Schizophrenia is a chronic, severe, and disabling mental disorder characterized by disturbances in thought processes, perceptions, emotions, behaviors, and social functioning. It involves episodes of psychosis including hallucinations, delusions, and disorganized thinking.
🎯 Prevalence:
Global Prevalence: Around 1% of the population worldwide.
In India: Estimated at 3-4 per 1000 people.
Onset typically occurs between 15-25 years in males and 25-35 years in females.
Equal prevalence among men and women, but earlier onset and poorer prognosis in males.
✅ Etiology (Causes):
📚 Biological Factors:
Genetic Predisposition: Family history significantly increases risk.
Neurochemical Imbalance:
Hyperactivity of dopamine (D2 receptors) (Dopamine Hypothesis).
Alterations in serotonin and glutamate pathways.
Structural Brain Changes: Enlarged ventricles, reduced brain volume in prefrontal cortex and hippocampus.
📚 Psychosocial Factors:
Stressful life events.
Poor family dynamics (Expressed Emotion – high criticism and hostility).
📚 Environmental Factors:
Infections during prenatal period (viral infections).
Birth complications (hypoxia).
Cannabis and substance abuse in adolescence.
✅ Signs and Symptoms:
📌 1. Positive Symptoms (Excessive or Distorted Functions):
Disorganized or Catatonic Behavior: Agitation, bizarre postures.
📌 2. Negative Symptoms (Loss of Normal Functions):
Affect Flattening: Reduced emotional expression.
Alogia: Poverty of speech.
Avolition: Lack of motivation.
Anhedonia: Inability to experience pleasure.
Social Withdrawal.
📌 3. Cognitive Symptoms:
Poor concentration and attention.
Impaired memory and executive functioning.
✅ Subtypes (As per Older Classifications – Now included under Spectrum):
Paranoid Type
Disorganized Type
Catatonic Type
Undifferentiated Type
Residual Type
✅ Prognosis:
Chronic, relapsing-remitting disorder.
About 20% achieve significant recovery with early and effective treatment.
Poor prognosis factors:
Early onset, poor social support, negative symptoms predominance, substance abuse.
Good prognosis factors:
Late onset, female gender, positive symptoms predominance, good social support.
✅ Medical Management:
📌 1. Pharmacological Management:
Drug Class
Examples
Notes
Typical (First-Generation) Antipsychotics
Haloperidol, Chlorpromazine
Effective for positive symptoms but high risk of extrapyramidal side effects (EPS).
Atypical (Second-Generation) Antipsychotics
Risperidone, Olanzapine, Quetiapine, Clozapine
Effective for both positive and negative symptoms, fewer EPS, but risk of metabolic syndrome.
Clozapine is used for treatment-resistant schizophrenia but requires regular WBC monitoring due to risk of agranulocytosis.
📌 2. Adjunctive Medications:
Antidepressants for depressive symptoms.
Benzodiazepines for acute agitation.
Anticholinergics (e.g., Trihexyphenidyl) for managing EPS.
✅ Psychosocial Management:
Cognitive Behavioral Therapy (CBT).
Family therapy and psychoeducation.
Social skills training and vocational rehabilitation.
✅ Nursing Management:
| Assessment:
Monitor for hallucinations, delusions, suicidal tendencies.
Assess medication compliance and side effects.
Assess social and occupational functioning.
| Interventions:
Ensure Safety:
Monitor for risk of self-harm or harm to others.
Provide a low-stimulus, calm environment.
Communication Strategies:
Use simple, clear language.
Avoid arguing with delusions; instead, acknowledge feelings and redirect conversations.
Medication Compliance:
Educate on importance of regular medication and side effect management.
Manage Hallucinations and Delusions:
Help patients identify triggers.
Encourage reality orientation.
Family Support and Psychoeducation:
Teach family about illness course, management, and reducing expressed emotions.
Promote Self-Care:
Assist with hygiene, nutrition, and daily activities.
📌 Golden One-Liners for Quick Revision:
🧠 “Schizophrenia is a disorder of thought, perception, and behavior.”
🧠 “Auditory hallucinations are the most common type in schizophrenia.”
🧠 “Dopamine hyperactivity is the primary neurochemical theory (Dopamine Hypothesis).”
🧠 “Clozapine is used for treatment-resistant schizophrenia but requires WBC monitoring.”
🧠 “Negative symptoms contribute more to poor functional outcomes.”
✅ 1. Which neurotransmitter is most commonly associated with the pathophysiology of schizophrenia?
A) Serotonin B) Dopamine C) Acetylcholine D) GABA
Correct Answer: B) Dopamine Rationale: The dopamine hypothesis suggests that hyperactivity of dopamine, especially in the mesolimbic pathway, is responsible for the positive symptoms of schizophrenia.
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✅ 2. Which antipsychotic drug is used for treatment-resistant schizophrenia but requires regular monitoring of white blood cell count?
A) Haloperidol B) Risperidone C) Clozapine D) Olanzapine
Correct Answer: C) Clozapine Rationale: Clozapine is highly effective in resistant cases but carries the risk of agranulocytosis, requiring regular WBC count monitoring.
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✅ 3. Which of the following is a negative symptom of schizophrenia?
A) Hallucinations B) Delusions C) Avolition D) Thought Insertion
Correct Answer: C) Avolition Rationale: Avolition refers to a lack of motivation and inability to initiate purposeful activities, which is a negative symptom.
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✅ 4. What is the most common type of hallucination experienced in schizophrenia?
A) Visual Hallucinations B) Tactile Hallucinations C) Auditory Hallucinations D) Olfactory Hallucinations
Correct Answer: C) Auditory Hallucinations Rationale: Hearing voices or sounds is the most frequent hallucination type, often involving critical or commanding voices.
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✅ 5. Which nursing intervention is most appropriate when a patient reports hearing distressing voices?
A) Ignore the hallucination completely. B) Argue with the patient about the reality of the voices. C) Acknowledge the patient’s feelings and redirect attention to reality-based activities. D) Provide complete isolation from others.
Correct Answer: C) Acknowledge the patient’s feelings and redirect attention to reality-based activities. Rationale: The nurse should validate the patient’s emotional experience without reinforcing the hallucination and gently guide them back to reality.
✅ 1. Which of the following is the most accepted neurochemical theory of schizophrenia?
A) Serotonin Hypothesis B) Dopamine Hypothesis C) Cholinergic Hypothesis D) GABA Hypothesis
Correct Answer: B) Dopamine Hypothesis Rationale: Hyperactivity of dopamine in the mesolimbic pathway is believed to cause positive symptoms of schizophrenia.
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✅ 2. Which of the following is a negative symptom of schizophrenia?
A) Delusions B) Hallucinations C) Anhedonia D) Thought Broadcasting
Correct Answer: C) Anhedonia Rationale: Anhedonia (inability to experience pleasure) is a classic negative symptom.
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✅ 3. Which type of hallucination is most commonly experienced by schizophrenic patients?
A) Auditory B) Visual C) Tactile D) Olfactory
Correct Answer: A) Auditory Rationale: Hearing voices is the most common hallucination in schizophrenia.
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✅ 4. Which medication is considered first-line treatment for schizophrenia?
A) Lithium B) Clozapine C) Risperidone D) Fluoxetine
Correct Answer: C) Risperidone Rationale: Risperidone, an atypical antipsychotic, is commonly used due to its efficacy on both positive and negative symptoms with fewer side effects.
·
✅ 5. Clozapine is used in schizophrenia for:
A) First-line treatment B) Treating hallucinations only C) Treatment-resistant schizophrenia D) Managing anxiety
Correct Answer: C) Treatment-resistant schizophrenia Rationale: Clozapine is effective when other antipsychotics fail but requires monitoring for agranulocytosis.
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✅ 6. Which of the following is a disorganized symptom of schizophrenia?
A) Poverty of speech B) Neologism C) Delusions D) Hallucinations
Correct Answer: B) Neologism Rationale: Neologism refers to creating new, meaningless words, often seen in disorganized speech.
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✅ 7. The first-generation antipsychotic drug most associated with extrapyramidal side effects is:
A) Clozapine B) Haloperidol C) Risperidone D) Olanzapine
Correct Answer: B) Haloperidol Rationale: Haloperidol is a typical antipsychotic with a high risk of EPS.
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✅ 8. Which of the following is a risk factor for poor prognosis in schizophrenia?
A) Late onset B) Predominance of positive symptoms C) Early onset D) Good social support
Correct Answer: C) Early onset Rationale: Early onset, especially in males, is associated with a poorer prognosis.
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✅ 9. What is the term for the false belief that one’s thoughts are being broadcast to others?
A) Thought Withdrawal B) Thought Broadcasting C) Delusion of Grandeur D) Delusion of Persecution
Correct Answer: B) Thought Broadcasting Rationale: This is a Schneiderian first-rank symptom seen in schizophrenia.
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✅ 10. A patient holds a bizarre posture for hours without moving. This is an example of:
A) Echolalia B) Catalepsy (Catatonic Posturing) C) Perseveration D) Flight of Ideas
Correct Answer: B) Catalepsy Rationale: Catalepsy is seen in catatonic schizophrenia, characterized by maintaining rigid, unusual postures.
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✅ 11. Which antipsychotic medication requires regular monitoring of white blood cell counts?
A) Haloperidol B) Clozapine C) Risperidone D) Quetiapine
Correct Answer: B) Clozapine Rationale: Clozapine carries a risk of agranulocytosis, necessitating regular WBC monitoring.
·
✅ 12. Which of the following symptoms is considered a cognitive symptom of schizophrenia?
A) Hallucinations B) Delusions C) Impaired executive functioning D) Avolition
Correct Answer: C) Impaired executive functioning Rationale: Cognitive deficits include poor attention, memory, and executive function.
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✅ 13. Which side effect is most commonly associated with long-term antipsychotic therapy?
A) Hypoglycemia B) Tardive Dyskinesia C) Insomnia D) Bradycardia
Correct Answer: B) Tardive Dyskinesia Rationale: This is a late-onset, often irreversible movement disorder caused by prolonged use of antipsychotics.
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✅ 14. What is the primary nursing priority when a patient experiences command hallucinations instructing them to harm themselves?
A) Document the hallucination. B) Place the patient in isolation. C) Ensure patient safety and remove harmful objects. D) Encourage the patient to ignore the voices.
Correct Answer: C) Ensure patient safety and remove harmful objects. Rationale: Command hallucinations increase the risk of self-harm; safety is the priority.
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✅ 15. Which nursing intervention is appropriate for a patient with paranoid delusions?
A) Argue to correct their false beliefs. B) Avoid unnecessary physical closeness. C) Force the patient to socialize. D) Agree with the delusion to calm them down.
Correct Answer: B) Avoid unnecessary physical closeness. Rationale: This prevents increasing the patient’s suspicion or perceived threat.
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✅ 16. Which symptom is a first-rank Schneiderian symptom of schizophrenia?
A) Auditory hallucinations commenting on behavior B) Flat affect C) Poor eye contact D) Social withdrawal
Correct Answer: A) Auditory hallucinations commenting on behavior Rationale: First-rank symptoms are specific positive symptoms associated with schizophrenia.
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✅ 17. Which of the following is a sign of extrapyramidal side effects?
A) Weight gain B) Bradykinesia and muscle rigidity C) Increased libido D) Euphoria
Correct Answer: B) Bradykinesia and muscle rigidity Rationale: EPS includes Parkinsonian symptoms such as tremors, rigidity, and bradykinesia.
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✅ 18. Which assessment tool is commonly used to assess the severity of schizophrenia symptoms?
A) PANSS (Positive and Negative Syndrome Scale) B) MMSE C) GCS D) Apgar Score
Correct Answer: A) PANSS Rationale: PANSS measures positive, negative, and general psychopathology symptoms of schizophrenia.
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✅ 19. Which of the following is NOT a negative symptom of schizophrenia?
A) Alogia B) Anhedonia C) Delusions D) Avolition
Correct Answer: C) Delusions Rationale: Delusions are positive symptoms, while the others are negative symptoms.
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✅ 20. The primary mechanism of action of atypical antipsychotics involves blocking:
A) GABA receptors B) Serotonin and Dopamine receptors C) Acetylcholine receptors D) Histamine receptors
Correct Answer: B) Serotonin and Dopamine receptors Rationale: Atypical antipsychotics modulate both dopamine and serotonin receptors, improving both positive and negative symptoms.
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✅ 21. Which nursing diagnosis is most appropriate for a patient experiencing auditory hallucinations?
A) Impaired Social Interaction B) Sensory-Perceptual Disturbance C) Ineffective Coping D) Risk for Violence
Correct Answer: B) Sensory-Perceptual Disturbance Rationale: Hallucinations indicate disturbances in perception.
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✅ 22. Which nursing intervention is appropriate when managing a patient experiencing active hallucinations?
A) Encourage the patient to discuss the content of hallucinations in a group. B) Reinforce reality and divert attention to activities. C) Agree with the patient’s hallucinations to reduce anxiety. D) Isolate the patient immediately.
Correct Answer: B) Reinforce reality and divert attention to activities. Rationale: This helps the patient focus on reality and decreases the impact of hallucinations.
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✅ 23. Which of the following is a risk factor for developing tardive dyskinesia?
A) Short-term use of benzodiazepines B) Long-term use of antipsychotics C) High-dose SSRIs D) Use of anticholinergics
Correct Answer: B) Long-term use of antipsychotics Rationale: Prolonged exposure to antipsychotics leads to tardive dyskinesia.
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✅ 24. Which lifestyle change is important for managing metabolic syndrome associated with atypical antipsychotics?
A) Reduce physical activity B) High carbohydrate diet C) Regular exercise and balanced diet D) Increase salt intake
Correct Answer: C) Regular exercise and balanced diet Rationale: Metabolic side effects like weight gain and diabetes can be managed by healthy lifestyle habits.
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✅ 25. Which of the following antipsychotics is least likely to cause extrapyramidal side effects?
A) Haloperidol B) Risperidone C) Clozapine D) Fluphenazine
Correct Answer: C) Clozapine Rationale: Clozapine has minimal EPS risk but requires monitoring for agranulocytosis.
📚 Mania
✅ Definition:
Mania is a mental state characterized by abnormally elevated mood, hyperactivity, impulsivity, decreased need for sleep, grandiosity, and impaired judgment. It is a key feature of Bipolar Disorder Type I.
🎯 Prevalence:
Lifetime prevalence of Bipolar Disorder (which includes mania): 1-2% of the global population.
Slightly more common in males for manic episodes, but overall Bipolar Disorder affects both genders equally.
Average age of onset: Late adolescence to early adulthood (18-30 years).
✅ Etiology (Causes):
📚 Biological Factors:
Genetic Predisposition: High familial risk; first-degree relatives have increased chances.
Neurochemical Imbalance:
Increased levels of norepinephrine and dopamine during manic episodes.
Possible involvement of serotonin dysregulation.
Neuroanatomical Factors: Dysfunction in the limbic system and prefrontal cortex.
📚 Psychosocial Factors:
Stressful life events (e.g., loss, relationship problems).
Lack of coping skills and poor emotional regulation.
📚 Environmental Triggers:
Substance abuse (cocaine, amphetamines).
Sleep deprivation.
Seasonal changes (more common in spring and summer).
✅ Signs and Symptoms (As per DSM-5 Criteria):
| Mood Symptoms:
Elevated, expansive, or irritable mood.
Unstable mood swings (can switch between euphoria and irritability).
Considered in severe mania not responding to medications or with suicidal risk.
✅ Nursing Management:
| Assessment:
Monitor for hyperactivity, impulsivity, and risky behaviors.
Assess for sleep disturbances and nutritional status.
Evaluate medication compliance and side effects.
| Interventions:
Ensure Safety:
Supervise to prevent self-harm or harm to others.
Limit access to money and dangerous objects.
Set Clear Limits:
Use firm, calm, and short communication.
Redirect activities when the patient becomes overstimulated.
Promote Rest and Nutrition:
Encourage rest periods; provide high-calorie finger foods if patient is unable to sit for meals.
Administer Medications as Prescribed:
Monitor for lithium toxicity and side effects of antipsychotics.
Educate Patient and Family:
Teach about the importance of medication compliance and recognizing early warning signs of mania.
Involve family members in care and provide psychoeducation.
📌 Golden One-Liners for Quick Revision:
🧠 “Lithium is the drug of choice for acute mania and long-term mood stabilization.”
🧠 “Manic patients have decreased need for sleep but high energy levels.”
🧠 “Flight of ideas and grandiosity are hallmark cognitive symptoms of mania.”
🧠 “High-calorie finger foods help meet nutritional needs in hyperactive manic patients.”
🧠 “Lithium requires regular serum level monitoring to avoid toxicity.”
✅ 1. Which of the following is the drug of choice for managing acute mania?
A) Haloperidol B) Lithium C) Sertraline D) Fluoxetine
Correct Answer: B) Lithium Rationale: Lithium is the gold-standard mood stabilizer used for both acute management and long-term prevention of manic episodes.
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✅ 2. A patient in a manic state is constantly talking and moving, refuses to eat meals, and becomes irritable when asked to rest. Which nursing intervention is most appropriate?
A) Allow the patient to continue without interruption. B) Encourage rest and offer high-calorie finger foods. C) Force the patient to sit and finish a full meal. D) Ignore the patient’s behavior and document it.
Correct Answer: B) Encourage rest and offer high-calorie finger foods. Rationale: Due to hyperactivity, manic patients often neglect meals. Providing high-calorie finger foods helps maintain nutrition without disrupting their activity.
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✅ 3. Which of the following symptoms is most characteristic of mania?
A) Slow speech and psychomotor retardation B) Grandiosity and decreased need for sleep C) Pessimistic thinking and suicidal ideation D) Auditory hallucinations without mood disturbance
Correct Answer: B) Grandiosity and decreased need for sleep Rationale: Elevated self-esteem (grandiosity) and reduced sleep requirements are classic features of mania.
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✅ 4. What is the therapeutic serum level of lithium for maintenance therapy in bipolar disorder?
A) 0.2 – 0.5 mEq/L B) 0.6 – 1.2 mEq/L C) 1.5 – 2.0 mEq/L D) Above 2.0 mEq/L
Correct Answer: B) 0.6 – 1.2 mEq/L Rationale: This is the safe and effective therapeutic range. Levels above 1.5 mEq/L increase the risk of toxicity.
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✅ 5. Which nursing action is most important when caring for a patient receiving lithium therapy?
A) Encourage a low-sodium diet. B) Monitor serum lithium levels regularly. C) Administer lithium on an empty stomach. D) Instruct the patient to avoid drinking water.
Correct Answer: B) Monitor serum lithium levels regularly. Rationale: Regular monitoring helps prevent toxicity and ensures therapeutic effectiveness.
✅ 1. Which of the following is the primary mood state in mania?
A) Depressed Mood B) Elevated or Expansive Mood C) Anxious Mood D) Fearful Mood
Correct Answer: B) Elevated or Expansive Mood Rationale: Mania is characterized by abnormally elevated, expansive, or irritable mood.
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✅ 2. Which of the following is the drug of choice for acute manic episodes?
A) Fluoxetine B) Haloperidol C) Lithium D) Diazepam
Correct Answer: C) Lithium Rationale: Lithium is the gold standard mood stabilizer for treating and preventing manic episodes.
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✅ 3. What is the therapeutic serum level range for lithium maintenance therapy?
A) 0.2 – 0.5 mEq/L B) 0.6 – 1.2 mEq/L C) 1.5 – 2.5 mEq/L D) Above 2.5 mEq/L
Correct Answer: B) 0.6 – 1.2 mEq/L Rationale: Levels above 1.5 mEq/L are toxic, and regular monitoring is essential.
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✅ 4. Which of the following is a classic behavioral symptom of mania?
A) Psychomotor Retardation B) Pressured Speech C) Hopelessness D) Social Withdrawal
Correct Answer: B) Pressured Speech Rationale: Rapid, loud, and continuous speech is a common sign in manic episodes.
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✅ 5. Which neurotransmitter is primarily associated with the hyperactivity seen in mania?
A) Serotonin B) Norepinephrine C) Acetylcholine D) GABA
Correct Answer: B) Norepinephrine Rationale: Increased levels of norepinephrine and dopamine contribute to manic symptoms.
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✅ 6. Which of the following is a hallmark cognitive symptom of mania?
A) Flight of Ideas B) Memory Loss C) Suicidal Ideation D) Delusions of Guilt
Correct Answer: A) Flight of Ideas Rationale: Flight of ideas involves rapid shifting from one topic to another, seen in mania.
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✅ 7. Which of the following is NOT a characteristic feature of mania?
A) Decreased Need for Sleep B) Excessive Goal-Directed Activity C) Slow Thinking D) Grandiosity
Correct Answer: C) Slow Thinking Rationale: Manic patients exhibit rapid thoughts, not slow thinking.
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✅ 8. In managing a manic patient, which nursing action is most appropriate?
A) Use long explanations to correct patient behavior. B) Provide a low-stimulus environment. C) Encourage group therapy immediately. D) Allow free financial decision-making.
Correct Answer: B) Provide a low-stimulus environment. Rationale: Reducing environmental stimuli helps decrease agitation and hyperactivity.
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✅ 9. Which of the following foods is most appropriate for a manic patient?
A) Complex meals requiring utensils. B) High-calorie finger foods. C) Liquid diet only. D) Caffeinated beverages.
Correct Answer: B) High-calorie finger foods. Rationale: Due to hyperactivity, patients prefer quick and easy foods.
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✅ 10. Which medication is considered when lithium is contraindicated or ineffective in mania?
A) Valproic Acid (Sodium Valproate) B) Fluoxetine C) Imipramine D) Buspirone
Correct Answer: A) Valproic Acid Rationale: Valproic acid is effective in acute mania and rapid cycling bipolar disorder.
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✅ 11. Which of the following is a common side effect of lithium therapy?
A) Bradycardia B) Polyuria and Fine Hand Tremors C) Visual Hallucinations D) Weight Loss
Correct Answer: B) Polyuria and Fine Hand Tremors Rationale: These are common, early side effects of lithium therapy.
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✅ 12. Which lifestyle advice is important for a patient on lithium therapy?
A) Reduce fluid intake. B) Increase salt intake suddenly. C) Maintain consistent fluid and salt intake. D) Engage in vigorous physical activities in hot weather.
Correct Answer: C) Maintain consistent fluid and salt intake. Rationale: Sudden changes in hydration or sodium levels can affect lithium concentration and lead to toxicity.
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✅ 13. What is the primary nursing goal during the acute manic phase?
A) Promote Insight into Behavior B) Ensure Patient Safety C) Encourage Social Interactions D) Discuss Long-term Plans
Correct Answer: B) Ensure Patient Safety Rationale: Due to impulsivity and risk-taking behaviors, safety is the priority.
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✅ 14. Which nursing intervention is best for promoting rest in a manic patient?
A) Allow free activity until the patient tires. B) Provide a calm environment and set limits on activity. C) Ignore the patient’s hyperactivity. D) Force the patient to lie down.
Correct Answer: B) Provide a calm environment and set limits on activity. Rationale: Structured limits and a low-stimulus environment encourage rest.
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✅ 15. Which statement by a manic patient indicates grandiosity?
A) “I feel a little sad today.” B) “I am the greatest scientist in the world!” C) “I am tired and need some rest.” D) “I’m worried about my family’s health.”
Correct Answer: B) “I am the greatest scientist in the world!” Rationale: This is an unrealistic, inflated self-esteem belief characteristic of mania.
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✅ 16. Which is a common behavioral manifestation in a patient experiencing acute mania?
A) Avoidance of all social contact. B) Engaging in risky sexual behavior. C) Constant fear and worry. D) Crying spells and sadness.
Correct Answer: B) Engaging in risky sexual behavior. Rationale: Risk-taking behaviors, including sexual indiscretions, are common in mania.
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✅ 17. What is the primary difference between hypomania and mania?
A) Mania lasts for less than 4 days. B) Hypomania involves psychotic features. C) Hypomania does not cause significant social or occupational impairment. D) Mania is less severe than hypomania.
Correct Answer: C) Hypomania does not cause significant social or occupational impairment. Rationale: Hypomania is a milder form of elevated mood without significant impairment.
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✅ 18. Which laboratory finding should be closely monitored in a patient on lithium therapy?
A) Liver Function Test B) Serum Lithium Level C) Blood Glucose Level D) Serum Magnesium Level
Correct Answer: B) Serum Lithium Level Rationale: Monitoring lithium levels is crucial to avoid toxicity.
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✅ 19. Which of the following is a late sign of lithium toxicity?
A) Fine Tremors B) Confusion and Ataxia C) Increased Appetite D) Mild Nausea
Correct Answer: B) Confusion and Ataxia Rationale: These are signs of severe lithium toxicity requiring immediate medical attention.
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✅ 20. Which psychotherapeutic approach is helpful in preventing relapse of manic episodes?
A) Psychoanalysis B) Cognitive Behavioral Therapy (CBT) C) Electroconvulsive Therapy (ECT) Only D) Isolation Therapy
Correct Answer: B) Cognitive Behavioral Therapy (CBT) Rationale: CBT helps patients develop coping strategies and manage early warning signs of relapse.
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✅ 21. Which mood stabilizer is most effective for rapid-cycling bipolar disorder?
A) Lithium B) Sodium Valproate C) Haloperidol D) Fluoxetine
Correct Answer: B) Sodium Valproate Rationale: Valproate is more effective in rapid-cycling forms of bipolar disorder.
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✅ 22. Which of the following interventions should be avoided during a manic episode?
A) Allow frequent rest periods. B) Engage the patient in high-stimulus group activities. C) Provide concise, simple instructions. D) Ensure the patient’s safety.
Correct Answer: B) Engage the patient in high-stimulus group activities. Rationale: High stimulation can worsen hyperactivity and agitation.
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✅ 23. Which term describes the constant movement and inability to sit still seen in mania?
A) Psychomotor Retardation B) Psychomotor Agitation C) Catalepsy D) Echopraxia
Correct Answer: B) Psychomotor Agitation Rationale: This is commonly seen in manic patients with increased energy levels.
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✅ 24. What is the best time to draw a blood sample for monitoring lithium levels?
A) Immediately after the morning dose. B) 12 hours after the last dose (trough level). C) Randomly during the day. D) Before administering the first dose.
Correct Answer: B) 12 hours after the last dose (trough level). Rationale: This gives an accurate measurement of lithium levels to adjust dosage safely.
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✅ 25. Which patient behavior indicates that the manic episode is resolving?
A) Insisting on staying awake all night. B) Engaging in conversations at a normal pace. C) Claiming they are a millionaire despite evidence to the contrary. D) Refusing to eat meals due to activity.
Correct Answer: B) Engaging in conversations at a normal pace. Rationale: Normalized speech and behavior suggest improvement in manic symptoms.
📚 Depression
✅ Definition:
Depression is a common, chronic mood disorder characterized by persistent sadness, loss of interest or pleasure in most activities (anhedonia), feelings of hopelessness, and a range of cognitive, physical, and behavioral symptoms that impair daily functioning.
🎯 Prevalence:
Global Prevalence: Over 280 million people worldwide (WHO, 2024).
In India: Lifetime prevalence is approximately 15%–20%.
More common in women (twice as likely as men).
Peak onset: Late adolescence to mid-40s.
✅ Etiology (Causes):
📚 Biological Factors:
Neurochemical Imbalance:
Low levels of serotonin, norepinephrine, and dopamine.
Known as the Monoamine Hypothesis.
Genetic Predisposition:
Higher risk in individuals with a family history of mood disorders.
Neuroendocrine Factors:
Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, leading to elevated cortisol.
Stressful life events (bereavement, job loss, relationship breakdown).
Chronic medical illnesses (diabetes, cancer, cardiovascular diseases).
Substance abuse.
✅ Signs and Symptoms (According to DSM-5 Criteria):
(Mnemonic: SIG E CAPS) – At least 5 symptoms present for ≥2 weeks.
| S – Sleep Disturbance (Insomnia or Hypersomnia) | I – Loss of Interest (Anhedonia) | G – Guilt or Feelings of Worthlessness | E – Low Energy or Fatigue | C – Poor Concentration or Indecisiveness | A – Appetite Changes (Weight Loss or Gain) | P – Psychomotor Changes (Agitation or Retardation) | S – Suicidal Thoughts or Attempts
✅ Types of Depression:
Major Depressive Disorder (MDD)
Persistent Depressive Disorder (Dysthymia)
Seasonal Affective Disorder (SAD)
Postpartum Depression
Atypical Depression
✅ Prognosis:
Good Prognosis with early diagnosis and proper treatment.
Around 80% of patients respond to treatment with medications, therapy, or both.
Recurrence is common; risk of relapse is higher without treatment.
Untreated depression can lead to suicide—more than 700,000 deaths annually worldwide.
✅ Medical Management:
📌 1. Pharmacological Management:
Drug Class
Examples
Notes
SSRIs (First-line)
Fluoxetine, Sertraline, Escitalopram
Fewer side effects, safer in overdose.
SNRIs
Venlafaxine, Duloxetine
Effective for both depression and anxiety.
Tricyclic Antidepressants (TCAs)
Amitriptyline, Imipramine
Older drugs, more side effects, cardiotoxicity in overdose.
MAO Inhibitors
Phenelzine, Tranylcypromine
Used rarely due to dietary restrictions.
💊 SSRIs are the preferred first-line treatment. 💊 Antidepressants typically take 2-4 weeks to show effect.
📌 2. Psychotherapy:
Cognitive Behavioral Therapy (CBT): Focuses on correcting negative thinking patterns.
Interpersonal Therapy (IPT): Addresses interpersonal conflicts contributing to depression.
Behavioral Activation Therapy.
📌 3. Electroconvulsive Therapy (ECT):
Used for severe, treatment-resistant depression or cases with imminent suicide risk.
✅ Nursing Management:
| Assessment:
Monitor mood changes, suicidal thoughts, and self-care abilities.
Assess sleep patterns, appetite, and energy levels.
| Interventions:
Ensure Patient Safety:
Conduct regular suicide risk assessments.
Remove harmful objects and supervise closely if needed.
Establish a Therapeutic Relationship:
Use active listening and show empathy.
Provide reassurance and positive reinforcement.
Promote Physical Health:
Encourage regular meals and hydration.
Promote sleep hygiene techniques.
Facilitate Social Interaction:
Encourage small group participation but avoid forcing interaction.
Educate About Treatment:
Discuss the importance of medication adherence and possible side effects.
🧠 “SSRIs are the first-line drugs for treating depression.”
🧠 “Beck’s Cognitive Theory explains depression through negative thinking patterns.”
🧠 “SIG E CAPS is a useful mnemonic to remember depression symptoms.”
🧠 “Suicide risk is highest shortly after initiating treatment when energy improves but mood remains low.”
🧠 “ECT is used for severe, life-threatening depression and suicidal ideation.”
✅ 1. Which of the following is the first-line drug class for treating major depressive disorder?
A) Tricyclic Antidepressants (TCAs) B) Monoamine Oxidase Inhibitors (MAOIs) C) Selective Serotonin Reuptake Inhibitors (SSRIs) D) Benzodiazepines
Correct Answer: C) Selective Serotonin Reuptake Inhibitors (SSRIs) Rationale: SSRIs like fluoxetine and sertraline are preferred due to their effectiveness and lower side effect profile.
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✅ 2. What is the most important nursing action when a depressed patient expresses suicidal thoughts?
A) Ignore the statement to avoid reinforcing it. B) Immediately assess the seriousness and intent of the suicidal thoughts. C) Advise the patient to avoid talking about such feelings. D) Leave the patient alone for some time to calm down.
Correct Answer: B) Immediately assess the seriousness and intent of the suicidal thoughts. Rationale: Suicide risk assessment is a priority to ensure patient safety.
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✅ 3. Which cognitive distortion is most commonly observed in patients with depression?
A) Grandiosity B) Negative Self-Evaluation C) Paranoid Delusions D) Magical Thinking
Correct Answer: B) Negative Self-Evaluation Rationale: According to Beck’s Cognitive Theory, patients often have negative views about themselves, the world, and the future.
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✅ 4. Which of the following symptoms is NOT a typical feature of depression?
A) Anhedonia B) Increased Energy and Hyperactivity C) Insomnia or Hypersomnia D) Feelings of Worthlessness
Correct Answer: B) Increased Energy and Hyperactivity Rationale: These are features of mania, not depression. Depression is associated with low energy.
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✅ 5. What is the most serious complication of untreated depression?
A) Sleep Disturbances B) Substance Abuse C) Suicide D) Social Isolation
Correct Answer: C) Suicide Rationale: Suicide is the most serious and life-threatening consequence of untreated or severe depression.
✅ 1. Which of the following is the most widely used first-line pharmacological treatment for depression?
A) Tricyclic Antidepressants (TCAs) B) Selective Serotonin Reuptake Inhibitors (SSRIs) C) Monoamine Oxidase Inhibitors (MAOIs) D) Benzodiazepines
Correct Answer: B) SSRIs Rationale: SSRIs like fluoxetine and sertraline are preferred due to their safety profile and effectiveness.
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✅ 2. Which neurotransmitter is most closely associated with the pathophysiology of depression?
A) Dopamine B) Acetylcholine C) Serotonin D) GABA
Correct Answer: C) Serotonin Rationale: Low levels of serotonin play a significant role in the development of depressive symptoms.
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✅ 3. Which of the following is a key symptom of depression according to DSM-5?
A) Increased energy B) Anhedonia C) Grandiosity D) Delusions
Correct Answer: B) Anhedonia Rationale: Anhedonia, or loss of interest/pleasure in activities, is a core symptom of depression.
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✅ 4. Which cognitive theory is most associated with explaining depression?
A) Beck’s Cognitive Theory B) Freud’s Psychoanalytic Theory C) Maslow’s Hierarchy of Needs D) Pavlov’s Classical Conditioning
Correct Answer: A) Beck’s Cognitive Theory Rationale: Beck emphasized negative automatic thoughts and cognitive distortions in depression.
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✅ 5. Which mnemonic helps remember the symptoms of depression?
A) SIG E CAPS B) SOAP C) SPICES D) SAD PERSONS
Correct Answer: A) SIG E CAPS Rationale: SIG E CAPS stands for Sleep disturbance, Interest loss, Guilt, Energy loss, Concentration issues, Appetite change, Psychomotor changes, Suicidal thoughts.
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✅ 6. Which of the following is a risk factor for depression?
A) Strong family support B) Regular physical activity C) Chronic illnesses like diabetes D) High self-esteem
Correct Answer: C) Chronic illnesses like diabetes Rationale: Chronic medical conditions increase the risk of developing depression.
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✅ 7. Which class of antidepressants has the highest risk of cardiotoxicity in overdose?
A) SSRIs B) SNRIs C) TCAs D) MAOIs
Correct Answer: C) TCAs Rationale: Tricyclic antidepressants can cause fatal arrhythmias in overdose.
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✅ 8. What is the most serious complication of untreated depression?
A) Sleep disturbances B) Suicide C) Weight loss D) Social isolation
Correct Answer: B) Suicide Rationale: Suicide is the most dangerous and life-threatening complication of depression.
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✅ 9. Which therapy focuses on correcting negative thought patterns in depression?
A) Behavioral Therapy B) Cognitive Behavioral Therapy (CBT) C) Psychoanalysis D) Systemic Desensitization
Correct Answer: B) CBT Rationale: CBT addresses cognitive distortions and teaches positive coping mechanisms.
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✅ 10. Which of the following antidepressants requires dietary restrictions to avoid hypertensive crisis?
A) Fluoxetine B) Imipramine C) Phenelzine (MAOI) D) Sertraline
Correct Answer: C) Phenelzine Rationale: MAOIs require avoidance of tyramine-rich foods to prevent hypertensive crisis.
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✅ 11. Which symptom is most commonly associated with seasonal affective disorder (SAD)?
A) Weight Loss B) Increased Energy C) Hypersomnia and Overeating D) Grandiose Delusions
Correct Answer: C) Hypersomnia and Overeating Rationale: SAD often presents with atypical depressive symptoms like increased sleep and appetite.
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✅ 12. Which of the following is an example of psychomotor agitation seen in depression?
A) Remaining motionless for hours B) Pacing around the room continuously C) Slow speech and delayed responses D) Sleeping throughout the day
Correct Answer: B) Pacing around the room continuously Rationale: This is a typical sign of psychomotor agitation.
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✅ 13. Which is the most appropriate nursing action for a patient expressing suicidal thoughts?
A) Ignore the thoughts to avoid reinforcing them. B) Assess intent and develop a safety plan immediately. C) Advise the patient to avoid discussing such feelings. D) Leave the patient alone for some time.
Correct Answer: B) Assess intent and develop a safety plan immediately. Rationale: Ensuring patient safety is the priority.
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✅ 14. Which antidepressant drug is also used to help with smoking cessation?
A) Bupropion B) Fluoxetine C) Amitriptyline D) Phenelzine
Correct Answer: A) Bupropion Rationale: Bupropion is an atypical antidepressant also used for smoking cessation.
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✅ 15. Which symptom indicates improvement in a depressed patient?
A) Increased withdrawal B) Interest in hobbies and socialization C) Decreased appetite D) Persistent negative thoughts
Correct Answer: B) Interest in hobbies and socialization Rationale: Engagement in pleasurable activities signals recovery.
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✅ 16. Which laboratory value is important to monitor in patients receiving SSRIs?
A) Sodium Levels B) Potassium Levels C) White Blood Cell Count D) Calcium Levels
Correct Answer: A) Sodium Levels Rationale: SSRIs can cause hyponatremia, especially in elderly patients.
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✅ 17. Which of the following symptoms differentiates depression from normal sadness?
A) Temporary low mood B) Persistent sadness with functional impairment C) Crying during a sad movie D) Feeling lonely after a breakup
Correct Answer: B) Persistent sadness with functional impairment Rationale: Clinical depression is marked by long-lasting symptoms and impairment in functioning.
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✅ 18. Which of the following side effects is most commonly associated with SSRIs?
A) Constipation B) Sexual Dysfunction C) Weight Loss D) Bradycardia
Correct Answer: B) Sexual Dysfunction Rationale: Sexual side effects are among the most frequent reasons for discontinuing SSRIs.
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✅ 19. Which of the following is the preferred non-pharmacological treatment for postpartum depression?
A) Isolation B) Group Therapy and CBT C) Electroconvulsive Therapy D) Complete bed rest
Correct Answer: B) Group Therapy and CBT Rationale: Psychotherapy, including CBT, is effective in managing postpartum depression.
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✅ 20. Which therapy is indicated for severe depression with suicidal ideation or treatment resistance?
A) Light Therapy B) Cognitive Therapy C) Electroconvulsive Therapy (ECT) D) Music Therapy
Correct Answer: C) ECT Rationale: ECT is used in severe, life-threatening depression when other treatments fail.
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✅ 21. What is the typical latency period before antidepressants show significant effects?
A) 12 hours B) 1-2 days C) 2-4 weeks D) 6 months
Correct Answer: C) 2-4 weeks Rationale: Most antidepressants take several weeks to show noticeable improvement.
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✅ 22. Which hormone is often elevated in patients with major depressive disorder?
A) Thyroxine B) Insulin C) Cortisol D) Estrogen
Correct Answer: C) Cortisol Rationale: Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis leads to elevated cortisol levels in depression.
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✅ 23. Which of the following is a priority nursing diagnosis for a patient with major depressive disorder?
A) Risk for Injury B) Ineffective Airway Clearance C) Deficient Fluid Volume D) Risk for Imbalanced Nutrition
Correct Answer: A) Risk for Injury Rationale: Due to suicidal ideation, ensuring patient safety is the top priority.
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✅ 24. Which neurotransmitter system is primarily targeted by MAO inhibitors?
A) GABA B) Monoamines (Serotonin, Norepinephrine, Dopamine) C) Histamine D) Glutamate
Correct Answer: B) Monoamines Rationale: MAOIs inhibit the breakdown of monoamines, increasing their availability in the brain.
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✅ 25. Which lifestyle modification is important for managing mild to moderate depression?
A) Isolate from social contacts B) Increase physical activity and engage in social activities C) Avoid exposure to sunlight D) Increase caffeine intake
Correct Answer: B) Increase physical activity and engage in social activities Rationale: Regular exercise and social engagement help improve mood and reduce depressive symptoms.
📚 Bipolar Mood Disorders
✅ Definition:
Bipolar Mood Disorder is a chronic psychiatric condition characterized by extreme mood swings that include episodes of mania or hypomania and depression. It significantly affects thinking, behavior, energy, and social functioning.
🎯 Prevalence:
Global Prevalence: About 1-2% for Bipolar I and 2-4% for Bipolar II Disorder.
Equally affects men and women, but mania is more common in males, and depressive episodes are more frequent in females.
Average age of onset: Late adolescence to early adulthood (18–25 years).
✅ Etiology (Causes):
📚 Biological Factors:
Genetic Predisposition:
First-degree relatives have a 5–10 times higher risk.
Neurochemical Imbalance:
Increased levels of norepinephrine and dopamine during mania.
Deficiency of serotonin associated with depression.
Neuroendocrine Dysregulation:
Dysfunction in the hypothalamic-pituitary-adrenal (HPA) axis affecting stress response.
📚 Psychosocial Factors:
Stressful life events (loss, trauma).
Dysfunctional family environment (high expressed emotions).
Poor coping mechanisms.
📚 Environmental and Lifestyle Factors:
Substance abuse (alcohol, stimulants).
Sleep deprivation and circadian rhythm disturbances.
Seasonal changes (mania more common in spring/summer).
✅ Classification (As per DSM-5):
Bipolar I Disorder:
At least one episode of mania, with or without depressive episodes.
Bipolar II Disorder:
Hypomania (milder mania) alternating with major depressive episodes.
Cyclothymic Disorder:
Chronic, fluctuating mood disturbances with hypomanic and depressive symptoms for at least 2 years (1 year in children).
✅ Signs and Symptoms:
📌 1. Manic Episode (Lasts ≥1 Week):
Elevated, expansive, or irritable mood.
Increased energy and goal-directed activity.
Decreased need for sleep.
Grandiosity (inflated self-esteem).
Pressured speech and flight of ideas.
Risky behaviors (spending sprees, sexual indiscretions).
📌 2. Hypomanic Episode (Lasts ≥4 Days):
Similar to mania but less severe; does not cause significant social/occupational impairment.
📌 3. Depressive Episode (Lasts ≥2 Weeks):
Persistent sadness and hopelessness.
Anhedonia (loss of interest).
Fatigue and low energy.
Suicidal ideation.
Sleep and appetite disturbances.
✅ Prognosis:
Bipolar disorder is lifelong and recurrent but can be managed with proper treatment.
Risk of suicide is higher than in major depressive disorder.
Effective in treatment-resistant depression or mania and when there is an immediate risk of suicide.
✅ Nursing Management:
| Assessment:
Assess mood changes, suicidal ideation, and risky behaviors.
Monitor medication side effects and compliance.
Evaluate sleep patterns and nutritional intake.
| Interventions:
Ensure Patient Safety:
Supervise during high-risk behaviors (financial, sexual, aggression).
Remove harmful objects if suicidal ideation is present.
Establish Therapeutic Relationship:
Use simple, direct communication.
Set clear boundaries for behavior.
Promote Rest and Nutrition:
Encourage adequate rest periods and offer high-calorie finger foods.
Administer Medications as Prescribed:
Educate about the importance of medication adherence.
Monitor serum lithium levels and watch for side effects.
Psychoeducation:
Teach patients and families about early warning signs of relapse.
Encourage regular sleep patterns and stress management techniques.
Facilitate Support Groups and Counseling.
📌 Golden One-Liners for Quick Revision:
🧠 “Bipolar I involves full mania; Bipolar II involves hypomania and depression.”
🧠 “Lithium is the drug of choice for both manic episodes and maintenance therapy.”
🧠 “Suicide risk is highest during depressive episodes in bipolar disorder.”
🧠 “Ensure safety and set firm behavioral limits during manic episodes.”
🧠 “Sleep deprivation can trigger manic episodes.”
✅ 1. Which of the following is the drug of choice for long-term maintenance therapy in bipolar disorder?
A) Haloperidol B) Lithium C) Fluoxetine D) Diazepam
Correct Answer: B) Lithium Rationale: Lithium is the gold-standard mood stabilizer used for both acute mania and long-term prevention of mood episodes.
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✅ 2. Which of the following symptoms best differentiates mania from hypomania?
A) Decreased need for sleep B) Grandiosity C) Severe impairment in social and occupational functioning D) Increased talkativeness
Correct Answer: C) Severe impairment in social and occupational functioning Rationale: Mania causes significant impairment and may require hospitalization, while hypomania does not cause marked dysfunction.
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✅ 3. A bipolar patient on lithium therapy shows tremors, confusion, and ataxia. What is the nurse’s immediate action?
A) Continue medication and reassure the patient. B) Administer an antipsychotic drug. C) Hold the lithium dose and notify the physician. D) Increase fluid intake and continue medication.
Correct Answer: C) Hold the lithium dose and notify the physician. Rationale: These are signs of lithium toxicity. Immediate action is to stop the drug and seek medical evaluation.
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✅ 4. Which of the following behaviors is most commonly seen during a manic episode?
A) Social withdrawal B) Flight of ideas and hyperactivity C) Excessive sleeping and fatigue D) Slow speech and indecisiveness
Correct Answer: B) Flight of ideas and hyperactivity Rationale: Manic patients show increased psychomotor activity, rapid thoughts, and pressured speech.
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✅ 5. What is the primary nursing intervention during the acute manic phase?
A) Encourage the patient to attend group therapy. B) Allow the patient to engage in stimulating activities. C) Maintain a low-stimulus environment and ensure patient safety. D) Ignore the patient’s disruptive behavior.
Correct Answer: C) Maintain a low-stimulus environment and ensure patient safety. Rationale: The focus should be on safety and reducing external stimuli to help the patient regain control over behavior.
✅ 1. What is the most characteristic feature of Bipolar I Disorder?
A) At least one depressive episode B) Recurrent episodes of hypomania C) At least one manic episode D) Mood swings without impairment
Correct Answer: C) At least one manic episode Rationale: Bipolar I is defined by the presence of at least one manic episode, with or without depression.
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✅ 2. Which of the following medications is the first-line treatment for acute mania and maintenance?
A) Fluoxetine B) Clozapine C) Lithium D) Lorazepam
Correct Answer: C) Lithium Rationale: Lithium is the gold-standard mood stabilizer used in both acute and maintenance phases of bipolar disorder.
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✅ 3. Which symptom is most commonly seen in a manic episode?
A) Social withdrawal B) Hypersomnia C) Flight of ideas D) Fatigue
Correct Answer: C) Flight of ideas Rationale: Rapidly shifting ideas and racing thoughts are hallmark signs of mania.
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✅ 4. A key difference between Bipolar I and Bipolar II Disorder is:
A) Bipolar I includes psychosis; Bipolar II includes hallucinations B) Bipolar I includes full mania; Bipolar II includes hypomania C) Bipolar II includes mania only D) Bipolar I is treated only with antipsychotics
Correct Answer: B) Bipolar I includes full mania; Bipolar II includes hypomania Rationale: The primary difference lies in the severity of the manic episode.
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✅ 5. Which of the following is considered a mood stabilizer?
A) Haloperidol B) Valproic Acid C) Diazepam D) Amitriptyline
Correct Answer: B) Valproic Acid Rationale: Valproate is used as a mood stabilizer in both mania and bipolar maintenance.
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✅ 6. What is the therapeutic range for serum lithium level?
A) 0.1–0.5 mEq/L B) 0.6–1.2 mEq/L C) 1.5–2.5 mEq/L D) 2.5–3.0 mEq/L
Correct Answer: B) 0.6–1.2 mEq/L Rationale: Lithium levels within this range are therapeutic. Levels above 1.5 mEq/L are toxic.
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✅ 7. Which of the following signs indicates lithium toxicity?
A) Weight gain and constipation B) Fine hand tremors and increased thirst C) Confusion, ataxia, slurred speech D) Increased energy and agitation
Correct Answer: C) Confusion, ataxia, slurred speech Rationale: These are late signs of lithium toxicity and require immediate medical attention.
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✅ 8. A patient is cheerful, overconfident, and easily distracted. These are signs of:
A) Delirium B) Mania C) Depression D) Dementia
Correct Answer: B) Mania Rationale: These symptoms indicate elevated mood and distractibility typical of mania.
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✅ 9. Which antidepressant must be used cautiously in bipolar disorder due to risk of switching to mania?
A) Fluoxetine B) Risperidone C) Lithium D) Olanzapine
Correct Answer: A) Fluoxetine Rationale: SSRIs like fluoxetine can precipitate manic episodes if not used with mood stabilizers.
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✅ 10. Which of the following is a feature of hypomania?
A) Causes hospitalization B) Includes hallucinations C) Involves mild elevation in mood without marked impairment D) Requires ECT
Correct Answer: C) Involves mild elevation in mood without marked impairment Rationale: Hypomania is a less severe form of mania and does not cause major social or occupational dysfunction.
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✅ 11. What is the priority nursing intervention during a manic episode?
A) Discuss long-term goals B) Offer group therapy C) Ensure patient safety D) Encourage physical activity
Correct Answer: C) Ensure patient safety Rationale: Due to impulsivity, risk-taking, and poor judgment, safety is the primary concern.
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✅ 12. Which antipsychotic is commonly used in the treatment of acute mania?
A) Risperidone B) Sertraline C) Amitriptyline D) Buspirone
Correct Answer: A) Risperidone Rationale: Atypical antipsychotics like risperidone are effective in controlling manic symptoms.
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✅ 13. Which dietary advice is crucial for a patient taking lithium?
A) Avoid salt completely B) Maintain consistent salt and fluid intake C) Consume more caffeine D) Increase sugar intake
Correct Answer: B) Maintain consistent salt and fluid intake Rationale: Fluctuations in sodium and hydration can affect lithium levels and increase toxicity risk.
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✅ 14. The most serious complication of untreated bipolar disorder is:
A) Excessive talking B) Suicidal behavior C) Mood elevation D) Euphoria
Correct Answer: B) Suicidal behavior Rationale: Suicide is a major cause of death in bipolar disorder, especially during depressive or mixed episodes.
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✅ 15. Which non-pharmacological treatment is considered for severe mania or depression unresponsive to medications?
A) Music therapy B) Light therapy C) Electroconvulsive therapy (ECT) D) Herbal therapy
Correct Answer: C) Electroconvulsive therapy (ECT) Rationale: ECT is effective for treatment-resistant mood episodes or suicidal patients.
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✅ 16. Which of the following is NOT a typical symptom of mania?
A) Increased self-esteem B) Decreased need for sleep C) Depressed mood D) Risky behavior
Correct Answer: C) Depressed mood Rationale: Depression is the opposite mood pole; mania involves euphoria or irritability.
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✅ 17. Which of the following describes cyclothymic disorder?
A) Full manic episodes with major depression B) Alternating periods of hypomania and mild depression for ≥2 years C) Seasonal manic episodes only D) Only depressive symptoms with no elevated mood
Correct Answer: B) Alternating periods of hypomania and mild depression for ≥2 years Rationale: Cyclothymic disorder involves chronic, fluctuating mood disturbances.
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✅ 18. Which patient behavior indicates improvement during the manic phase?
A) Sleeping 2 hours a night B) Spending large sums impulsively C) Participating in structured activities and resting D) Engaging in arguments
Correct Answer: C) Participating in structured activities and resting Rationale: This reflects self-control and balance, showing signs of recovery.
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✅ 19. The most important nursing assessment before starting lithium therapy is:
A) ECG B) Liver function test C) Renal function test D) Glucose level
Correct Answer: C) Renal function test Rationale: Lithium is excreted by kidneys, so renal function must be normal to prevent accumulation.
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✅ 20. Which is a key goal of psychoeducation in bipolar disorder?
A) Encourage sudden medication stoppage after mood stabilizes B) Avoid all physical activity C) Recognize early signs of relapse D) Promote complete dependency on hospital care
Correct Answer: C) Recognize early signs of relapse Rationale: Educating the patient and family helps in early detection and management of episodes.
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✅ 21. Which of the following is NOT a warning sign of a manic episode?
A) Excessive talking B) Sleeping 8–10 hours at night C) Risk-taking behavior D) Irritability
Correct Answer: B) Sleeping 8–10 hours at night Rationale: Decreased sleep is typical in mania; normal sleep patterns are not a warning sign.
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✅ 22. Which lab value should be regularly monitored in patients on valproic acid?
A) Hemoglobin B) Liver function tests (LFTs) C) Blood glucose D) Serum calcium
Correct Answer: B) Liver function tests (LFTs) Rationale: Valproic acid may cause hepatotoxicity; regular liver monitoring is essential.
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✅ 23. A patient with bipolar disorder says, “I’m going to open five businesses this week!” What symptom is this?
A) Hallucination B) Grandiosity C) Delusion of control D) Perseveration
Correct Answer: B) Grandiosity Rationale: Unrealistic overconfidence in abilities is a key manic symptom.
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✅ 24. Which phase of bipolar disorder poses the highest suicide risk?
A) Hypomanic B) Manic C) Depressive D) Maintenance
Correct Answer: C) Depressive Rationale: Suicide risk is highest during depressive and mixed episodes.
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✅ 25. Which is the best nursing approach for managing manic behavior?
A) Engage in confrontational discussions B) Set firm, non-judgmental boundaries C) Ignore the behavior D) Allow unrestricted freedom
Correct Answer: B) Set firm, non-judgmental boundaries Rationale: Structured, clear communication helps maintain safety and control without escalation.
Disorder
Key Mood Features
Key Thought Features
Key Behavioral Features
Risk Factors/Complications
Schizophrenia
Flat or inappropriate affect
Delusions (false beliefs), Hallucinations (mostly auditory), Thought disorders (loose associations)
Social withdrawal, Neglect of personal hygiene, Catatonia or agitation
Suicide, Poor social functioning, Non-compliance with treatment
Mania
Elevated, expansive, or irritable mood
Grandiosity, Flight of ideas, Distractibility
Hyperactivity, Decreased need for sleep, Risk-taking behavior, Pressured speech
Injury due to risky behavior, Financial/social ruin, Exhaustion
Depression
Persistent sadness, Hopelessness, Anhedonia (loss of interest)