
• continually seeks reassurance and worries over minor details

• obsessions - thoughts, impulses or images that persist or recur and cannot be dismissed
• compulsions - ritualistic behaviors that are driven to be performed in an attempt to reduce anxiety

• persons are preoccupied with an imagined defective body part and has obsessional thinking
• false assumptions about the importance of appearance, fear of rejection, perfectionism