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114 Cards in this Set
- Front
- Back
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A mood Disorders, Formerly known as Manic Depression |
Bipolar Disorder |
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Characterized by recurrent episode of depression and mania |
Bipolar Disorders |
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Risk Factors of Bipolar Disorder |
Biochemical imbalances Family Genetics Environmental factors (stress, losses, poverty, and isolation) Psychological Influences (inadequate coping, denial of disordered behavior) |
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Specific Biological risk factors For Bipolar disorders |
*Possible excess of norepinephrine, serotonin, and dopamine. *Increased intracellular sodium and calcium *Neurotransmitters supersensitive to transmission of impulses *Defective feedback mechanism in limbic system |
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What are the types of Bipolar disorder? |
*Bipolar disorder 1 *Bipolar disorder 2 *Cyclothymia *Bipolar disorder, Unspecified |
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Characterized by at least 1 manic episode |
Bipolar disorder 1 |
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Includes 1 major depressive episode with an episode of Hypomania |
Bipolar disorder 2 |
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Has a less intense episode of depression and hypomania |
Cyclothymia |
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Doesn't meet the criteria for any other type but still has periods of abnormally elevated mood. |
Bipolar disorder, Unspecified |
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At least one episode of mania lasting more than a week |
Bipolar 1 |
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Tends to be milder than other bipolar types. Some experiences no depressions |
Bipolar 1 |
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Bipolar 1 symptoms |
Increased energy Talking extremely quickly Euphoria |
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Symptoms of hypomania ( a milder form of mania ) lasting at least four days. |
Bipolar 2 |
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At least one depressive episode, broken up by periods of hypomania |
Bipolar 2 |
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Bipolar 2 symptoms |
Feeling of hopelessness Fatigue Irritable and anxious |
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Hypomanic and manic episodes are bought by antidepressant drugs |
Bipolar 4 (IV) disorder |
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Involves people with genetic predisposition to bipolar disorder suffering major depression. |
Bipolar 5 (V) disorder |
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Subthreshold types of disorder, which means their symptoms aren't as pronounced |
Bipolar 4 and 5 |
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Nursing Diagnosis for Bipolar disorder |
*High risk for violence, directed at self or others *Impaired verbal communication *Anxiety *Individual coping, ineffective *Disturbance of self-esteem *Alteration of thought processes *Self-care deficit *Sleep pattern disturbances *Alteration in Nutrition |
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Therapeutic Nursing Management |
Environment Psychological treatment Somatic and psychopharmacology |
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Psychological treatment for Bipolar disorder |
Individual therapy Group therapy Family therapy |
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Verbalized family frustration and establishes a treatment plan for outpatient use |
Family therapy |
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Maybe used to identify stressors and pattern of behavior. |
Individual Psychotherapy |
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Establishes a supportive environment and redirect inappropriate behavior. |
Group therapy |
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Somatic and psychopharmacology treatments |
Electroconvulsive therapy Psychopharmacology |
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Nursing intervention for Bipolar disorder |
*establish a calm environment for the client *Reinforce and focus on reality *Provide outlets for physical activity but prevent clients from escalating *Monitor client's nutrition, fluid intake and sleep. |
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Cause for Bipolar |
Unknown |
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Results for disturbance in the area of the brain that regulates mood |
Bipolar |
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It involves periods of excitability (mania) alternating with periods of depression |
Bipolar |
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Bipolar usually appears between ages____ |
15 - 25 |
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Symptoms of Mania (manic episode) |
1 fun weeks |
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DIGFAST (manic episode) |
Disturbance (poorly focused) Indiscretion (excessive pleasurable activities) Grandiosity (unrealistic beliefs in one's ability) Flight of ideas Activities (increased goal direction) Sleep deficit (decreased need for sleep) Talkativeness (pressured speech) |
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Depressed episode symptoms |
2 blue weeks |
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SIGECAPS (depressive episode) |
Sleep Interest Guilt /Worthlessness Energy Concentration Appetite Psychomotor Agitation / Retardation Suicidality |
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Medical intervention for bipolar disorder |
*Proper History taking and observation *Antipsychotics medication (lithium and mood stabilizer or antidepressant for depressive phase) *Electroconvulsive therapy |
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Nursing Interventions |
*provide a calm environment *Giving health teachings about regular exercise, and proper diet *Explain to the pt that getting enough sleep helps a stable mood |
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Another name for Major depressive disorder |
Unipolar |
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A type of mood disorder marked by consistent low mood |
Unipolar |
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Mean onset of unipolar |
40 yrs old ( becoming increasingly common in younger ages) |
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Causes of unipolar |
* The diathesis-stress model *Monoamine theory *Hypothalamic-Pituitary Axis Disturbance *Immune system |
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Specifies that depression results when a preexisting vulnerability, or diathesis, is activated by stressful life events |
The diathesis-stress model |
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Lack of monoamine neurotransmitters ( SE, DA, NE) |
Monoamine theory |
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Elevated Cortisol, decreased Dexamethasone supression |
Hypothalamic-Pituitary Axis Disturbance |
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Excessive Cytokine release |
Immune system |
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Risk factors for Unipolar |
Genetics Environmental |
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Symptoms in Unipolar (DSM 5 criteria) |
*low mood *Anhedonia (1 of these must be present) *Weight gain/loss *Sleep disturdence *Fatigue/ Low energy *psychomotor Retardation *Inappropriate guilt/worthless *Decreased Concentration *Recurrent thoughts of death |
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RF in Unipolar (Genetics ) |
High rate in monozygotic twins Family Hx |
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RD in Unipolar (Environmental) |
Stressful life events; child abuse Substance abuse/ medical condition |
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Medical intervention for Unipolar |
*antidepressant *Tricyclic antidepressant *Monoamine oxidase inhibitors *Selective Serotonin re-uptake inhibitors *Electroconvulsive therapy |
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Nursing Intervention for Unipolar |
*interpersonal therapy *Psychotherapy *Encourage client to have a regular exercise *Cognitive behavioral therapy *Behavioral modification therapy |
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Difference between Bipolar and Unipolar in terms of (Gender and age onset) |
UNIPOLAR -affects woman -later in life
BIPOLAR -men and women equally -18yrs (average suspected ) |
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Difference between Bipolar and Unipolar in terms of (Sleep) |
UNIPOLAR UNIPOLAR -insomina, difficulty falling asleep or walking repeatedly during the night BIPOLAR UNIPOLAR -insomina, difficulty falling asleep or walking repeatedly during the night BIPOLAR -insomina, difficulty falling asleep or walking repeatedly during the night UNIPOLAR -insomina, difficulty falling asleep or walking repeatedly during the night BIPOLAR BIPOLAR -Hypersomnia, excessive tiredness and difficulty waking in the morning |
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Difference between Bipolar and Unipolar in terms of (Appetite) |
UNIPOLAR -often has a loss of appetite -diminished interest in eating BIPOLAR -often binge-eating -craving for carbohydrates, may alter with loss of appetite |
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Difference between Bipolar and Unipolar in terms of (Activity level) |
UNIPOLAR - agitated, pacing and restlessness (more common) BIPOLAR -inactive, somnolence, slowing down of movements (Psychomotor Retardation) |
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Difference between Bipolar and Unipolar in terms of (Mood) |
UNIPOLAR - sadness, hopelessness, feeling of worthlessness BIPOLAR - sadness, hopelessness, feeling of worthlessness ( guilt is more prominent) |
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Difference between Bipolar and Unipolar in terms of (Other) |
UNIPOLAR - ep often last longer -sometimes more resposive to treatment BIPOLAR - risk of drug abuse and suicide (higher than in unipolar depression) |
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Characterized by the disruption of thinking, memory, processing, and problem solving |
Cognitive Disorders |
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Types of cognitive disorders |
Delirium Dementia Memory loss disorders ( amnesia or dissociative fugue) |
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RF in Cognitive disorders |
*Physiological changes ( neurological, metabolic, and cardiovascular disease *Cognitive changes *Family Genetics *Infections *Tumors *Sleep disorders *Substance abuse *Drug intoxications and withdrawals |
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Delirium or also called ... |
Acute Confusion State or Metabolic Encephalopathy |
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An acute, transient, usually reversible, fluctuating disturbance in attention, cognition and consciousness level. Delirium |
Delirium |
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Delirium can occur at any age but more commonly in ... |
-elderly -have previously compromised Mental status |
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ICU psychoais |
Delirium after surgery and ICU patients |
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Causes of delirium |
*Drugs (anticholinergic, psychoactive drugs and opioids *Dehydration *Infection |
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Affected parts of the Brain (delirium) |
*Thalamus *Parietal lobe *Frontal lobe |
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Causes of delirium in older people |
*Dehydration *A non-neurologic disorder (UTI, influenza, thiamin, vit.B12 deficiency) *Pain *Urinary Retention or Severe constipation *Sensory deprivation *Sleep deprivation *Stress *Use of a bladder catheter |
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Age related factors make older people more susceptible to developing delirium |
*increase sensitivity to drugs (sedative, anticholinergic, and antihistamine) *Changes in the brain (atrophy, lower levels of anticholinergic) *Presence of conditions that increases the risk of delirium. (Stroke, dementia, Parkinson disease, other neurodegenerative disorders, dehydration, polypharmacy, undernutrition, immobility) |
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PINCHME (to identify potential causes of delirium) |
Pain Infection Nutrition Constipation Hydration Medication Environment |
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Predisposing factors in Delirium |
*Brain disorders *Advanced age *Sensory impairment *Alcohol intoxication *Multiple coexisting d/o |
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Contributing factors in Delirium |
* Reversible impairment of cerebraloxidative metabolism * Multiple neurotransmitterabnormalities, especially cholinergic deficiency * Generation of inflammatory markers,including CRP, interleukin-1 beta and 6, and tumor necrosis factor– alpha |
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DSM-5 Criteria for Delirium |
*disturbance in attention *The disturbance develops over a short period of time *Acute change in cognition |
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difficulty focusing or following what issaid) and awareness(reduced orientation to the environment ) |
Disturbance in attention |
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( over hours to days) and tends to fluctuate during the day |
The disturbance develops over a shot period of time |
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(deficits of memory, language,perception, thinking) |
Acute change in Cognition |
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Confusion Assessment Methos (CAM) criteria |
Altered level of consciousness Disorganized thinking |
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CAM criteria (hyperalert, lethargic, stuporous, comatose) |
Altered level of consciousness |
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CAM criteria (rambling, irrelevant conversation, illogical flow ofideas) |
Disorganized thinking |
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DIAGNOSIS for Delirium |
Mental examination Thorough history Physical examination Testing |
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___is assessed first in diagnosing delirium |
Attention |
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Afterinitial assessment (for delirium ), standard diagnostic criteria may be used, such as the |
Diagnostic and Statistical Manualof Mental Disorders, 5th Edition (DSM-5) or Confusion Assessment Method (CAM), |
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Vitalsigns Hydrationstatus Potentialfoci for infection Skinand head and neck Neurologicexamination |
Physical Examination |
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Testing for Delirium |
*CT or MRI *Tests for suspected infections (CBC,blood cultures, CXR, U/A) *Evaluation for hypoxia (pulseoximetry or arterial blood gases) *Electrolytes, blood ureanitrogen (BUN), creatinine, plasma glucose *A urine drug screen |
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Treatment for delirium |
*correcting the cause *Supportive Care *Management for Agitation |
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Medications for delirium |
*low-dosehaloperidol *Second-generation(atypical) antipsychotics *Benzodiazepines |
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chronic,global, usually irreversible deterioration of cognition (mainlymemory), istypically caused by anatomic changes in the brain, & has slower onset. |
Dementia |
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First sign for dementia |
loss of short-term memory |
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Classifications of Dementia: |
•Alzheimer or non-Alzheimer type • Cortical or subcortical • Irreversible or potentially reversible • Common or rare |
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Themore rapid the onset; ____ (lack of awareness of one’s disability) may also develop, as may personalitychanges |
Anosognosia |
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themost common, a gradual decline in memory, thinking, behavior and socialskills-- these changes affect a person's ability to function |
Alzheimer’s D. |
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Vascular dementia (now called vascularcognitive impairment) are manifested by forgetfulness to more serious problemswith attention, memory, language, and executive functions like problem solving. |
Non-Alzheimer D. |
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( e.g.,Parkinson's disease) involve less severe intellectual and memory dysfunctionand lack |
subcortical |
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(aphasia, agnosia, and apraxia typical ofthe--- dementia of the Alzheimer type) |
cortical |
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canbe caused by medical or psychiatric conditions--- high fever, vit. deficiency,head trauma, or depression |
reversible |
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dementiaare associated with brain damage--- Vascular Dementia (VaD),Strokes and transient ischemic attack, Atrial fibrillation |
irreversible |
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isa rare and fatal form of dementia, caused by abnormal prion proteins that aretoxic to the brain |
Creutzfeldt-Jakob disease (CJD) |
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is one of the common types of dementia--called Pick'sdisease or frontallobe dementia (symptomsare changes to personality and behavior and/or difficulties with language) |
Frontotemporal dementia (FTD) |
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Risk Factors for Dementia |
*Age-associatedmemory impairment *Mildcognitive impairment (MCI) *Subjectivecognitive decline (SCD) *Medications |
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refersto changes in cognition that occur with aging. Older people have a relativedeficiency in recall, particularly in speed of recall. |
Age-associatedmemory impairment |
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causesgreater memory loss and sometimes other cognitive functions are worse, butdaily functioning is typically not affected. Up to 50% of patients with mildcognitive impairment develop dementia within 3 years. |
Mildcognitive impairment (MCI) |
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isdefined as a self-experienced persistent decline in cognitive capacity butnormal performance on standardized cognitive tests. |
Subjectivecognitive decline (SCD) |
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Clinicalcriteria According to DSM-5: Involve≥ 2 of the following domains |
* Impaired ability to acquire andremember new information *Impaired reasoning and handling of complextasks and poor judgment * Language dysfunction *Visuospatial dysfunction *Changes in personality, behavior, orcomportment |
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Early(mild) dementia symptoms |
* Recentmemory is impaired * Learningand retaining new information become difficult * Languageproblems (especially with word finding), mood swings, and personality changes develop * Patientsmay have progressive difficulty with independent activities of daily living (eg, balancing their checkbook,finding their way around, remembering where they put things) * Impairedabstract thinking, insight, or judgment * Irritability,hostility, and agitation in response to loss of independence & memory |
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Impairedability to identify objects despite intact sensory function |
Agnosia |
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Impairedability to do previously learned motor activities despite intact motor function |
Apraxia |
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Impairedability to comprehend or use language |
Aphasia |
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Intermediate (moderate) dementiasymptoms |
* Unableto learn and recall new information * ReducedMemory of remote events but not totally lost (may require help with basicADL’s) * Personalitychanges may progress * Irritable,anxious, self-centered, inflexible, or angry more easily * Morepassive, with a flat affect (may develop depression, indecisive, losespontaneity, or generally withdraw from socialsituations) * Moreexaggerated Personality traits or habits (concern with money becomes obsession) * Behaviordisorders may develop (may wander or become suddenly hostile,uncooperative, or physically aggressive) * Lostall sense of time and place (can’t effectively use normalenvironmental & social cues) * Oftenget lost (unableto find their own bedroom or bathroom) * Ambulatorybut are at riskof falls or accidents secondary to confusion * Alteredsensation or perception may culminate in psychosis with hallucinations and paranoid and persecutory delusions * DisorganizedSleep patterns |
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Late (severe) dementia symptoms |
* Patientscannot walk, feed themselves, or do any other ADL’s * Incontinent * Recent and remote memory is completelylost * Patients may be unable to swallow * At risk of undernutrition, pneumonia (especially due to aspiration), and pressure ulcers * Depend completely on others for care(placement in a long- term care facility often becomes necessary) * Eventually, patients become Mute * End-stage dementia results in coma anddeath (due to infection-- leukocytic response to infection) |
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DIAGNOSTICS for dementia |
•Historyand Neurologic Examination(including mental status) •Laboratory testing (CBC, UA, FBS, drug/alcohol tests (toxicology screen), CSFanalysis (r/o specific infections that can affect thebrain), & TSH level •CT scan, MRI • Neuropsychologictesting |
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Management for Dementia pt: |
. Patient safety OT/PT can evaluate the home for safety; the goals are to: * Prevent accidents (particularlyfalls) * Manage behavior disorders * Plan for change as dementiaprogresses . Environmental measures Patients with mild to moderate dementiausually function best in familiar surroundings. Whether at home or in an institution, the environment should be designed to help preservefeelings of self-control and personal dignity |
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Environmental measures |
• Frequentreinforcement of orientation (by placing large calendars andclocks in the room and establishing a routine for daily activities; medical staff members can wear large name tags andrepeatedly introduce themselves. •Abright, cheerful, familiar environment (Quiet, dark, private rooms shouldbe avoided)•Minimalnew stimulation (Regular, low-stress activities) •Roomsshould be reasonably bright and contain sensory stimuli(eg,radio, television, night-light) to help patients remain oriented and focus their attention. •Activitiescan help patients function better (should be enjoyable, provide somestimulation, but not involve too many choices or challenges) •Exercisetoreduce restlessness, improve balance, and maintain cardiovascular tone shouldbe done daily. •Occupationaltherapy andmusic therapy help maintain fine motor control and provide nonverbalstimulation. •Grouptherapy (eg,reminiscence therapy, socialization activities) may help maintainconversational and interpersonal skills. |
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What to avoid during medication in Dementia pt. ? |
Sedatingand Anticholinergic medications (tend to worsen dementia) |
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Medication for( Cognitive Function ) |
Cholinesterase Inhibitors (Donepezil,Rivastigmine, and Galantamine)- increasing the ACH level in the brain. NMDA(N-methyl-d-aspartate) Antagonist- mayhelp slow the loss of cognitive function in mod.-sev.Dementia |
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Medication for (Behavioral Disorder |
Antipsychotics (Quetiapineand Clozapine)- reduce and control many symptoms |
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medication for (deoression) |
Selective Serotonin ReuptakeInhibitor (SSRIs)(Sertraline, Citalopram, Mirtazapine and Trazodone)- may contribute to cognitive performance |
