NR 547 QUESTIONS AND ANSWERS LATEST UPDATE
Non-Pharmacological Treatments for Depression Psychotherapy
Cognitive Behavioral Therapy (CBT) - First-line for mild-moderate depression,
Interpersonal Therapy (IPT) - Focus on relationship issues, Behavioral Activation
Therapy - Encourages positive behaviors
Lifestyle Interventions
Exercise - Comparable to SSRIs for mild depression, Mindfulness-Based CBT (MBCT),
Electroconvulsive Therapy (ECT) - For severe, refractory cases
Antidepressant Dosing (Starting Doses)
SSRIs: Fluoxetine (Prozac) 10-20 mg/day, Sertraline (Zoloft) 25-50 mg/day,
Escitalopram (Lexapro) 5-10 mg/day; SNRIs: Venlafaxine (Effexor) 37.5 mg/day,
Duloxetine (Cymbalta) 30 mg/day
Bipolar Disorder Screening Across the Lifespan
Adults: Mood Disorder Questionnaire (MDQ), Children/Adolescents: Child Mania Rating
Scale (CMRS), DSM-5-TR Diagnostic Criteria for Bipolar Disorders
Bipolar I
At least 1 manic episode
Bipolar II
Hypomania + MDD
Cyclothymia
2 years of subthreshold hypomanic/depressive symptoms
Differential Diagnoses for Bipolar Disorder Medical Conditions
Hyperthyroidism, Neurological disorders (TBI, MS, epilepsy), Substance-Induced:
Cocaine, amphetamines, steroids
Rapid Cycling in Bipolar Disorder
Definition: ≥4 mood episodes in 12 months, Risk Factors: Female gender, Thyroid
dysfunction, Antidepressant monotherapy
Manic Triggers
Medications: Antidepressants (esp. SSRIs/SNRIs), Corticosteroids, Stimulants (e.g.,
ADHD meds); Lifestyle Factors: Sleep deprivation, Substance use
Treatment of Acute Mania (First-Line Mood Stabilization)
, Lithium, Valproate (Depakote), Atypical Antipsychotics (e.g., Olanzapine, Quetiapine)
Manic Symptoms - Urgent Treatment & Consequences of Non-Treatment
Untreated Manic Episode Duration: 3-6 months, Consequences: Impulsivity, Psychosis,
Suicidality, Increased hospitalization risk
Pharmacological Management of Bipolar Disorder
Lithium: Therapeutic range: 0.6-1.2 mEq/L, Labs: Kidney, thyroid, electrolytes, Side
effects: Tremor, polyuria, weight gain; Lamotrigine (Lamictal): Prevention of depressive
episodes, Monitor for Stevens-Johnson Syndrome (rash)
TSH
0.4-4.5 mIU/L (Rule out thyroid dysfunction)
Hemoglobin (women)
12-16 g/dL
Hemoglobin (men)
14-18 g/dL
Lithium
0.6-1.2 mEq/L
Depakote (Valproate)
50-125 mcg/mL
Suicide Risk Factors - Male
Increased risk factor demographic
Suicide Risk Factors - Older age
Increased risk factor demographic
Suicide Risk Factors - Single, unemployed
Increased risk factor demographic
Suicide Risk Factors - Psychiatric History
Includes Depression, Bipolar disorder, Schizophrenia
Suicide Risk Factors - Medical Conditions
Includes Chronic pain, Terminal illness
Suicide Risk Factors - Personal History
Includes Past attempts, Family history of suicide
Suicide Risk Factors - Substance Use
Non-Pharmacological Treatments for Depression Psychotherapy
Cognitive Behavioral Therapy (CBT) - First-line for mild-moderate depression,
Interpersonal Therapy (IPT) - Focus on relationship issues, Behavioral Activation
Therapy - Encourages positive behaviors
Lifestyle Interventions
Exercise - Comparable to SSRIs for mild depression, Mindfulness-Based CBT (MBCT),
Electroconvulsive Therapy (ECT) - For severe, refractory cases
Antidepressant Dosing (Starting Doses)
SSRIs: Fluoxetine (Prozac) 10-20 mg/day, Sertraline (Zoloft) 25-50 mg/day,
Escitalopram (Lexapro) 5-10 mg/day; SNRIs: Venlafaxine (Effexor) 37.5 mg/day,
Duloxetine (Cymbalta) 30 mg/day
Bipolar Disorder Screening Across the Lifespan
Adults: Mood Disorder Questionnaire (MDQ), Children/Adolescents: Child Mania Rating
Scale (CMRS), DSM-5-TR Diagnostic Criteria for Bipolar Disorders
Bipolar I
At least 1 manic episode
Bipolar II
Hypomania + MDD
Cyclothymia
2 years of subthreshold hypomanic/depressive symptoms
Differential Diagnoses for Bipolar Disorder Medical Conditions
Hyperthyroidism, Neurological disorders (TBI, MS, epilepsy), Substance-Induced:
Cocaine, amphetamines, steroids
Rapid Cycling in Bipolar Disorder
Definition: ≥4 mood episodes in 12 months, Risk Factors: Female gender, Thyroid
dysfunction, Antidepressant monotherapy
Manic Triggers
Medications: Antidepressants (esp. SSRIs/SNRIs), Corticosteroids, Stimulants (e.g.,
ADHD meds); Lifestyle Factors: Sleep deprivation, Substance use
Treatment of Acute Mania (First-Line Mood Stabilization)
, Lithium, Valproate (Depakote), Atypical Antipsychotics (e.g., Olanzapine, Quetiapine)
Manic Symptoms - Urgent Treatment & Consequences of Non-Treatment
Untreated Manic Episode Duration: 3-6 months, Consequences: Impulsivity, Psychosis,
Suicidality, Increased hospitalization risk
Pharmacological Management of Bipolar Disorder
Lithium: Therapeutic range: 0.6-1.2 mEq/L, Labs: Kidney, thyroid, electrolytes, Side
effects: Tremor, polyuria, weight gain; Lamotrigine (Lamictal): Prevention of depressive
episodes, Monitor for Stevens-Johnson Syndrome (rash)
TSH
0.4-4.5 mIU/L (Rule out thyroid dysfunction)
Hemoglobin (women)
12-16 g/dL
Hemoglobin (men)
14-18 g/dL
Lithium
0.6-1.2 mEq/L
Depakote (Valproate)
50-125 mcg/mL
Suicide Risk Factors - Male
Increased risk factor demographic
Suicide Risk Factors - Older age
Increased risk factor demographic
Suicide Risk Factors - Single, unemployed
Increased risk factor demographic
Suicide Risk Factors - Psychiatric History
Includes Depression, Bipolar disorder, Schizophrenia
Suicide Risk Factors - Medical Conditions
Includes Chronic pain, Terminal illness
Suicide Risk Factors - Personal History
Includes Past attempts, Family history of suicide
Suicide Risk Factors - Substance Use
