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Questions and Answers
What is a common reason for hospitalization during a manic episode?
Which medication is considered an anticonvulsant used for managing manic episodes?
What should be avoided in patients with manic episodes when prescribing medication?
Which therapy is primarily recommended for improving depressive symptoms?
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Which of the following describes a characteristic of Cluster A personality disorders?
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What type of therapy focuses on addressing social rhythm issues?
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What is a common characteristic of Schizoid personality disorder?
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What psychological therapy is known for enhancing cognitive processes?
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Which drug is classified as a second-generation antipsychotic for treating acute psychosis?
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What is the primary treatment focus for individuals exhibiting borderline personality disorder?
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What is a defining characteristic of Bipolar I Disorder?
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Which of the following disorders is commonly associated with Bipolar I Disorder?
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What duration differentiates a hypomanic episode in Bipolar II Disorder?
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What cognitive symptom is often observed in individuals with manic episodes?
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Which disorder is characterized by mild to moderate depression occurring over at least 2 years?
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What is a common behavior observed in individuals with manic episodes?
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What is the primary assessment focus for someone suspected of having bipolar disorder?
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Which of the following statements about Bipolar II Disorder is accurate?
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What should be included in the medical assessment of a patient with bipolar disorder?
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In the context of Bipolar disorders, what is 'rapid cycling'?
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Study Notes
Bipolar 1 Disorder
- Most severe form of bipolar disorder
- Highest mortality rate of the three bipolar disorders
- At least one manic episode (hallucinations, delusions, high energy)
Bipolar II Disorder
- At least one hypomanic episode (1 day or longer with 3 behaviors, mania outside of norms, no hallucinations)
- At least one major depressive episode
Cyclothymic Disorder
- Alternating symptoms of mild to moderate depression for at least 2 years (adults)
- Rapid cycling possible
Hypomania
- Lower level, less dramatic than mania
- Tends to be euphoric and often increases functioning
- Usually accompanied by excessive activity and energy
Bipolar 1 Disorder - Associated Disorders
- Nearly all anxiety disorders are associated with bipolar 1, affecting about 75% of individuals with this disorder (panic attacks, social anxiety disorder, phobias)
- Substance abuse is present
- Other disorders may complicate clinical presentation:
- ADHD
- All disruptive, impulse-control, or conduct disorders
- Bipolar II Disorder
Bipolar II Disorder - Associated Disorders
- 75% of individuals with bipolar II have comorbid anxiety disorders
- Eating disorders, particularly binge-eating disorder
- Substance use disorders
Bipolar Assessment
- Mood:
- Altman's Self-Rating Mania Scale
- Behavior:
- Can be manipulative or demanding for staff
- Splitting (need unity)
- Thought Processes and Speech patterns:
- Speech is pressured, circumstantial, tangential, flight of ideas
- Thought content: delusions
- Grandiose delusions
- Persecutory delusions
- Cognitive Dysfunction:
- Cognitive Deficit
- Discomfort is common
Bipolar Assessment Guidelines
- Danger to self or others
- Need for protection from uninhibited behaviors
- Need for hospitalization
- Medical Status:
- Coexisting medical conditions
- Acute Phase (↑ Mania), Maintenance Phase
Bipolar Implementation: Depressive vs. Manic Episodes
Depressive Episodes
- Hospitalization for suicidal, psychotic, or catatonic signs.
- Medication concerns about bringing on a manic phase.
Manic Episodes
- Hospitalization for acute mania (bipolar 1 disorder) and communication challenges.
Bipolar Communication Strategies
- Provide safety
- Use firm and calm approach
- Use short, concise explanations
- Identify expectations in simple, concrete terms
- Hear and act on legitimate complaints
Pharmacotherapy - Manic Episodes
- Avoid excessive caffeine & over-the-counter medications (NSAIDs)
- Side effects: loss of appetite, dizziness, headaches, nausea/vomiting/diarrhea, change in urination, thirst, hand tremors, dry mouth
- Anticonvulsants:
- Valproate (Depakote)
- Carbamazepine (Equetro)
- Lamotrigine (Lamictal)
- Second-Generation Antipsychotics (Short term) (Acute Psychosis)
- Olanzapine
- Disperidone
- Quetiapine
- Ziprasidone
- Aripipra
- Cariprazine
Integrative Therapy
- Omega-3 fatty acids:
- Cod liver oil, fish oil
- No evidence to support use in treating mania
- May improve depressive symptoms
Brain Stimulation Therapies
- Electroconvulsive therapy (ECT)
- Repetitive transcranial magnetic stimulation (rTMS)
Psychological Therapies
- Cognitive-Behavioral Therapy (CBT)
- Interpersonal and Social Rhythm Therapy
- Family-Focused Therapy
Personality Disorders
-
Cluster A:
- Paranoid: Long-standing distrust of others, they don't want help, need psychotherapy, not group, avoid being overly friendly
- Schizoid: Long-standing pattern of social withdrawal, expressionless emotion, don't socially interact well, introvert, no range of
- Schizotypal: Don't blend in, strange or odd beliefs, anxiety
-
Cluster B:
- Borderline: Most challenging, severe impairment, dysfunction!
- Avoidant: Low self-esteem, shy
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