NR546 FINAL EXAM LATEST
UPDATE 2024/2025 (ACTUAL
QUESTIONS AND VERFIED
ANSWERS)
Pharmacologic Treatment of Bipolar Disorder
Lithium
An9convulsants
Second genera9on an9psycho9cs
Unipolar depression
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 ac9vi9es
-irritability
-withdrawal
-problems with sleep, ea9ng, energy, concentra9on, or self-worth
-severe depression: may experience thoughts of suicide or psycho9c
symptoms.
Bipolar disorder (BD)
Chronic condi9on characterized by extreme fluctua9ons in mood, energy, and
ability to func9on
,-Moods may be manic, hypomanic, or depressed and may include mixed mood
or psycho9c features
-many have only experienced only one manic episode in their life9me
-Mood fluctua9ons 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
Mania
Characterized by a persistently elevated, expansive, or irritable mood. Related
symptoms may include inflated self-esteem, increased goal-directed ac9vity or
energy, including grandiosity, decreased need for sleep, excessive talka9veness,
racing thoughts, flight of ideas (FOI), distrac9bility, psychomotor agita9on, and
a propensity to be involved in high-risk ac9vi9es. Mania leads to significant
func9onal impairment and may include psycho9c features or necessitate
hospitaliza9on
Bipolar Type I:
Requires at least one episode of mania for at least one week (or any dura9on if
hospitaliza9on due to symptoms is required)
Bipolar Type II:
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 dura9on or severity to cause
significant func9onal impairment, psychosis, or hospitaliza9on.
-Anger and irritability are common.
-Clients o^en enjoy the eleva9on of mood and are reluctant to report these
,symptoms, making bipolar more difficult to diagnose if the client presents in
the depression phase.
Cyclothymia:
Involves the chronic presenta9on of hypomanic and depressive symptoms that
do not meet the diagnos9c criteria for a major depressive or manic/hypomanic
episode.
If bipolar depression is mistaken for MDD:
An9depressant 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
An9depressants are used cau9ously in clients with bipolar disorder and never
as ________________.
Monotherapy
-An9depressants should be combined with a mood stabilizer to prevent the
onset of a hypomanic or manic episode
DA, NE Dysfunc9on causes what mood related symptoms
Decreased posi9ve affect:
depressed mood
loss of joy
lack of interest
loss of energy
decreased alertness
decreased self-confidence
appe9te changes
5HT, NE Dysfunc9on causes what mood related symptoms
, Increased nega9ve affect:
depressed mood
guilt
fear/anxiety
hos9lity
irritability
loneliness
appe9te changes
Monoamine hypothesis of depression
-depression occurs as a result of a deficiency of one or all three monoamine
transmicers
• serotonin, norepinephrine, and dopamine
-while mania may result from an excess
Medica9on Management for Depression, First-Line Treatment:
• Selec9ve Serotonin Reuptake Inhibitors (ssris)
• Serotonin Norepinephrine Reuptake Inhibitors (snris)
• Norepinephrine Dopamine Reuptake Inhibitors (NDRI)
• Serotonin Antagonist and Reuptake Inhibitors (saris)
SSRI's
Mechanism of ac9on
• inhibit 5-HT reuptake
Adverse effects
-diarrhea
-headache
-weight gain
-sexual side effects
SNRI's
UPDATE 2024/2025 (ACTUAL
QUESTIONS AND VERFIED
ANSWERS)
Pharmacologic Treatment of Bipolar Disorder
Lithium
An9convulsants
Second genera9on an9psycho9cs
Unipolar depression
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 ac9vi9es
-irritability
-withdrawal
-problems with sleep, ea9ng, energy, concentra9on, or self-worth
-severe depression: may experience thoughts of suicide or psycho9c
symptoms.
Bipolar disorder (BD)
Chronic condi9on characterized by extreme fluctua9ons in mood, energy, and
ability to func9on
,-Moods may be manic, hypomanic, or depressed and may include mixed mood
or psycho9c features
-many have only experienced only one manic episode in their life9me
-Mood fluctua9ons 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
Mania
Characterized by a persistently elevated, expansive, or irritable mood. Related
symptoms may include inflated self-esteem, increased goal-directed ac9vity or
energy, including grandiosity, decreased need for sleep, excessive talka9veness,
racing thoughts, flight of ideas (FOI), distrac9bility, psychomotor agita9on, and
a propensity to be involved in high-risk ac9vi9es. Mania leads to significant
func9onal impairment and may include psycho9c features or necessitate
hospitaliza9on
Bipolar Type I:
Requires at least one episode of mania for at least one week (or any dura9on if
hospitaliza9on due to symptoms is required)
Bipolar Type II:
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 dura9on or severity to cause
significant func9onal impairment, psychosis, or hospitaliza9on.
-Anger and irritability are common.
-Clients o^en enjoy the eleva9on of mood and are reluctant to report these
,symptoms, making bipolar more difficult to diagnose if the client presents in
the depression phase.
Cyclothymia:
Involves the chronic presenta9on of hypomanic and depressive symptoms that
do not meet the diagnos9c criteria for a major depressive or manic/hypomanic
episode.
If bipolar depression is mistaken for MDD:
An9depressant 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
An9depressants are used cau9ously in clients with bipolar disorder and never
as ________________.
Monotherapy
-An9depressants should be combined with a mood stabilizer to prevent the
onset of a hypomanic or manic episode
DA, NE Dysfunc9on causes what mood related symptoms
Decreased posi9ve affect:
depressed mood
loss of joy
lack of interest
loss of energy
decreased alertness
decreased self-confidence
appe9te changes
5HT, NE Dysfunc9on causes what mood related symptoms
, Increased nega9ve affect:
depressed mood
guilt
fear/anxiety
hos9lity
irritability
loneliness
appe9te changes
Monoamine hypothesis of depression
-depression occurs as a result of a deficiency of one or all three monoamine
transmicers
• serotonin, norepinephrine, and dopamine
-while mania may result from an excess
Medica9on Management for Depression, First-Line Treatment:
• Selec9ve Serotonin Reuptake Inhibitors (ssris)
• Serotonin Norepinephrine Reuptake Inhibitors (snris)
• Norepinephrine Dopamine Reuptake Inhibitors (NDRI)
• Serotonin Antagonist and Reuptake Inhibitors (saris)
SSRI's
Mechanism of ac9on
• inhibit 5-HT reuptake
Adverse effects
-diarrhea
-headache
-weight gain
-sexual side effects
SNRI's
