NR 547 Week 8 Final Study Guide with Answers

• Components: o 13 yes/no questions to screen for Bipolar Disorder o Assesses manic symptoms like mood elevation, hyperactivity, grandiosity, and decreased need for sleep • Scoring: o Positive screen: ≥7 symptoms present, occurring in the same episode, with moderate-to-severe impairment Normal Lab Values: • TSH: 0.4–4.5 mIU/L • Hemoglobin: o Males: 13.8–17.2 g/dL o Females: 12.1–15.1 g/dL • Lithium: 0.6–1.2 mEq/L (Therapeutic range) • Depakote (Valproic Acid): 50–100 mcg/mL (Therapeutic range) Major Depressive Disorder (MDD) Specifiers: • With anxious distress • With mixed features • With melancholic features • With atypical features • With psychotic features • With peripartum onset • With seasonal pattern Premenstrual Dysphoric Disorder (PMDD) • Diagnostic Criteria: o ≥5 symptoms in the week before menses, improving within days of onset o Symptoms include mood swings, irritability, depression, anxiety, anhedonia, and physical symptoms (bloating, breast tenderness) Persistent Depressive Disorder (Dysthymia) • Diagnostic Criteria: Rapid Cycling in Bipolar: • Definition: ≥4 mood episodes in 12 months • Risk Factors: o Female gender o Hypothyroidism o Antidepressant use in bipolar patients DIGFAST Symptoms of Mania: • Distractibility • Impulsivity (poor judgment) • Grandiosity • Flight of ideas • Activity increase (hyperactivity) • Sleep deficit (reduced need for sleep) • Talkativeness (pressured speech) Duration of Untreated Manic Episode: • Typically 3–6 months without treatment First-Line Monotherapy for Bipolar Disorder: • Lithium • Anticonvulsants (Valproate, Lamotrigine) • Atypical Antipsychotics (Quetiapine, Olanzapine) Lithium Patient Education: • Stay hydrated to prevent toxicity • Avoid NSAIDs (increase lithium levels) • Maintain consistent salt intake Lithium Monitoring: Unipolar vs. Bipolar Depression: • Unipolar Depression (MDD): o No history of mania/hypomania o Persistent depressed mood, anhedonia, cognitive disturbances • Bipolar Depression: o Depressive episodes with history of mania/hypomania o More atypical symptoms (hypersomnia, weight gain, mood reactivity) o Bipolar II is often misdiagnosed as MDD due to subtle hypomanic episodes Geriatric Depression Scale (GDS) Indications: • Used in older adults (≥65 years) • Preferred over PHQ-9 due to reduced somatic emphasis Scoring: • 0–9: Normal • 10–19: Mild depression • 20–30: Severe depression Indications for Treatment: • Persistent moderate to severe scores • Functional impairment • Suicidal ideation DSM-5-TR Diagnostic Criteria Major Depressive Disorder (MDD) • ≥5 symptoms for ≥2 weeks (SIGECAPS) o Sleep changes o Interest loss o Guilt o Energy loss o Concentration issues o Appetite changes o Psychomotor changes o Suicidal ideation 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: o Fluoxetine (Prozac) 10–20 mg/day o Sertraline (Zoloft) 25–50 mg/day o Escitalopram (Lexapro) 5–10 mg/day • SNRIs: o Venlafaxine (Effexor) 37.5 mg/day o 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