Understanding Bipolar Disorder

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Questions and Answers

What is one of the symptoms required for a diagnosis of depression according to DSM-5?

Chronic restlessness

Increased energy levels

Excessive happiness

Significant weight loss or gain (correct)

Which of the following descriptions best characterizes the progression from hypomania to mania?

Heightened need for sleep and introspection

Reduced impulsivity and irritability

Increased hostility and paranoia (correct)

Enhanced sociability and calmness

What type of speech pattern is linked with manic episodes?

Slow and deliberate

Verbose and detailed

Clang and sexually explicit (correct)

Logical and structured

Which of the following symptoms is NOT part of the DSM-5 criteria for depression?

Increased sociability Signup and view all the answers

What is the relationship between bipolar disorder and depression in terms of time spent in each state?

Individuals generally spend more time in depressed states than manic states Signup and view all the answers

Which medication is recommended instead of NSAIDs for individuals on lithium?

Acetaminophen Signup and view all the answers

What is a potential early sign of lithium toxicity?

Tremors Signup and view all the answers

What condition can chronic lithium toxicity potentially lead to due to resistance to anti-diuretic hormone?

Nephrogenic Diabetes Insipidus Signup and view all the answers

What type of motor symptoms might EPS from antipsychotics resemble?

Parkinson’s Disease Symptoms Signup and view all the answers

How frequently should lithium levels be checked in patients?

Regularly, as per physician's recommendation Signup and view all the answers

What symptom is least likely to directly improve upon ceasing medication for TD?

Tardive Dyskinesia Signup and view all the answers

What characterizes akathisia in patients taking antipsychotics?

Distressing motor restlessness Signup and view all the answers

What could be a sign of lithium toxicity as it progresses?

Scattered thoughts Signup and view all the answers

What is defined as rapid cycling in mood disorders?

Four or more episodes of mood changes within a 12-month period Signup and view all the answers

What is a primary goal during the acute phase of bipolar treatment?

Maintain hydration and encourage sleep Signup and view all the answers

What severe symptom is associated with mania in mood disorders?

Excessive energy and reduced sleep Signup and view all the answers

Which of the following behaviors may indicate the need for safety assessment in a patient experiencing mania?

Engaging in poor impulse control Signup and view all the answers

How long does it typically take lithium to inhibit acute manic episodes?

Between 10-21 days Signup and view all the answers

What precaution should be taken to avoid lithium toxicity?

Ensure adequate hydration of about 2-3 liters per day Signup and view all the answers

Which of the following can elevate lithium levels and increase toxicity risk?

Severe dehydration Signup and view all the answers

What symptom may indicate lithium toxicity?

Excessive diarrhea Signup and view all the answers

What is a key difference between dysthymia and Major Depressive Disorder (MDD)?

Dysthymia is chronic while MDD is episodic. Signup and view all the answers

Which of the following is NOT a symptom of Persistent Depressive Disorder?

Severe hallucinations Signup and view all the answers

What does Beck’s Triad emphasize about individuals with depression?

They process information negatively despite positive factors. Signup and view all the answers

Which treatment is typically the first choice for managing depression?

Selective Serotonin Reuptake Inhibitors (SSRI) Signup and view all the answers

Which of the following statements is true regarding the biological aspect of depression?

Depression involves biological aspects beyond personal strength. Signup and view all the answers

What additional symptom must accompany a depressed mood to diagnose Persistent Depressive Disorder?

Difficulty thinking Signup and view all the answers

What is a major consideration when prescribing antidepressant medications?

Suicide risk should be monitored with all antidepressants. Signup and view all the answers

What type of therapy involves skill training and problem-solving for depression?

Cognitive Behavioral Therapy (CBT) Signup and view all the answers

How often should someone with a first-degree relative diagnosed with colorectal cancer before age 60 get screened after a normal colonoscopy?

Every 5 years Signup and view all the answers

What is the primary purpose of a biopsy in colorectal cancer diagnosis?

To examine tissue under a microscope for cancer Signup and view all the answers

Which of the following factors influences the type of surgery a patient might undergo for colorectal cancer?

Stage of the cancer and tumor characteristics Signup and view all the answers

What is the most accurate test for colorectal cancer diagnosis?

Colonoscopy Signup and view all the answers

What dietary modification is recommended for patients undergoing follow-up care for colorectal cancer?

High fiber diet Signup and view all the answers

Patients with inflammatory bowel disease should consider surveillance for colorectal cancer due to their increased risk. Which conditions fall into this category?

Crohn’s disease involving the colon and ulcerative colitis Signup and view all the answers

After a normal colonoscopy result, how frequently should individuals with a first-degree relative diagnosed at age 60 or older be screened?

Every 10 years Signup and view all the answers

What should patients be cautious about regarding laxatives or antidiarrheal medications during follow-up care?

They should only take them as prescribed by the doctor Signup and view all the answers

Study Notes

Bipolar Disorder

Individuals with bipolar disorders tend to spend more time in depressed states than manic states
Treatment is very similar to Major Depressive Disorder (MDD)
During the manic phase, individuals can experience flight, clang, and graniosity
- Flight: content is often sexually explicit and inappropriate
- Clang: "cinema I and II, last row. Row, row, row your boat. Don't be cutthroat! Cut your throat. Get your goat. Go out and vote. And so I wrote"
- Graniosity: example à God is speaking to them, they are secretly friends with celebrities
As the manic phase progresses from hypomania to mania, sociability and euphoria are replaced by hostility, irritability, and paranoia
Rapid Cycling: 4 or more episodes of mood changes (depression and/or mania) within a 12-month period
- Associated with severe symptoms and high recurrence rate
- This can happen in all mood disorders, not just bipolar
- Resistant to traditional treatments

Phases of Bipolar Disorder

Acute:
- Keep individuals hydrated
- Promote sleep and rest
- Encourage self-control
- DO NOT ATTEMPT SELF HARM
Continuation:
- Educate individuals about their disease, medication, and consequences of substance addiction/relapse
- Teach individuals about early signs and symptoms
- Help individuals control and decrease stress

Assessing an Individual with Bipolar Disorder

Safety: Mania is exhausting. Individuals may not eat or sleep. Poor impulse control can lead to harmful behaviors
Protection: Individuals may give away all possessions or go into bankruptcy
Medical Status: Determine if the individual's behavior is substance induced. Rule out other medical conditions or medications that may contribute to their behavior.

Main Medications

Lithium: Inhibits about 80% of acute manic and hypomanic episodes in 10-21 days
- Ensure salt is NOT reduced and ensure plenty of fluids (~2-3L/day)
- Low serum sodium leads to toxicity
- Suspect toxicity if excessive diarrhea, vomiting, or diuresis
- Avoid diuretics
- Do not give with NSAIDs
- Ensure proper hydration!
- Want a salt balance – don’t add extra salt, but do not reduce intake
- Link to hypothyroidism

Lithium Side Effects

Leukocytosis (high WBC)
Increased urination
Thirst and tremor
Hypothyroidism
Interactions with medications are common
Upset stomach (nausea, vomiting, diarrhea)
Must get levels checked frequently

Signs of Lithium Toxicity

All signs advance as lithium toxicity becomes more severe
Tremor may become seizure, lethargy may become confusion, then coma
Early signs include scattered thoughts and tremors
Clients with lithium toxicity may develop polyuria, due to the resistance to anti-diuretic hormone potentially leading to nephrogenic diabetes insipidus with chronic lithium toxicity

Lithium Level Monitoring:

It may take some time to get to a proper lithium level, an antipsychotic or benzodiazepine may be used in the meantime to prevent exhaustion, coronary collapse, and death until lithium reaches therapeutic levels
Antipsychotics act promptly. They may be discontinued when lithium takes effect
EPS (Extrapyramidal Symptoms): involve involuntary motor symptoms similar to those associated with Parkinson's disease. Also known as pseudoparkinsonism and includes such symptoms as akathisia (distressing motor restlessness) and acute dystonia (painful muscle spasms)
- Akathisia is often misdiagnosed as anxiety, restless leg syndrome, or agitation.
- Watch for EPS in individuals taking antipsychotics, especially 1st generation and SSRIs
TD (Tardive Dyskinesia): symptoms are most common with 1st-generation antipsychotics
- Symptoms usually improve with ceasing medication, but may not always be reversible.

Depression (DSM-5)

Must have symptom #1 or 2 and a minimum of 5/9 in total
- Symptom #1: Depressed mood
- Symptom #2: Diminished interest in activities
- Symptom #3: Significant weight loss or gain
- Symptom #4: Insomnia or hypersomnia
- Symptom #5: Psychomotor agitation or retardation
- Symptom #6: Fatigue/loss of energy
- Symptom #7: Feelings of worthlessness or guilt
- Symptom #8: Decreased concentration or indecisiveness
- Symptom #9: Suicidal ideation or attempt

Other Types of Depression

Dysthymia (Persistent Depressive Disorder)
- Also known as Persistent Depressive Disorder (PDD)
- occurs when depression occurs most of the day, on the majority of days
- Differs from MDD
- The symptoms in dysthymia are lower-level and last at least 2 years in adults, or 1 year in children
Persistent Depressive Disorder (PDD):
- Depressed mood + two or more additional symptoms
  - Symptom #1: Decreased appetite or overeating
  - Symptom #2: Insomnia or hypersomnia
  - Symptom #3: Low energy
  - Symptom #4: Poor self-esteem
  - Symptom #5: Difficulty thinking
  - Symptom #6: Hopelessness
- Symptoms cause significant distress and impairment of critical areas of functioning

Public Perception

Although we've come a long way in public perception and understanding over the last number of years, many people still view depression as a disease for the 'weak'
We have no more control over our neurotransmitters than we do over our blood pressure. It isn't an issue of strong or weak, simply biology.

Beck's TRIAD

Beck & Rush (1995) found that individuals with depression process information in negative ways, even in the midst of positive factors.
Components:
- A negative, self-deprecating view of self: "Nobody loves me, I'm worthless and inadequate"
- A pessimistic view of the world: "Everyone is against me, because I am worthless"
- The belief that negative reinforcement (or no validation for the self) will continue in the future: “I will always be a failure”
Beck argues that by challenging these thoughts, an individual can experience new feelings and beliefs.

Treatments for Depression

CBT (Cognitive Behavioral Therapy): Skill training and problem-solving through therapy
ECT (Electroconvulsive Therapy): Used if resistant to treatment with medication with good results
Medications: SSRIs and SNRIs are most common, may also have atypical antidepressants, or tricyclic antidepressants

SSRI's (Selective Serotonin Reuptake Inhibitors)

First choice treatment
Monitor for suicide and serotonin syndrome
MONITOR FOR SUICIDE RISK WITH ALL ANTIDEPRESSANTS!

Colorectal Cancer

Average risk = Ages 50 to 74 with no first-degree relative diagnosed with colorectal cancer and no personnal history of precancerous colorectal polyps requiring surveillance or inflammatory bowel disease (i.e., Crohn's disease involving the colon, or ulcerative colitis)
Screening:
- Every 5 years: for people with a first-degree relative who was diagnosed with colorectal cancer before age 60
- Every 10 years: for people with a first-degree relative who was diagnosed with colorectal cancer at age 60 or older

Diagnosis

General Physical Exam: Includes a digital rectal examination
Lab and Blood Tests: Testing of stool sample for occult (hidden) blood
Colonoscopy: Scope that looks at the entire bowel
Biopsy: Removal of a small portion of the colon or rectum to examine under a microscope. This is the most accurate test of all, but because it involves cutting the body, the other tests are usually done first
CT Scan: Can see the tumor and if the cancer has spread

Surgery and Follow-Up Care

Surgery: Various types of surgery can be done based on multiple factors (i.e. tumor resection vs. hemicolectomy)
Chemotherapy/Radiation: Based on cancer staging
Monitor:
- The patient’s bowel patterns
- The patient’s diet modification, and assess the adequacy of his nutrition intake
Diet: Encourage a high fiber diet
Caution: Only take laxatives or antidiarrheal medications as prescribed by a doctor
Screenings: Inform the patient about screening and early detection.

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Description

This quiz explores the characteristics and treatment of bipolar disorder. Participants will learn about the differences between manic and depressive states, the impact of rapid cycling, and the complexities of treatment strategies similar to those for Major Depressive Disorder. Test your knowledge and understanding of this mental health condition.