Exam 2

Question 1

What is Bipolar 1?

Answer 1

At lease one episode of mania* lasting more than one week alternating with major depression.

• TRUE mania

Question 2

What is Bipolar 2?

Answer 2

One or more hypomanic episodes alternating with major depressive episodes.

Hypomania, NOT mania. Hypomania is one step below mania.

Question 3

What is mania?

Answer 3

Abnormally elevated mood, irritable, or expansive.

Question 4

Identify the expected findings among clients experiencing mania in bipolar disorders

Answer 4

DIG FAST
D: Distractibility
I:   Indiscretion; excessive involvement in pleasurable activities
G: Grandiosity
F:  Flight of ideas
A:  Activity increase
S:  Sleep deficit/decreased need for sleep
T:  Talkative/pressured speech

Question 5

What are some characteristics of depression in Bipolar?

Answer 5

Flat
Blunted
Labile affect
lack of energy
anhedonia

Question 6

What are the risk factors for bipolar disorders?

Answer 6

Genetics: immediate family member with bipolar
Physiological: co-occuring mental health, substance use, or personality disorder.
Environmental: Stress can cause mania and depression and increase the severity of manifestations.

Question 7

What is hypomania?

Answer 7

Less intense than mania
Has to last at least 4 days
Has to have 3 or more manifestations of mania
Does NOT require hospitalization
Slight impairment in daily functioning. E.g. hypomanic patient would be sleeping less than usual. As opposed to the patient with mania not sleeping for days at all.
No Psychosis occurs here, like it can in mania.

Question 8

What can a a hypomanic episode be a cue for?

Answer 8

That a manic episode is coming.

Question 9

What constitutes a mental status exam?

Answer 9

General appearance
Behavior
Mood
Affect
Speech
Thought process
Thought content
Perceptions
Cognition
Insight
Judgment

Question 10

Milieu therapy for manic episodes includes:

Answer 10

Decrease environmental stimulation (diminish loud noises/lights)
Avoid situations with lots of people
Avoid lots of decision making
Promote sleep and naps, frequent rest periods.
Provide outlets for physical activity, allow to pace and walk
Prompt hygiene and dress
Handheld high calories foods!! Offer frequently
Set clear, calm, and concise expectations and boundaries

Question 11

Priorities for manic patients in Milieu therapy

Answer 11

Assess for SI, Suicidal intentions, escalating behavior

Monitor for poor judgment and impulsive behavior

Question 12

Identify methods of relapse prevention among clients with bipolar disorders

Answer 12

Strong discharge planning with ongoing support groups
Long term meds
Education on cues before manic and depressive episodes begin
Maintaining sleep, avoiding excess caffeine and alcohol. Poor sleep can trigger episodes or be indicative of an episode starting.

Question 13

What is conversion in anxiety?

Answer 13

Responding to stress through unconscious development of physical manifestations not caused by a physical illness.

E.g. person experiences deafness after their partner tells them they want a divorce

Question 14

What is repression in anxiety?

Answer 14

Unconsciously putting unacceptable thoughts and feelings out of awareness

E.g. person who has a fear of going to the dentist forgets their dental appointment.

Question 15

What is dissociation?

Answer 15

Disruption in consciousness, perception, memory, or identity in order to compartmentalize uncomfortable feelings or circumstances

E.g. person forgets who they are after sexual assault

Question 16

What is depersonalization?

Answer 16

“out of body experience”

Observing one’s personality or body from the outside

Question 17

What is derealization?

Answer 17

Feeling like the world is not real; objects appear larger or smaller than they should.

Question 18

What are risk factors for anxiety?

Answer 18

Female
OCD
Acute medical conditions (PE, MI, hyperthyroidism)
Adverse effects of medications
Substance use or withdrawal from substance use

Question 19

Manifestations of MILD anxiety

Answer 19

Typical baseline anxiety
*Restlessness
*Mild discomfort
Irritability
Impatience
Tension-relief behaviors:  foot tapping, fidgeting, inc. perception

Question 20

Manifestations of MODERATE anxiety

Answer 20

Slight reduced perception and information processing 
Selective inattention
Difficulty concentrating, losing train of thought
Tiredness
Pacing
Change in voice pitch
Voice tremors
Shakiness
Increased HR and RR
Headaches, Backaches
Insomnia
Benefits from instructions from others usually

E.g. public speaking**

Question 21

Manifestations of SEVERE anxiety

Answer 21

*Very apparent at this point
*Distorted perceptions
*Restless, Pacing, Automatic behaviors (that dont have a purpose)
Worked up
*Unable to focus/learn/problem solve, just so anxious
Confusion
Feeling of impending doom
HTN, Tachy
Loud rapid speech
Cannot take instructions

Question 22

Manifestations of PANIC level anxiety

Answer 22

Markedly disturbed behavior and dysfunction in speech
Dilated pupils
Severe shakiness
Withdrawal or dissociation
Inability to sleep
Delusions and hallucinations
Think panic attacks.  
Full blown feeling like you cannot breath
Pressure on chest
May lose touch with reality
Extreme fright or horror
Severe hyperactivity, flight, or immobility

Question 23

List the formal anxiety disorders:

Look at ATI definitions

Answer 23

Separation anxiety disorder
Specific phobias (dont need to know them)
Agoraphobia
Social anxiety disorder
Panic disorder
Generalized anxiety disorder

Question 24

List the obsessive compulsive disorders

Look at ATI definitions

Answer 24

Obsessive compulsive disorder (OCD)
Hoarding disorder
Body dysmorphic disorder

Question 25

What are some therapeutic interventions for anxiety disorders? Look at ATI definitions

Answer 25

Cognitive Therapy
Behavioral Therapy
Cognitive Behavioral Therapy (CBT)

Question 26

What is cognitive therapy? Get ATI definition

Answer 26

Helps people reframe the anxious thoughts they are having.
“Is the anxiety caused by the true reality of the moment, or is it based on a thought?”

Checking the thought process and reframing it. “Is this actually true? Is there a solid reason to believe this?”

Question 27

What is behavioral therapy? Get ATI definition

Question 28

Pharmacologic interventions for anxiety disorders

Answer 28

B-Adrenergic Blocker Antagonists (beta blockers): may be PRN to calm the body
Benzodiazepines
Non-benzodiazepine Anti-anxiety agents
Antidepressants: can help if due to neurotransmitter imbalances

Question 29

Anhedonia

Answer 29

lack of pleasure/joy

Question 30

Alogia

Answer 30

poverty of thought or speech. Ex. a patient only mumbles or responds vaguely with visitors.

Question 31

Avolition

Answer 31

lack of motivation in hygiene and activities. Patient may complete a task but is unable to start the next task without being prompted.

Question 32

Neologisms

Answer 32

Made-up words that only have meaning to patient

Question 33

Grandeur

Answer 33

Believes that they are all powerful and important, like a god

Question 34

DIG FAST- Manic characteristics

Answer 34

Distractibility- decreased attention span
Indiscretion- excessive involvement in pleasurable activities
Grandiosity- thinking oneself is very important, a god
Flight of ideas
Activity increase
Sleep deficit/decreased need for sleep
Talkative/pressured speech