Depression/Bipolar/Mania/Suicide (Mental Health Test #2)

Which assessment data would be inconsistent with a diagnosis of mania? The patient is demonstrating severe irritability. Family report that the mood change occurred gradually over a 5-day period. The behaviors have increased in severity since onset 2 weeks ago. The patient has been abusing alcohol consistently since onset of symptoms.

Family report that the mood change occurred gradually over a 5-day period.

hypomanic episode

less severe and less disruptive version of a manic episode that is one of the criteria for several mood disorders (at least 4 days_

Antipsychotic mood stabilizers

risperidone (Risperdal) olanzapine (Zyprexa) aripiprazole (Abilify)

Examples of SSRIs used to treat depression

sertraline (Zoloft) escitalopram (Lexapro) citalopram (Celexa) fluoxetine (Prozac)

Adverse Effects of SSRIs

sexual dysfunction, nausea, headache, weight gain, anxiety, insomnia

Mechanism of action of tricyclic antidepressants

to inhibit reuptake of norepinephrine (NE)and serotonin

Anticonvulsants used in mania therapy

valproic acid (Depakote, Depakene) lamotrigine (Lamictal) carbamazepine (Tegretol) topiramate (Topamax)

When does serotonin syndrome develop?

when SSRIs are combined with drugs that potentiate serotonin neurotransmission.

"No SAD Me" Mnemonic

} Non-antidepressant therapy should be considered, e.g., lithium, quetiapine. } Safe-to-use adjunctive antidepressants can be considered if relapse occurs. } Avoid antidepressant monotherapy. } Do not use tricyclic antidepressants (TCAs) or venlafaxine. Both carry a high risk of "inducing pathologically elevated states of mood and behavior." } Monitor closely. } Non-antidepressant therapy should be considered, e.g., lithium, quetiapine. } Safe-to-use adjunctive antidepressants can be considered if relapse occurs. } Avoid antidepressant monotherapy. } Do not use tricyclic antidepressants (TCAs) or venlafaxine. Both carry a high risk of "inducing pathologically elevated states of mood and behavior." } Monitor closely.

3 main themes with suicidal thoughts

◦ Hopelessness ◦ Meaninglessness ◦ Being out of control

Range of safe lithium

0.5-1.5

Bipolar 1 vs Bipolar 2

1 - manic episodes, depressive episodes common but not required for diagnosis 2 - hypomanic episodes, >1 major depressive episodes required

What are the DSM V features of Major Depressive Disorder?

Depressed mood Anhedonia (inability to feel pleasure) Appetite disturbance/weight change Sleep disturbance Psychomotor disturbance Fatigue or loss of energy Worthlessness/guilt Indecision/poor concentration Recurrent thoughts of death/suicide

Which assessment question is appropriate to identify a unique characteristic of a patient experiencing bipolar depression? "Do you experience insomnia on a regular basis?" "Have you experienced a weight loss recently?" "Have you ever been diagnosed with anorexia?" "Do you experience paranoid thoughts?"

"Do you experience paranoid thoughts?"

Which statement made by a severely depressed client reflects the greatest barrier to the nurse's goal of establishing and maintaining a working client-nurse relationship? "I'll talk we you later; I'm too tired right now." "I don't have any idea why I'm so depressed." "I don't see what good talking to you will do."

"I don't see what good talking to you will do."

A depressed patient originally responded to a failure by stating, "I can't do anything right." Which statement by the same client would demonstrate the successful implementation of negative thought reprogramming? "I'm a fairly accomplished cook." "I wish I wasn't so worried about how I look." positive self-esteem. "I'll try but I'm very done this before"a sense of personal worth. "I'll look at the want ads and see who's hiring." effective problem solving.

"I'm a fairly accomplished cook."

Onset of lithium

1-3 weeks

Medications for an ECT procedure

1. glycopyrrolate (Robinul) -- anticholinergic 2. propofol (Diprivan)-- anesthesia 3. succinycholine (anectine)--muscle relaxer

A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following is appropriate for the nurse to include in the plan of care? (Select all that apply) Select all that apply: ___1. Provide flexible client behavior expectations __2. Offer concise explanations __3. Establish consistent limits ___4. Disregard client complaints ___5. Use a firm approach with communication

2,3,5

What are tyramine-rich foods?

Aged cheese, smoked meats (pepperoni, salami), avocados, figs, bananas, smoked fish, protein, protein supplements, wine, beers.

The nurse is preparing to administer lithium (Eskalith) to a client with bipolar disorder. The client complains of nausea and muscle weakness, and his speech is slurred. His lithium level is 1.6 mEq/liter. What would be the nurse's best action? 1. Chart the client's symptoms after giving the lithium. 2. Explain that these are common side effects. 3. Withhold the client's lithium. 4. Administer a prn antiparkinsonism drug.

3. Withhold the client's lithium.

When comparing the needs of patients experiencing depression and those experiencing bipolar disorder, both groups will require which intervention? Careful monitoring of environmental stimuli Suicide and escape precautions Fall and seizure precautions Assessment of eating and sleeping patterns

Assessment of eating and sleeping patterns

Which intervention will best address the low self-esteem issues experienced by a middle-aged adult who has been unemployed for 2 years? Provide the patient with a regular bathing and grooming schedule. Incorrect Listen attentively as the patient retells the details of being unemployed. Assist the patient in identifying personal skills and achievements. Encourage the patient to focus on retraining opportunities in the community.

Assist the patient in identifying personal skills and achievements.

Which disorder is being described? Dramatic life changes Losses Death Relocation Illness Financial stress

Adjustment disorder with depressed mood

Objective symptoms of depression

Alterations in activity Psychomotor agitation or retardation Altered social interactions Poor social skills

Subjective symptoms of depression

Alterations of mood Alterations of affect Feelings mood, emotional tone Alterations of cognition Inability to concentrate, confusion, loss of interest/motivation Alterations of physical nature Alterations of perception

examples of tricyclic antidepressants

Amitriptyline, imipramine,

Debra has been laughing, talking rapidly, with pressured speech. She is running from one part of the unit to the other. Her interactions with the staff and patients are abrupt, and sometimes she violates the individual's personal space. What nursing intervention is appropriate? A. Offer a PRN medication B. Offer seclusion C. Offer restraints D. Offer to pace with the patient

B. Offer seclusion

One important sequelae of a person's life who has bipolar disorder A. Can get a lot done when manic B. Often has high intelligence C. Experiences frequent job loss D. Loses weight from not eating

C. Experiences frequent job loss

Growth hormone assessment is a frequently used biologic diagnostic tool to diagnosis depression in which population? Children Adolescents Middle-aged adults Older adults

Children

Most effective psychotherapy approach for depression

Cognitive-behavioral therapy

The neurobiological psychopathology of depression:

Deficiency in norephenephrine, serotonin, dopamine, acetylcholine An MAO imbalance Thyroid dysfunction

Exampes of SNRIs

Cymbalta; Effexor

Debra has not been able to eat sufficient calories to sustain her increased activity. What nursing intervention would assist her? A. Provide a larger high-calorie meal. B. Distract her to encourage eating. C. Provide an increase in high-calorie snacks. D. Provide frequent portable food items.

D. Provide frequent portable food items.

A nurse who understands the psychopathology of bipolar disorder will include which intervention into the client's care plan? Assist the patient in making frequent calls to friends and neighbors while on the inpatient unit. Distract the patient to avoid negative outcomes resulting from manic behavior. Provide frequent large meals to the patient who is experiencing flight of ideas. Promote the therapeutic relationship with humor and joking behaviors.

Distract the patient to avoid negative outcomes resulting from manic behavior.

A patient in acute mania is inappropriately humorous. Patients and staff are laughing at the patient's expense and embarrassment. What intervention should the nurse implement immediately? Distract the patient to engage in another activity apart from the group. Confront the group to stop the disrespectful behavior. Join the group, and further assess the situation. Consult the multidisciplinary team to determine the behavioral consequences for the staff.

Distract the patient to engage in another activity apart from the group. Correct

Most common form of somatic therapy for depression

ECT

Rebooting, rebalancing, rebuilding:what therapy?

ECT

s/s of serotonin syndrome

HYPERTENSIVE CRISIS confusion, anxiety, restlessness, hypertension, tremors, sweating, ataxia, in severe cases death can occur.

A 70-year-old man comes to the clinic for his annual physical exam and influenza vaccine. He shares that his "life has no meaning," he "feels tired all the time," and "has lost all hope for the future." What should be the initial nursing intervention? Ask him to stay in the clinic until a mental health professional arrives to further assess him. Alert the physician that he may be depressed and require inpatient treatment. Further assess his concerns and history of psychiatric issues. Note that the patient is experiencing expected aging processes.

Further assess his concerns and history of psychiatric issues.

What are the risk factors for depression?

History of abuse, neglect, loss Dysfunctional family relationships Personal or family history of mental illness, substance abuse

Which assessment data would support a diagnosis of bipolar II disorder? Hypomania Behaviors that span at least a 6-day period Paranoia Behaviors requiring hospitalization

Hypomania Correc

Only real mania drug

Lithium carbonate

What medicine requires a tyramine free diet?

MAOIs

Elevated mood for at least 1 weeks

Manic episode

Manic individuals often attempt to control others and to achieve their goals through which mechanism? Displaying tantrum-like behavior when frustrated Physically aggressive behavior directed toward others Manipulatively praising others to gain favor Threatening to physically harm themselves

Manipulatively praising others to gain favor

A patient has just completed electroconvulsive therapy. Which intervention is most important for the nurse to implement? Observe for disorientation. Ask the patient to state his or her name. Monitor the patient's respiratory status.

Monitor the patient's respiratory status.

Term for disturbances in mood manifested by extreme sadness or extreme elation?

Mood Disorders

Persistent Depressive Disorder (Dysthymia)

Mood disorder involving persistently depressed mood, with low self-esteem, withdrawal, pessimism, or despair, present for at least 2 years, with no absence of symptoms for more than 2 months.

Can you prevent depression?

Not definitively BUT exercise, appropriate diet, rest, and avoid drugs

Which disorder is being described? Chronic depression for most days At least 2 years No more than 2 months symptom free Symptoms tend to be less severe than those of MDD Childhood, adolescence, early adulthood Tends to be chronic

Persistent Depressive Disorder (Dysthmic disorder)

Which nursing intervention is likely to be most helpful in providing adequate nutrition while the patient is experiencing acute mania? Provide nutrient-rich finger foods so the patient can eat while walking and talking. Offer only liquids that are rich in calories to avoid choking. Make food readily available knowing the client will eat when hungry. Insist that the patient join the other patients on the unit during mealtimes.

Provide nutrient-rich finger foods so the patient can eat while walking and talking.

A patient has been expressing beliefs that are not in touch with reality. The nurse's decision not to challenge the patient concerning these delusions is based on the understanding that to do so would bring about what most likely outcome? Reinforcement of the delusion. Confuse the patient's sense of reality more. Increase the risk of psychotic behavior. Undermine the patient's sense of self-worth.

Reinforcement of the delusion.

What initial intervention should be implemented by the nurse when managing a manic patient whose behavior is disrupting a group therapy session? Setting behavioral limits for the patient that are appropriate and well defined Remaining involved with the patient while demonstrating a calm demeanor Communicating with the patient using brief, simple statements Removing the patient from the group to de-escalate the situation

Remaining involved with the patient while demonstrating a calm demeanor

A person with major depressive disorder may describe feelings of:

Sadness Discouragement Hopelessness Isolation

Which disorder is being described? Usually in winter months Natural light may help modulate rhythms Buproprion extended release

Seasonal Affective Disorder

Mechanism of action of SSRIs

Slow the reuptake the serotonin

SSRI Teaching Takes________weeks maybe 6 to experience therapeutic effects Take when? _________ Take with ____________ Notify health care provider if ______________ occurs (possible Stevens-Johnson syndrome)

Takes 2-4 weeks maybe 6 to experience therapeutic effects Take in a.m., interferes with sleep if taken at bedtime Take with food to avoid GI upset Notify health care provider if skin rash or other allergic reaction occurs (possible Stevens-Johnson syndrome)

Which older adult client is at greatest risk for later life depression and resulting suicidal thoughts? The client who has a license to carry a concealed handgun. The client who has adjustly poorly to recent retirement. The client experiencing signs of short-term memory loss. The client who recently lost a sibling and an adult child.

The client who recently lost a sibling and an adult child.

It is most important for the nurse to include the client's significant others when teaching which aspect of bipolar self-care? The need to notify the health care provider when the client is facing a crisis situation The importance of eating a heart-healthy diet and exercising regularly Watching for and reporting impending signs of relapse such as sleeping difficulties and irritability Receiving credit counseling in the case the client's behavior has resulted in a large debt

Watching for and reporting impending signs of relapse such as sleeping difficulties and irritability

cyclothymic disorder

a disorder marked by numerous periods of hypomanic symptoms and mild depressive symptoms

What results when mixing MAOIs and foods containing tyramine?

hypertensive crisis