VERIFIED 16, MARYVILLE N663 EXAM 2 QUESTIONS AND
ANSWERS
Hypomania
Same criteria as mania, however functional impairment does not exist, no psychotic
features, not due to a substance
Bipolar Disorder treatment in children and adolescents
Second gen antipsychotics
Mood stabilizers: lamotrigine, lithium, depakote, tegretol
Depakote in treatment of bipolar disorder
NOT for females of childbearing age due to teratogenic effects. Also can lead to PCOS.
Lamictal
Shows improvements in bipolar, fewer side effects, watch for rash / Stevens Johnson
syndrome. Rash above the neck, in mucous membranes. Useful also for anxiety, PTSD,
adjunct
Antipsychotics for bipolar disorder
Dopamine blockers
Indications for antipsychotics for bipolar disorder
Acute and mixed mania: aripiprazole, risperidone, olanzapine,quetiapine, asenapine
Bipolar depression: lurasidone, olanzapine + fluoxetine (symbiax)
The role of antidepressants in bipolar disorder
Don't use them if there is any family hx of bipolar disorder, mania, tried many
depressants and done poorly
Lithium
Original bipolar disorder treatment
Lithium indications
mania, depression, suicidality
Lithium levels
•Lithium requires close monitoring, including regular blood levels. Obtain Li level twelve
hours after last dose
Wait 5 days after changing dose to get new lithium level
, •Therapeutic levels are between 0.5 to 1.2 mEQ/L for most patients (1.0 to 1.5 in acute
mania)
•Blood levels can become elevated with dehydration, profuse sweating, and chronic
diarrhea leading to toxicity
•
Lithium monitoring
Renal Function
TSH
Lithium levels - requires 5 doses to get to steady state
Lithium side effects and toxicity
Side effects: Frequent urination, increased thirst, weight gain, sedation
Avoid increasing or decreasing fluid intake dramatically
Toxicity: Early warning signs include nausea, vomiting, and sedation. Also tremors,
muscle weakness, slurred speech, confusion, seizures
Anxiety Disorders
A class of disorders marked by feelings of excessive apprehension and anxiety.
Generalized anxiety disorder (GAD)
a disorder characterized by chronic excessive worry accompanied by three or more of
the following symptoms: restlessness, fatigue, concentration problems, irritability,
muscle tension, and sleep disturbance
Separation Anxiety Disorder (SAD)
A form of anxiety disorder in which the individual displays age-inappropriate, excessive,
and disabling anxiety about being apart from his or her parents or away from home.
Selective Mutism
Developmental disorder characterized by a consistent failure to speak in specific social
situations despite speaking in other situations
Panic disorder
An anxiety disorder marked by unpredictable minutes-long episodes of intense dread in
which a person experiences terror and accompanying chest pain, choking, or other
frightening sensations.
ANSWERS
Hypomania
Same criteria as mania, however functional impairment does not exist, no psychotic
features, not due to a substance
Bipolar Disorder treatment in children and adolescents
Second gen antipsychotics
Mood stabilizers: lamotrigine, lithium, depakote, tegretol
Depakote in treatment of bipolar disorder
NOT for females of childbearing age due to teratogenic effects. Also can lead to PCOS.
Lamictal
Shows improvements in bipolar, fewer side effects, watch for rash / Stevens Johnson
syndrome. Rash above the neck, in mucous membranes. Useful also for anxiety, PTSD,
adjunct
Antipsychotics for bipolar disorder
Dopamine blockers
Indications for antipsychotics for bipolar disorder
Acute and mixed mania: aripiprazole, risperidone, olanzapine,quetiapine, asenapine
Bipolar depression: lurasidone, olanzapine + fluoxetine (symbiax)
The role of antidepressants in bipolar disorder
Don't use them if there is any family hx of bipolar disorder, mania, tried many
depressants and done poorly
Lithium
Original bipolar disorder treatment
Lithium indications
mania, depression, suicidality
Lithium levels
•Lithium requires close monitoring, including regular blood levels. Obtain Li level twelve
hours after last dose
Wait 5 days after changing dose to get new lithium level
, •Therapeutic levels are between 0.5 to 1.2 mEQ/L for most patients (1.0 to 1.5 in acute
mania)
•Blood levels can become elevated with dehydration, profuse sweating, and chronic
diarrhea leading to toxicity
•
Lithium monitoring
Renal Function
TSH
Lithium levels - requires 5 doses to get to steady state
Lithium side effects and toxicity
Side effects: Frequent urination, increased thirst, weight gain, sedation
Avoid increasing or decreasing fluid intake dramatically
Toxicity: Early warning signs include nausea, vomiting, and sedation. Also tremors,
muscle weakness, slurred speech, confusion, seizures
Anxiety Disorders
A class of disorders marked by feelings of excessive apprehension and anxiety.
Generalized anxiety disorder (GAD)
a disorder characterized by chronic excessive worry accompanied by three or more of
the following symptoms: restlessness, fatigue, concentration problems, irritability,
muscle tension, and sleep disturbance
Separation Anxiety Disorder (SAD)
A form of anxiety disorder in which the individual displays age-inappropriate, excessive,
and disabling anxiety about being apart from his or her parents or away from home.
Selective Mutism
Developmental disorder characterized by a consistent failure to speak in specific social
situations despite speaking in other situations
Panic disorder
An anxiety disorder marked by unpredictable minutes-long episodes of intense dread in
which a person experiences terror and accompanying chest pain, choking, or other
frightening sensations.
