Mood and Affect Pt 2

Question 1

is mood objective or subjective

Answer 1

subjective

Question 2

is affect objective or subjective

Answer 2

objective

Question 3

how is bipolar characteriszed

Answer 3

mood swings from profound
depression to extreme
euphoria (mania), with
intervening periods of
normalcy.

Question 4

what is mania

Answer 4

An alteration in mood that may be expressed by feelings of
elation, inflated self-esteem, grandiosity, hyperactivity, agitation,
racing thoughts, and accelerated speech

Question 5

what is hypomania

Answer 5

Symptoms not sufficiently severe to cause
marked impairment in social or occupational
functioning or to require hospitalization
* Cheerful mood
* Rapid flow of ideas; heightened perception
* Increased motor activity

Question 6

what is acute mania

Answer 6

Marked impairment in functioning; usually requires
hospitalization
* Elation and euphoria; a continuous “high”
* Flight of ideas; accelerated, pressured speech
* Hallucinations and delusions may be present
* Excessive motor activity
* Social and sexual inhibition
* Little need for sleep (may go days without sleeping)

Question 7

what is delerious mania

Answer 7

A grave form of the disorder characterized by
an intensification of the symptoms associated with
acute mania.
* The condition is rare because the advent of
antipsychotic medication.
* Labile (unstable) mood; panic anxiety
* Clouding of consciousness; disorientation
* Frenzied psychomotor activity
* Exhaustion and possibly death without
intervention

Question 8

what is bipolar 1

Answer 8

Individual has experienced at least one full manic episode usually
followed by a depressed state
* May also experience hypomania
* May experience mixed episodes (mania/depression) lasting at least one-
week, anxious distress, or rapid cycling causing marked impairment in life.
* Psychotic or catatonic features may also be present
* Mania can be precipitated by medications to treat depression (SSRI,
SNRIs, TCAs)

Question 9

what is bipoalr 2

Answer 9

• History of at least one hypomania episode
• History of at least one episode of depression
• No history of full mania
• Characterized by recurrent bouts of depression with episodic occurrence
  of hypomania
• Not severe enough to cause marked impairment in social/occupational
  functioning or require hospitalization
• No psychosis in hypomania

Question 10

what is cyclothymic disorder

Answer 10

A chronic mood disturbance of at least 2 years’ duration
not as extreme as bipolar

Question 11

what is lithium

Answer 11

Helps control acute mania associated with bipolar disorder
 Used prophylactically to prevent recurrence of mania or depression
 The primary and preferred drug for treating mania associated with
bipolar disorder
 Not entirely clear how lithium regulates the mood
 Makes changes to the transport of sodium ions in nerve cells which
alters the metabolism of catecholamines (fight-or-flight hormones
released in response to stress)
 A sudden decrease in Na intake can increase lithium levels, while an
increase in NA may decrease lithium levels
 Decreases mania

Question 12

adverse reactions of lithium

Answer 12

 At therapeutic blood levels: Gastrointestinal symptoms may occur, but often
subside with time (take with milk or meals)
 A third of people taking lithium experience transient
 Fatigue
 Headache
 Confusion
 Muscle weakness
 Memory impairment
 Polyuria (antagonizing effect lithium has on ADH )
 Decrease secretion of thyroid hormone, may cause goiter or hypothyroidism
(monitor for lethargy, low heart rate, decreased body temperature)
 Fine hand tremor may develop and is exacerbated by stress or fatigue

Question 13

therapeutic blood levels of lithium

Answer 13

.4-1 mEq/L

Question 14

toxic level of lithium

Answer 14

> 1.5 mEq/L

Question 15

how much h20 to drink per day

Answer 15

8-12 glasses or 2-3L

Question 16

when are labs drawn

Answer 16

1-2 months post hosptial
12 hours after dose

Question 17

what else do we monitor foe when on lithium

Answer 17

Monitor BUN/Creatinine (danger of renal failure with toxicity) thyroid function, &
pregnancy (teratogenic – fetal heart defects)

Question 18

what else to know about lithium

Answer 18

 Those who are dehydrated, have low sodium levels, low sodium diets, and
taking diuretics should not take lithium
 May cause sodium depletion until consistent blood levels are achieved,
increases lithium levels, risk for toxicity
 Hx of angioedema from ACE inhibitors should not take lithium (risk for
toxicity)
 Drug interactions: NSAIDs (exception of aspirin), tetracycline (antibiotic),
diuretics, methyldopa (cardiac med for HTN), probenecid (med for gout)
 Weight gain is a common side effect

Question 19

s/s of lithium toxicity

Answer 19

 Low sodium diet can
decrease lithium elimination
leading to increased lithium
levels
 Persistent nausea and
vomiting, Severe diarrhea,
Ataxia (impaired
coordination), Blurred vision,
Tinnitus, Excessive output of
urine, Increasing tremors,
Mental confusion
Severe Nausea/Vomiting/Diarrhea Severe hand tremors
Confusion Vision Changes

Question 20

examples of anticonvulsants

Answer 20

valproate/valproic acid/divalproex: Therapeutic Level: 50-100 mcg/ml
lamotrigine, carbamazepine and oxcarbamazepine

Question 21

risks w/ valproate/valproic acid/divalproex

Answer 21

risk for thrombocytopenia: Check CBC, INR
- Risk of hepatotoxicity: Check LFTs
- Common side effects: GI upset, weight gain, alopecia

Question 22

risks w/ lamotrigine, carbamazepine, and oxcarbamazepine

Answer 22

Risk of life-threatening rash (Steven’s Johnson Syndrome)
* Risk of blood dyscrasias
* Blood disorders, i.e., anemia, clotting, bleeding
* Monitor CBC w/ diff
* Risk of eosinophilia (allergic response to medication)
* Inflammation of tissues, i.e., heart, lungs, skin, and nervous system
most affected
* Monitor white blood cells, specifically eosinophil count
* Risk of hepatotoxicity; monitor LFT
* GI upset

Question 23

what do you monitor for anticonvulsants in general

Answer 23

Monitor for skin rash, unusual bleeding, spontaneous bruising, signs of
hemorrhage, sore throat, fever, back pain, dark urine, and yellow skin

Question 24

is recovery model pt centered or illness centered

Answer 24

pt centered