Module 7,8 & 9 Flashcards

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Mania

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 Mood alteration expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, racing thoughts, accelerated speech.  May be part of bipolar disorder, some other psychiatric condition, or a response to a substance

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Hypomania

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Milder version of mania, does not impair functioning, does not include psychotic features. Common in cyclothymic and Bipolar II disorders.

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Grandiose delusions

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I am having dinner at the White House

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PERSECUTORY DELUSIONS

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 The FBI is following me

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Bipolar I

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 Has manic episodes alternating with major depression episodes; may experience psychosis

                ●Most severe type of bipolar disorder

●Mortality rate is severe.

       ●75% have anxiety disorders

-          Speech can be affected- Flight of Ideas or Clang “I am eating a house, ouch firework, run into fire, car”

-          Individuals with bipolar I have experienced at least one manic episode.

 Last at least 1 week, almost daily for  most of the day.

• These high energy periods alternate with depression or a mix of depression and anxiety.

• Symptoms of mania are so severe it is considered a psychiatric emergency.

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Bipolar II

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Recurrent bouts of major depression alternating with hypomania

 Individuals have experienced 1 or more hypomanic episode followed by 1 or more major depressive episode.

 ✓ It is underdiagnosed and mistaken for major depression or personality disorders.

 ✓ Anxiety & eating disorders are associated with the depressive side.

 Hypomania (NOT extreme maniac)-

 -Euphoric & can increase functioning

 -The excessive activity and energy will last at least 4 days and involve 3+ behaviors in the DMS-5.

 -Psychosis is never present and hospitalization is rare.

 *Individuals may be at risk for suicide because the depressive symptoms are serious.

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Cyclothymic Disorder

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 Has elevated mood (does not meet criteria for hypomania) alternating with depressed mood (does not meet major depression criteria) lasting at least 2 years

➢Symptoms of elevated mood alternate with symptoms of mild to moderate depression for at least 2 years in adults and 1 year in children

➢Difficult to differentiate from Bipolar II.

➢Does not meet criteria for bipolar II or major depression.

➢Maintain regular sleep, eating and activity patterns

-Children

-Irritability

-Sleep disturbances

-Rapid Cycling

◦≥4 mood episodes in a 12 month period

◦Can occur in 1 month or 24 hour period

◦Associated with more severe symptoms

-Poorer global functioning

-High recurrence risk

-Resistance to conventional somatic treatments

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Tx for Bipolar Disorder

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- Individual Therapy

- Group Therapy 

-Family Therapy                                                            

-          Cognitive Therapy

 

 ●Electric Convulsive Therapy (ECT)

 ●Psychopharmacology

 ●MOST EFFECTIVE- combination of psychotropic medication and psychosocial therapy

 ●BASIC PREMISE OF RECOVERY- EMPOWERMENT OF CLIENT

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Medications for Bipolar

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           Antidepressants

◦         Not appropriate for bipolar disorder; may trigger manic episode

           Lithium

◦         33% of people with bipolar disease respond to lithium positively

◦         Must be kept in narrow therapeutic range:  can be fatal when toxic

◦         Keep salt intake constant; be sure to get enough water

◦         Watch for signs of toxicity:  nausea/vomiting, diarrhea, ataxia, blurry vision, excessive urination, increasing tremors, confusion

           Anticonvulsants:  Used as mood stabilizers

◦         Carbamazepine, valproic acid, lamotrigine, gabapentin, topiramate

◦         Watch for rashes (Steven’s-Johnson syndrome), liver disturbances (jaundice)

           Antipsychotics:  May be used during acute mania

◦         Olanzapine, quetiapine, ziprasidone

◦         May cause CNS depression

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Lithium Toxicity

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vomiting, diarrhea,  tremors, sedation, confusion, delirium, seizures, coma, cardiovascular collapse, death