Anxiety, Bipolar Disorders, & Insomnia Flashcards
The clinical features of geriatric bipolar disorder differ from those of bipolar disorder in younger (age <50 years) patients. Determine features of geriatric bipolar disorder that are specific to this population.
General medical illnesses are least common in older patients.
Excessive sexual interest and behavior during manic or hypomanic episodes appear to be less common in older patients.
There is inability to sit for periods longer than 10 minutes.
There is a high predisposition to fight or cause physical altercations during exam.
Excessive sexual interest and behavior during manic or hypomanic episodes appear to be less common in older patients.
The NP provides research to peers and NP students that support the identification of certain risk factors for generalized anxiety disorders (GADs). Establish a risk factor sensitive for GAD diagnosis in late life and in the geriatric patient.
Parental loss or separation
History of mental problems in parents
Transgender identity
Recent adverse life events
Recent adverse life events
The NP studying anxiety in the elderly should understand associated specified anxiety disorders. Predict what should be included in patient and family education regarding the possible signs and behaviors that they may expect at home.
The patient may become evasive and lie more.
The patient may avoid family.
The patient may develop Tourette-like symptoms.
The patient may have apprehensiveness and irritability.
The patient may have apprehensiveness and irritability.
The NP understands that treating bipolar disorder is often difficult. Bipolar diagnosis for a geriatric patient and family can be challenging. Recommend an accurate statement to share with the patient and family.
Most patients will overcome these experiences without the need for intervention.
Talking with family is the primary method of treating and approaching bipolar disorder.
Psychotherapy alone is the best treatment option for bipolar disorder.
Geriatric patients with bipolar disorder often have moments of repetitive mood control and inability to control their symptoms at various levels, regardless of treatment.
Geriatric patients with bipolar disorder often have moments of repetitive mood control and inability to control their symptoms at various levels, regardless of treatment.
Mrs. Wool arrives to the clinic today to discuss her inability to continue her job as a billing clerk. She often gets sweaty when she has a message to return a phone call because of an error in a bill. She states that “I just know the person on the phone will give me a hard time. I start to tear before I pick up the phone now.” She is often stressed in public places at least daily for the last several months. Recommend how to treat Mrs. Wool’s anxiety.
Send Mrs. Wool home with the task of monitoring her symptoms.
Mrs. Wool needs Flexeril 10 mg PO daily and return to the clinic in 4 weeks.
Prescribe fluoxetine 100 mg po daily with return in 2 weeks for follow-up.
Prescribe paroxetine 5 mg PO daily with referral for counseling.
Prescribe paroxetine 5 mg PO daily with referral for counseling.
To screen for insomnia, it is important to involve a therapeutic and holistic approach. Recommend a question type in the HPI to determine best treatment approach for a patient with insomnia.
Ask if they are able to sleep away from home.
Ask if they have many friends who stay up late with them.
Ask if they have a family history of sleep disorders.
Ask about napping and dozing during the day or evening, which should be avoided to maximize sleep drive at night.
Ask about napping and dozing during the day or evening, which should be avoided to maximize sleep drive at night.
The diagnosis of generalized anxiety disorder (GAD) is based on the presence of generalized, persistent, and excessive anxiety and a combination of various psychological and somatic complaints. DSM-5 diagnostic criteria for GAD require the presence of six symptoms (with at least some symptoms having been present for more days than not for the past 6 months). Determine a symptom specific for diagnosing GAD.
Mania
No existence of significant impact to daily life
Euphoria
Restlessness or feeling keyed up or on edge
Restlessness or feeling keyed up or on edge
The NP student is seeing a 68-year-old patient today who arrives to the clinic with a history of bipolar disorder. She would expect the patient to have difficulty with daily routine activities. Propose an activity that this geriatric bipolar patient might describe as particularly difficult.
Communicating daily with family
Getting dressed daily
Routine job functions that require concentration
Household chores
Household chores
A full history is the best and only initial evaluation to determine approach, severity, and effect of physical, mental, and functional impairments correlating with insomnia. The NP understands that there are many precipitating factors that can contribute to insomnia. Predict the best precipitating factor to listen and inquire about.
Psychiatric disorders do not contribute to insomnia
Sleeping in a room with pink tones
Childhood memories
Nocturia or shortness of breath
Nocturia or shortness of breath
The NP has continued to research appropriate treatment and management options for the bipolar patient who is diagnosed and treated in late life. Recommend the best treatment choice for the patient with bipolar disorder.
Lithium 600 mg PO daily with routine serum levels
Hydroxyzine 25 mg PO qhs
Sertraline 40 mg PO daily
Paxil 10 mg PO daily
Lithium 600 mg PO daily with routine serum levels
Choose a screening tool specific for bipolar disorder that can be administered easily for geriatric patients.
DSM-V Depression and Anxiety Scale
CAGE questionnaire
PHS-6
PHQ-9
PHQ-9
It is important to understand all treatment options that are available for insomnia for your patient. Propose the best therapeutic option for the geriatric patient struggling with insomnia.
Watch the clock or a scary movie at bedtime.
Take medication (e.g., medical marijuana or other).
Set realistic allotted time and attempts to avoid lying in bed awake for longer time frames.
Undergo physical therapy.
Set realistic allotted time and attempts to avoid lying in bed awake for longer time frames.
The NP is working in the geriatric unit today to establish care for new patients. She meets an 80-year-old male who has been working with a psychologist for depression. The patient reports that he is being treated for depression but unsure if the medication he is taking will work for anxiety. He is anxious most times that there are events or new people around. Recommend the best medication to treat anxiety and depression.
Mirtazapine 45 mg PO qhs
Duloxetine 60 mg PO qd
Flexeril 10 mg po qhs
Buspirone 7.5 mg po BID
Duloxetine 60 mg PO qd
Anxiety in the elderly should not be ignored. Oftentimes, NPs treat patients daily without recognizing anxiety caused by depressive symptoms. Determine the most accurate statement surrounding anxiety behavior.
Worry is common for all, and excess worrying means caring more.
Worry about the uncontrollability and presumed dangerous consequences of worrying.
Worrying excessively about depression is not associated with anxiety.
The ability to calm oneself would eliminate the diagnosis of anxiety.
Worry about the uncontrollability and presumed dangerous consequences of worrying.
The NP understands the importance of selecting the correct class of medications for the patient suffering from insomnia. Propose the indicated class of medications for the patient with insomnia.
SSRIs
Melatonin
Stimulants
Muscle relaxers
Melatonin
