Mental Health Fall '12

1. Chapter 29

2.  A disorder which is characterized by mood
swings from profound depression to extreme
euphoria (Mania), this coexists with periods
of normalcy.
 Mania: an alteration in mood that is
expressed by feelings of elation, grandiosity,
hyperactivity, agitation, and accelerated
thinking and speaking.

3.  Mood Swings
 Chronic; recurring
 Delusions/ Hallucinations
 Seasonal pattern onset
 May require hospitalization
 Highest lifetime suicide rate

4.  High genetic relationship
 Imbalances in neurotransmitters
 Lesions or brain trauma in the limbic system
 Medications (steroids/seizure
meds/antidepressants/ narcotics)
 Psychosocial- this theory is declining due to
the evidence based research which
acknowledges this disease as a biological
disease of the brain.

5. Substance abuse
Personality Disorders
Anxiety Disorders
Eating Disorders
ADHD

6.  Milder clinical picture
 No marked occupational/ social impairment
 Cheerful and expanded personality
 Does not require hospitalization
 Rapid flow of ideas, hyperactivity, social butterfly
 Does not include psychosis
 Increased libido
 Anorexia, weight loss, spending large amts without
thinking of any repercussions

7.  Mood is elevated, expansive, irritable
 Euphoric, on a huge “high”, that changes to anger
or crying without any warning.
 Impaired occupation/social functioning and
relationships
 May become psychotic, thoughts are disjointed,
flight of ideas, pressured speech
 Excessive/frenzied motor activity/no impulse
control/ sexually manipulative

8.  Hallucinations/ delusions
 Inexhaustible/ no sleep/ no eat!
 Hygiene and grooming neglected
 Dress may by flamboyant/ excessive makeup/
bizarre
 You feel pressured and nervous talking to
them and after your interview you are tired

9.  This is an emergency because the client can
have a severe clouding of consciousness with
the mania symptoms intensifying
 Confusion/ disorientation/panic
 Delusions of persecution/ grandeur/
religiosity
 Safety is at stake; they are so physically
exhausted and have been overworking their
cardiovascular system for days.

10.  Bipolar I
 Bipolar II
 Cyclothymic
 Rapid Cycling

11. Upper socioeconomic class
Educational and Occupational
status

12.  Level of mood
 Elated mood
▪ (hypomania)
▪ VS
 MANIA, EUPHORIC
▪ (manic)

13.  Assess Behavior
 Assess Thought Process
 Flight of ideas, speech, communication,c lang
associations, grandiosity
 Assess Cognitive Functions
 Cognitive difficulties in psychosocial areas
 Impairment core features

14.  Resists control
 Splitting
 Aggressively demanding
 Setting limits
 Shallow relationships

15. Danger to self and others
Controls
Hospitalization
Medical Status
Co-existing condition
Pt/family education

16. See page 548 for excellent concept map on this!!!!

17.  The client will:
 Exhibit no signs of physical injury
 Not harm self or others
 No longer exhibit physical anxiety/agitation
 Eat a balanced diet
 Accept responsibility for their behaviors
 Will sleep 6-8 hours a night
 Will not manipulate others for self gratification

18.  Any thoughts?
 I’ll start:
▪ Risk for violence: self directed or other directed
▪ Short term goal- client will recognize increasing anxiety
and will report this to staff for assistance
▪ Longterm goal- client will not harm self or others

19.  Therapies once meds initiated
 Cognitive therapy
 ECT/TMS
 Basic interventions:
 Reduce stimuli
 Lower lights in room
 Remove dangerous items from room/observe for safety
per unit protocal
 Provide finger foods/high calorie/ juice/ milk
 Set limits on manipulative behavior/ remain calm

20. Mood Stabilizers/ Lithium Carbonate

21.  Initially mania treated with antipsychotics or
Valproic Acid until Lithium level is
therapeutic (7-10 days)
 Therapeutic level
 Maintenance level
 Normal side effects expected:
 Drowsy, headache, thirst, pulse irregularities, polyuria,
and weight gain ….look at Lithium as a SALT..it causes
similar effects

22.  Early Toxicity signs
 Ataxia, severe diarrhea, blurred vision, N/V, tinnitis
 Advanced Toxicity signs
 Excessive dilute urine, tremors, seizure, impaired
consciousness, arrhythmias, coma, ..death
* There is a very slim margin between
therapeutic and TOXIC
 Levels must be checked weekly until therapeutic level
reached, then monitored monthly during maintenance
therapy.

23.  So what do we do if the client is experiencing
toxicity?
 STOP THE LITHIUM
 The monitor for arrythmias
 Hydrate maintaining fluid and electrolyte balance

24.  Antiepileptics
 Depakote/ Tegretol/ Lamictal
These drugs are sometimes used while Lithium
is reaching levels or may be used alone. It
decreases the firing of neurons, therefore
slowing down the client.

25.  Anxiolytics- Clonazepam and Lorazepam
 Acute Mania / psychomotor agitation
 Antipsychotics
▪ Olanzapine
▪ Quetiapine
▪ Risperidone
▪ (These can be used alone or with lithium)

26.  Severe treatment resistant mania
 Rapid Cyclers
 Paranoid
 Acutely Suicidal
 Used when meds have failed. ECT creates a grand
mal seizure which “reboots” the brain. TMS are more
specific waves of electricity to specific nerve cells,
this does not cause a grand mal. TMS is one of the
newer technologies being used.

27.  Seclusion / Restraints (what is seclusion)
 Rationale
 Documented Justification
 Complex therapeutic, ethical and legal issues
 Restraint/ Seclusion policy/ Protocal
 NEVER USED AS PUNISHMENT/ STAFF
CONVIENENCE

28.  Depression and Bipolar Support Alliance
(DBSA)
 National Alliance for the Mentally Ill (NAMI)
 National Mental Health Association
 Manic-Depressive Association

29.  Drink???
 Do drugs????
 Why knowing their diagnosis do you think a
bipolar client will become noncompliant with
meds and then use substances?

30. MOVIE TIME!
http://www.youtube.com/watch?v=zEmZ8clcEUs&feature=related

31.  Mostly application questions, what will you say???
Remember restate for clarification, set limits
 Know the drugs and any client teaching ( ie MAOI, TCA etc).
Meds that are used for EPS , anticholinergic effects, side
effects
 Treatments : ECT (interventions and monitoring) , seclusion
(removing stimuli)
 Documentation of care, planning care
 Client teaching for meds, resources, diet
 Nursing diagnosis priorities
 Chemical dependency, care of client, crisis intervention