59 Questions
What is the defining characteristic of cyclothymia?
Experiencing hypomanic and depressive symptoms that do not meet criteria for major episodes
Which neurotransmitters are affected in mood disorders?
Dopamine, norepinephrine, and serotonin
What is the effect of low dopamine levels?
Loss of pleasure, interest, alertness, and self-confidence
What is the effect of high norepinephrine levels?
Increased anxiety, nervousness, and difficulty focusing
What is the role of serotonin in mood disorders?
Serotonin is involved in the regulation of mood, appetite, and sleep
What is the defining characteristic of mania?
Persistently elevated, expansive, or irritable mood
What are symptoms of decreased positive affect?
Decreased energy and self-confidence
Which neurotransmitter is responsible for decreased positive affect?
Dopamine (DA)
What is Bipolar Disorder characterized by?
Fluctuations in mood, energy, and ability to function
How is Bipolar Disorder diagnosed?
When a client has episodes of mania or hypomania with a history of major depressive episodes
What distinguishes Bipolar type 1 from Bipolar type 2?
Duration of manic episodes
What is mania characterized by?
Persistent elevated, expansive, or irritable mood
What should be the first step in selecting initial treatment according to the text?
Assess client safety, comorbidities, and treatment adherence
Which factor is associated with nonadherence to medication according to the text?
Manifestations of bipolar disorder like mixed episodes, rapid-cycling, hallucinations, & bipolar 1 disorder
What is the mechanism of action of Carbamazepine (Tegretol) according to the text?
Glutamate voltage-gated sodium and calcium channel blocker
What should be considered in patients with Asian ancestry before prescribing Carbamazepine (Tegretol) per the text?
HLA-B 2501 allele genotyping
Which neurotransmitter system is influenced by Lamotrigine (Lamictal) according to the text?
GABA
What is a characteristic of Lamotrigine (Lamictal) mentioned in the text?
Higher efficacy compared to lithium
Which medication has a risk for a rare, but serious, skin rash and multiorgan failure?
Lamotrigine (Lamictal)
What is the primary effect of valproic acid (Depakene) on the brain?
Affects ion transport and enhances the activity of GABA
If a patient is taking both lamotrigine (Lamictal) and valproic acid (Depakene), how should the valproate dose be adjusted?
Decrease the valproate dose by 50%
Which of the following is the most appropriate use of intramuscular (IM) aripiprazole?
After an oral trial has established tolerability
Which of the following is a primary therapeutic use of lithium?
All of the above
What is the most important question the PMHNP should ask before prescribing medication to the patient who reports feeling very depressed, irritable, and distracted?
Have you had any thoughts of harming yourself or others?
What is a common symptom of manic episodes in bipolar disorder?
Grandiosity
Which term describes a manic episode that is not severe enough to cause significant functional impairment or hospitalization?
Hypomanic
What is a challenge in diagnosing bipolar disorder when a client presents in the depression phase?
Reluctance to report elevated mood
What symptom is commonly seen in the depressed mixed phase of bipolar disorder?
Pacing and fidgeting
Which of the following is a recommended treatment for agitation in bipolar disorder?
Rapid-acting oral antimanic medications
Why can diagnosing bipolar disorder be more challenging when clients enjoy elevated moods?
They are reluctant to report symptoms
Which brain region is associated with racing thoughts and grandiosity in patients with mood disorders?
Nucleus Accumbens & PFC
Which brain region is commonly associated with guilt, suicidality, and worthlessness?
Prefrontal Cortex & Amygdala
Which brain region is primarily associated with risk-taking and talkative/pressured speech?
Prefrontal Cortex
Which brain region is related to physical fatigue and motor agitation?
Striatum
Most appropriate medication for pt. who struggles with adherence is?
Aripiprazole
Which brain region is specifically linked to sleep and appetite regulation?
Hypothalamus
Which brain region plays a role in decreased sleep/arousal according to the provided information?
Thalamus & hypothalamus
Which neurotransmitter is associated with increased negative effect according to the text?
Serotonin (5-HT) & Norepinephrine
What is the defining characteristic of Bipolar Disorder Type 2 according to the text?
Symptoms last at least 4 days but less than 7 days
What is the second step in selecting initial treatment for a patient with a mood disorder according to the text?
Initiate/optimize therapy, choose monotherapy/combination, optimize dose, & check for adherence
Which factor is associated with nonadherence to medication according to the text?
Demographics (male sex, younger, lower educational level, & Single status.
What is the primary therapeutic use of lithium according to the text?
First line treatment for new onset bipolar disorder
What is the effect of high dopamine levels according to the text?
Causes hallucinations in schizophrenia and psychosis
What is the primary role of norepinephrine in the body?
Responsible for flight, fight, or fright responses
Which brain region is involved when a patient experiences racing thoughts, pleasure interests, and grandiosity?
Nucleus accumbens
What is the established benefit of lithium in clients with mood disorders?
Helps prevent suicide
Which medication is considered first-line treatment for new-onset bipolar disorder?
Lithium
Which brain region is linked to concentration, mental fatigue, and mood regulation?
Prefrontal Cortex (PFC)
What factor is commonly associated with nonadherence to medication in bipolar disorder treatment?
Comorbidities (Obsessive-compulsive disorder, substance abuse)
What is the primary role of norepinephrine?
Managing flight, fight, or fright responses
What are the manifestations of bipolar disorder as described in the text?
Mixed episodes, rapid cycling, hallucinations
What is the medication factor associated with nonadherence mentioned in the text?
Medication factors (adverse effects, low treatment doses)
Which comorbidity is linked to bipolar disorder as per the text?
Substance abuse & OCD
What is the significance of lithium in treating bipolar disorder?
It is first-line treatment for new onset bipolar disorder
What factors associated with nonadherence are mentioned in the text?
Medication factors: Low treatment doses & adverse effects
How does lithium affect transport in the nerve and muscle?
It enhances transport in the nerve and muscle
Which manifestation of bipolar disorder is mentioned in the text?
All of the above
In the context of nonadherence, what are medication factors that contribute to the problem?
Low treatment doses & adverse
What is a consequence of nonadherence to medication in bipolar disorder treatment?
Increased likelihood of mood episodes
Study Notes
Selecting Initial Treatment for Bipolar Disorder
- The stepwise approach to selecting initial treatment involves:
- Assessing client safety, comorbidities, and treatment adherence
- Initiating and optimizing therapy, choosing monotherapy or combination, optimizing dose, and checking for adherence
- Adding on or switching therapy, using alternate 1st line agents, adding on additional 1st line agents, or switching to 2nd line agents if 1st line agents are not effective
Factors Associated with Nonadherence
- Medication factors: adverse effects, low treatment doses
- Manifestation of bipolar disorder: mixed episodes, rapid cycling, hallucinations, bipolar disorder 1
- Comorbidities: substance abuse, obsessive-compulsive disorder
- Demographics: male, younger, lower educational level, single
- Other: poor insight, negative attitude, low self-esteem
Medications for Bipolar Disorder
- Lithium:
- 1st line treatment for new onset bipolar disorder
- Alerts transport in nerve and muscle
- Effective in treating manic episodes, preventing reoccurrence, and to a lesser degree, depressive episodes
- Has a narrow therapeutic window and requires lab draws
- Well-established to help prevent suicide in clients with mood disorders
- Lamotrigine (Lamictal):
- Affects Na channel ion transport and enhances the activity of gamma-aminobutyric acid (GABA)
- Equal in efficacy to lithium
- Educate patients on potential symptoms: inflated self-esteem, increased goal-directed activity, grandiosity, decreased need for sleep, excessive talkativeness, flight of ideas, and propensity to be involved in high-risk activities
- Carbamazepine (Tegretol):
- Glutamate voltage-gated Na and Ca++ channel blocker (Glu-CB)
- Consider genotyping patients with Asian ancestry, as the HLA-B 1502 allele increases the risk of SJS
- Valproic acid (Depakene):
- DA, NE, and 5-HT receptor antagonist
- Affects ion transport and enhances the activity of GABA
- If using with lamotrigine, decrease valproate levels by ½
- Aripiprazole:
- Appropriate for patients who struggle with adherence
- IM after oral trial establishes tolerability
Mood Disorders and Neurotransmitters
- Mood disorders are characterized by abnormalities of mood, including depression, mania, or both
- Mania: persistently elevated, expansive, or irritable mood
- Symptoms of mania: inflated self-esteem, increased goal-directed activity, grandiosity, decreased need for sleep, excessive talkativeness, flight of ideas, distractibility, psychomotor agitation, and propensity to be involved in high-risk activities
- Neurotransmitters affected by mood disorders: dopamine, norepinephrine, and 5-HT
- Too little positive affect is associated with dopamine (DA) and norepinephrine (NE) dysfunction
- Too much negative affect is associated with 5-HT and NE dysfunction
- Symptoms of decreased positive affect: depressed mood, loss of joy, lack of interest, loss of energy, decreased alertness, decreased self-confidence, appetite changes
- Symptoms of increased negative affect: depressed mood, guilt, fear, anxiety, hostility, irritability, loneliness, appetite changes
Brain Regions and Functions
- Nucleus accumbens: associated with racing thoughts, grandiosity, pleasure interests
- Prefrontal cortex (PFC): associated with concentration, mental fatigue, mood, guilt, suicidality, worthlessness, risk-taking, talkative/pressured speech
- Amygdala: associated with guilt, suicidality, worthlessness, mood
- Striatum: associated with physical fatigue, motor/agitation
- Hypothalamus: associated with sleep, appetite
- Thalamus: associated with decreased sleep/arousal
Test your knowledge on cyclothymia, mania, depression, and mood disorders. Learn about the symptoms and presentations of these conditions.
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