Bipolar II Disorder and Antidepressants Overview
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Questions and Answers

Which feature distinguishes Bipolar II disorder from more severe forms of bipolar disorder?

  • Inclusion of psychotic symptoms
  • Presence of marked impairment in social functioning
  • Recurrent manic episodes
  • Duration of hypomanic episodes lasting at least 4 days (correct)

    • What is a common side effect associated with selective serotonin reuptake inhibitors (SSRIs)?

  • Intense mood elevation
  • Significant liver damage
  • Increased serotonin levels leading to serotonin syndrome (correct)
  • Severe psychotic episodes

    • Which statement about serotonin syndrome is TRUE?

  • It occurs only after long-term use of antidepressants
  • The symptoms develop within hours or days after a dosage increase (correct)
  • It cannot cause any severe complications
  • It is commonly treated with surgery

    • What is NOT a characteristic of Bipolar II disorder?

    <p>Involvement of marked impairment in functioning</p> Signup and view all the answers

    Which of the following drugs is classified as a serotonin norepinephrine reuptake inhibitor (SNRI)?

    <p>Effexor</p> Signup and view all the answers

    Which of the following is NOT a common symptom of a manic episode?

    <p>Persistent sadness</p> Signup and view all the answers

    What is a key nursing intervention during a manic episode?

    <p>Promote sleep</p> Signup and view all the answers

    Which assessment question is essential when assessing for suicidal ideation?

    <p>Do you have thoughts of hurting yourself?</p> Signup and view all the answers

    Which intervention is important to maintain a safe environment during a manic episode?

    <p>Maintain low levels of environmental stimuli</p> Signup and view all the answers

    What should the nurse prioritize in the assessment of a patient with suicidal ideation?

    <p>Determine the lethality of the patient's plan</p> Signup and view all the answers

    In managing a patient experiencing a manic episode, which of the following is a recommended dietary choice?

    <p>Finger foods and fluids</p> Signup and view all the answers

    Which behavior suggests a higher risk for suicide in a patient?

    <p>Giving away personal possessions</p> Signup and view all the answers

    How is Dysthymic Disorder different from Major Depressive Disorder?

    <p>It is a milder but chronic form of depression</p> Signup and view all the answers

    What is a significant risk associated with MAOIs?

    <p>Hypertensive crisis when combined with tyramine-containing foods</p> Signup and view all the answers

    Which of the following is NOT a common side effect of Tricyclic Antidepressants (TCAs)?

    <p>Increased energy levels</p> Signup and view all the answers

    Why should TCAs be taken at bedtime?

    <p>To minimize side effects</p> Signup and view all the answers

    What is the typical format of the Geriatric Depression Scale?

    <p>Yes/No format</p> Signup and view all the answers

    What should be monitored due to the potential lethality of MAOIs?

    <p>Suicide potential in patients</p> Signup and view all the answers

    Which of the following drugs is considered a Tricyclic Antidepressant?

    <p>Tofranil</p> Signup and view all the answers

    What is a common use for Beck's Depression Inventory?

    <p>To measure symptoms of depression</p> Signup and view all the answers

    Which side effect of TCAs is most commonly associated with antihistaminic properties?

    <p>Dry mouth</p> Signup and view all the answers

    Which symptom is NOT associated with dysthymic disorder?

    <p>Increased self-esteem</p> Signup and view all the answers

    What is a crucial assessment question related to suicide risk?

    <p>Do you have a plan?</p> Signup and view all the answers

    Which medication class is commonly used for acute management of violent behavior?

    <p>Antianxiety agents</p> Signup and view all the answers

    In dysthymic disorder, how long must symptoms persist for a diagnosis?

    <p>At least two years</p> Signup and view all the answers

    What does the acronym B52 refer to in psychiatric treatment?

    <p>A combination of medications</p> Signup and view all the answers

    Which of the following interventions focuses on enhancing patient safety?

    <p>Removing harmful objects from the environment</p> Signup and view all the answers

    Which of the following is a red flag for potential suicide risk?

    <p>Giving away personal belongings</p> Signup and view all the answers

    What is the primary goal when managing a patient with suicidal tendencies?

    <p>To prevent self-harm</p> Signup and view all the answers

    What is the primary effect of acetylcholine disruption on cognitive functioning?

    <p>Damage to memory.</p> Signup and view all the answers

    Which class of medications is specifically noted for improving cognition and behavior in mild to moderate Alzheimer's disease?

    <p>Cholinesterase Inhibitors</p> Signup and view all the answers

    What process is involved in Granulovascular Degeneration?

    <p>Filling of brain cells with fluid and granular material.</p> Signup and view all the answers

    Which medication targets symptoms of moderate to severe Alzheimer's disease?

    <p>Memantine</p> Signup and view all the answers

    What is a longer-term goal for therapy following a sexual assault?

    <p>Reduction in fear and anxiety.</p> Signup and view all the answers

    What is emphasized as crucial for reducing violence in intimate partner relationships?

    <p>Educating communities about IPV.</p> Signup and view all the answers

    What approach should be taken when prescribing medications for Alzheimer's disease?

    <p>START LOW &amp; GO SLOW!</p> Signup and view all the answers

    Which neurotransmitter deficiency is mentioned in relation to cognitive functioning?

    <p>Norepinephrine.</p> Signup and view all the answers

    Study Notes

    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.

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    Description

    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!

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