Lithium for Bipolar Disorder, Schizophrenia and Borderline Personality Disorder – Mood Stabilizer (Nursing)

00:01 Hi, welcome to this topic in CNS medications.

00:04 We're gonna take a look at lithium in this series.

00:07 Now, lithium is a mood stabilizer.

00:10 Mood stabilizers are drugs that are used to treat mood disorders where a patient experiences extreme mood shifts from way high to way low.

00:19 So, they can become kinda manic or very sad and depressed.

00:22 That's why they're called 'mood stabilizers'.

00:25 So, they're often used in bipolar disorder, borderline personality disorder, and schizophrenia.

00:32 Now, before we get rolling into this, I have some people that are very precious to me that suffer from bipolar disorder.

00:38 So, I've kinda walked through this and seen what it's like for these types of patients.

00:42 So even if we use humor throughout this presentation, I want you to know that I take mental health very seriously but sometimes laughter is a coping mechanism.

00:52 So, let's talk about how mood stabilizers can help our patients with bipolar, borderline personality, or schizophrenia find a more level place in their life.

01:03 Now, lithium is the oldest mood stabilizer and we still give a lot of it in the United States.

01:09 We can also use anticonvulsants.

01:11 That a little bit newer treatment for mood stabilizers.

01:14 Now, anticonvulsants are used to treat epilepsy but they can also help with the mood stabilizing factor.

01:20 But let's get back to lithium.

01:22 That's what we're gonna focus on for now.

01:24 We've listed some drug names down there of anticonvulsants that are used as mood stabilizers just for your reference.

01:30 Let's look at bipolar disorder first.

01:32 Now, if you haven't interacted with someone or you don't know someone who has this disorder, I wanna give you some brief characteristics of what it's like.

01:39 Patients with bipolar disorder can suffer from severe highs and severe lows in their moods.

01:45 They can be what we call very manic, they have high energy, and everything's exaggerated or they can be very severely depressed.

01:52 Those are the examples of the low moods.

01:54 Now, it impacts all areas of their life and their family members who live with them.

01:59 So, it can impact their sleep, their level of energy, how they think, and their behaviors particularly their social behaviors.

02:08 So, if they're in a manic phase, they may be insomnia.

02:11 If they're in a low phase, they could also have insomnia or difficulty staying asleep or they may sleep way too much more than normal.

02:19 Their energy in a manic phase is super, super high.

02:22 When they're in a low phase, it's difficult for them to even get out of bed and get dressed and go with the activities of daily living.

02:29 Their thinking is not particularly rational in the manic phase. It's very exaggerated.

02:35 They also have difficulty sleeping in the low moods.

02:37 Now their social behaviors can be all over the map with bipolar and sometimes their behaviors seem kind of strange to people if they don't understand the disorder.

02:47 So these severe mood swings impact a patient's quality of life, their relationships, their family members, and their activities of daily living.

02:57 It can even make maintaining a stable job a real difficulty unless we can help them find a middle ground.

03:04 Now we use lithium in bipolar disorder for acute mania when they're in that really extreme high energy phase and everything is exaggerated.

03:14 We can also use it to prevent future episodes of mania or depression.

03:18 So, we can use lithium in an acute phase when they're acutely in mania or we can use it to prevent future mania or depression.

03:26 So, if a patient is in bipolar -- has a bipolar disorder, comes in a manic phase, we'll start lithium but it takes a little bit for it to really kick in for the patient to start to feel that effect.

03:37 In fact, it may be five to seven days. Now that's a relatively long period of time.

03:44 It's really hard for a patient to recognize that it's gonna take that long for these drugs to really take effect.

03:49 So, educate your patients and their family members that lithium will help but it's gonna take a little bit before it does.

03:56 Maybe even up to two to three weeks for the patient to experience the peak benefits of lithium in bipolar disorder.

04:03 Okay, so we know that lithium is a mood stabilizer.

04:07 We can use it in the acute manic phase of bipolar disorder but it's gonna take a while for the patient to really feel the effects.

04:14 Five to seven days and to feel that peak effects, it could take up to two to three weeks.

04:20 See, that's the problem with central nervous system medications.

04:23 They take a while to really kick into gear.

04:26 Okay now let's look at lithium in treating schizophrenia.

04:30 Now, we have a picture of a unicorn there and you might be wondering why.

04:34 We mean no disrespect, we just wanted you to recognize it.

04:38 Schizophrenia can cause hallucinations and delusions.

04:41 And while it's easy for you to look at that picture and know like 'unicorns don't exist', someone in schizophrenia, their hallucinations and delusions are very, very real.

04:53 In fact, they can't tell the difference.

04:55 Their brain doesn't know how to separate reality from their hallucination or their delusions.

05:01 So, they have a very difficult time living in a world when recognizing what is real and what is not.

05:07 Now we can treat patients with antipsychotic medications in addition to the lithium but we add the lithium when the treatment isn't fully effective with antipsychotics alone.

05:17 So, patients with schizophrenia are treated with antipsychotic medications but if that isn't enough to help them recognize the difference between reality and their hallucinations and delusions, then we can add lithium to help them.

05:31 Now the third disorder is lithium in borderline personality disorder.

05:36 Now you may or may not be familiar with borderline personality disorder.

05:40 It has the same initials as bipolar disorder but this one is different.

05:44 It's also a mental health disorder and it's characterized by these frequent mood swings.

05:50 Hey, that's kinda sounding familiar but it's different than bipolar but patients with borderline personality disorder have extreme emotions and they're very impulsive.

06:00 They also have unstable and intense relationships.

06:03 They don't have a good self-image.

06:06 It's kind of distorted in how they see themselves.

06:08 Here's where it really starts to be a little different than bipolar.

06:12 Someone with borderline personality disorder has an intense fear of abandonment and being alone.

06:20 So that's one of the criteria you can think about that is different with borderline personality disorder.

06:24 Incredibly intense fear of abandonment and being alone.

06:28 That's kinda what can shape some of their unusual behaviors.

06:32 We can use lithium to help patients who have borderline personality disorder treat their impulsivity because they're likely to make decisions that just wouldn't make sense in the rational mind.

06:42 It can also might help them treat their anger and irritation.

06:46 So, to get kind of a snapshot to what borderline personality disorder is.

06:51 They have frequent mood swings, extreme emotions, and impulsiveness.

06:56 They don't see themselves accurately.

06:59 They have a very distorted self-image and they are terrified of abandonment.

07:04 So, we can use lithium to treat that impulsivity and hopefully also treat anger or irritation.