NURS 6501 Bipolar Disorder
NURS 6501 Bipolar Disorder
NURS 6501 Bipolar Disorder
Scenario 2: Bipolar Disorder
A 44-year-old female came to the clinic today brought in by her husband. He notes that she has been with various states of depression and irritability over the past 3 months with extreme fatigue, has lost 20 pounds and has insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to “flit from one thing to another.”. She hasn’t slept in 3 days. The wife went on an excessive shopping spree for new clothes that resulted in their credit card being denied for exceeding the line of credit. The wife is unable to sit in the exam room and is currently pacing the hallway muttering to herself and is reluctant to talk with or be examined the ARNP. Physical observation shows agitated movements, rapid fire speech, and hyperactivity.
DIAGNOSIS: bipolar type 2 disorder.
Question
1. How does genetics play in the development of bipolar 2 disorders?
Selected Answer: The pathophysiology of bipolar disorder, or manic-depressive illness (MDI), has not been fully identified, and there are no objective biologic markers that correspond definitively with the disease state. Twin, family, and adoption studies indicate that bipolar disorder has a significant genetic component. First-degree relatives of a person with bipolar disorder are approximately seven times more likely to develop bipolar disorder than the rest. The heritability of bipolar I disorder (BPI) has recently been estimated at 0.73. Bipolar individuals, who may exhibit psychotic behavior, have deficits in reelin expression linked to genetic loci located on chromosome 22, which confers susceptibility to schizophrenia. Given that, large variations in clinical symptoms still suggest that developmental and environmental factors are as important as genetic factors in contributing to the etiology of mood disorders.
Correct Answer:
The pathophysiology of bipolar disorder, also known as manic-depressive illness (MDI), is not fully understood, and there are no objective biologic markers that definitively correspond with the disease state. Twin, family, and adoption studies have all found a significant genetic component to bipolar disorder. First degree relatives of people with bipolar disorder are approximately 7 times more likely than the general population to develop bipolar disorder, and the heritability of bipolar I disorder (BPI) has recently been estimated at 0.73. Bipolar people, who may exhibit psychotic behavior, have reelin expression deficits linked to genetic loci on chromosome 22, which confers susceptibility to schizophrenia. Given this, the fact that clinical symptoms vary widely suggests that developmental and environmental factors are involved.
Response Feedback: [None Given]
https://nursingassignmentgurus.com/nurs-6501-knowledge-check-concepts-of-psychological-disorders/
In this exercise, you will complete a 10- to 20-essay type question Knowledge Check to gauge your understanding of this module’s content.
Possible topics covered in this Knowledge Check include:
-
- Generalized anxiety disorder
- Depression
- Bipolar disorders
- Schizophrenia
- Delirium and dementia
- Obsessive compulsive disease
Photo Credit: agsandrew – stock.adobe.com
Complete the Knowledge Check By Day 7 of Week 9
To complete this Knowledge Check:
Module 6 Knowledge Check
What’s Coming Up in Module 7?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
In Module 7, you will analyze processes related to women’s and men’s health, infections, and hematologic disorders through case study analysis. To do this, you will analyze alterations in the relevant systems and the resultant disease processes. You will also consider patient characteristics, including racial and ethnic variables, which may impact physiological functioning and altered physiology.
Week 10 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders
In the Week 10 Knowledge Check, you will demonstrate your understanding of the topics covered during Module 7. This Knowledge
Check will be composed of a series of questions related to specific scenarios provided. It is highly recommended that you review the
Learning Resources in their entirety prior to taking the Knowledge Check, since the resources cover the topics addressed. Plan your time accordingly.
Next Module
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Week 9: Concepts of Psychological Disorders
Among the many risk factors for mental disorders are genetics and other pathophysiological factors. While other factors, such as environmental factors or substance abuse, can also have an impact, it is important to recognize the connections between biological factors and psychological disorders.
Ranging from anxiety to schizophrenia, psychological disorders offer unique challenges in diagnosis and treatment. Clearly, the presence of these disorders can be life-altering for patients, but they can also significantly impact families and other loved ones.
This week, you examine fundamental concepts of psychological disorders. You explore common psychological disorders, and you apply the key terms and concepts that help communicate the pathophysiological nature of these issues to patients.
Learning Objectives
Students will:
- Analyze concepts and principles of pathophysiology across the lifespan
Learning Resources
Required Readings (click to expand/reduce)
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
- Chapter 19: Neurobiology of Schizophrenia, Mood Disorders, Anxiety Disorders, and Obsessive-Compulsive Disorder, including Summary Review
Required Media (click to expand/reduce)
Module 6 Overview with Dr. Tara Harris
Dr. Tara Harris reviews the structure of Module 6 as well as the expectations for the module. Consider how you will manage your time as you review your media and Learning Resources throughout the module to prepare for your Knowledge Check. (1m)
Concepts of Psychological Disorders – Week 9 (12m)
Generalized Anxiety Syndrome
Note: The approximate length of the media program is 5 minutes.
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Question 1
Scenario 1: Schizophrenia
A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”. The boyfriend relates episodes of unexpected rage and crying.
PMH: noncontributory
FH: positive for a first cousin who “had mental problems”.
SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.
PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.
DIAGOSIS: schizophrenia.
Questions
1. What are known characteristics of schizophrenia and relate those to this patient.
Selected Answer: Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in hallucinations, delusions, and extremely disordered thinking and behavior that impair daily functioning and can be disabling. Schizophrenia involves a range of problems with thinking (cognition), behavior, and emotions. Signs and symptoms of schizophrenia may vary but usually involve delusions, hallucinations, or disorganized speech and reflect an impaired ability to function.
1- Delusions: These are false beliefs not based on reality. For example, you think that you are being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you, or a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.
2- Hallucinations: These usually involve seeing or hearing things that do not exist. Nevertheless, the person with schizophrenia has the full force and impact of a normal experience. Hallucinations can be in any sense, but hearing voices is the most common hallucination.
3- Disorganized thinking (speech): Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that cannot be understood, sometimes known as word salad.
4- Extremely disorganized or abnormal motor behavior: This may show in several ways, from childlike silliness to unpredictable agitation. Behavior is not focused on a goal, so it is hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.
5- Negative symptoms: This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion (does not make eye contact, does not change facial expressions, or speaks in a monotone). Also, the person may lose interest in everyday activities, socially withdraw or lack the ability to experience a pleasure.
Certain factors seem to increase the risk of developing or triggering schizophrenia, including having a family history of schizophrenia; some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development; taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood.
In summary, Positive symptoms of schizophrenia include hallucinations that may be auditory, olfactory, somatic-tactile, visual, voices commenting, and voices conversing. Delusions are also positive symptoms and include delusion of being controlled, mind-reading, the delusion of reference, grandiosity, guilt, persecution, somatic thought broadcasting, thought insertion, and thought withdrawal. Thought disorder symptoms include distractible speech, incoherence, illogicality, circumstantiality, and derailment. Bizarre behaviors are other positive symptoms of schizophrenia. Those behaviors include aggressiveness and agitated states, clothing appearance, repetitive stereotyping, and social and sexual behavior. This patient exhibited signs of auditory hallucinations, disheveled appearance, and persecution.
Correct Answer: 
Positive symptoms of schizophrenia include hallucinations that may be auditory, olfactory, somatic-tactile, visual, voices commenting, and voices conversing. Delusions are also positive symptoms and include delusion of being controlled, delusion of mind reading, delusion of reference, delusion of grandiosity, guilt, persecution, somatic thought broadcasting, thought insertion and thought withdrawal. Thought disorder symptoms include distractible speech, incoherence, illogicality, circumstantially, and derailment. Bizarre behaviors are other positive symptoms of schizophrenia. Those behaviors include aggressiveness and agitated states, clothing appearance, repetitive stereotyped, and social and sexual behavior. This patient exhibited signs of auditory hallucinations, disheveled appearance, and persecution.
Response Feedback: [None Given] -
Question 2
Scenario 1: Schizophrenia
A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”. The boyfriend relates episodes of unexpected rage and crying.
PMH: noncontributory
FH: positive for a first cousin who “had mental problems”.
SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.
PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.
DIAGOSIS: schizophrenia.
Question:
1. Genetics are sometimes attached to schizophrenia explain this.
Selected Answer: The causes of schizophrenia are not known. There are probably at least two sets of risk factors, genetic and perinatal. In addition, undefined socioenvironmental factors may increase the risk of schizophrenia in international migrants or urban populations of ethnic minorities. Increased paternal age is associated with a greater risk of schizophrenia. The risk of schizophrenia is elevated in biological relatives of persons with schizophrenia but not in adopted relatives. The risk of schizophrenia in first-degree relatives of persons with schizophrenia is 10%. If both parents have schizophrenia, the risk of schizophrenia in their child is 40%. Concordance for schizophrenia is about 10% for dizygotic twins and 40-50% for monozygotic twins. Genome-wide association studies have identified many candidate genes. However, the individual gene variants that have been implicated so far account for only a small fraction of schizophrenia cases, and these findings have not always been replicated in different studies. The genes that have been found mostly change a gene’s expression or a protein’s function in a small way.
Correct Answer: The causes of schizophrenia are not known. There are probably at least 2 sets of risk factors, genetic and perinatal. In addition, undefined socioenvironmental factors may increase the risk of schizophrenia in international migrants or urban populations of ethnic minorities. Increased paternal age is associated with a greater risk of schizophrenia. The risk of schizophrenia is elevated in biologic relatives of persons with schizophrenia but not in adopted relatives. The risk of schizophrenia in first-degree relatives of persons with schizophrenia is 10%. If both parents have schizophrenia, the risk of schizophrenia in their child is 40%. Concordance for schizophrenia is about 10% for dizygotic twins and 40-50% for monozygotic twins. Genome-wide association studies have identified many candidate genes, but the individual gene variants that have been implicated so far account for only a small fraction of schizophrenia cases, and these findings have not always been replicated in different studies. The genes that have been found mostly change a gene’s expression or a protein’s function in a small way.
Response Feedback: [None Given] -
Question 3
Scenario 1: Schizophrenia
A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”. The boyfriend relates episodes of unexpected rage and crying.
PMH: noncontributory
FH: positive for a first cousin who “had mental problems”.
SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.
PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.
DIAGOSIS: schizophrenia.
Question:
What roles do neurotransmitters play in the development of schizophrenia?
Selected Answer: Abnormalities of the dopaminergic system are thought to exist in schizophrenia. The first observable effective antipsychotic drugs, chlorpromazine, and reserpine, were structurally different, but they shared antidopaminergic properties. Drugs that diminish the firing rates of mesolimbic dopamine. D2 neurons are antipsychotic, and drugs that stimulate these neurons (e.g., amphetamines) exacerbate psychotic symptoms. Hypodopaminergic activity in the mesocortical system, leading to negative symptoms, and hyperdopaminergic activity in the mesolimbic system, leading to positive symptoms, may coexist. The newer antipsychotic drugs block dopamine D2 and serotonin (5- hydroxytryptamine [5-HT]) receptors. Clozapine, probably the most effective antipsychotic agent, is a particularly weak dopamine D2 antagonist. Thus, other neurotransmitter systems, such as norepinephrine, serotonin, and gamma-aminobutyric acid (GABA), are undoubtedly involved.
Correct Answer: Abnormalities of the dopaminergic system are thought to exist in schizophrenia. The first observable effective antipsychotic drugs, chlorpromazine and reserpine, were structurally different from each other, but they shared antidopaminergic properties. Drugs that diminish the firing rates of mesolimbic dopamine D2 neurons are antipsychotic, and drugs that stimulate these neurons (eg, amphetamines) exacerbate psychotic symptoms. Hypodopaminergic activity in the mesocortical system, leading to negative symptoms, and hyperdopaminergic activity in the mesolimbic system, leading to positive symptoms, may coexist. The newer antipsychotic drugs block both dopamine D2 and serotonin (5- hydroxytryptamine [5-HT]) receptors. Clozapine, probably the most effective antipsychotic agent, is a particularly weak dopamine D2 antagonist. Thus, other neurotransmitter systems, such as norepinephrine, serotonin, and gamma-aminobutyric acid (GABA), are undoubtedly involved.
Response Feedback: [None Given] -
Question 4
Scenario 1: Schizophrenia
A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”. The boyfriend relates episodes of unexpected rage and crying.
PMH: noncontributory
FH: positive for a first cousin who “had mental problems”.
SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.
PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.
DIAGOSIS: schizophrenia.
Questions:
Explain what structural abnormalities are seen in people with schizophrenia.
Selected Answer: Advances in neuroimaging studies show differences between the brains of those with schizophrenia and those without this disorder. In people with schizophrenia, the ventricles are somewhat larger, and there is decreased brain volume in medial temporal areas and changes in the hippocampus. Magnetic resonance imaging (MRI) studies show anatomic abnormalities in a network of neocortical and limbic regions and interconnecting white-matter tracts. Some studies using diffusion tensor imaging (DTI) to examine white matter found that two networks of white-matter tracts are reduced in schizophrenia. Brain imaging showed reductions in whole-brain volume and left and right prefrontal and temporal lobe volumes in many people at high genetic risk for schizophrenia. The changes in the prefrontal lobes are associated with the increasing severity of psychotic symptoms. MRI studies of schizophrenic patients show that structural brain abnormalities may progress over time. The abnormalities identified included whole-brain volume loss in both gray and white matter and increases in lateral ventricular volume.
Correct Answer: Advances in neuroimaging studies show differences between the brains of those with schizophrenia and those without this disorder. In people with schizophrenia, the ventricles are somewhat larger, there is decreased brain volume in medial temporal areas, and changes are seen in the hippocampus. Magnetic resonance imaging (MRI) studies show anatomic abnormalities in a network of neocortical and limbic regions and interconnecting white-matter tracts. Some studies using diffusion tensor imaging (DTI) to examine white matter found that 2 networks of white-matter tracts are reduced in schizophrenia. Brain imaging showed reductions in whole-brain volume and in left and right prefrontal and temporal lobe volumes in many people who are at high genetic risk for schizophrenia. The changes in prefrontal lobes are associated with increasing severity of psychotic symptoms. MRI studies of schizophrenic patients show that structural brain abnormalities may progress over time. The abnormalities identified included loss of whole-brain volume in both gray and white matter and increases in lateral ventricular volume.
Response Feedback: [None Given] -
Question 5
Scenario 2: Bipolar Disorder
A 44-year-old female came to the clinic today brought in by her husband. He notes that she has been with various states of depression and irritability over the past 3 months with extreme fatigue, has lost 20 pounds and has insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to “flit from one thing to another.”. She hasn’t slept in 3 days. The wife went on an excessive shopping spree for new clothes that resulted in their credit card being denied for exceeding the line of credit. The wife is unable to sit in the exam room and is currently pacing the hallway muttering to herself and is reluctant to talk with or be examined the ARNP. Physical observation shows agitated movements, rapid fire speech, and hyperactivity.
DIAGNOSIS: bipolar type 2 disorder.
Question
1. How does genetics play in the development of bipolar 2 disorders?
Selected Answer: The pathophysiology of bipolar disorder, or manic-depressive illness (MDI), has not been fully identified, and there are no objective biologic markers that correspond definitively with the disease state. Twin, family, and adoption studies indicate that bipolar disorder has a significant genetic component. First-degree relatives of a person with bipolar disorder are approximately seven times more likely to develop bipolar disorder than the rest. The heritability of bipolar I disorder (BPI) has recently been estimated at 0.73. Bipolar individuals, who may exhibit psychotic behavior, have deficits in reelin expression linked to genetic loci located on chromosome 22, which confers susceptibility to schizophrenia. Given that, large variations in clinical symptoms still suggest that developmental and environmental factors are as important as genetic factors in contributing to the etiology of mood disorders.
Correct Answer: The pathophysiology of bipolar disorder, or manic-depressive illness (MDI), has not been fully identified, and there are no objective biologic markers that correspond definitively with the disease state. Twin, family, and adoption studies all indicate that bipolar disorder has a significant genetic component. Firstdegree relatives of a person with bipolar disorder are approximately 7 times more likely to develop bipolar disorder than the rest of the population, and the heritability of bipolar I disorder (BPI) has recently been estimated at 0.73. Bipolar individuals, who may exhibit psychotic behavior, have deficits in reelin expression linked to genetic loci located on the chromosome 22, which confers susceptibility to schizophrenia. Given that, there still are large variations in clinical symptoms suggests that developmental and environmental factors are as important as genetic factors in contributing to the etiology of mood disorders.
Response Feedback: [None Given] Scenario 2: Bipolar Disorder
A 44-year-old female came to the clinic today brought in by her husband. He notes that she has been with various states of depression and irritability over the past 3 months with extreme fatigue, has lost 20 pounds and has insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to “flit from one thing to another.”. She hasn’t slept in 3 days. The wife went on an excessive shopping spree for new clothes that resulted in their credit card being denied for exceeding the line of credit. The wife is unable to sit in the exam room and is currently pacing the hallway muttering to herself and is reluctant to talk with or be examined the ARNP. Physical observation shows agitated movements, rapid fire speech, and hyperactivity.
DIAGNOSIS: bipolar type 2 disorder.
Question
1. How does genetics play in the development of bipolar 2 disorders?
Selected Answer: The pathophysiology of bipolar disorder, or manic-depressive illness (MDI), has not been fully identified, and there are no objective biologic markers that correspond definitively with the disease state. Twin, family, and adoption studies indicate that bipolar disorder has a significant genetic component. First-degree relatives of a person with bipolar disorder are approximately seven times more likely to develop bipolar disorder than the rest. The heritability of bipolar I disorder (BPI) has recently been estimated at 0.73. Bipolar individuals, who may exhibit psychotic behavior, have deficits in reelin expression linked to genetic loci located on chromosome 22, which confers susceptibility to schizophrenia. Given that, large variations in clinical symptoms still suggest that developmental and environmental factors are as important as genetic factors in contributing to the etiology of mood disorders. Correct Answer: The pathophysiology of bipolar disorder, or manic-depressive illness (MDI), has not been fully identified, and there are no objective biologic markers that correspond definitively with the disease state. Twin, family, and adoption studies all indicate that bipolar disorder has a significant genetic component. Firstdegree relatives of a person with bipolar disorder are approximately 7 times more likely to develop bipolar disorder than the rest of the population, and the heritability of bipolar I disorder (BPI) has recently been estimated at 0.73. Bipolar individuals, who may exhibit psychotic behavior, have deficits in reelin expression linked to genetic loci located on the chromosome 22, which confers susceptibility to schizophrenia. Given that, there still are large variations in clinical symptoms suggests that developmental and environmental factors are as important as genetic factors in contributing to the etiology of mood disorders. Response Feedback: [None Given]