Psychiatric Mental Health Nursing by Videbeck

354 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS

called lithium or anticonvulsant medications used
as mood stabilizers (see Chapter 2). This is the only
psychiatric disorder in which medications can pre-
vent acute cycles of bipolar behavior. Once thought
to help reduce manic behavior only, lithium and
these anticonvulsants also protect against the effects
of bipolar depressive cycles. If a client in the acute
stage of mania or depression exhibits psychosis (dis-

ordered thinking as seen with delusions, hallucina-

tions, and illusions), an antipsychotic agent is ad-

ministered in addition to the bipolar medications.

Some clients keep taking both bipolar medications

and antipsychotics.

Lithium.Lithium is a salt contained in the human

body; it is similar to gold, copper, magnesium, man-

ganese, and other trace elements. Once believed to be

helpful for bipolar mania only, investigators quickly

realized that lithium also could partially or com-

pletely mute the cycling toward bipolar depression.

Response rate in acute mania to lithium therapy is

70% to 80%. In addition to treating the range of

bipolar behaviors, lithium also can stabilize bipolar

disorder by reducing the degree and frequency of

cycling or eliminating manic episodes (Griswold &

Pessar, 2000).

Lithium not only competes for salt receptor sites

but also affects calcium, potassium, and magnesium

ions as well as glucose metabolism. Its mechanism

of action is unknown, but it is thought to work in the

synapses to hasten destruction of catecholamines

(dopamine, norepinephrine), inhibit neurotransmitter

MAJOR DEPRESSIVE DISORDER'S GRADUAL DESCENT INTO AND BACK FROM DEPRESSION

CAN LAST 6 TO 24 MONTHS

Normal mood (euthymia)

Depression (dysthymia)

GRAPHIC REPRESENTATION OF CYCLES OF BIPOLAR DISORDER

Mania

Normal mood

Depression

1. Bipolar
   mixed
   or cyclic
   2. Bipolar
   manic
   3. Bipolar
   depressed


2. Bipolar disorder mixed or cyclic = cycles alternate between periods of depression,
   back to normal behavior (euthymia) then to mania.


3. Bipolar manic = cycle only alternates between mania and normal (euthymic) behavior.


4. Bipolar depressed = cycle alternates between depression and normal (euthymic) behavior.

Figure 15-2.Graphic depic-

tion of mood cycles.

◗ MAJORSYMPTOMS OFMANIA

• Heightened, grandiose, or agitated mood


• Exaggerated self-esteem


• Sleeplessness


• Pressured speech


• Flight of ideas


• Reduced ability to filter out extraneous stimuli;
  easily distractible


• Increased number of activities with increased
  energy


• Multiple, grandiose high-risk activities, using
  poor judgment with severe consequences