Bipolar II Disorder and Antidepressants Overview

Bipolar II Disorder

• Characterized by hypomania alternating with major depression.
• Symptoms are similar to manic episodes, but less severe and duration is shorter (at least 4 days).
• No marked impairment in social or occupational functioning present.
• Psychosis is NOT present.
• Individuals may experience personality disturbances, difficulty controlling impulses, mood instability, and recurrent depression.

Selective Serotonin Reuptake Inhibitors (SSRIs)

• Examples: Lexapro, Prozac, Zoloft, Paxil, Celexa.
• Less side effects compared to older antidepressants.
• Safer in overdose.
• Common side effects: gastrointestinal issues, sexual dysfunction, and weight gain (in some cases).
• Potential for serotonin syndrome, which can be dangerous and even fatal.

Tricyclic Antidepressants (TCAs)

• Examples: Elavil, Tofranil, Sinequan, Pamelor.
• Proven efficacy and cost-effective.
• Common side effects: sedation, weight gain, blurred vision, dry mouth, constipation, urinary retention, sinus tachycardia, and decreased memory.
• Take at bedtime to minimize many side effects.
• Lethal in overdose.

Monoamine Oxidase Inhibitors (MAOIs)

• Examples: Nardil, Parnate.
• Often reserved for patients whose depression doesn't respond to other antidepressants or who can't tolerate typical antidepressants.
• Notable side effects and must be used cautiously.
• Can trigger a hypertensive crisis when taken with certain foods or substances containing tyramine (e.g., aged cheese, draft beer, smoked salmon, soy sauce, red wine).
• May be more lethal in overdose than newer antidepressants.

Depression Inventories

• Beck's Depression Inventory: Self-report questionnaire measuring attitudes and symptoms of depression (21 items).
• Geriatric Depression Scale: Self-report measure assessing depression in older adults (30 items, yes/no format).

Manic Episode Interventions

• Safety is paramount.
• Medically stabilize the patient first.
• Use short, clear explanations.
• Maintain neutrality and consistency in interactions.
• Distract the patient with constructive activities.
• Minimize environmental stimuli.
• Supervise clothing choices (particularly for women).
• Provide finger foods and fluids (to avoid potential dangers with utensils).
• Promote sleep.

Assessment for Suicidal Ideation

• Always assess for suicidal ideation.
• Ask directly: "Have you thought about hurting yourself?" "How often do these thoughts occur?" "Do you have a plan?"
• Assess the lethality of the plan.
• Establish a safety contract with the patient.
• Be aware of elopement risks.
• Consider past attempt history.
• Pay attention to potential warning signs: giving away possessions, making lists.

Major Depression: Diagnosis and Interventions

• Dysthymic Disorder: Characterized by a depressed mood for most days for at least 2 years.
• Symptoms are less severe than major depression but are more chronic (long-lasting).
• Assessment includes asking about suicidal ideation and plans, assessing lethality, establishing safety contracts, and reviewing previous attempts.
• Goal: Prevent self-harm.
• Interventions: One-on-one supervision, close observation, frequent checks, removal of potentially harmful objects, medication monitoring, suicide prevention education, and support groups.

Milieu Management

• Focus on providing a safe environment on the depression unit.

Drugs for Acute Management of Violent Behavior

• Antianxiety Agents (Benzodiazepines)
  • Lorazepam (Ativan)
  • Alprazolam (Xanax)
  • Diazepam (Valium)
• First-Generation Antipsychotics
  • Haloperidol (Haldol)
  • Perphenazine
  • Chlorpromazine (Thorazine)
  • Loxapine (Adasuve)
• Second-Generation Antipsychotics
  • Risperidone (Risperdal)
  • Olanzapine (Zyprexa)
  • Ziprasidone (Geodon)
• Combinations ("B52")
  • Haloperidol (Haldol)
  • Lorazepam (Ativan)
  • Diphenhydramine (Benadryl)

Alzheimer's Disease

• Affected neurotransmitters include acetylcholine (cognitive functioning), norepinephrine, and serotonin (deficits).
• Granulovascular Degeneration: Fluid and granular material fill brain cells, contributing to mental decline.
• Brain Atrophy: Observable in cerebral ventricles (visible in CT scan and MRI).
• Medications
  • Cholinesterase Inhibitors: (Galantamine, Rivastigmine, Donepezil) for mild to moderate Alzheimer's.
  • N-methyl-D-aspartate (NMDA) Antagonist: Memantine (Namenda) for moderate to severe Alzheimer's.
  • Atypical Antipsychotics: To manage behavioral symptoms (e.g., aggression, agitation).
  • SSRIs: To address coexisting depression.
  • Start Low & Go Slow! Dose medications carefully to minimize side effects.

Sexual Assault Interventions

• Focus on immediate support and long-term healing.
• Help survivors verbalize their experience, express feelings, understand common responses to assault, develop a plan for immediate needs, and connect with community resources.
• Long-term goals include physical healing, emotional healing, reducing fear and anxiety, and improving social interactions.

Intimate Partner Violence Education

• Educating communities about intimate partner violence is crucial for identifying, supporting, and protecting individuals from abuse.
• Reducing violence in intimate relationships requires community-based education and outreach.

This quiz covers the characteristics of Bipolar II Disorder and explores various antidepressant classes, including SSRIs and TCAs. You'll learn about their symptoms, side effects, and treatment implications. Test your understanding of these mental health topics!