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411 Mental Health Exam 1 > Module 4: Suicide Prevention, Bipolar Disorder, & Anti-Manic Agents > Flashcards

Module 4: Suicide Prevention, Bipolar Disorder, & Anti-Manic Agents Flashcards

1
Q

List some suicide risk factors.

A
  • Medical and mental illnesses
  • Trauma
  • Previous attempts
  • Recent psychiatric hospitalization
  • Access to lethal means
  • Social losses
  • Hopelessness
  • Family history of suicide
  • Local epidemics
  • COVID?
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2
Q

List some population groups that have a higher risk for suicide.

A
  • 10th leading cause of death
  • 2nd leading cause of death age 10-34
  • Suicide peaks during middle age – 2nd peak age 75 and older
  • Male suicide completion 4X than females
  • White middle-aged male 45 – 65 years of age 70%
  • Veterans
  • American Indian and Alaska Native highest
  • Use of firearms most prominent
  • High risk groups
    • Older adults
    • LGBTQIA+
    • Black youth
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3
Q

Describe risk assessment for suicide.

A

Suicide assessment is always a priority

  1. Identification of suicidal ideation
  2. Elicitation of a plan
  3. Determination of the severity of intent
  4. Evaluation of availability of means
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4
Q

Nursing intervention to reduce imminent risk of suicide?

A
  • Ensuring safety
  • Reconnecting the patient to other people and instilling hope
  • Restoring emotional stability and reducing suicidal behavior
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5
Q

Nursing interventions to reduce intermediate and long-term risk of suicide?

A
  • Expect setbacks
  • Understand triggers, develop coping and goals
  • Continuous engagement with healthcare services (Inpatient →Outpatient)
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6
Q

Bipolar I Disorder diagnostic criteria?

A
  • At least 1 Manic Episode
  • Mania and other mood symptoms cannot be better explained by another diagnosis
  • Major depressive episodes are common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder.
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7
Q

Mania diagnostic criteria?

A
  • Marked impairment in functioning
  • Elevated, expansive, or irritable mood and increased activity/energy for at least 1 week (or less if hospitalization required)
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8
Q

Mania symptoms?

A

Distractibility ↑
Irresponsibility
Grandiosity ↑
Flight of Ideas
Activity ↑
Sleep ↓
Talkativeness ↑

DIGFAST

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9
Q

Define hypomania.

A

Elevated, expansive, or irritable mood and increased activity/energy for at least 4 days

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10
Q

Bipolar II Disorder diagnostic criteria?

A
  • At least one hypomanic episode + a major depressive episode (required)
  • Less “marked impairment” yet observable and unusual
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11
Q

Bipolar II Disorder diagnostic criteria also includes 3 of the following:

A
  • Decreased need for sleep
  • Increased self-esteem
  • More talkative or pressured speech
  • Distractibility
  • Increased goal directed activity or psychomotor agitation
  • Racing thoughts
  • Risky Activities/ Excessive spending
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12
Q

Cyclothymia diagnostic criteria?

A

Chronic fluctuating mood:

  • For at least 2 years, for at least 50% of the time, there have been multiple:
    • Hypomanic symptoms without meeting full criteria
    • Depressive episodes without meeting full criteria
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13
Q

List some Antimanic Drugs.

A
  • Lithium
  • Valproic Acid (Depakote)
  • Carbamazepine (Tegretol)
  • Lamotrigine (Lamictal)
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14
Q

Lithium MOA?

A

unknown

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15
Q

Lithium drug interactions?

A

Diuretics, NSAIDS, TCAs all cause lithium accumulation (TOXICITY RISK!)

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16
Q

Lithium therapeutic range?

A

12-hour trough serum level of 0.6 to 1.2 mEq/L (narrow therapeutic range!)

17
Q

Lithium nursing consideration & patient education?

A
  • Monitor at least 5 days after dose changes, then every 1-3 months while in maintenance (Lithium level, BUN, Creatinine)
  • Thyroid must be assessed annually!
18
Q

Lithium mnemonic?

A

Levels (0.6-1.2 mEq/L)
Increased urination (polyuria)/ Insipidus
Tremors/Thirst
Hypothyroidism
Interactions (NSAIDS, ACE-Is, Diuretic, etc.)
Upset stomach
Muscle weakness/ Miscellaneous- EKG changes)

19
Q

Valproic Acid (Divalproex Sodium) MOA?

A
  • Blockade of Na+, possibly Ca++ and K+ channels
  • Simulates ADH release
20
Q

Valproic Acid (Divalproex Sodium) common adverse effects?

A
  • Sedation
  • Tremor
  • Thrombocytopenia
  • Anorexia
  • N/V
21
Q

Valproic Acid (Divalproex Sodium) black box?

A
  • Hepatotoxic
  • Pancreatitis
  • Teratogenic
22
Q

Valproic Acid (Divalproex Sodium) nursing considerations?

A
  • Traditional AEDs cause CNS effects, educate patients about drowsiness, sedation and depression (what about driving!)
  • Monitor for S/S of toxicity (nystagmus, diplopia)
  • Hepatotoxicty + Pancreatitis: Monitor LFTs + amylase periodically, patient should also monitor for N/V, jaundice, abdominal pain
  • Rarely Thrombocytopenia: Monitor platelets, educate patient to notify prescriber of bruising
23
Q

Carbamazepine MOA?

A
  • Increases dopamine availability
  • Works on GABA
24
Q

Carbamazepine common adverse effects?

A
  • Nystagmus
  • Blurred vision
  • Dizziness
  • Drowsiness
  • N/V
25
Q

Carbamazepine black box?

A
  • Stevens-Johnson syndrome
  • Bone marrow suppression leading to anemia and agranulocytosis
26
Q

Carbamazepine nursing considerations?

A

CNS effects:

  • Use caution when driving
  • The visual disturbances should decrease over time

Due to SJS/TEN:

  • Protect skin from sun exposure
  • Report skin rash/mouth sores

Due to bone marrow suppression:

  • Periodic checks of CBC
  • Report fever/sore throat

Fluid Retention:

  • Check BMP (Na, BUN)

Administration:

  • Give with food (can cause GI symptoms)
  • Can give at bedtime, if possible, to sleep through symptoms
27
Q

SJS nursing consideration?

A
  • Fever, Rash
  • Early catching and discontinuation of the offending drug is essential.
28
Q

Lamotrigine MOA?

A

Weak inhibitory effect on the serotonin 5-HT3 receptor

29
Q

Lamotrigine common adverse effects?

A
  • Diplopia
  • Dizziness
  • Headache
  • N/V
30
Q

Lamotrigine black box?

A

Stevens-Johnson syndrome

31
Q

Lamotrigine nursing considerations?

A

Due to SJS/TEN:

  • Protect skin from sun exposure
  • Report skin rash/mouth sores

CNS effects:

  • Use caution when driving
  • The visual disturbances should decrease over time

411 Mental Health Exam 1 (4 decks)

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