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72 Cards in this Set

  • Front
  • Back
Bipolar disorder involves extreme mood swings from episodes of ____ to episodes of _______.
mania
depression
During manic phases, clients are what four things?
(adjectives)
euphoric
grandiose
energetic
sleepless
During manic phases, they have what 4 things? (nouns)
poor judgment
rapid thoughts
actions
speech
During depressed phases of bipolar disorder, what 3 things are the same as in people diagnosed with major depression?
mood
behavior
thoughts
If a person's first episode of bipolar illness is a depressed phase, he might be diagnosed with major ______ and a diagnosis of bipolar disorder will not be made until the person experiences a _____ episode.
depression
manic
Bipolar disorder ranks _____ only to major depression as a cause of worldwide disability.
second
The life-time risk of bipolar disorder is at least ____ with a risk of completed suicide of ____.
1.2%
15%
_____ ____ in the course of their illness are at highest risk for suicide, esp. those with a history of suicide attempts or alcohol abuse as well as those recently discharged from the hospital.
Young men
Whereas a person with major depression slowly slides into depression that can last for ___ months to ___ years, the person with bipolar disorder _____ between depression and normal behavior (bipolar depressed) or mania and normal behavior (bipolar manic)
6 months to 2 years
cycles
A bipolar can also run the gamut from ____ to normal _____ to _____ and back again in repeated cycles (bipolar MIXED episodes).
mania
behavior
depression
A person with bipolar _____ episodes alternates between major depressive and manic episodes interspersed with periods of normal behavior.
MIXED
A bipolar MIXED episode may last for ____ or ____ before the pattern begins to descend or ascend once again.
weeks or months
Bipolar disorder occurs almost equally among _____ and _____.
men and women
Bipolar disorder is more common in highly _____ people.
educated
The mean age for a first manic episode is the early ___, but some people experience onset in adolescence while others tart older than ____ years.
20s
50
Manic episodes typically begin suddenly with rapid ____ of symptoms over a few days and they last from a few weeks to several months.
escalation
Manic episodes tend to be briefer and to end more suddenly than ______ episodes.
depressive
Adolescents are more likely to have _____ manifestations.
psychotic
The diagnosis of a manic episode or mania requires at least ___ week of unusual mood and incessantly heightened, grandiose, or agitated mood in addition to three or more of the following symptoms? (12)
one

exaggerated self-esteem
sleeplessness
pressured speech
flight of ideas
reduced ability to filter extraneous stimuli
distractibility
increased activities with
increased energy
multiple, grandiose high-risk
activities involving poor
judgment
severe consequences such as
spending sprees
sex with strangers
impulsive investments
Clients often do not understand how their illness affects _____.
others
Bipolars may stop taking _____ because they like the euphoria and feel burdened by the side effects, blood tests, and physician's visits needed to maintain treatment.
medications
Family members are concerned and exhausted by their loved one's behavior; they often stay up late at night for fear that the manic person may do something impulsive and _______.
dangerous
Treatment for bipolar disorder involves a lifetime regimen of _____ : either an antimanic agent called _____ or _______ medications used as mood stabilizers.
medications

lithium
anticonvulsant
Bipolar disorder is the only psychiatric disorder in which medications can prevent ____ cycles of bipolar behavior.
acute
Once thought to help reduce manic behavior only, ____ and _____ medications also protect against the effects of bipolar depressive cycles.
lithium
anticonvulsants
If a client in the acute stage of mania or depression exhibits psychosis (disordered thinking as seen with delusions, hallucinations, and illusions), a _____ agent is administered in addition to the bipolar medications. Some clients keep taking both bipolar medications and ______.
antipsychotic
antipsychotics
Major symptoms of mania include? (8)
Heightened, grandiose, or
agitated mood
Exaggerated self-esteem
Sleeplessness
Pressured speech
Flight of ideas
Reduced ability to filter
out extraneous stimuli;
easily distractible
Increased number of
activities with increased
energy
Multiple, grandiose high-
risk activities, using
poor judgment with severe
consequences
What is lithium?
salt
Lithium is similar to?
gold
copper
magnesium
manganese
other trace elements
Response rate in acute mania to lithium therapy is what percentage?
70 to 80%
In addition to treating the range of bipolar behaviors, lithium also can stabilize bipolar disorder by reducing the degree and frequency of ____ or eliminating manic episodes.
cycling
Lithium not only competes for ____ receptor sites but also affects calcium, potassium, magnesium ions as well as glucose metabolism.
salt
Lithium mechanism of action is unknown, but it is thought to work in the synapses to hasten destruction of (dopamine, norepinephrine), inhibit neurotransmitter release, and decrease the sensitivity of postsynaptic receptors.
catecholamines
Lithium's action peaks in ___ minutes to ___ hours for regular forms and __ to___ hours for the slow-release form.
30 minutes to 4 hours

4 to 6 hours
_____ crosses the blood brain barrier and placenta and is distributed in sweat and breast milk.
Lithium
Lithium use during pregnancy is not recommended because it can lead to first-trimester developmental abnormalities.
okay
Onset of action is ____ to ____ days; with this lag period, antipsychotic or antidepressant agents are used carefully in combination with lithium to reduce symptoms in acutely manic or acutely depressed clients.
5 to 14 days
Half-life of lithium is ____ to ___ hours.
20 to 27 hours
Lithium is effective in about what percentage of clients with bipolar?
75%
About 25% of bipolars do not respond or have difficulty taking lithium because of side effects, problems with the treatment regimen, drug interactions, or medical conditions such as ____ disease that contraindicate use of lithium.
RENAL
Several miscellaneous _______ traditionally used to treat seizure disorders have proven helpful in stabilizing the moods of people with bipolar illness.
The mechanism of action is unknown.
anticonvulsants
The trade name for carbamazepine is?
Tegretol
Which drug had been used for grand mal and temporal lobe epilepsy as well as trigeminal neuralgia, was the first anticonvulsant found to have mood-stabilizing properties but the threat of ______ was of great concern?
carbamazepine (Tegretol)
agranulocytosis
Clients taking carbamazepine need to have drug serum levels checked regularly to monitor for toxicity and to determine if the drug has reached therapeutic levels, which are generally ____ to ___ ug per ml. Baseline and periodic lab testing must also be done to monitor for suppression of _____.
4 to 12
WBCs
Trade name for valproic acid?
Depakote
(also known as divalproex sodium or sodium valproate)
Valproic acid is an anticonvulsant used for simple absence and mixed seizures, migraine prophylaxis, and mania. The mechanism of action is unclear. Therapeutic levels are monitored periodically to remain at ____ to ____ ug per ml, as are baseline and ongoing liver function tests including serum ammonia levels and platelet and bleeding times.
50 to 125
What lab tests are important when taking valproic acid (Depakote)?
therapeutic levels
baseline and ongoing liver
function tests which
include ammonia levels
platelet and bleeding times
Another name for Gabapentin?
neurontin
Another name for lamotrigine is?
Lamictal
Another name for topiramate is?
Topamax
Neurontin, Lamictal, and Topamax are other anticonvulsants sometimes used as mood stabilizers but less frequently than valproic acid. Value ranges for therapeutic levels are not established.
okay
Another name for clonazepam is?
Klonopin
Klonopin is an anticonvulsant and a BENZODIAZEPINE used in simple absence and minor motor seizures, panic disorder, and bipolar disorder. Physiologic dependence can develop with long-term use.
Klonopin (clonazepam)
_______ may be used in conjunction with Lithium or other mood stabilizers but is not used alone to manage bipolar disorder.
Klonopin
Psychotherapy can be useful in _____ depressive or _____ portion of the bipolar cycle. It is not useful during acute manic stages because the person's attention span is brief and he or she can gain little insight during times of accelerated psychomotor activity.
mildly
normal
Psychotherapy combined with ____ can reduce the risk of suicide and injury, provide support to the client and family, and help the client to accept diagnosis and treatment plan.
medication
While assessing history of bipolar patient, watching and listening is beneficial. It's difficult to assess patient while he's in the ____ phase, as patient may jump from subject to subject. Keep sessions short and talk to family.
manic
Sitting still is difficult for the bipolar during the manic phase, as they experience agitation and are in perpetual motion. The continual movement may cause? (2)
injury
exhaustion
In the manic phase, the client may wear clothes that reflect the elevated mood:
For example?
clothing that is brightly
colored
flamboyant
attention-getting
sexually suggestive

A woman in the manic phase may wear a lot of jewelry and hair ornaments or her makeup can be garish and heavy, while a male client may wear a tight revealing muscle shirt or go bare-chested.
Clients experiencing a _____ episode think, move, and talk fast.
manic
____ _____, one of the hallmark symptoms, means unrelentingly rapid and often loud speech without pauses. Those with pressured speech interrupt and cannot listen to others.
They ignore verbal and nonverbal cues indicating that others wish to speak and they continue with constant intelligible or unintelligible speech, turning from one listener to another or speaking to no one at all. If interrupted, clients with mania often start over from the beginning.
Pressured speech
Mania is reflected in periods of the following? (4)
euphoria
exuberant activity
grandiosity
false sense of well-being
Projection of an all-knowing and all-powerful image may be an unconscious defense against underlying low ____-____.
self-esteem
Some clients manifest ____ with an angry, verbally aggressive tone and are sarcastic and irritable especially when others set limits on their behavior.
Mood is quite labile (unstable), and periods of loud laughter may alternate with episodes of tears.
mania
Term used for confused cognitive ability or thinking and jumbled with thoughts racing one after another. Clients cannot connect concepts and jump from one subject to another.
flight of ideas
A disturbance in the associative thought process in which one tends to digress readily from one topic under discussion to other topics that arise through association.
tangentiality
A disturbance in the thought process by detail that is often tangential and irrelevant.
circumstantiality
Due to flight of ideas, tangentiality, and circumstantiality, the client may not be able to communicate thoughts or needs in ways that others understand.
okay
Bipolars start many projects at one time but cannot carry any out to completion. There is little true planning, but the client talks nonstop about plans and projects to anyone and everyone, insisting on the importance of accomplishing the activities. May participate in risk-taking behavior. Some may claim to be the President, a famous movie star, or even God or prophet.
okay
Clients may be oriented to person and place, but rarely to?
TIME
Intellectual functioning is difficult to assess during the ____ phase.
manic
Clients with mania can go days without sleep or food and not even realize they are hungry or tired...hygiene is considered "boring" when they have "more important things" to do...may throw away possessions or destroy valued items
okay