TOPIC 5 - impulse control disorders

Question 1

co occurring psychologic disorders of bipolar disorders

Answer 1

Anxiety disorders
Panic attacks
Behavioral disorders
Substance use and anxiety disorders worsen the prognosis and greatly increase the risk of suicide

Question 2

co occurring medical conditions with bipolar disorders

Answer 2

Cardiovascular
Cerebrovascular
Metabolic disorders
Conditions associated with manic symptoms

Question 3

manic episodes include three or more of these symptoms

Answer 3

Abnormally upbeat, jumpy, or wired

Increased activity, energy, or agitation

Exaggerated sense of well-being and self-confidence (euphoria)

Decreased need for sleep

Unusual talkativeness

Racing thoughts

Distractibility

Poor decision-making

Question 4

phases of mania treatment

Answer 4

acute phase : medical stabilization, maintaining safety, self care
continuation : maintain med adherence, pyschoeducational teaching, referrals
maintenance : preventing relapse

Question 5

mood stabilizer meds

Answer 5

lithium and anticonvulsants

Question 6

other meds for bipolar disorders

Answer 6

anxiolytics and atypical antipsychotics

Question 7

lithium carbonate

Answer 7

first line drug

alters sodium transport in nerve and muscle cells to inhibit the release of NE and dopamine, stabilizing depression and mania

Question 8

clients should not do what when taking lithium

Answer 8

avoid NSAIDs
not limit sodium intake
do not take diuretics

Question 9

mild lithium toxicity

Answer 9

muscle weakness, muscle twitching & ataxia, confusion, slurred speech, GI effects (nausea, vomiting, diarrhea), thirst, polyuria

Question 10

advanced toxicity

Answer 10

significant (coarse) hand tremor, persistent GI upset, ataxia & clonic movements, incoordination, EEG changes

Question 11

severe toxicity

Answer 11

Ataxia & clonic movements, blurred vision, large output of dilute urine, significant EEG changes, seizures, tinnitus, stupor, severe hypotension, coma. At levels over 2.5 mEq/L, clients decline rapidly due to cardiac dysrhythmias, peripheral circulatory collapse, proteinuria, oliguria, and death may occur. Death from lithium toxicity is most often due to pulmonary complications.

Question 12

therapeutic range for lithium

Answer 12

normal : 0.6-1.2
toxic : above 1.5
severe toxic : above 2

Question 13

mood stabilizer anticonvulsants

Answer 13

divalproex
carbamazepine
lamotrigine

Question 14

atypical antipsychotics

Answer 14

olanzapine
risperidone
aripiprazole
ziprasidone
quetiapine

used in mania for sedative properties

Question 15

anxiolytics

Answer 15

clonazepam
lorazepam

used in mania for treatment of resistant mania to calm psychomotor agitation

Question 16

oppositional defiant disorders

Answer 16

A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, often loses temper, easily annoyed, angry, argumentative with authority figures, defies or refuses to follow rules, annoyance, vindictive.

Question 17

conduct disorder

Answer 17

(before age 10) physically aggressive, has poor relationships, shows little to no concern for others, lacks guilt, more likely to continue to adulthood

(10-18) less aggressive, acts out misconduct with peer group, less likely to continue into adulthood

Question 18

impulse control disorders

Answer 18

decreased ability to resist an impulse
tension builds until a particular action is taken
similar to OCD, but no associated with obsession

Question 19

nonpharmacologic treatments of impulse control

Answer 19

hypnotherapy, CBT, biofeedback, behavioral conditioning, group psychotherapy