15. Bipolar and Related disorders

Question 1

TRUE / FALSE

• Bipolar disorders are manifested by cycles of mania and depression.
• Mania is an alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation and accelerated thinking and speaking.
• A somewhat milder degree of this clinical symptom picture is called hypomania.

Answer 1

TRUE

Question 2

TRUE / FALSE

The average age of onset for bipolar disorder is the early twenties, and following the first manic episode, the disorder tends to be recurrent.

Answer 2

TRUE

Question 3

______it is the diagnosis given to an individual who is experiencing or has a history of one or more manic episodes. The client may also have experienced episodes of depression.
This diagnosis is further specified by the current or most recent behavioral episode experienced.

Answer 3

Bipolar I disorder

Question 4

The essential feature is a chronic mood disturbance with a duration of at least 2 years, involving numerous periods of elevated mood that do not meet the criteria for a hypomanic episode and numerous periods of depressed mood of insufficient severity or duration to meet the criteria for major depressive episode.

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

Answer 4

Cyclothymic Disorder

Question 5

Bipolar II disorder

Answer 5

It is characterized by recurrent bouts of major depression with the episodic occurrence of hypomania.

The individual who is assigned this diagnosis may present with symptoms (or history) of depression or hypomania.

The client has never experienced a full manic episode.

Question 6

The disturbance of mood associated with this disorder is considered to be the direct result of physiological effects of a substance (e.g., ingestion of or withdrawal from a drug of abuse or a medication).

Answer 6

Substance/Medication-Induced Bipolar Disorder

Question 7

Medication Side Effects: Certain medications used to treat somatic illnesses have been known to trigger a manic response.

The most common of these are:

Answer 7

Steroids frequently used to treat chronic illnesses such as multiple sclerosis and systemic lupus erythematosus.

Amphetamines, antidepressants, and high doses of anticonvulsants and narcotics also have the potential for initiating a manic episode

Question 8

Symptoms of alterations in thought processes and communication patterns are manifested by the following:

Answer 8

• Flight of Ideas: there is a continuous, rapid shift from one topic to another.
• Loquaciousness: the pressure of the speech is so forceful and strong that it is difficult to interrupt maladaptive thought processes.
• Delusions of Grandeur: the individual believes he or she is all important, all powerful, with feelings of greatness and magnificence.
• Delusions of Persecution: the individual believes someone or something desires to harm or violate him or her in some way.

Question 9

• Motor activity is constant: the individual is literally moving at all times.
• Dress is often inappropriate: bright colors that do not match; clothing inappropriate for age or stature; excessive makeup and jewelry.
• The individual has a meager appetite: despite excessive activity level. He or she is unable or unwilling to stop moving in order to eat.
• Sleep patterns are disturbed: client becomes oblivious to feelings of fatigue, and rest and sleep are abandoned for days or weeks.
• Spending sprees are common: the individual spends large amounts of money, which is not available, on numerous items, which are not needed.
• Usual inhibitions are discarded: in favor of sexual and behavioral indiscretions.
• Manipulative behavior and limit testing are common in the attempt to fulfill personal desires.
• Verbal or physical hostility may follow failure in these attempts.
• Projection is a major defense mechanism: the individual refuses to accept responsibility for the negative consequences of personal behavior.
• There is an inability to concentrate because of a limited attention span: the individual is easily distracted by even the slightest stimulus in the environment
• Alterations in sensory perception may occur, and the individual may experience hallucinations.
• As agitation increases, symptoms intensify. Unless the client is placed in a protective environment, death can occur from exhaustion or injury

Answer 9

Symptoms

Question 10

For maintenance therapy, lithium serum levels should be:

Answer 10

0.6 to 1.2 mEq/L; serum levels should be monitored every 2 months once the client’s condition is stabilized.