Bipolar Case Study Practice 2

BIPOLAR CASE STUDY PRACTICE 2 How would you respond to "the file says it all"? - CORRECT ANSWERS-The file is important for your history but I need to know your current symptoms How do you get a better assessment of Emily's moods? - CORRECT ANSWERS-- SI assessment - How long did your hypomania last? - How frequently have you had the changes in moods this year? What observations for the psychiatrist and tx. team would be important to gather? - CORRECT ANSWERS-- Physical assessment Family hx. - Medical/medication hx. - Self-care deficits - Case management to get her insurance Since the client only mentions depression, why is it important to know about the client's variations in mood, especially manic moods? - CORRECT ANSWERS-- Need to know moods to confirm bipolar 1 or 2 What is a mixed-episode (specific to Bipolar 1)? - CORRECT ANSWERS-Presence of high and low symptoms (manic and depression) lasting at least one week -- Severe enough to go to hospital What is the criteria for diagnosis of Bipolar 2? - CORRECT ANSWERS-Recurrent episodes of hypomania and depression (no full mania or mixed episode has occurred) Similarities between hypomania and mania - CORRECT ANSWERS-1. Inflated selfesteem 2. Decreased need of sleep 3. Hyperverbal/hyperactivity 4. Flight of ideas 5. Distractibility Differences in hypomania and mania - CORRECT ANSWERS-Hypomania is less severe than mania (mania is debilitating) Is the shopping spree hypomanic or manic behavior? - CORRECT ANSWERSHypomania Shopping spree hypomania vs. manic - CORRECT ANSWERS-- Hypomania: can be convinced to return items - Mania: buys 1000 pool equipment with no pool and will not return The pt. asked, "Why isn't the health care provider adding sertraline now?" You would answer: - CORRECT ANSWERS-SSRI could potentially throw pt. with bipolar into mania if you do not maintain mood stabilizer levels first Med teaching for lamotrigine (Lamictal) - CORRECT ANSWERS-Anti-convulsant -- Adverse response: SI or stevens-johnsons -- May take 2-4 weeks to begin working -- Abruptly stopping can cause seizure to occur Can you use st. john's wort for depression in a pt. with bipolar? - CORRECT ANSWERS-Do not use st. john's wort and sertraline together because it can throw pt. into serotonin syndrome What is rapid cycling? - CORRECT ANSWERS-Disorder of mood episodes of highs and lows with at least 4 in a 12 month period (can be in both bipolar 1 and 2) Do people with Bipolar 2 have less depression and less time ill than people with bipolar 1? - CORRECT ANSWERS-Not necessarily; depends on patient -- key factor: med complicance What is the common age of onset for bipolar 2? - CORRECT ANSWERS-20-30 y/o What is the cause of bipolar 2? - CORRECT ANSWERS-We think it is genetic, but also influenced by environment (drugs, etc.) Goals for bipolar pt. - CORRECT ANSWERS-- Medication compliance - Better nutrition (finger foods) - Increase rest periods/relaxation