368 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
crying, lack of motivation, asocial behavior,
and psychomotor retardation (slowed think-
ing, talking, and movement). Sleep distur-
bances, somatic complaints, loss of energy,
change in weight, and a sense of worthless-
ness are other common features.- Several antidepressants are used to treat de-
pression. Selective serotonin reuptake
inhibitors, the newest type, have the fewest
side effects. Tricyclic antidepressants are older
and have a longer lag period before reaching
adequate serum levels; they are the least ex-
pensive type. Monoamine oxidase reuptake in-
hibitors are used least: clients are at risk for
hypertensive crisis if they ingest tyramine-
rich foods and fluids while taking these drugs.
MAOIs also have a lag period before reaching
adequate serum levels.- People with bipolar disorder cycle between
mania, normalcy, and depression. They also
may cycle only between mania and normalcy
or between depression and normalcy. - Clients with mania have a labile mood, are
grandiose and manipulative, have high self-
esteem, and believe they are capable of any-
thing. They sleep little, are always in frantic
motion, invade others’ boundaries, cannot
sit still, and start many tasks. Speech is
rapid and pressured, reflects rapid thinking,
and may be circumstantial and tangential
with features of rhyming, punning, and
flight of ideas. Clients show poor judgment
with little sense of safety needs and take
physical, financial, occupational, or inter-
personal risks. - Lithium is used to treat bipolar disorder. It
is helpful for bipolar mania and can partially
or completely eradicate cycling toward bi-
polar depression. Lithium is effective in 75%
of clients but has a narrow range of safety;
thus, ongoing monitoring of serum lithium
levels is necessary to establish efficacy while
preventing toxicity. Clients taking lithium
must ingest adequate salt and water to avoid
Critical Thinking Questions
1.Is it possible for someone to make a “rational”
decision to commit suicide? Under what
circumstances?
2.Are laws ethical that permit physician-assisted
suicide? Why or why not?
3.A person with bipolar disorder frequently
discontinues taking medication when out of
the hospital, becomes manic, and engages in
risky behavior such as speeding, drinking
and driving, and incurring large debts. How
do you reconcile the client’s right to refuse
medication with public or personal safety?
Who should make such a decision? How could
it be enforced?I NTERNET R ESOURCES
Resource Internet Address
◗National Institute of Mental Health suicide
research consortium http://www.nih.gov/research/suicide.htm
◗Suicide Information and Education Centre http://www.siec.ca
◗SAD Association http://www.sada.org.uk
◗Postpartum depression http://www.chss.iup.edu/postpartum
◗National Foundation for Depressive Illness, Inc. http://www.depression.org
◗National Depressive and Manic-Depressive
Association http://www.ndmda.org
◗Depression.com http://www.depression.com
◗Depression and Related Affective
Disorders Association http://www.med.jhu.edu/drada