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,Bipolar I disorder characterized by - correct ans:at least one week long manic episode that results in
excessive activity. Mostly mania with mix of depression
Mania can be - correct ans:euphoric or dysphoric
Bipolar II disorder - correct ans:mostly depression and hypomania. Early ages of 20 and 60 years old. Not
severe enough to impair social/occupational life.
Cyclothymic disorder - correct ans:cycle in and out of hypomania (no delusions and hallucinations) and
depression. Two years for an adult, 1 year for a child
Bipolar II disorders are more common - correct ans:among females
More than half the people with bipolar disorder have - correct ans:have another psychiatric disorder,
most being panic attacks, social phobia, etc.
Bipolar disorders have a strong - correct ans:heritability
Diathesis stress model - correct ans:genetic predisposition or chemical imbalance may never experience
symptoms, until an event triggers the disorder.
Bipolar disorder may be more common in - correct ans:upper socioeconomic classes
For Bipolar, Early diagnosis and treatment is key in - correct ans:preventing suicide attempts,
alcohol/substance abuse, marital/work problems, etc.
Mania characteristics - correct ans:○ Mood - highly unstable. May laugh or joke or speak in a continuous
stream. Mood can quickly change to irritation or anger. Patients have high self confidence and know no
strangers. Excessive spending, elaborate schemes.
○ Behavior- constant activity and reduced need for sleep prevent proper rest. Non stop physical activity
can lead to physical exhaustion and death if not treated; this is an EMERGENCY! Act on impulses.
,○ Thought processes and speech patterns- flight of ideas is continuous flow of accelerated speech-
change in topic and plays on word. Speech is usually loud, vulgar and sexua. Clang associations are
stringing words together based on their rhyming sounds.
For Mania, Always assess if the patient is - correct ans:a danger to self or others
With people with mania, nurses need to - correct ans:SET LIMITS! Consistency is key among staff if limit
setting is to be carried out consistently.
Big diagnosis for mania is - correct ans:RISK FOR INJURY
Acute phase - correct ans:primary outcome is injury prevention- stabilizing the patient (hydrating,
maintaining cardiac status, getting enough sleep and rest)
Continuation phase - correct ans:focuses on adhering to the medication regimen and preventing relapse
Maintenance therapy - correct ans:focuses on relapse prevention and limitation of further episodes
Meds to use during acute phase - correct ans:use Lithium and Lamictal are the first line of treatment for
someone with bipolar disorder
Lithium - correct ans:naturally occurring salt in the body- effective in tx of bipolar I disorder- start low
and go slow- takes about 10-21 days to be effective- must reach therapeutic level to be effective (7-14
days)- 0.4-1.3 mEq/L-levels should not exceed 1.5 (considered toxic)- Should be taken 5 days after
beginning lithium therapy- after therapeutic levels are reached, check every month- after 6 months of
stability, levels should be checked every 3 months. Risks are hypothyroidism and impairment of the
kidneys. Be sure patients know they need to continually take medication. IF DIARRHEA, VOMITING OR
SWEATING OCCURS STOP LITHIUM AND CONTACT YOUR PHYSICIAN. Take with meal, do not take with
diuretics.
Anticonvulsant drugs - correct ans:effective at diminishing impulsive and aggressive behaviors in pts who
are not psychotic- Valproate (Depakote)- monitor liver function and platelet count
, Antianxiety drugs - correct ans:should be avoided in patients with h/o substance abuse. Clonazepam
(Klonopin) and Lorazepam (Ativan)
ECT - correct ans:can be used to subdue manic behavior and severe depression- side effect is memory
loss
induces a seizure - patient will complain about a h/a, and may be confused or disoriented for several
hours.
SECLUSION AND RESTRAINTS ARE - correct ans:NEVER TO BE USED AS PUNISHMENT
If a patient is secluded - correct ans:check every 15 minutes, offer food and fluids every 30 minutes
Major depressive disorder - correct ans:persistent depressed mood lasting longer than 2 weeks
○ Accompanied by a lack of interest in previous pleasurable activity (anhedonia), fatigue, sleep
disturbances, changes in appetite, feelings of hopelessness or worthlessness.
○ Complain of problems with family and friends, inability to concentrate and make decisions,
psychomotor agitation (restless, fidgety, wringing of hands). Can be preoccupied with death
Terminal insomnia (early morning awakening) - correct ans:is a red flag for depression
Disruptive mood dysregulation disorder - correct ans:in children b/w the ages of 6 and 18- frequent
temper tantrums resulting in verbal or behavioral outbursts.
Dysthymic disorders - correct ans:feelings of depression consistently for at least 2 years
Premenstrual dysphoric disorder - correct ans:occurs during week prior to menstrual cycle- sx similar to
major depression and interfere with person's life.
Depressive disorder associate with another medical condition - correct ans:Parkinson's, kidney failure,
etc.
If depression occurs in childhood or adolescence - correct ans:recurrence is high