NR 546 FINAL EXAM VERSION 1 AND VERSION 2
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS)
Lithium Pharmacologic Treatment of Bipolar Disorder
Anticonvulsants
Second generation antipsychotics
major depressive disorder (MDD) Unipolar depression
one of the most common mental disorders
-Approximately 7.1% of adults in the U.S. had episode in
last year, prevalence highest (13.1%) among individuals
aged 18-25
S/S
-depressed mood
-loss of interest or pleasure in daily activities
-irritability
-withdrawal
-problems with sleep, eating, energy, concentration, or
self-worth
-severe depression: may experience thoughts of suicide
or psychotic symptoms.
,Chronic condition characterized by extreme fluctuations Bipolar disorder (BD)
in mood, energy, and ability to function
-Moods may be manic, hypomanic, or depressed and may
include mixed mood or psychotic features
-many have only experienced only one manic episode in
their lifetime
-Mood fluctuations may be separated by periods of high
stability or may cycle rapidly
-diagnosed when a client has one or more episodes of
mania or hypomania with a history of one or more major
depressive episodes
-high risk for suicide
characterized by a persistently elevated, expansive, or mania
irritable mood. Related symptoms may include inflated
self-esteem, increased goal-directed activity or energy,
including grandiosity, decreased need for sleep,
excessive talkativeness, racing thoughts, flight of ideas
(FOI), distractibility, psychomotor agitation, and a
propensity to be involved in high-risk activities. Mania
leads to significant functional impairment and may
include psychotic features or necessitate hospitalization
requires at least one episode of mania for at least one Bipolar Type I:
week (or any duration if hospitalization due to symptoms is
required)
diagnosis requires a current or past hypomanic episode Bipolar Type II:
and a current or past major depressive episode.
Symptoms last for at least 4 days but fewer than seven.
-Hypomanic symptoms are 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.
involves the chronic presentation of hypomanic and Cyclothymia:
depressive symptoms that do not meet the diagnostic
criteria for a major depressive or manic/hypomanic
episode.
antidepressant therapy may precipitate a manic episode If bipolar depression is mistaken for MDD:
or induce rapid-cycling bipolar depression
-may contribute to the increased incidence of death by
suicide in children and adults younger than 25
monotherapy Antidepressants are used cautiously in clients with bipolar disorder and never as
-Antidepressants should be combined with a mood ________________.
stabilizer to prevent the onset of a hypomanic or manic
episode
, Decreased positive affect: DA, NE Dysfunction causes what mood related symptoms
depressed mood
loss of joy
lack of
interest loss
of energy
decreased alertness
decreased self-confidence
appetite changes
Increased negative affect: 5HT, NE Dysfunction causes what mood related symptoms
depressed mood
guilt
fear/anxiety
hostility
irritability
loneliness
appetite changes
-depression occurs as a result of a deficiency of one or monoamine hypothesis of depression
all three monoamine transmitters
• serotonin, norepinephrine, and dopamine
-while mania may result from an excess
• Selective Serotonin Reuptake Inhibitors (SSRIs) Medication Management for Depression, First-Line Treatment:
• Serotonin Norepinephrine Reuptake Inhibitors
(SNRIs)
• Norepinephrine Dopamine Reuptake Inhibitors
(NDRI)
• Serotonin Antagonist and Reuptake Inhibitors
(SARIs)
Mechanism of action SSRI's
• inhibit 5-HT
reuptake Adverse
effects
-diarrhea
-headache
-weight gain
-sexual side effects
Mechanism of action SNRI's
• inhibit 5-HT reuptake
• inhibit NE reuptake (increase energy, focus)
• increase DA in prefrontal cortex (increase
cognition) Adverse effects
-elevated blood pressure
-anxiety
-insomnia
-constipation
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS)
Lithium Pharmacologic Treatment of Bipolar Disorder
Anticonvulsants
Second generation antipsychotics
major depressive disorder (MDD) Unipolar depression
one of the most common mental disorders
-Approximately 7.1% of adults in the U.S. had episode in
last year, prevalence highest (13.1%) among individuals
aged 18-25
S/S
-depressed mood
-loss of interest or pleasure in daily activities
-irritability
-withdrawal
-problems with sleep, eating, energy, concentration, or
self-worth
-severe depression: may experience thoughts of suicide
or psychotic symptoms.
,Chronic condition characterized by extreme fluctuations Bipolar disorder (BD)
in mood, energy, and ability to function
-Moods may be manic, hypomanic, or depressed and may
include mixed mood or psychotic features
-many have only experienced only one manic episode in
their lifetime
-Mood fluctuations may be separated by periods of high
stability or may cycle rapidly
-diagnosed when a client has one or more episodes of
mania or hypomania with a history of one or more major
depressive episodes
-high risk for suicide
characterized by a persistently elevated, expansive, or mania
irritable mood. Related symptoms may include inflated
self-esteem, increased goal-directed activity or energy,
including grandiosity, decreased need for sleep,
excessive talkativeness, racing thoughts, flight of ideas
(FOI), distractibility, psychomotor agitation, and a
propensity to be involved in high-risk activities. Mania
leads to significant functional impairment and may
include psychotic features or necessitate hospitalization
requires at least one episode of mania for at least one Bipolar Type I:
week (or any duration if hospitalization due to symptoms is
required)
diagnosis requires a current or past hypomanic episode Bipolar Type II:
and a current or past major depressive episode.
Symptoms last for at least 4 days but fewer than seven.
-Hypomanic symptoms are 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.
involves the chronic presentation of hypomanic and Cyclothymia:
depressive symptoms that do not meet the diagnostic
criteria for a major depressive or manic/hypomanic
episode.
antidepressant therapy may precipitate a manic episode If bipolar depression is mistaken for MDD:
or induce rapid-cycling bipolar depression
-may contribute to the increased incidence of death by
suicide in children and adults younger than 25
monotherapy Antidepressants are used cautiously in clients with bipolar disorder and never as
-Antidepressants should be combined with a mood ________________.
stabilizer to prevent the onset of a hypomanic or manic
episode
, Decreased positive affect: DA, NE Dysfunction causes what mood related symptoms
depressed mood
loss of joy
lack of
interest loss
of energy
decreased alertness
decreased self-confidence
appetite changes
Increased negative affect: 5HT, NE Dysfunction causes what mood related symptoms
depressed mood
guilt
fear/anxiety
hostility
irritability
loneliness
appetite changes
-depression occurs as a result of a deficiency of one or monoamine hypothesis of depression
all three monoamine transmitters
• serotonin, norepinephrine, and dopamine
-while mania may result from an excess
• Selective Serotonin Reuptake Inhibitors (SSRIs) Medication Management for Depression, First-Line Treatment:
• Serotonin Norepinephrine Reuptake Inhibitors
(SNRIs)
• Norepinephrine Dopamine Reuptake Inhibitors
(NDRI)
• Serotonin Antagonist and Reuptake Inhibitors
(SARIs)
Mechanism of action SSRI's
• inhibit 5-HT
reuptake Adverse
effects
-diarrhea
-headache
-weight gain
-sexual side effects
Mechanism of action SNRI's
• inhibit 5-HT reuptake
• inhibit NE reuptake (increase energy, focus)
• increase DA in prefrontal cortex (increase
cognition) Adverse effects
-elevated blood pressure
-anxiety
-insomnia
-constipation
