Psychiatric Nursing

SUMMER II 2016
Chapter 13:(PP.227-248)
Bipolar and Related disorders

Bipolar Disorder
ETIOLOGY
Predisposing Factors
Genetics
Biochemical
Physiological
Psychogenic/Psychosocial
Developmental Considerations
Precipitating Factors
Real or imagined Loss
Endogenous vs. Exogenous

Clinical Picture

BIPOLAR I
Criteria, recurring mania with at least one episode of
depression and 4 of the following:

1 week duration
Increased self esteem, grandiosity, elevated mood
Decreased need for sleep, feels rested after 3 hours of
sleep
Pressured speech, very talkative
Racing thoughts (flight of ideas)
Distractibility, may be irritable
Increase in goal direction and psychomotor agitation
Increase involvement in pleasurable activity such as sex,
spending leading to painful consequences

Clinical Picture

BIPOLAR II
Criteria

History of one hypomanic episode that includes:

Elevated mood for al least 4 days
Grandiosity and increased self esteem
Decreased sleep
Behavior not severe enough to cause social or
occupational problems

Depressive symptoms as above

Treatment Modalities

Hospitalization
Interpersonal Talking Therapies
Activity Therapies
Somatic Therapies
-Medications
-Electric Convulsive Therapy
Crisis Intervention

Antimanic Medication

Lithium (Lithium Carbonate)

Depakote (Valproic Acid
Tegretal (Carbamazapine)

Lithium

Mode of Action-alters sodium mechanism,

blocks some dopamine receptors, action not
fully understood. Takes 1-3 weeks.

Target Signs and Symptoms-All phases of

bipolar illness, both mania and depression.
May be effective in schizoaffective disorder.

TABLE 13-3

Lithium Side effects and s/s of Lithium

Toxicity
Levels

Lithium (contd)

Contraindications- severe cardiac disease and severe renal

disease.
Side Effects:
Fine hand tremors, dizziness, drowsiness
Pregnancy

Nausea, vomiting, loose

stools Risk C

Frequent urination

Hypothyroidism

Diabetes Insipidus
Adverse Effects:
Lithium toxicity:
Course Hand tremor, confusion, ataxia, slurred speech
Polyuria (over 3000ml.), diarrhea with incontinence

Lithium (contd)

Lithium blood levels:

Acute mania 0.8MEQ/L-1.5MEQ/L

Maintenance 0.6MEQ/L-1.2MEQ/L
Therapeutic levels are close to toxic levels

Nursing Implications:
Monitor mental status and suicidality
Monitor for toxic effects
Provide variety in diet with adequate sodium
Provide fluids up to 3000ml/day
Blood sample for lithium level is taken 12 hrs. after
last dose

Nursing Process

Assessment
Hypomania
Acute Mania
Delirious Mania
*Nursing Problems
*Goals/Outcomes
*Implementation/Teaching
*Evaluation

Nursing (contd)

Teach about safety

Teach about Lithium toxicity, ie, anything that
causes the body to lose salt, such as vomiting,
diarrhea, fasting and high protien diets will cause the
body to retain lithium.
Teach patient that certain drinks may cause the body
to lose Lithium such as alcohol and caffeine drinks