PMHNP Bipolar Disorder Assessment Quiz
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Questions and Answers

Which type of bipolar disorder does the patient most likely have if they are experiencing severe mania & depression?

  • Cyclothymia
  • Chronic Mania
  • Bipolar type 2
  • Bipolar type 1 (correct)

    • Which of the following questions is most important for the PMHNP to ask prior to prescribing the patient a medication?

  • Does anybody in your family have depression or anxiety?
  • Have you ever experienced symptoms such as increased self-esteem, increased activity, or a decreased need for sleep? (correct)
  • Have you ever thought about participating in psychotherapy?
  • Did these symptoms occur when you lost your job?

    • Which brain region is affected when a patient is experiencing racing thoughts and grandiosity?

  • Nucleus accumbens (correct)
  • Hypothalamus
  • Striatum
  • Amygdala

    • What is the primary risk of prescribing antidepressants to a patient with undiagnosed bipolar disorder?

    <p>Precipitating a manic episode or rapid-cycling bipolar depression</p> Signup and view all the answers

    What is the most important step the PMHNP should take before prescribing medication for the patient?

    <p>Obtain a detailed medical and psychiatric history</p> Signup and view all the answers

    Which of the following is a key difference between major depressive disorder and bipolar disorder?

    <p>Presence of manic or hypomanic episodes</p> Signup and view all the answers

    What can happen if major depressive disorder (MDD) is mistaken for bipolar depression?

    <p>It may precipitate a manic episode and induce a rapid-cycle bipolar depression</p> Signup and view all the answers

    Which neurotransmitter is targeted by selective serotonin reuptake inhibitors (SSRIs) to inhibit their reuptake?

    <p>Serotonin (5-HT)</p> Signup and view all the answers

    Which SSRI has mild antihistamine effects?

    <p>Citalopram (Lexapro)</p> Signup and view all the answers

    Which SSRI should be prescribed for a client who suffers from hypersomnolence (excessive sleepiness) and social anxiety?

    <p>Sertraline (Zoloft)</p> Signup and view all the answers

    Which medication that treats both anxiety and depression needs to be increased if the client is an active smoker?

    <p>Fluvoxamine (Luvox)</p> Signup and view all the answers

    Which SSRI is used in patients who may forget to take their medication?

    <p>Escitalopram (Lexapro)</p> Signup and view all the answers

    Why do dementia medications cause GI distress?

    <p>As a result of their direct effect on the gastrointestinal lining</p> Signup and view all the answers

    Which medication is made from a substance that is extracted from daffodils?

    <p>Rivastigmine (Exelon)</p> Signup and view all the answers

    Why should lamotrigine not be stopped abruptly?

    <p>Abrupt cessation can precipitate seizures</p> Signup and view all the answers

    Which medication is the first-line treatment for dementia-related agitation?

    <p>Galantamine (Razadyne)</p> Signup and view all the answers

    How do dementia medications differ in terms of their mechanism of action?

    <p>Some act on acetylcholine, while others target glutamate receptors</p> Signup and view all the answers

    Which of the following neurotransmitter systems is primarily implicated in mood disorders?

    <p>Monoamine neurotransmitter system</p> Signup and view all the answers

    What is the recommended approach when initiating antidepressant therapy?

    <p>Start with the lowest recommended dose to prevent side effects</p> Signup and view all the answers

    If an initial antidepressant medication is not effective after a sufficient trial period, what is the next recommended step?

    <p>Increase the dose gradually to see if an efficacious dose occurs</p> Signup and view all the answers

    Which of the following is NOT a potential contributing factor to mood disorders?

    <p>Regular exercise and a balanced diet</p> Signup and view all the answers

    Which of the following statements about the genetics of mood disorders is correct?

    <p>Mood disorders are heritable disorders with contributions from genetic factors</p> Signup and view all the answers

    Which of the following neurotransmitter systems is implicated in the pathophysiology of mania?

    <p>Excess of serotonin, norepinephrine, and dopamine</p> Signup and view all the answers

    What is the recommended duration for titrating medications to achieve efficacy?

    <p>At least 8 weeks</p> Signup and view all the answers

    What is the recommended course of action after titrating a medication for 8 weeks?

    <p>Add a second medication as an adjunct</p> Signup and view all the answers

    Which age group is at the highest risk for antidepressant-induced suicide?

    <p>Children, adolescents, and adults younger than 25 years</p> Signup and view all the answers

    What is the recommended practice when prescribing medications to a client?

    <p>All of the above</p> Signup and view all the answers

    Which condition can occur when serotonergic antidepressants are combined with other serotonergic drugs?

    <p>Serotonin Syndrome</p> Signup and view all the answers

    When choosing a medication, what factor should be considered to assist clients with sleep disturbances?

    <p>Choose a medication with sedating effects taken at night</p> Signup and view all the answers

    What is the primary reason why antidepressants should not be used as monotherapy in clients with bipolar disorder?

    <p>They may cause rapid cycling of mood episodes.</p> Signup and view all the answers

    Which medication is specifically used for the treatment of euphoric mania in bipolar disorder?

    <p>Lithium (Priadel)</p> Signup and view all the answers

    In bipolar disorder, which medication can be used for acute mania, mixed mood states, or comorbid substance use?

    <p>Valproic acid (Depakote)</p> Signup and view all the answers

    What is a primary use of second-generation antipsychotics in the treatment of bipolar disorder?

    <p>Treating acute bipolar depression</p> Signup and view all the answers

    Why might some clients require combination therapy for symptom management in bipolar disorder?

    <p>To target both manic and depressive symptoms</p> Signup and view all the answers

    In Major Depressive Disorder (MDD), what symptoms may an individual experience that differentiate severe depression from moderate depression?

    <p>Thoughts of suicide and decreased self-worth</p> Signup and view all the answers

    What can happen if major depressive disorder (MDD) is mistaken for bipolar depression?

    <p>It may lead to a manic episode and contribute to the incidence of death by suicide in children and adults under 25 years of age.</p> Signup and view all the answers

    Which neurotransmitter is targeted by selective serotonin reuptake inhibitors (SSRIs) to inhibit their reuptake?

    <p>Serotonin (5-HT)</p> Signup and view all the answers

    Which SSRI has mild antihistamine effects?

    <p>Citalopram (Celexa)</p> Signup and view all the answers

    Which SSRI should be prescribed for a client who suffers from hypersomnolence (excessive sleepiness) and social anxiety?

    <p>Sertraline (Zoloft)</p> Signup and view all the answers

    Which medication that treats both anxiety and depression needs to be increased if the client is an active smoker?

    <p>Fluoxetine (Prozac)</p> Signup and view all the answers

    Which SSRI is used in patients who may forget to take their medication?

    <p>Escitalopram (Lexapro)</p> Signup and view all the answers

    Which neural network, located in the basal ganglia, is responsible for posture and voluntary motor movements?

    <p>Nigrostriatal network</p> Signup and view all the answers

    What medication should be avoided in clients with eating disorders?

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

    Which neurotransmitter is primarily affected in the mesolimbic location of the dopamine pathways?

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

    In which neural network location would overactivation lead to positive symptoms?

    <p>Mesocortical location</p> Signup and view all the answers

    What are the symptoms of low dopamine levels in the nigrostriatal location of the dopamine pathways?

    <p>Chorea and akathisia</p> Signup and view all the answers

    Which neural network, located in the VTA and DLPFC, is responsible for cognition, executive function, and emotions?

    <p>Mesocortical network</p> Signup and view all the answers

    What is the primary cause of mood disorders according to the text?

    <p>Genetic factors</p> Signup and view all the answers

    Which neurotransmitter deficiency is linked to the development of depression?

    <p>Serotonin (5HT)</p> Signup and view all the answers

    What is the consequence of an excess of serotonin (5HT), norepinephrine (NE), and dopamine (DA) in the brain?

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

    Which monoamine neurotransmitters are targeted by pharmacological treatments for mood disorders?

    <p>Serotonin (5HT), Dopamine (DA), Norepinephrine (NE)</p> Signup and view all the answers

    What is the initial recommended approach if an antidepressant medication does not work effectively?

    <p>Switch to a medication from a different class</p> Signup and view all the answers

    Which factor contributes significantly to the causes of mood disorders as mentioned in the text?

    <p>Seasonal changes</p> Signup and view all the answers

    Which medication should be avoided in patients with COPD or hepatic impairment?

    <p>Galantamine (Razadyne)</p> Signup and view all the answers

    What is the proposed mechanism of action for the gastrointestinal side effects associated with dementia medications?

    <p>Inhibition of acetylcholinesterase in the gastrointestinal tract</p> Signup and view all the answers

    Which medication used in the treatment of dementia is derived from a substance extracted from daffodils?

    <p>Galantamine (Razadyne)</p> Signup and view all the answers

    Which medication used in the treatment of dementia does NOT involve the cytochrome P450 (CYP450) enzyme system?

    <p>Memantine (Nemdatine)</p> Signup and view all the answers

    Which medication used in the treatment of dementia should NOT be stopped abruptly?

    <p>Donepezil (Aricept)</p> Signup and view all the answers

    Which medication is considered the first-line treatment for dementia-related agitation?

    <p>Memantine (Nemdatine)</p> Signup and view all the answers

    What is a potential cause of mood disorders mentioned in the text?

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

    What deficiency can lead to depression according to the text?

    <p>Deficiency of NE, DA, and 5HT</p> Signup and view all the answers

    Which neurotransmitter system is targeted by pharmacological treatments for mood disorders?

    <p>NE, DA, and 5HT</p> Signup and view all the answers

    What is the recommended step if an initial antidepressant medication does not work effectively after the trial period?

    <p>Switch to a completely different class of medication</p> Signup and view all the answers

    Which neurotransmitter is associated with mania according to the text?

    <p>Dopamine (DA)</p> Signup and view all the answers

    What should be considered when initiating antidepressant therapy?

    <p>Start with the lowest recommended dose to prevent side effects</p> Signup and view all the answers

    What neural network is responsible for cognition, executive function, and emotions?

    <p>Mesocortical location network</p> Signup and view all the answers

    Which symptom would result from low dopamine levels in the brain?

    <p>Parkinson's disease</p> Signup and view all the answers

    What effect does chronic blockage of dopamine have on the body?

    <p>Tardive dyskinesia</p> Signup and view all the answers

    Which neural network is responsible for regulating emotional behaviors and pleasure?

    <p>Mesolimbic location network</p> Signup and view all the answers

    What are the symptoms associated with overactivation of the mesocortical location network?

    <ul> <li>symptoms</li> </ul> Signup and view all the answers

    In which location do high dopamine levels lead to tics, dyskinesias, and chorea?

    <p>Nigrostriatal location network</p> Signup and view all the answers

    What type of MAOI is typically used as an antidepressant and anxiolytic?

    <p>MAOI-A</p> Signup and view all the answers

    Which of the following foods should be avoided when taking an MAOI?

    <p>Red wine and aged cheese</p> Signup and view all the answers

    Which medication should NOT be prescribed in clients with COPD or hepatic impairment?

    <p>Dementia medications</p> Signup and view all the answers

    Why do MAOIs increase the risk of a hypertensive crisis when ingesting foods containing tyramine?

    <p>MAOIs inhibit the breakdown of tyramine in the gut</p> Signup and view all the answers

    Why do dementia medications cause gastrointestinal (GI) distress?

    <p>They have a cholinergic mechanism of action, which can lead to GI side effects.</p> Signup and view all the answers

    Which medication used in the treatment of dementia is derived from a substance extracted from daffodils?

    <p>Galantamine (Razadyne)</p> Signup and view all the answers

    Which class of medications should be avoided when taking MAOIs due to the risk of serotonin syndrome?

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

    What is the recommended number of half-lives to wait before starting an MAOI after discontinuing a serotonergic medication?

    <p>5 half-lives</p> Signup and view all the answers

    Which medication used in the treatment of dementia should NOT be stopped abruptly?

    <p>Memantine (Nemdatine)</p> Signup and view all the answers

    Which medication is considered the first-line treatment for dementia-related agitation?

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

    What is the goal of antidepressant treatment according to the text?

    <p>Complete remission of symptoms</p> Signup and view all the answers

    Will the gastrointestinal (GI) side effects from dementia medications decrease over time?

    <p>The GI side effects may decrease over time, but they can also worsen depending on the patient's condition.</p> Signup and view all the answers

    What is a crucial step when a client presents to the emergency department (ED)?

    <p>Identifying the substance taken based on symptoms</p> Signup and view all the answers

    Which consideration is highlighted regarding medication prescribing practices?

    <p>Reviewing lifespan considerations and pregnancy risks</p> Signup and view all the answers

    What is the recommended approach when prescribing stimulants for Attention Deficit Hyperactivity Disorder (ADHD)?

    <p>Consider risks and benefits based on the individual's age</p> Signup and view all the answers

    Which term describes a persistent, irresistible urge to perform a specific behavior or ritual?

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

    What is a key consideration when initiating antidepressant therapy?

    <p>Gradual dose titration to achieve efficacy</p> Signup and view all the answers

    Which neurotransmitter system is primarily implicated in the pathophysiology of mania?

    <p>Dopaminergic system</p> Signup and view all the answers

    Which medication can be prescribed to assist a patient with sleep disturbances?

    <p>Trazadone (Desyrel)</p> Signup and view all the answers

    What is a key aspect to be aware of regarding the initiation of addiction medications?

    <p>Precipitation of withdrawal symptoms</p> Signup and view all the answers

    What is a crucial consideration when prescribing medications for clients with bipolar disorder?

    <p>Using combination therapy for symptom management</p> Signup and view all the answers

    Which neurotransmitter system is targeted by pharmacological treatments for mood disorders?

    <p>Multiple neurotransmitter systems</p> Signup and view all the answers

    What should be known about substances of abuse according to the provided text?

    <p>Mechanism of action and associated signs and symptoms</p> Signup and view all the answers

    What is a distinguishing feature of hypomanic episodes compared to manic episodes in bipolar disorder?

    <p>Hypomanic episodes do not lead to hospitalization</p> Signup and view all the answers

    Which symptom is commonly seen in individuals experiencing mania or hypomania?

    <p>Increased irritability</p> Signup and view all the answers

    What is a common challenge in diagnosing bipolar disorder when the client presents during the depressive phase?

    <p>Clients may not report manic or hypomanic symptoms</p> Signup and view all the answers

    In bipolar disorder, what symptom may make clients hesitant to report symptoms of hypomania or mania?

    <p>Feelings of grandiosity</p> Signup and view all the answers

    What is a key characteristic that helps differentiate cyclothymia from major depressive disorder or manic episodes?

    <p>Presence of mixed mood features</p> Signup and view all the answers

    Why might individuals with bipolar disorder experience challenges in seeking treatment?

    <p>Reluctance to report euphoric moods or irritability</p> Signup and view all the answers

    Which type of bipolar disorder does the patient most likely have?

    <p>Bipolar type 1</p> Signup and view all the answers

    Which of the following questions is most important for the PMHNP to ask prior to prescribing the patient a medication?

    <p>Have you ever experienced symptoms such as increased self-esteem, increased activity, or a decreased need for sleep?</p> Signup and view all the answers

    Which brain region is affected when a patient is experiencing racing thoughts and grandiosity?

    <p>Nucleus accumbens</p> Signup and view all the answers

    What can happen if major depressive disorder (MDD) is mistaken for bipolar depression?

    <p>All of the above</p> Signup and view all the answers

    Which neurotransmitter is associated with mania according to the text?

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

    Which neurotransmitter deficiency can lead to depression according to the text?

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

    What should be considered when prescribing MAOIs?

    <p>Dietary restrictions</p> Signup and view all the answers

    Which medication should be chosen for a client likely to forget to take their medication?

    <p>Bupropion (Wellbutrin)</p> Signup and view all the answers

    What can happen to clients with comorbid anxiety when taking Fluoxetine?

    <p>Activation and panic attacks</p> Signup and view all the answers

    Which antipsychotic has the longest half-life?

    <p>Fluoxetine (Prozac)</p> Signup and view all the answers

    Which medication is known for having fewer sexual side effects?

    <p>Bupropion (Wellbutrin)</p> Signup and view all the answers

    Which class of medications can help improve cognition?

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

    What is the main reason for swiftly identifying which drug a client has taken in the Emergency Department?

    <p>To initiate appropriate treatment quickly</p> Signup and view all the answers

    Which factor is crucial in determining when medications can be started for a client?

    <p>The severity of the client's symptoms</p> Signup and view all the answers

    What is a key consideration when prescribing medications to special populations like pregnant individuals or the elderly?

    <p>Considering medication-associated pregnancy risks</p> Signup and view all the answers

    What is the difference between impulsivity and compulsivity in the context of medication prescribing?

    <p>Compulsivity involves unwanted behaviors while impulsivity does not</p> Signup and view all the answers

    Which factor should be considered when determining medication dosages for the elderly population?

    <p>Avoiding medications that might cause drowsiness</p> Signup and view all the answers

    In the context of prescribing stimulants for ADHD across the lifespan, what should be considered for adults with a history of substance abuse?

    <p>Considering non-stimulant alternatives due to potential risks</p> Signup and view all the answers

    Study Notes

    Antidepressants and Mood Stabilizers

    • Black Box Warning: Antidepressants increase the risk of suicide in children, adolescents, and adults under 25 years.
    • Titration: Start with a low dose and increase gradually to achieve efficacy over a minimum of 8 weeks.
    • Adjunct Therapy: Add a second medication if necessary.
    • Discontinuation: Carefully review the client's medication list before discontinuing medications.

    Prescribing Principles

    • Client Preference: Consider client preference when selecting a medication.
    • Prior Treatment Response: Choose a medication that has been effective in the past.
    • Anticipated Adverse Effects: Consider age, family planning, and potential adverse effects when selecting a medication.

    Mood Disorders

    • Major Depressive Disorder (MDD): Affects approximately 7.1% of adults in the US, with a prevalence of 13.1% among 18-25-year-olds.
    • Bipolar Disorder: A heritable disorder with contributions from genetic factors, dysfunctions in the brain, and imbalance of neurotransmitters.

    Neuroanatomy and Neurotransmitters

    • Neural Networks: Depression occurs from a deficiency of one or all three monoamine transmitters (5HT, NE, and DA), while mania occurs from an excess of these neurotransmitters.
    • Monoamine Hypothesis: Depression is caused by a deficiency of neurotransmitters, while mania is caused by an excess.

    SSRIs

    • First-Line Treatment: SSRIs are the first-line treatment for depression.
    • Mechanism of Action: SSRIs target 5HT to inhibit its reuptake.
    • Side Effects: Diarrhea, headache, weight gain, and sexual side effects.
    • Prescribing Pearls:
      • Citalopram has mild antihistamine effects.
      • Escitalopram has no known drug interactions.
      • Fluoxetine has a long half-life.
      • Paroxetine (Paxil) is effective for insomnia and social anxiety.
      • Sertraline (Zoloft) is effective for hypersomnolence and social anxiety.

    Bipolar Disorder Medications

    • Lithium: Used for euphoric mania, rapid cycling, or maintenance therapy.
    • Lamotrigine: Used for maintenance therapy or monotherapy for bipolar disorder.
    • Valproic Acid: Used for acute mania, mixed mood, or comorbid substance use.
    • Carbamazepine: Used for acute mania or mixed mood.
    • 2nd Generation Antipsychotics: Used for acute bipolar depression, acute manic or mixed episodes, or maintenance therapy.

    Combination Therapy

    • Required for Symptom Management: Combination therapy may be required for symptom management.
    • Useful for Depression Symptoms: Additional medications may be required to target depression symptoms.

    Genetics and Neuroanatomy

    • MDD and BD: Heritable disorders with contributions from genetic factors.
    • Causes of Mood Disorders: Complex and may include dysfunctions in the brain, imbalance of neurotransmitters, life events, abuse/trauma, substance use, medications, menstruation, and season changes.

    Neural Signaling

    • Monoamine NTM System: NE, DA, and 5HT pharmacological treatments act on this system.
    • Dopamine Pathways: Mesolimbic, mesocortical, nigrostriatal, and tuberoinfundibular locations.

    Dementia Medications

    • GI Distress: Medications cause GI distress, which may decrease over time.
    • Actions to Decrease GI Side Effects: Unknown.
    • Medication Made from Daffodils: Unknown.

    MAOIs

    • Last Choice Medication: MAOIs are the last choice medication class for depression due to potential serious side effects.
    • Form of MAOI: MAOI-A is used as an antidepressant and anxiolytic, while MAOI-B is used to treat Parkinson's disease.
    • Foods to Avoid: Foods that contain tyramine, such as red wine, sauerkraut, and aged cheese.
    • Medications to Avoid: Serotonergic agents, which increase the risk of serotonin syndrome.
    • Wait Time: Wait 5 half-lives after discontinuing a serotonergic medication before starting an MAOI.### Medications for Sleep Disturbances
    • Trazadone can assist with sleep disturbances
    • Fluoxetine has a long half-life, making it suitable for patients who have trouble falling and staying asleep at night

    Neural Circuits and Neurotransmitters

    • Know the neural circuits and neurotransmitters associated with reward and addiction (Stahl)

    Addiction Medications

    • FDA-approved indications for each medication
    • Medications that can precipitate withdrawal
    • Required actions prior to medication initiation
    • Initiation time frame for each medication
    • Client education for the medications

    Substances of Abuse

    • Mechanism of action of each substance
    • Associated signs and symptoms on a physical exam
    • Symptoms last at least 4 days but < 7 days

    Bipolar Disorder

    • Cyclothymia: chronic presentation of hypomania and major depressive symptoms that do not meet the criteria for a major depressive or manic/hypomanic episode
    • Mania: characterized by persistently elevated, expansive, or irritable mood
    • Hypomanic: not of sufficient duration or severity to cause significant functional impairment, psychosis, or hospitalization
    • Anger and irritability are common
    • Clients often enjoy the elevation of mood and are reluctant to report these symptoms, making bipolar more difficult to diagnose if the client presents in the depression phase

    Patient Case

    • Patient presents with irritability, no sleep in 3 days, can't think straight, and stole a bike from a store
    • PMHNP suspects bipolar disorder
    • Most likely diagnosis: Bipolar type 1 or Cyclothymia

    Important Question to Ask

    • Prior to prescribing medication, ask: "Have you ever experienced symptoms such as increased self-esteem, increased activity, or a decreased need for sleep?"

    Brain Region Affected

    • Racing thoughts and grandiosity: affected brain region is unknown (options: Striatum, Amygdala, Nucleus accumbens)

    Medication Restriction

    • MAOIs should be restricted to clients who do not respond to other treatments due to dietary restrictions

    Medication Interactions

    • Fluoxetine is also known to activate clients and cause panic attacks in clients with comorbid anxiety
    • Many antidepressants have significant interactions with other medications due to CYP450 enzyme involvement

    Medication Choice

    • If the client is likely to forget to take a medication, choose a medication with a longer half-life to avoid discontinuation syndrome
    • Fluoxetine (Prozac) has the longest half-life
    • Bupropion has fewer side effects than other first-line treatments
    • SNRIs (e.g., Venlafaxine, Duloxetine, Desvenlafaxine) can help with brain fog
    • Mirtazapine can be used to treat depression

    Medication Safety

    • Cost, insurance benefits, and pharmaceutical assistance programs should be considered when prescribing
    • Medication interactions and side effects should be taken into account when prescribing
    • Medication adherence is crucial for treatment success

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    Description

    Test your knowledge on assessing bipolar disorder in a patient with depressive symptoms. Identify the most likely type of bipolar disorder and the important questions to ask before prescribing medication.

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