Test 2 (case study quiz) - Chapter 26 - Bipolar and related disorders

Question 1

Bipolar disorders is characerized by….

Answer 1

mood swings from profound depression to extreme euphoria (mania)

delusions or hallucinations may be present
onset of symptoms reflect a seasonal pattern.

Question 2

What is the difference between mania and hypomania?

Answer 2

hypomania does not impair social or occupational functioning or require hospitalization like mania does

Question 3

Bipolar dx can be labeled as I or II. What is the difference between the two?

(UPDATE AFTER LECTURE)

Answer 3

Bipolar I includes at least one MANIA or mixed episode + major depressive episodes

Bipolar II includes at least one major depressive episode + at least 1 hypomanic episode with normal moods in between.

Question 4

What is a manic episode like?

Answer 4

Distinct period of persistently elevated, expansive or irritable mood and abnormally focused/persistent goal directed activity or energy last at least 1 week.

Inflated self esteem/grandiosity

decreased need for sleep.

more talkative

flight of ideas (racing thoughts)

distractibility

engaged in reckless behavior (buying srees, sexual
indiscretion, foolish investments, etc)

mood distrubance that severely impairs socially/occupationally

Question 5

What is a HYPOmanic episode like?

Answer 5

exactly like above EXCEPT mood disturbance DOES NOT impair the person socially/occupationally

Question 6

Degrees of mania

Answer 6

See slide for more details

hypomania, acute, delirious

Question 7

This disorder is a chronic mood disturbance of at least 2 years’ duration. The elevated period does not meed hypomania criteria and the depressed mood is not as severe as bipolar. What is the DO?

Answer 7

cyclothymic disorder

the individual is never without the symptoms for more than 2 months.

Question 8

A person gets intoxicated on drugs, alcohol or medications which cause mood disturbances. This is known as

Answer 8

substance/medication induced bipolar disorder

Question 9

How can bipolar be caused by another medical condition?

Answer 9

deficiency (depression) or increase (mania) in DA and NE (5ht remains low in both)

right sided lesions in limbic system is another example

see page 502 in ch 26

Question 10

Medication for bipolar

_______ is antimanic, mood stabilizer. It requires an ekg and intake of salt and water. It is used to treat mania.

Answer 10

Lithium (considered the gold standard)

Remember to check the blood lithium levels daily!

Question 11

T or F: The calcium channel blocker Verapamil can be used to treat Bipolar depression.

Answer 11

True

Question 12

_________ is an anticonvulsant used to treat bipolar disease. it is good for rapid cyclers.

Answer 12

Carbamazpine (Tegretol, Equetro)

Know TEGRETOL acronym

T - Trigeminal neurolgia = tonic clonic seizures (do not stop abruptly)

E - Evaluate for UE: anorexia, nausea, dizziness, sedation, heart attack, sore throat, blood dyscrasias.

G - Give with food, milk to reduce GI upset

R - Review levels, maintain between 4-12

E - Evaluate hepatic and renal function (and for anorexia - sign for toxicity)

T - Tablet = chewable, do not swallow whole! Or take extended release

O - Open and mis with food (extended release)

L - Look for many drug/drug interactions (toxic with lithium)

Question 13

T or F: 2nd and 3rd generation antipsychotics and atypicals may be used to treat bipolar disorder.

Answer 13

true.

approved for mania and may also be effective against depressive symptoms. Most atypicals can lead to weight gain and increase the incidence of type II diabetes.

Question 14

________ ( ______ ) works well in patients with bipolar 2.

Answer 14

aripiprazole (Abilify)

Two i’s - bipolar 2

Hip hip hurray, I have the ability 2 feel better

Question 15

Paroxetine (Paxil) is what type of med? How does it effect bipolar disorder patients?

Answer 15

SSRI

Works well, decreases switching to other antidepressants.

Question 16

Which group of antidepressants should be avoided in bipolar treatment?

Answer 16

TCAs

Question 17

There are three stages of mania ranging from hypomania to delirious mania. explain MOOD we expect to see in each stage.

Answer 17

Stage I: Hypomania - Cheerful and expansive (with underlying irritability that surfaces rapidly when desires unfulfilled); volatile and fluctuating.

Stage II: Acute Mania - characterized by euphoria and elation. Appears to be on continuous high. Always subject to frequent variation.

Stage III: Delirious Mania - very labile. Might go from despair to urestrained merriment and ectasy. Might be irritable or indifferent. Panic anxiety may be evident.

Question 18

There are three stages of mania ranging from hypomania to delirious mania. explain COGNITION AND PERCEPTION we expect to see in each stage.

Answer 18

Stage I: Hypomania - perception of self is exalted. Easily distracted by irrelevant stimuli.

Stage II: Acute Mania - flight of ideas (fragmented, psychotic, disjointed); abrupt topic changes.

Stage III: Delirious Mania - clouding of consciousness + confusion, disorientation and sometimes stupor.

Question 19

There are three stages of mania ranging from hypomania to delirious mania. explain ACTIVITY AND BEHAVIOR we expect to see in each stage.

Answer 19

Stage I: Hypomania - extroverted, sociable, talk loudly and inappropriately. increased libido.

Stage II: Acute Mania - xcessive activity. excessive spending poor impulse control. manipulate others. energy seems inexhaustible. no need for sleep. Dress may be disorganized, flamboyant, bizarre and excessive.

Stage III: Delirious Mania - purposeless movements, frenzied, agitated. Intervention or death.

Question 20

T or F: bipolar persons should be treated by someone of the same sex

Answer 20

True. Consistent person of same sex.

Question 21

What type of foods should you have available to bipolar DO pts?

Answer 21

things that can be eaten on the run; finger foods.

Question 22

A person in the manic phase will have a short attention span. What can we do to communicate?

Answer 22

Walk and talk with patient.

Reduce stimuli

SECLUSION (away from nurses station - too much noise)

Use short simple sentences

Question 23

T or F: You should be strict with rules when it comes to bipolar patients.

Answer 23

True. no special favors or privileges. Patient may try to charm you to fulfill their own desires.

Patient may try to make sexual advances - set boundaries verbally and physically (ask colleague to help. Do not go “off-site” for sessions). redefine your role as a reminder!