Exam 2 Flashcards
What is Bipolar 1?
At lease one episode of mania* lasting more than one week alternating with major depression.
- TRUE mania
What is Bipolar 2?
One or more hypomanic episodes alternating with major depressive episodes.
Hypomania, NOT mania. Hypomania is one step below mania.
What is mania?
Abnormally elevated mood, irritable, or expansive.
Identify the expected findings among clients experiencing mania in bipolar disorders
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
What are some characteristics of depression in Bipolar?
Flat Blunted Labile affect lack of energy anhedonia
What are the risk factors for bipolar disorders?
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.
What is hypomania?
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.
What can a a hypomanic episode be a cue for?
That a manic episode is coming.
What constitutes a mental status exam?
General appearance Behavior Mood Affect Speech Thought process Thought content Perceptions Cognition Insight Judgment
Milieu therapy for manic episodes includes:
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
Priorities for manic patients in Milieu therapy
Assess for SI, Suicidal intentions, escalating behavior
Monitor for poor judgment and impulsive behavior
Identify methods of relapse prevention among clients with bipolar disorders
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.
What is conversion in anxiety?
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
What is repression in anxiety?
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.
What is dissociation?
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
What is depersonalization?
“out of body experience”
Observing one’s personality or body from the outside
What is derealization?
Feeling like the world is not real; objects appear larger or smaller than they should.
What are risk factors for anxiety?
Female
OCD
Acute medical conditions (PE, MI, hyperthyroidism)
Adverse effects of medications
Substance use or withdrawal from substance use
Manifestations of MILD anxiety
Typical baseline anxiety *Restlessness *Mild discomfort Irritability Impatience Tension-relief behaviors: foot tapping, fidgeting, inc. perception
Manifestations of MODERATE anxiety
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**
Manifestations of SEVERE anxiety
*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
Manifestations of PANIC level anxiety
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
List the formal anxiety disorders:
Look at ATI definitions
Separation anxiety disorder Specific phobias (dont need to know them) Agoraphobia Social anxiety disorder Panic disorder Generalized anxiety disorder
List the obsessive compulsive disorders
Look at ATI definitions
Obsessive compulsive disorder (OCD)
Hoarding disorder
Body dysmorphic disorder
What are some therapeutic interventions for anxiety disorders? Look at ATI definitions
Cognitive Therapy
Behavioral Therapy
Cognitive Behavioral Therapy (CBT)
What is cognitive therapy? Get ATI definition
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?”
What is behavioral therapy? Get ATI definition
Pharmacologic interventions for anxiety disorders
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
Anhedonia
lack of pleasure/joy
Alogia
poverty of thought or speech. Ex. a patient only mumbles or responds vaguely with visitors.
Avolition
lack of motivation in hygiene and activities. Patient may complete a task but is unable to start the next task without being prompted.
Neologisms
Made-up words that only have meaning to patient
Grandeur
Believes that they are all powerful and important, like a god
DIG FAST- Manic characteristics
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
