Exam 2 Maryville NURS 663
Cyclothymic Disorder
Diagnostic Criteria: - correct answer · Diagnostic Criteria: For at least 2 years (1 year in children and
adolescents) there have been numerous periods with hypomanic symptoms that do not meet the
criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet the
criteria for a major depressive episode
· During the above 1- or 2-year period, the hypomanic and depressive periods have been present for at
least half of the time and the individual has not been without symptoms for more than 2 months at a
time
· Prevalence is 0.4% to 1%
· 15-50% risk for turning into Bipolar I or II
Lithium labs - correct answer level, NA, Ca, P, EKG, Creatinine, Urinalysis, CBC, TSH
bipolar meds: depression - correct answer lurasidone (13+), olanzapine + fluoxetine (10+)(symbyax)
bipolar acute and mixed mania - correct answer aripiprazole, risperidone, olanzapine (13+), quetiapine
(acute only), asenapine (10+)
classic mood stabilizers - correct answer Lamotrigine (excellent medication to use), lithium, Depakote
(avoid in females if possible due to PCOS and Pregnancy), Tegretol, Trileptal (no evidence for true
Bipolar disorder)
anti-depressants - correct answer class not used w/bipolar disorder
lithium - correct answer Anti-manic, antidepressant, anti-suicidal
Lithium side effects - correct answer Frequent urination, increased thirst, weight gain, sedation
lithium toxicity - correct answer sudden onset tremors, N/V/D, muscle weakness, slurred speech,
confusion, seizures (slowing down, feel really out of it)
Tourette's d/o - correct answer Multiple motor and at least one vocal tic (some tics come and go, they
don't have them all at the same time to receive the diagnosis)
HRT - correct answer habit reversal training can be used to manage tics
Tics tx - correct answer Alpha agonists (clonidine, guanfacine); Haldol is not the first-line txt
Specific Learning Disorders - correct answer difficulties in the acquisition and use of listening, speaking,
reading, writing, reasoning, or mathematical abilities; dx by other professionals w/specialized training;
NP tx comorbid d/o
,Exam 2 Maryville NURS 663
Anorexia nervosa - correct answer an eating disorder in which an irrational fear of weight gain leads
people to starve themselves; restrictive or binge/purge/exercise
Bulimia nervosa - correct answer an eating disorder characterized by episodes of overeating, usually of
high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise
Binge-eating disorder - correct answer significant binge-eating episodes, followed by distress, disgust,
or guilt, but without the compensatory purging, fasting, or excessive exercise
Avoidant/restrictive eating disorder - correct answer avoiding or restricting foods in childhood.
significantly low BMI; no distortion of body image or fear of gaining wt. r/o delusions around food
Pica - correct answer an abnormal craving or appetite for nonfood substances, such as dirt, paint, or
clay that lasts for at least 1 month; decrs incidence with incr age
Feeding and Eating Disorders tx - correct answer Talk therapy (counseling is needed for the distress)
(intensive outpatient, partial inpatient or actual inpatient admission may be needed); most have
associated depression and/or anxiety
Feeding and Eating Disorders meds - correct answer fluoxetine help but not direct tx
Vyvanse approved for binge eating but not because of stimulant effects
Enuresis treatment - correct answer 1. First line is behavioral interventions: bed alarms, toileting at
bedtime and during the night, bladder training
2. reassurance, resolves spontan, normal 4-5 yo
Enuresis meds - correct answer Desmopressin nasal spray; Infants 3 months of age to children 12 years
of age:
Intranasal: 5 mcg/day as a single dose or in 2 divided doses. Dose range is 5 to 30 mcg/day. The morning
and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover.
Major Depressive Disorder Dx - correct answer 5+ for at least a 2-week period; either #1 or 2 req
1. Depressed mood most of the day, nearly every day (can be irritability in children & adolescents)
2. Diminished interest or pleasure in all, or almost all, activities
3. Change appetite/weight; kids not wt goals
Insomnia or hypersomnia nearly every day
4. Up or down Psychomotor
5. Fatigue or loss of energy
6. Worthlessness/excessive or inappropriate guilt
7. Diminished ability to think or concentrate, or indecisiveness (don't confuse with ADHD, address mood
first)
,Exam 2 Maryville NURS 663
8. Recurrent thoughts of death, thoughts of suicide, or suicidal plan/intent: if hosp then 2 wk not req.
SLAP - correct answer Social supports; lethal; access to means; plan and previous attempt
Suicide risk: IS PATH WARM - correct answer Ideation, substance abuse, purpose to live gone; anxiety,
trapped feeling; hopelessness, w/d from soc supports, anger w/rage; reckless, dramatic moods
SIGECAPS - correct answer Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicide
bipolar vs unipolar: look at bipolar if - correct answer 1. family hx: 1st degree relatives
2. Substance use: chasing high or low
3. Response to SSRI: no resp to multiple tries or evidence of mania with use (not diagnostic)
coprolalia - correct answer involuntary utterance of obscenities or inappropriate remarks
Bipolar I criteria - correct answer One manic episode required
Mania - correct answer elevated, expansive, energetic + 3, (unless irritable
mood then requires 4+)
1. SX Lastat least one week-any duration if hosp
2. Inflated self-esteem, grandiosity
3. Decreased need for sleep
4. More talkative, pressure to keep talking
5. Flight of ideas or racing thoughts
6. Distractibility: r/o ADHD (constant) intermit w/BD
7. Increase in goal-directed activity
8. Risky, impulsive behaviors (sex, money, pot for harm)
hypomania vs mania - correct answer a milder form of elevated mood that are less severe and cause
less impairment than ______ and (usually) don't require hospitalization
Mania impairment - correct answer severe in work, social activities, or relationships or to necessitate
hosp or there are psychotic features
Hypomania impairment - correct answer cause a change in functioning but not severe
Mood disorder r/o - correct answer No symptoms can be due to a substance or general medical
condition
Most common anxiety disorder in children - correct answer separation anxiety disorder-per p 193 &
222 in DSM-V
Panic attack vs anxiety attack - correct answer thoughts of impending death distinctive for panic
, Exam 2 Maryville NURS 663
generalized anxiety disorder - correct answer an anxiety disorder in which a person is continually tense,
apprehensive, and in a state of autonomic nervous system arousal for 6 mo or more
social anxiety disorder - correct answer an anxiety disorder involving the extreme and irrational fear of
being embarrassed, judged, or scrutinized by others in social situations; avoidance of soc situations
Phobias - correct answer A group of anxiety disorders involving a pathological fear of a specific object or
situation
Anxiety disorder tx - correct answer - First line tx: SSRIs: most effective, least s/e
- Anti-anxiety drugs: buspirone, hydroxyzine, benadryl
- Beta blockers: propranolol
- Psychotherapy
Avoid benzos
Anxiety disorder meds - correct answer Fluoxetine, sertraline, escitalopram, citalopram, paroxetine,
duloxetine, venlafaxine,
desvenlafaxine, vilazodone (Viibryd), vortioxetine (Trintellix) from most to least often used/EBP
SSRI mechanism of action - correct answer Blocking reabsorption / reuptake, of serotonin, leaves more
serotonin available, which improves mood
SNRI mechanism of action - correct answer Inhibit reuptake of both serotonin and norepinephrine
Anti-depressant education - correct answer Always teach the Black Box warning for incr SI risk up to 24
y/o.
Schizophrenia - correct answer a psychological disorder characterized by 2 of the following for at least 1
mo; must include at least one of first 3:
1. delusions,
2. hallucinations,
3. disorganized speech
4. Grossly disorganized/catatonic behavior
5. diminished, inappropriate emotional expression
6. IF have ASD or comm d/o then delu or hall a must
bizarre delusions - correct answer clearly implausible and not understandable to same-culture peers
and do not derive from ordinary life experiences; do not play into delusions
positive symptoms of schizophrenia - correct answer Delusions of reference, delusions of persecution,
delusions of grandeur, thought broadcasting, though insertion, hallucinations, disorganized thought,
disorganized behavior, catatonia
