Bipolar

Drug therapy
Psychotherapy

Lithium- to prevent and relieve manic episodes.
Anticonvulsants to slow electrical impulses.
Antidepressants to treat deprssive symptoms

Elevated, grandiose, or hyperirritable mood; Increased psychomotor activity; Excessive social extroversion; Short attention span; Rapid/presured speech; Flight of ideas (frequent topic changes); decreased need for sleep or food; impulsivity and impaired judgment; exaggerated self-esteem.

Depressed mood; low self-esteem; Overwhelming inertia; Social withdrawl; feelings of hopelessness/helplessness or Suicidal ideation; difficulty concentrating or thinking clearly; psychomotor retardation; slowing of speech; anhedonism (inability to express pleasure); unintentional weight change; change sleep pattern; agitation; fatigue; worthlessness or excessive guilt; .

Maintain a calm enviornment; protect pt from overstimulation; provide emotional support; set realistic goals for behavior; set firm limits; watch for early signs of frustration; tell pt hitting and threats are unacceptable; alert heathcare team when acting out escalates; do not try to manage adverse behaviors by yourself; administer medications as ordered; monitor for adverse effects of medications.

Provide for the pt physical needs, help w/hygiene; encorage pt. to eat, feed if necessary; give continual positive reinforcement to improve self-esteem; provide structured routine; remove harmful objects from enviornment; institute suicide precautions per facility policy; strictly supervise medications.

Pt. successfully cares for self
Pt exhibits appropriate behavior
Pt. experiences minimal adverse drug effects
Pt. identifies positive aspects of self.
Pt is free from self-harm.

Bipolar I
Bipolar II
Cyclothymic disorder

Combination of major depressive, manic or mixed episodes (symptoms of both mania and depression).

Combination of major depression and hypomania.

Combination of hypomanic episodes intermixed with depressive episodes that do not fully satisfy the criteria for a major depressive episode.

A mood disorder with manic episodes that usually begin suddenly, with rapid escalation; Chronic cycling condition; results in severe functional impairments as manifestd by isolation from family, friends, and coworkers, financial difficulties, and job loss.

chronic abnormalities of neurotransmission
anxiety disorders, especially panic disorder and social phobia
substance use, most commonly alcohol and marijuana
family Hx
Sleep disturbances

At least one manic or mixed episode, with at least one major depressive episode.
See signs and symptoms of mania and major depression.

Stabilizes bipolar disorder by decreasing degree and frequency of manic episodes or eliminating them altogether.; precise action unknown; enters nerve cells where it is believed to have effects on several neurotransmitters; Onset usually 5-7 days may take up to 2 weeks.

Administer as ordered; encorage pt to comply w/regimen; take w/food or after meals; Monitor blood levels closely (0.6-1.2 mEq/L) 2-3x's/week for first month, then weekly to monthly; inform importance of taking medication when pt doesn't think they need it; manitain fluid intake of 2500-3000 mL/day; do not drive until drowsiness, fatigue or blurrd vision clears; Monitor AE, document them, &n report toxic effects to Dr.; encourage pt and family to report AE to dr.

Pt takes as prescribed
Pt has Blood levels checked as ordered
Pt maintains and adequate fluid/Na intake
Pt.verbalizes understanding of possibe AE and controls them successfully; Pt resumes driving when no longer affected by adverse effects.

Excessive thirst
un;peasant metalic taste
Frequent urination
fine hand tremor
drowsiness
mild diarrhea
weight gain
elevated thyroid-stimulating hormone.

high sodium intake decreases levels
Low sodium intake may lead to toxicity

may increase serum lithium

Increased lithium, increased tremor

Increases serum lithium levels.

increased excretion of lithium, decreasing drug levels.

Increases neurotoxicity, despite normal dosage and serum levels.

Increased serum Iithium.

Increased neurotoxicity, despite normal dosage and serum levels.

Increased serum lithium.

increased excretion of lithium, decreasing levels.

promote sodium and potassium excretion; increased lithium levels; may cause cardiotoxicity and neurotoxicity.

Increased neurotoxicity without increasing serum levels.

decreased lithium clearance

Increased tremor; increased pharmacologic effects of TCAs.

is a neurological sign consisting of lack of voluntary coordination of muscle movements