Review the Classifications of the Antidepressant medications
- MAOs- often food restrictions that go with consumption of tyramine (if too much can
cause a hypertensive crisis- don’t eat anything that is aged like beer, wine, cheese)
o So if they are on a MAO they are going to have a strict tyramine restriction
- Caution use of antidepressants with Bipolar patients cause it can flip them back into
mania
Therapeutic Communication
- How we respond to patients
- Offer yourself – pt. in turmoil – offer yourself as a method of therapeutic communication
- Stay away from WHY
- Broad opening that forces the pt. to talk about how they feel (evaluate the therapeutic
responses)
Bipolar
- Mania- important nursing interventions
o Limit setting- decrease environment stimuli
o Limit behavior (ornery pts.) deescalate behaviors or altercations
o Frequent rest periods
o Nutritional support- foods on the go (NO Utensils) High protein
o Safety is priority in full manic
o Supervision of clothing- no naked pts.
- Clinical Manifestation
o Speech- Clanging (rhythming)
- Mania
o Grandiosity- delirious, that they can do something that is way outside of
capability
o Decreased need for sleep
o Agitation
o Excessive involvement in pleasurable activity (sex, shopping spree)
- Caused by
o Neurotransmitter imbalances in the brain
o Genetic- 7x more likely with family history
o Environmental factors
- Risk Factors
o Physical illness (delirium due to head injury)
o Substance abuse (cocaine and meth overdose)
o Relapse:
Use of substances (drug, alcohol, caffeine)- lead to an episode
Sleep Disturbances often first manifestation of mania
- Bipolar 1
o Ends of the spectrum- severe mania, and severe depression
o Manic episode lasts over one week or requires hospitalization
o Not secondary to substance abuse
o Cause impairment in normal function
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, o Psychotic episode (hearing voices, hallucinations)
- Bipolar 2
o Hypomanic episode (lasting 4 days or longer not requiring hospitalization) and
then cycle into severe depression
o Not secondary to substance abuse
o No impairment of normal function
Suicide Precautions
- Specific precautions
- Pt. mood improves- do not stop precautions it may indicate that they are more suicidal
and that they have made a plan to carry it out
Interpersonal Therapy
- Psychotherapy that improves interpersonal relationships
SSRI-
TCA- Sedative quality- more at risk of overdose
Review Adderall- ADHD
Concept on Malpractice
- Things to do to keep us out of it
- Make sure we are up to date on standards of care
Involuntary Commitments
- Harm to self or others in the community
- 24-72 hr observation
Lithium
- Main drug for Bipolar
- Drug of choice when patient is depressed with bipolar
- Side effects
o GI irritation- give after meal
o Headache
o Drowsiness
o Fine Tremors
o Metallic taste
o Suppress ADH- Polyuria and Polydipsia
o Goiter
o Edema
o Weight Gain
- 2-4 weeks before full therapeutic effects
- Salt intake- must have enough sodium in your body for lithium to work
o Adequate sodium and fluid intake- avoid toxicity
- Nursing Interventions
o Avoid conception- harm pregnancy
o Elevate legs- edema
o Consistent salt intake
- Counterindications-
o Pregnancy
This study source was downloaded by 100000903111493 from CourseHero.com on 03-06-2026 12:10:28 GMT -06:00
https://www.coursehero.com/file/92725894/Mental-Health-Exam-1docx/
- MAOs- often food restrictions that go with consumption of tyramine (if too much can
cause a hypertensive crisis- don’t eat anything that is aged like beer, wine, cheese)
o So if they are on a MAO they are going to have a strict tyramine restriction
- Caution use of antidepressants with Bipolar patients cause it can flip them back into
mania
Therapeutic Communication
- How we respond to patients
- Offer yourself – pt. in turmoil – offer yourself as a method of therapeutic communication
- Stay away from WHY
- Broad opening that forces the pt. to talk about how they feel (evaluate the therapeutic
responses)
Bipolar
- Mania- important nursing interventions
o Limit setting- decrease environment stimuli
o Limit behavior (ornery pts.) deescalate behaviors or altercations
o Frequent rest periods
o Nutritional support- foods on the go (NO Utensils) High protein
o Safety is priority in full manic
o Supervision of clothing- no naked pts.
- Clinical Manifestation
o Speech- Clanging (rhythming)
- Mania
o Grandiosity- delirious, that they can do something that is way outside of
capability
o Decreased need for sleep
o Agitation
o Excessive involvement in pleasurable activity (sex, shopping spree)
- Caused by
o Neurotransmitter imbalances in the brain
o Genetic- 7x more likely with family history
o Environmental factors
- Risk Factors
o Physical illness (delirium due to head injury)
o Substance abuse (cocaine and meth overdose)
o Relapse:
Use of substances (drug, alcohol, caffeine)- lead to an episode
Sleep Disturbances often first manifestation of mania
- Bipolar 1
o Ends of the spectrum- severe mania, and severe depression
o Manic episode lasts over one week or requires hospitalization
o Not secondary to substance abuse
o Cause impairment in normal function
This study source was downloaded by 100000903111493 from CourseHero.com on 03-06-2026 12:10:28 GMT -06:00
https://www.coursehero.com/file/92725894/Mental-Health-Exam-1docx/
, o Psychotic episode (hearing voices, hallucinations)
- Bipolar 2
o Hypomanic episode (lasting 4 days or longer not requiring hospitalization) and
then cycle into severe depression
o Not secondary to substance abuse
o No impairment of normal function
Suicide Precautions
- Specific precautions
- Pt. mood improves- do not stop precautions it may indicate that they are more suicidal
and that they have made a plan to carry it out
Interpersonal Therapy
- Psychotherapy that improves interpersonal relationships
SSRI-
TCA- Sedative quality- more at risk of overdose
Review Adderall- ADHD
Concept on Malpractice
- Things to do to keep us out of it
- Make sure we are up to date on standards of care
Involuntary Commitments
- Harm to self or others in the community
- 24-72 hr observation
Lithium
- Main drug for Bipolar
- Drug of choice when patient is depressed with bipolar
- Side effects
o GI irritation- give after meal
o Headache
o Drowsiness
o Fine Tremors
o Metallic taste
o Suppress ADH- Polyuria and Polydipsia
o Goiter
o Edema
o Weight Gain
- 2-4 weeks before full therapeutic effects
- Salt intake- must have enough sodium in your body for lithium to work
o Adequate sodium and fluid intake- avoid toxicity
- Nursing Interventions
o Avoid conception- harm pregnancy
o Elevate legs- edema
o Consistent salt intake
- Counterindications-
o Pregnancy
This study source was downloaded by 100000903111493 from CourseHero.com on 03-06-2026 12:10:28 GMT -06:00
https://www.coursehero.com/file/92725894/Mental-Health-Exam-1docx/
