__)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_________________________________________________________________________
_________________________________________________________________________________________________________
NR 546 FINAL EXAM VERSION 1 AND VERSION 2.pdf!#()*_*$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#())))))))))
NR 546 FINAL EXAM VERSION 1 AND
VERSION 2
Lithium
Anticonvulsants
Second generation antipsychotics
Pharmacologic Treatment of Bipolar Disorder
major depressive disorder (MDD)
one of the most common mental disorders
-Approximately 7.1% of adults in the U.S. had episode in last year, prevalence highest (13.1%) among
individuals aged 18-25
S/S
-depressed mood
-loss of interest or pleasure in daily activities
-irritability
-withdrawal
-problems with sleep, eating, energy, concentration, or self-worth
-severe depression: may experience thoughts of suicide or psychotic symptoms.
Unipolar depression
Chronic condition characterized by extreme fluctuations in mood, energy, and ability to function
-Moods may be manic, hypomanic, or depressed and may include mixed mood or psychotic features
$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))____________________________________________
_________________________________________________________________________________________________________
NR 546 FINAL EXAM VERSION 1 AND VERSION 2.pdf!#()*_*$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#())))))))))
,__)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_________________________________________________________________________
_________________________________________________________________________________________________________
NR 546 FINAL EXAM VERSION 1 AND VERSION 2.pdf!#()*_*$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#())))))))))
-many have only experienced only one manic episode in their lifetime
-Mood fluctuations may be separated by periods of high stability or may cycle rapidly
-diagnosed when a client has one or more episodes of mania or hypomania with a history of one or
more major depressive episodes
-high risk for suicide
Bipolar disorder (BD)
characterized by a persistently elevated, expansive, or irritable mood. Related symptoms may include
inflated self-esteem, increased goal-directed activity or energy, including grandiosity, decreased need
for sleep, excessive talkativeness, racing thoughts, flight of ideas (FOI), distractibility, psychomotor
agitation, and a propensity to be involved in high-risk activities. Mania leads to significant functional
impairment and may include psychotic features or necessitate hospitalization
mania
requires at least one episode of mania for at least one week (or any duration if hospitalization due to
symptoms is required)
Bipolar Type I:
diagnosis requires a current or past hypomanic episode and a current or past major depressive episode.
Symptoms last for at least 4 days but fewer than seven.
-Hypomanic symptoms are not of sufficient duration or severity to cause significant functional
impairment, psychosis, or hospitalization.
-Anger and irritability are common.
-Clients often enjoy the elevation of mood and are reluctant to report these symptoms, making bipolar
more difficult to diagnose if the client presents in the depression phase.
Bipolar Type II:
$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))____________________________________________
_________________________________________________________________________________________________________
NR 546 FINAL EXAM VERSION 1 AND VERSION 2.pdf!#()*_*$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#())))))))))
,__)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_________________________________________________________________________
_________________________________________________________________________________________________________
NR 546 FINAL EXAM VERSION 1 AND VERSION 2.pdf!#()*_*$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#())))))))))
involves the chronic presentation of hypomanic and depressive symptoms that do not meet the
diagnostic criteria for a major depressive or manic/hypomanic episode.
Cyclothymia:
antidepressant therapy may precipitate a manic episode or induce rapid-cycling bipolar depression
-may contribute to the increased incidence of death by suicide in children and adults younger than 25
If bipolar depression is mistaken for MDD:
monotherapy
-Antidepressants should be combined with a mood stabilizer to prevent the onset of a hypomanic or
manic episode
Antidepressants are used cautiously in clients with bipolar disorder and never as ________________.
Decreased positive affect:
depressed mood
loss of joy
lack of interest
loss of energy
decreased alertness
decreased self-confidence
$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))____________________________________________
_________________________________________________________________________________________________________
NR 546 FINAL EXAM VERSION 1 AND VERSION 2.pdf!#()*_*$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#())))))))))
,__)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_________________________________________________________________________
_________________________________________________________________________________________________________
NR 546 FINAL EXAM VERSION 1 AND VERSION 2.pdf!#()*_*$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#())))))))))
appetite changes
DA, NE Dysfunction causes what mood related symptoms
Increased negative affect:
depressed mood
guilt
fear/anxiety
hostility
irritability
loneliness
appetite changes
5HT, NE Dysfunction causes what mood related symptoms
-depression occurs as a result of a deficiency of one or all three monoamine transmitters
• serotonin, norepinephrine, and dopamine
-while mania may result from an excess
monoamine hypothesis of depression
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
• Norepinephrine Dopamine Reuptake Inhibitors (NDRI)
• Serotonin Antagonist and Reuptake Inhibitors (SARIs)
Medication Management for Depression, First-Line Treatment:
$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))____________________________________________
_________________________________________________________________________________________________________
NR 546 FINAL EXAM VERSION 1 AND VERSION 2.pdf!#()*_*$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#())))))))))
_________________________________________________________________________________________________________
NR 546 FINAL EXAM VERSION 1 AND VERSION 2.pdf!#()*_*$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#())))))))))
NR 546 FINAL EXAM VERSION 1 AND
VERSION 2
Lithium
Anticonvulsants
Second generation antipsychotics
Pharmacologic Treatment of Bipolar Disorder
major depressive disorder (MDD)
one of the most common mental disorders
-Approximately 7.1% of adults in the U.S. had episode in last year, prevalence highest (13.1%) among
individuals aged 18-25
S/S
-depressed mood
-loss of interest or pleasure in daily activities
-irritability
-withdrawal
-problems with sleep, eating, energy, concentration, or self-worth
-severe depression: may experience thoughts of suicide or psychotic symptoms.
Unipolar depression
Chronic condition characterized by extreme fluctuations in mood, energy, and ability to function
-Moods may be manic, hypomanic, or depressed and may include mixed mood or psychotic features
$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))____________________________________________
_________________________________________________________________________________________________________
NR 546 FINAL EXAM VERSION 1 AND VERSION 2.pdf!#()*_*$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#())))))))))
,__)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_________________________________________________________________________
_________________________________________________________________________________________________________
NR 546 FINAL EXAM VERSION 1 AND VERSION 2.pdf!#()*_*$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#())))))))))
-many have only experienced only one manic episode in their lifetime
-Mood fluctuations may be separated by periods of high stability or may cycle rapidly
-diagnosed when a client has one or more episodes of mania or hypomania with a history of one or
more major depressive episodes
-high risk for suicide
Bipolar disorder (BD)
characterized by a persistently elevated, expansive, or irritable mood. Related symptoms may include
inflated self-esteem, increased goal-directed activity or energy, including grandiosity, decreased need
for sleep, excessive talkativeness, racing thoughts, flight of ideas (FOI), distractibility, psychomotor
agitation, and a propensity to be involved in high-risk activities. Mania leads to significant functional
impairment and may include psychotic features or necessitate hospitalization
mania
requires at least one episode of mania for at least one week (or any duration if hospitalization due to
symptoms is required)
Bipolar Type I:
diagnosis requires a current or past hypomanic episode and a current or past major depressive episode.
Symptoms last for at least 4 days but fewer than seven.
-Hypomanic symptoms are not of sufficient duration or severity to cause significant functional
impairment, psychosis, or hospitalization.
-Anger and irritability are common.
-Clients often enjoy the elevation of mood and are reluctant to report these symptoms, making bipolar
more difficult to diagnose if the client presents in the depression phase.
Bipolar Type II:
$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))____________________________________________
_________________________________________________________________________________________________________
NR 546 FINAL EXAM VERSION 1 AND VERSION 2.pdf!#()*_*$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#())))))))))
,__)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_________________________________________________________________________
_________________________________________________________________________________________________________
NR 546 FINAL EXAM VERSION 1 AND VERSION 2.pdf!#()*_*$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#())))))))))
involves the chronic presentation of hypomanic and depressive symptoms that do not meet the
diagnostic criteria for a major depressive or manic/hypomanic episode.
Cyclothymia:
antidepressant therapy may precipitate a manic episode or induce rapid-cycling bipolar depression
-may contribute to the increased incidence of death by suicide in children and adults younger than 25
If bipolar depression is mistaken for MDD:
monotherapy
-Antidepressants should be combined with a mood stabilizer to prevent the onset of a hypomanic or
manic episode
Antidepressants are used cautiously in clients with bipolar disorder and never as ________________.
Decreased positive affect:
depressed mood
loss of joy
lack of interest
loss of energy
decreased alertness
decreased self-confidence
$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))____________________________________________
_________________________________________________________________________________________________________
NR 546 FINAL EXAM VERSION 1 AND VERSION 2.pdf!#()*_*$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#())))))))))
,__)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_________________________________________________________________________
_________________________________________________________________________________________________________
NR 546 FINAL EXAM VERSION 1 AND VERSION 2.pdf!#()*_*$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#())))))))))
appetite changes
DA, NE Dysfunction causes what mood related symptoms
Increased negative affect:
depressed mood
guilt
fear/anxiety
hostility
irritability
loneliness
appetite changes
5HT, NE Dysfunction causes what mood related symptoms
-depression occurs as a result of a deficiency of one or all three monoamine transmitters
• serotonin, norepinephrine, and dopamine
-while mania may result from an excess
monoamine hypothesis of depression
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
• Norepinephrine Dopamine Reuptake Inhibitors (NDRI)
• Serotonin Antagonist and Reuptake Inhibitors (SARIs)
Medication Management for Depression, First-Line Treatment:
$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))____________________________________________
_________________________________________________________________________________________________________
NR 546 FINAL EXAM VERSION 1 AND VERSION 2.pdf!#()*_*$_!*$__________________________)(&)$*&!)($)(*&&*^(&(#())))))))))
