psych

Question 1

Bipolar disorder was formerly called

Answer 1

manic depressive illness

Question 2

what are the two opposite poles that characterizes Bipolar disorder

Answer 2

–Euphoria
–Depression

Question 3

bipolar disorder is

Answer 3

•Chronic, recurring, life-threatening illness
–Individuals experience interpersonal, occupational difficulties even during remission
–Associated with highest lifetime suicide rate among psychiatric disorders

Question 4

Bipolar I

Answer 4

–At least one episode of mania alternating with major depression
–Psychosis may accompany manic episode
could see psychosis, or hallucinations

Question 5

Bipolar II

Answer 5

–Hypomanic episode(s) alternating with major depression
–Not accompanied by psychosis
when they drop down to major depression they may have delusions.

Question 6

cyclothymia

Answer 6

–Hypomanic episodes alternating with minor depressive episodes

Question 7

•Specifier from DSM-IV-TR

Answer 7

–Rapid cycling (four or more episodes in 12-month period)

Question 8

prevelance of bipolar disorder

Answer 8

–Lifetime prevalence in U.S. estimated at 3.9%
–First episode commonly occurs between ages 18 and 30

Question 9

comorbidity bipolar disorder

Answer 9

–Substance use disorders, personality disorders, anxiety disorders, attention deficit hyperactivity disorder
–Medical conditions: cardiovascular, cerebrovascular, metabolic disorders

Question 10

Bipolar Genetics

Answer 10

–Twin, family, and adoptive studies support strong genetic component
–Specific genes identified on chromosome 13 associated with bipolar disorder

Question 11

cycling

Answer 11

moving up and down between moods. The faster someone moves between mania and depression, the more acutley ill the person is.

Question 12

neurobiological factors bipolar

Answer 12

–Hypothalamic-pituitary-thyroid-adrenal axis dysfunction implicated

Question 13

neuroanatomical factors bipolar

Answer 13

–Dysregulation in prefrontal cortex and medial temporal lobe implicated

Question 14

psychological influences

Answer 14

–Stressful life events
–Families characterized by high expressed emotion most associated with relapse

Question 15

cultural considerations

Answer 15

–More prevalent in higher socioeconomic classes
–Higher rates noted among creative writers, artists, highly educated men and women

Question 16

bipolar periods

Answer 16

•Periods of abnormal and persistently elevated mood for at leas:
–4 days for hypomania
–1 week for mania

Question 17

hypomania

Answer 17

–Episode associated with decreased function
–Hospitalization not required

Question 18

mania

Answer 18

–Episode associated with marked impairment in function
–Hospitalization necessary

Question 19

common symptoms of mania

Answer 19

–Unstable euphoric mood, intense feeling of well-being, mood may change to irritation and anger when thwarted

Question 20

behavioral symptoms of mania

Answer 20

– Excessive hyperactivity, involved in pleasurable activities with painful consequences, sexual indiscretion, excessive spending of money, mode of dress/makeup may be outlandish, bizarre

Question 21

physical symptoms of mania

Answer 21

– Nonstop activity, minimal food intake, little or no sleep
–Can lead to exhaustion and even death

Question 22

cognitive suymptoms of mania

Answer 22

–Poor concentration, problems with verbal memory, sustained attention and executive functioning (may persist even in remission)
–Flight of ideas: continuous flow of accelerated speech with abrupt changes from topic to topic usually based on understandable associations

–Disorganized and incoherent speech with content often sexually explicit and grossly inappropriate
–Clang associations: stringing together of words because of rhyming sounds
–Grandiose persecutory delusions

Question 23

assessment for bipolar disorder

Answer 23

•Determine if patient dangerous to self or others
–Presence of physical exhaustion
–Poor impulse control
–Uncontrolled spending of money
•Determine medical symptoms
–Dehydration, infections

•Determine presence of other medical/psychiatric conditions
•Determine if hospitalization is necessary
•Determine patient’s and family’s understanding of disorder, treatment, medications, support groups
•

Question 24

common nursing diagnosis for bipolar

Answer 24

–Risk for injury, Risk for self- or other-directed violence, Risk for suicide, Ineffective coping, Disturbed thought processes, Interrupted family processes, Impaired verbal communication, Imbalanced nutrition: less than body requirements

Question 25

outcomes of bipolar disorder

Answer 25

–Acute phase: goal is prevention of physical injury and decrease in symptoms manifested
–Continuation of treatment phase: goal is relapse prevention
–Maintenance phase: goal is relapse prevention and limiting severity of future episodes

Question 26

planning bipolar

Answer 26

Geared toward particular phase of mania as well as other co-occurring issues (e.g., risk of suicide, risk of violence, family/legal crisis, substance abuse, risk-taking behaviors, medical compliance

Question 27

implementation bipolar

Answer 27

–Directed toward establishing therapeutic alliance
–Acute phase implementations related to safety in hospital environment, establishment of controls and medical stabilization

Question 28

clang associations (billy madison)

Answer 28

rhyming words

crunch you, munch you , punch you

Question 29

communication guidlines bipolar

Answer 29

•Use firm, calm approach
•Use short, concise statements
•Remain neutral; avoid power struggles
•Be consistent
–Important with firm limit setting
•Hear and act on legitimate complaints
•Firmly redirect energy into appropriate channels

Question 30

milieu treatment bipolar

Answer 30

•Seclusion and restraints may be used if patient becomes dangerously out of control and other least restrictive measures failed
–Purposes: reduces overwhelming stimuli, protects patient and others from injury, prevents destruction of property

•Use of seclusion/restraint associated with complex legal, ethical, and therapeutic issues
–Follow well-established institutional protocols for use of these measures

Question 31

mood stabilizer treatment bipolar

Answer 31

•Used for lifetime maintenance therapy
•Lithium carbonate: first-line treatment for mania
–Therapeutic blood level must be reached for drug to be effective (usually takes 7-14 days)
•Maintenance/therapeutic blood levels between 0.4 and 1.3 mEq/L
–Used in combination with antipsychotics or antianxiety medications in initial acute mania

Question 32

lithium carbonate

Answer 32

first-line treatment for mania
–Therapeutic blood level must be reached for drug to be effective (usually takes 7-14 days)
•Maintenance/therapeutic blood levels between 0.4 and 1.3 mEq/L
–Used in combination with antipsychotics or antianxiety medications in initial acute mania
•Adverse reactions
–Related to lithium toxicity—fine line between therapeutic and toxic levels
–Lithium toxicity ranges from mild to moderate and severe symptoms depending on blood level
•Severe symptoms include ataxia, ECG changes, clonic movements, seizures, coma, and death

•
–Major long-term risks include hypothyroidism and kidney impairment
•Necessity for periodic thyroid and renal function tests

•Patient and family teaching important
–Continue drug therapy to prevent relapse
–Maintenance of normal diet with normal salt and fluid intake (1500-3000 mL/day)
•Lithium decreases sodium absorption and low sodium levels/dehydration cause lithium toxicity
–Stop taking lithium and call physician if symptoms of dehydration develop from sweating and/or nausea, vomiting, diarrhea

Question 33

antiepileptic medications bipolar

Answer 33

•Adjunct to lithium as well as treatment for patients not responsive to lithium
•Commonly used drugs
–Carbamazepine (Tegretol), divalproex (Depakote), lamotrigine (Lamictal)
•Adverse effects of individual antiepileptic drugs vary but include such problems as sedation, agranulocytosis, hepatitis, life-threatening rash

Question 34

ECT

Answer 34

• Can be used to subdue severe manic behavior in patients who are treatment resistant to usual medications
• May also be used in patients who are suicidal

Question 35

pyschotherapy bipolar

Answer 35

•Cognitive-behavioral therapy
–Cognitive restructuring effective in decreasing affective symptoms, increasing social functioning, and reducing relapse
•Interpersonal and social rhythm therapy (IPSRT)
–Focuses on resolution of interpersonal problems and prevention of further disputes

•Family-focused therapy
–Treatment approach focusing on communication within family, communication skills, and education to prevent relapse

Question 36

evaluation bipolar

Answer 36

•Short-term and intermediate evaluation focused on goal attainment such as:
–Are patient’s vital signs stable?
–Is patient well hydrated ?
–Is patient able to control behavior or respond to external controls?
–Does patient sleep at least 5 hours per night?
–Does family have understanding of illness and treatment?

•Long-term evaluation focused on goal attainment such as compliance with medication regimen, resumption of functioning in community, and family

Question 37

therapeutic range of lithium

Answer 37

Therapeutic blood level must be reached for drug to be effective (usually takes 7-14 days)
•Maintenance/therapeutic blood levels between 0.4 and 1.3 mEq/L

Question 38

lithium toxicity

Answer 38

•Severe symptoms include ataxia, ECG changes, clonic movements, seizures, coma, and death

Question 39

major side effects of Lamictal

Answer 39

steven johnson’s syndrome