Mental Health Session 8: Mania

Session 8: Mania

 

  • Mania – poor sleep, poor impulse control, hyperverbal, sexually impulsive, extreme increased self esteem, and may include symptoms of psychosis.

 

  • Bipolar 1 – needs a manic episode for one week straight with at least 3 mania s/s
    • Mostly mania
    • About 4.5% of the population
    • More common in women

 

  • Bipolar 2 – meets criteria for major depressive episode, with hypomania s/s for 3 – 4 days
    • Some maina with a major depressive episode
    • Less than 1% of the population
    • More common in women
  • Major depressive episode 5 symptoms for 2 weeks
    • Low energy, sad, hopeless, decreased activity ect.
  • Cyclothymic – alternating hypomania and a mild to moderate depressive episode. This lasts for 2 years in adults and 1 year in
    • Moderate swings in mood, never get to manic or major depressive episode

  • Bipolar disorder is linked to genetic factors, and risk of getting the disease increases with the closer the family member is to you.
    • Up to 60% of the population with this disorder will attempt suicide.
  • Duty to warn

 

  • Pharmacology
    • Stimulants and antidepressants can make bipolar worse, and will make the manic episode much more prominent.
    • Norepinephrine, dopamine, Serotonin
    • Lithium – for mania with suicidal thoughts
      • Dosed 2-3 times a day
      • 1200mg average total daily dose
      • Mood stabilization, and desired med for manic state. (can also use benzodiazepines to calm a person down)
      • Toxicity s/s – slurred speech, tremors, EKG changes, severe dysrhythmias, coma, death, headache, nausea, vomiting, diarrhea.
      • Is a salt, they will get polydipsia
      • Lab values .8-1.2mEq/L drawn 12 post dose
      • Cipriani (2013) meta analysis  lithium is the only med to decrease suicidal ideation

 

  • Depakote
    • Seizure medication
    • Sedation, weight gain, teratogenic
  • Lamotrigine (lamictal)
    • Steven johnson’s rash!
    • Excreted renally
  • Tegretol, carbamazepine
    • Makes birth control pill decrease efficacy
  • Risperdal Consta
    • Long acting injectable
    • Bipolar
    • Increases adherence

 

  • ECT
    • Electroconvulsive therapy
    • Temporary memory loss
    • Headache
    • Only used if pharmacologic interventions fail.

 

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