23
Bipolar Disorder Mood Behaviors and Symptom Management In Skilled Nursing With Dr. Michael Changaris

Bipolar treatment skilled nursing

Embed Size (px)

Citation preview

  • 1.Mood Behaviors and SymptomManagementIn Skilled Nursing With Dr. Michael Changaris

2. Unipolar Depression: Disrupts lifethrough increased irritability, isolationand robs people of joy. Bipolar Disorder a DisorderlyDisorder. It leads to extremes inbehaviors and moods. An Unique Mind is a memoir by DrKay Redfield Jamison who lives withbipolar disease. She is a well respected psychiatristwith a prestigious career. Had personal struggles with wantingto take medications. 3. 400 BC - Hippocrates linksthe black bile of melancholia with theyellow bile of mania. 1899 - Emil Kraepelin introduces the term"manic-depressive intopsychiatric textbooks. 1949 - Australian doctor John Cadediscovers the efficacy of lithium as atreatment. 1968 - The DSM changes to the termmanic-depressive illness and biologicalperspectives come to dominate. 2010 - New draft of DSM proposed. 4. For most the onset for Bipolar occurs inlate teens and early 20s. Rates in general population for adults is between 1% and4% depending on criteria. In elders in community rates are between 1% and .5% Rates in nursing homes are as high 10%. Psychosocial factors increase severity of symptoms andpredicts health, behavioral problems, and rate of relapse. Family relationships, Poverty, Racism, Lack of SocialRelationships, Life Stress are Key Factors in Prognosis. 5. 1. Identify episode of mania, hypomania, depression or mixed episode.2. From the episode the diagnosis is given.3. In bipolar the rate of change and severity of symptoms are key diagnostic questions. 6. Bipolar I disorder: One or more manic episodes. Subcategoriesspecify whether there has been more than one episode, and the typeof the most recent episode. Bipolar II disorder: No manic episodes, but one or more hypomanicepisodes and one or more major depressive episode.Hypomanicepisodes do not go to the full extremes of mania. Cyclothymia: A history of hypomanic episodes with periods ofdepression that do not meet criteria for major depressive episodes. Bipolar Disorder NOS (Not Otherwise Specified): This is acatchall category, diagnosed when the disorder does not fall within aspecific subtype. Rapid cycling: Most people who meet criteria for bipolar disorderexperience a number of episodes, on average 0.4 to 0.7 peryear, lasting three to six months.Rapid cycling is defined as havingfour or more episodes per year. 7. Bipolar Disorder: Sami Khalife, Vivek Singh, David J. Muzinahttp://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/psychiatry-psychology/bipolar-disorder/#f0015 8. People can loose jobs, face jokes, feel judged forbehavior and can feel isolated. Bipolar disorder is associated with creativity:Painters, Writers, Actors. One 2011 Study found, We propose thatcreativity in BD might be linked to the putativehyperdopaminergic state of mania and bedependent on intact executive function. Positive social and emotional functioning increaseexecutive functioning 9. The overall heritability of the bipolar spectrum hasbeen put at 0.71. Bipolar disorder co-occurs in 67% ofmonozigotic twins and 19% of dizigotic Half of adults diagnosed with bipolar disorderreport traumatic/abusive experiences inchildhood (independent of trauma due to increasedhealth destructive behaviors). Childhood abuse relates to severity ofsymptoms, prognosis and symptoms later in life. 10. MRI studies in bipolar disorder: Increase in the volume of thelateral ventricles, globus pallidus, abnormalities inhypothalamic-pituitary-adrenal axis (HPA axis). The "kindling" theory: A genetic predisposition is catalyzed bystressors that lowers threshold for mood episodes anddisrupts emotional regulation. After this occurs often enoughmood symptoms self-perpetuate. Disruptions in mitochondria and neuron pump also have beenidentified. Individuals with bipolar disorder have alterations in:Circadian rhythms, sleep, diurnal cortisol and melatonin. 11. Individuals with bipolar disorder can lead veryproductive lives if there is the right social andemotional support. More then individuals with psychosis individuals withbipolar tend to be in higher paying work. However there is often a lower reported quality of lifefor individuals with bipolar disorder despite successes. If there are significant life stressors, poor socialsupport, chaos, etc. there is another life course for theillness. 12. Medications: Lithium, Anticonvulsants(depakote&tegretol), AtypicalAntipsychotics. Anti-depressants are not effective. Psychotherapy regard to relapseprevention: Cognitive behavioral therapy. Family-focused therapy. Psychoeducation Psychotherapy regard to residualdepr. symptoms: Social rhythm therapy. Cognitive-behavioral therapy. 13. Cognitive Behavioral Therapy: Targets therelationship between thoughts, feelings andbehaviors. Family Focused Therapy: Helps recognize signsof impending episodes or relapses, increasecommunication and conflict resolution, teachesproblem-solving skills, and helps individual createconcrete steps to get support in a crisis. Psychoeducation: Teaches individuals about thedisorder and helps develop tools to managesymptoms. 14. Is a treatment combining psychological andmedical interventions. Finds dysregulation in circadian rhythms as acause for episodes. PET found effects of sleep deprivation in themedial prefrontal cortex (mood and emotionregulation centers). Sleep deprivation leads to increase in positivemood for people who are depressed. 15. 1) Stressful life events.2) Disruptions in social rhythms.3) Medication non-adherence. 16. 1) The link between mood and life events.2) The importance of maintaining regular daily rhythms.3) The identification and management of potential precipitants of rhythm dysregulation with special attention to interpersonal triggers.4) The facilitation of mourning the lost healthy self.5) The identification and management of affective symptoms. 17. Instruction on the importance of medication compliance(e.g., log and review of medication record and whatmedications were taken, what time, date). Management of BD. Improvement of communication. Counseling regarding marital relationship and related issues. Caregiver support and education. Observation and assessment of postoperative medicalconditions including chest pains, pedal edema, and urinaryincontinence. Counseling regarding nutrition-specifically a low fat, lowsalt, and low sugar diet. 18. Behaviors are a chain reaction Triggering events. Internal events (thoughts, emotions). Vulnerability factors (lack of sleep, feeling rejected). Consequences that either make a behavior more or less likely. 19. In the skilled nursing context people are isolated fromsocial support, have pain, adjustment to illness, anxietyabout health, and challenges with sleep. Regularity in skilled nursing of meals and therapiescould be very supportive. Evening noise, pain, racing thoughts, difficulty fallingasleep or waking up multiple times per night iscommon. There are multiple risk factors that increase bipolarbehaviors and multiple protective factors against thedevelopment of a bipolar episode. 20. Keep Healthy Boundaries Be careful what you reinforce. What you reinforce will continue. Mice can be reinforced for a behavior with a fight just like it was the best tastingfood. Treat Symptoms Depression or manic episode Anxiety Paranoia Grief, Pain, Sleep, Social Connection etc. Behavioral Chain Analysis Consult with behavioral health. Assess triggers, internal factors, precipitating factors. Change triggers, internal factors, precipitating factors. Self-regulate: Your emotions are contagious. Individuals who havebipolar, traumatic histories or personality problems have aheightened sensitivity to the emotions of others.