Ch 13 Vocab

Question 1

Bipolar 1 disorder

Answer 1

A mood disorder that is characterized by at least one week-long manic episode that results in excessive activity and energy. (May alternate with depression or mixed state of agitation and depression). Psychosis may occur during mania. Antidepressant are not recommended for this phase

Question 2

Psychosis

Answer 2

Hallucinations, delusions, and dramatically disturbed thoughts

Question 3

Behaviors constituting mania

Answer 3

Extreme drive and energy, inflated sense of self-importance, drastically reduced sleep requirements, unusually obsessed with and over focused on goals, purposeless arousal and movement, dangerous activities such as indiscriminate spending, reckless sexual encounters, risky investments. Can be euphoric or dysphoric

Question 4

Euphoric mania

Answer 4

Feels wonderful in the beginning. Turns scary and dark as it progresses toward loss of control and confusion.

Question 5

Dysphoric mania

Answer 5

Mixed state or agitated depression, with depressive symptoms. May be irritable, angry, suicidal, or hyper sexual. May have panic attacks, pressured speech, agitation, severe insomnia, grandiosity and persecutory delusions and confusion

Question 6

Bipolar II disorder

Answer 6

Low-level mania (hypomania) alternates with profound depression. Hypomania tends to be euphoric and often increases in functioning. Disorder is less severe. Psychosis is only present in the depressive side of the disorder. Depressive symptoms tend to put those who suffer from it at particular risk for suicide.

Question 7

Hypomania

Answer 7

Excessive activity and energy for at least four days and involves at least three of the behaviors listed under mania. Psychosis is never present in hypomania. Voracious appetites for social engagement, spending, and activity, even indiscriminate sex. Reduced need for sleep (could be several days in a row), short periods of sleep are possible. Nonstop activity, lack of sleep, and food can lead to physical exhaustion and even death if not treated so hypomania is an emergency

Question 8

Cyclothymic disorder

Answer 8

Hypomania symptoms alternate with mild to moderate depression symptoms for at least two years in adults and one year in children. Neither set of symptoms constitutes an actual diagnosis of either disorder but the symptoms are disturbing enough to cause social and occupational impairment. irritable hypomania episodes. In children it presents as irritability and sleep disturbances.

Question 9

Rapid cycling

Answer 9

At least four mood episodes in a 12-month period. Cycling can also occur within the course of a month or even a 24-hour period. Associated with more severe symptoms: poorer global functioning, high recurrence risk, and resistance to conventional somatic treatments. Estimated to be present in 12-24% of patients who go to specialized clinics for mood disorders

Question 10

Flight of Ideas

Answer 10

Nearly continuous flow of accelerated speech with abrupt changes from topic to topic that are usually based on understandable associations or plays on words. Speech is rapid, verbose, and circumstantial (including minute and unnecessary detail). Severe condition may mean the speech is disorganized and incoherent. Incessant talking includes joking, puns, and teasing. Content of speech is often sexually explicit and ranges grossly inappropriate to vulgar.

Question 11

Clang associations

Answer 11

The stringing together of words because of their rhyming sounds, without regard to their meaning.

Question 12

Grandiosity

Answer 12

Inflated self regard in both the ideas expressed and the persons behavior. People with may exaggerate their achievements or importance and say that God is speaking to them or that the FBI is out to stop them from saving the world. Delusions and hallucinations may occur with mania escalation.

Question 13

Acute phase outcomes

Answer 13

The primary outcome is injury prevention. Outcomes are both physiological and psychological. Patients will be:well hydrated, maintain stable cardiac status, maintain/obtain tissue integrity, get sufficient sleep and rest, demonstrate thought self-control, make no attempt at self harm

Question 14

Outcomes for Continuous phase

Answer 14

Lasts for 4-9 months. The overall outcome of this phase is relapse prevention. These things need to be achieved in order to prevent relapse from occurring: psychoeducational classes for patient and family related to:
-knowledge of disease process
-knowledge of medication
-consequences of substance addictions for predicting future relapse
-knowledge of early signs and symptoms of relapse
Support groups or therapy (conflictive behavioral-interpersonal). Communication and problem solving skills training.

Question 15

Outcomes for maintenance phase

Answer 15

Focus on prevention of relapse and limitation of the severity and duration of future episodes

• participation in learning interpersonal strategies related to work, interpersonal, and family problems
• participation in psychotherapy, group, or other ongoing supportive therapy modality

Question 16

The first line of treatment for a person with bipolar disorder experiencing an acute depressive episode

Answer 16

Lithium and lamotrigine (lamictal)

Question 17

Lithium Carbonate

Answer 17

LiCO3 is effective in the treatment of bipolar 1 acute and recurrent manic and depressive episodes. Lithium is less effective in people with mixed mania.
Indications: elation, grandiosity, and expansiveness
Flight of ideas, irritability and manipulation, anxiety
Lesser lithium control: insomnia, psychomotor agitation, threatening or assaultive behavior, distractibility, hypersexuality, paranoia
Therapeutic levels must be reached in the patients blood to be effective. It usually takes 7-14 days.
-antipsychotic or benzodiazepines can be used to prevent exhaustion, coronary collapse, and death until lithium reaches therapeutic levels.
Antipsychotics act promptly in slow speech, inhibit aggression, and decrease psychomotor activity. Many patients receive lithium for maintenance indefinitely and experience manic and depressive episodes if the drug is discontinued.

Question 18

Lithium blood levels

Answer 18

Therapeutic range= 0.8-1.4
Maintenance range= 0.4-1.3
Avoid lithium toxicity= bellow 1.5
Early signs of toxicity= 1.5-2.0
Advanced signs of toxicity= 2.0-2.5

Gastric lovage, treatment with urea, mannitol, and aminophylline can hasten lithium excretion
Lithium levels should me measured at least 5 days after beginning lithium therapy and after any dosage change, until the therapeutic level has been reached. Once therapeutic blood levels are reached, blood levels are tested every month. After 6 months to a year of stability, measurement of blood levels every 3 months is needed.
Blood should be drawn in the morning, 8-12 hours after the last dose of lithium is taken.
Start low and go slow

Question 19

2 major long term risks for lithium therapy

Answer 19

Hypothyroidism and impairment of the kidney’s ability to concentrate urine

Question 20

Anticonvulsant drugs

Answer 20

Used for the treatment of mood disorders: valoroate (depakote) carbamazepine (tegratol), and lamotrigine (Lamictal)
Superior for continuously cycling patients, more effective when there is no family history of bipolar disease, effective at dampening effective mood swings in schizoaffective patients, diminishes impulsive and aggressive behavior in some nonpsychotic patients, helpful in alcohol and benzodiazepine withdrawal, beneficial in controlling mania (within 2 weeks) and depression (within 3 weeks or longer)