Ch. 13 - BPD
Which symptom distinguishes mania from hypomania? Which type (BP I or BP II) most commonly experiences mania?
What is:
- Psychosis
- BP I
Hallucinations and delusions are considered this type of symptom.
What is:
- Positive symptoms
What is the first line treatment for Depression? Which drug class is known to be LETHAL and requires careful attention with suicidal patients?
What is:
- SSRIs (1st line)
- TCAs (Lethal; use in caution with suicidal patients)
What is:
- Is there a plan?
- How lethal is the proposed method?
- Do they have access to said method/weapon?
A patient becomes angry during group therapy and throws a chair at another patient, causing injury. This behavior is known as:
What is:
Violence
During the late phase of mania, what risk is the most concerning?
What is:
- Suicide risk
What are the neurotransmitter that are increased and decreased in Schizophrenia?
What is:
- Dopamine (increased)
- GABA (decreased)
What neurotransmitters are associated with depression?
What is:
- Serotonin, Norepinephrine, and Glutamate
A patient reports planning to shoot themselves with a firearm stored in their home.This suicide method is categorized as what level of lethality?
What is:
High/Hard methods (High risk)
A teacher observes a student teasing a classmate, kicking their backpack, and threatening to bite them during recess. This is best classified as: Bullying, Anger, Aggression or Violence
What is:
Bullying
What are some of the symptoms for lithium toxicity? What is the therapeutic window for lithium?
What is:
- N/V, diarrhea, polyuria, lethargy, fine hand tremor (EARLY S&S), and goiter.
- Range: 0.8-1.2 mEq/L
What is the generation of antipsychotics that help treat positive symptoms of schizophrenia, and has the greatest risk for severe side effects?
What is:
- First generation antipsychotics
What neurotransmitters are low/high in depression, and what lab(s) are used that indicate a patient is depressed?
What is:
DECREASED Serotonin; DECREASED NE; DECREASED Glutamate; DECRASED Dopamine
INCREASED ACh, INCREASED Cortisol levels
Lab: Thyroid labs (Hypothyroidism)
A patient reports they planned to take several sleeping pills but has not obtained them yet. What type of method is this?
What is:
- Soft method (low risk)
A nurse observes a patient pacing, speaking loudly, clenching fists, and staring intensely at another patient. These behaviors are described as? (Aggression, Violence, Anger, Bullying)
What is:
- Aggression
What are some patient and family teaching indications for lithium therapy?
What is:
- Ensure adequate fluid intake to prevent dehydration (1500-3000 mL/day)
- Consume the same amount of salt each day (be cautious with salt)
- Take with food or milk to minimice GI AE
- STOP LITHIUM IF: Excessive diarrhea, vomiting/nausea
What are the negative symptoms associated with schizophrenia? (6-7 As)
What is:
- Anhedonia
- Avoliton
- Asociality
- Apathy
- Affective Blunting
- Alogia
What is Serotonin Syndrome, and what are some of the S&S and relevant tx?
SS: Overactivation of the CNS's serotonin receptors due to an increase in Serotonin
S&S:
- Myoclonus; increase motor activity; elevated BP; delirium; tachycardia; Mood change
TX: Remove all offending agents; provide cooling blankets (Chlorpromazine for hyperthermia); Dantrolene/Diazepam for muscle rigidity
What are some factors that contribute to nonadherence of the treatment plan?
What is:
Agnosognosia; medication side effects, treatment inadequacy, residual symptoms, and relapse/chronicity/loss
A patient is severely aggitated and irritated. The patient beings to yell and starts pacing in the hallway. What drug classes do you anticipate to give this patient to prevent escalation?
What are the most common types of drugs given for de-escalation:
- Anxiolytics, First Generation Antipsychotics, Second Generation Antipsychotics, Combos (Haldol + Ativan + Benadryl/Congentin)
A patient with bipolar disorder takes only an antidepressant. What episode may be triggered?
What is:
- increases the risk of bringing a manic episode
(manic episodes decrease with a combo of antidepressants and moos stabilizer)
A patient tells the nurse, “The voice says I must stab my roommate tonight because they’re dangerous. I believe that I am God Himself.”
The nurse recognizes this as the highest-risk type of hallucination(s) because it may direct the patient to harm someone. (2 types of hallucinations)
What is:
- Grandiose
- Command
What are some differences between Dysthymia (Persistent Depressive Disorder) and Major Depressive Disorder (MDD)?
What is:
PDD: Low levels of depression occuring most of the day; depressive feelings last at least 2 years; chronic low levels of depression; TEENAGER ONSET; no pyschotic features; chronic and milder ; DSM-5 CRIT of >2 S&S; low risk of suicide; functional impact is ongoing impairment (most people think its normal/part of their functioning)
MDD: Persistent depressed mood lasting more than 2 WEEKS; psychotic features may be present; acute and severe; recurrent episodes w/ remissions; DSM-5 CRIT of >5 of 9 S&S ; high suicide risk ; functional impact is significant/disabling
dang, you got lucky huh. Freebie!!
(Actually, nevermind. What class of drug is this? Sertraline (Zoloft). What does it treat?)
What is:
SSRIs
Treats: Depression
What is a smaller amygdala often associated with?
What is:
Increased aggressive response