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Chapter 14: Bipolar Disorders Acute phase- injury prevention.

Outcomes in the acute phase reflect both physiological and psychiatric issues. Examples include the patient: being well hydrated; maintaining stable cardiac status; maintaining/obtaining tissue integrity; getting sufficient sleep and rest; demonstrating thought selfcontrol; and making no attempt at self-harm Anticonvulsant drugs- used to control seizures in people with epilepsy. Epilepsy is not a single disease it is a set of symptoms that may have different causes in different people. The common thread is an imbalance in the brain's electrical activity. This imbalance causes seizures that may affect part or all of the body and may or may not cause a loss of consciousness. Anticonvulsant drugs act on the brain to reduce the frequency and severity of seizures. Some cases of epilepsy are brought on by head injuries, brain tumors or infections, or metabolic problems such as low blood sugar. But in some people with epilepsy, the cause is not clear. Anticonvulsant drugs are an important part of the treatment program for epilepsy. Different kinds of drugs may be prescribed for different types of seizures. In addition to taking medicine, patients with epilepsy should get enough rest, avoid stress, and practice good health habits. Some physicians believe that giving the drugs to children with epilepsy may prevent the condition from getting worse in later life. However, others say the effects are the same, whether treatment is started early or later in life. Determining when treatment begins depends on the physician and his assessment of the patient's symptoms. Physicians also prescribe certain anticonvulsant drugs for other conditions, including bipolar disorder and migraine headaches. Bipolar I disorder- 1. an affective disorder characterized by the occurrence of alternating (for example, mixed, manic, and major depressive) episodes. 2. a DSM diagnosis is established when the specified criteria are met Bipolar II disorder- 1. an affective disorder characterized by the occurrence of alternating hypomanic and major depressive episodes. 2. a DSM diagnosis that is established when the specified criteria are met Clang associations- Psychic associations resulting from sounds, often observed in the manic phase of manic-depressive psychosis. A shift in a conversation or flow of ideas, based on the sound of the words being used, not the content Aetiology Schizophrenia, manic phase of bipolar disorder Continuation phase- lasts for 4-9 months. Overall outcome is relapse prevention. Outcomes include: (1) Psychoeducational classes for patient and family related to: knowledge of disease process; knowledge of medication; consequences of substance addictions for predicting future relapse; and knowledge of early signs and symptoms of relapse. (2) support groups or therapy (cognitive-behavioral, interpersonal); (3) communication and problem-solving skills training Cyclothymia- A mild mood disorder characterized by alternating periods of elation and depression. A mental disorder characterized by marked swings of mood from depression to hypomania but not to the degree that occurs in bipolar disorder Flight of ideas- a continuous stream of talk in which the patient switches rapidly from one topic to another and each subject is incoherent and unrelated to the preceding one or is stimulated by some

environmental circumstance. The condition is frequently a symptom of acute manic states and schizophrenia Grandiosity- An exaggerated belief or claim of ones importance or identity, manifest by delusions of wealth, power, or fame Hypomania- A mild, nonpsychotic form of mania, characterized by increased levels of energy, physical activity, and talkativeness Lithium carbonate- a psychotropic drug used to treat acute manic attacks in bipolar disorder and, when given on a maintenance basis, to prevent the recurrence of manic-depressive episodes. The desired serum levels are in the range 0.51.5 mEq/L. Life-threatening central nervous system effects and kidney damage occurs at levels above 3.0 mEq/L. It is very important that the levels be carefully controlled. Lithium should not be given to patients with severe renal or cardiovascular disease or taken with diuretics because the potential for toxicity is very high. It is suspected of causing birth defects and should not be used during pregnancy Maintenance phase- the period following treatment for a specific condition during which the patient may undergo occasional examinations and treatments in order to regain optimal mental health Mania- an abnormally elated mental state, typically characterized by feelings of euphoria, lack of inhibitions, racing thoughts, diminished need for sleep, talkativeness, risk taking, and irritability. In extreme cases, mania can induce hallucinations and other psychotic symptoms Mood stabilizers- a psychiatric medication used to treat mood disorders characterized by intense and sustained mood shifts, typically bipolar disorder. Rapid cycling- experiencing four or more mood episodes in a 12-month period. Seclusion protocol- proper reporting procedure through the chain of command when a patient is to be secluded.