NLE Psychiatric Disorders — Mood Disorders: Depression and Bipolar DisorderCheat Sheet

Section Title

Major Depressive Disorder (MDD) — Definition & Assessment

Important Facts

• SIG E CAPS mnemonic: Sleep (insomnia/hypersomnia), Interest (anhedonia), Guilt (worthlessness, excessive guilt), Energy (fatigue), Concentration (poor focus), Appetite (significant change), Psychomotor (agitation or retardation), Suicide (recurrent thoughts of death/suicide)
• Duration requirement: ≥2 weeks of symptoms
• Depressive episode may include psychotic features (mood-congruent delusions or hallucinations)
• Depression with atypical features: hypersomnia, hyperphagia, mood reactivity, rejection sensitivity
• Always assess for suicidal ideation — this is the HIGHEST priority in MDD
• Poor grooming, social withdrawal, constipation, and somatic complaints are common presentations
• Recurrent episodes are typical; single episode MDD is less common

Key Definitions

Diagrams To Know

• SIG E CAPS symptom checklist for rapid assessment
• Depression severity scale (mild, moderate, severe, with psychotic features)

Section Title

Suicide Risk Assessment & Safety — HIGHEST PRIORITY

Important Facts

• NEVER ask 'Are you suicidal?' — ASK DIRECTLY: 'Are you thinking of killing yourself?' Asking does NOT plant the idea.
• Assess for the TRIAD: (1) Plan, (2) Method, (3) Means (access). If specific, lethal, and accessible = HIGH RISK.
• WARNING SIGNS: giving away prized possessions, making a will, saying goodbye, sudden calm/mood lift after deep depression (DANGER PERIOD), previous attempts, hopelessness.
• STRONGEST PREDICTOR of future suicide: previous suicide attempt.
• Risk factors: male sex, older age (especially >65), social isolation, chronic illness, substance use, access to lethal means.
• CRITICAL TIMING: Suicide risk INCREASES in EARLY TREATMENT when ENERGY RETURNS before mood improves — patient now has energy to act on plan.
• Sudden calm/lift in mood after severe depression may signal decision has been made — this is a DANGER PERIOD.
• Do NOT promise to keep suicidal disclosures secret; always report to treatment team and document.
• Under RA 11036 (Mental Health Act): involuntary treatment permitted for imminent risk of harm with appropriate safeguards and documentation.
• One-to-one continuous observation for HIGH RISK: client must remain in sight, including bathroom use.

Key Definitions

Diagrams To Know

• Suicide risk stratification: low, moderate, high, imminent
• Precaution escalation based on risk level

Section Title

Nursing Interventions for MDD & Suicide Prevention

Important Facts

• PRIORITY #1: Safety — direct assessment for suicidal thoughts and plan; implement precautions based on risk level.
• Spend TIME with the client — silence communicates acceptance; do NOT use false reassurance or artificial cheerfulness (invalidates feelings).
• Meet BASIC PHYSIOLOGIC NEEDS (Maslow): nutrition, hydration, elimination, sleep, hygiene — depressed client lacks motivation.
• Structure day with SIMPLE, ACHIEVABLE activities to build sense of accomplishment and purpose.
• WATCH CLOSELY during early treatment: as energy RETURNS, suicide risk INCREASES before mood improves — provide closer observation.
• Provide SAFE ENVIRONMENT: remove or secure potential means — sharps, belts, cords, glass, excess medications, window access.
• Implement observation level based on risk: LOW (checkins every 30 min), MODERATE (continuous visual contact), HIGH (one-to-one continuous, never alone).
• Encourage expressing feelings and hopelessness without contradiction; validate emotion.
• Promote sleep, nutrition, and grooming; gently assist with self-care.
• Avoid engaging in argument about reasons to live; focus on coping and symptom management.

Key Definitions

Diagrams To Know

• Observation levels by suicide risk category
• Depression-to-recovery timeline with danger periods marked

Section Title

Bipolar Disorder — Bipolar I vs Bipolar II

Important Facts

• BIPOLAR I = at least ONE MANIC EPISODE (full-blown mania); may or may not have depressive episodes.
• BIPOLAR II = NEVER has full mania; defined by hypomanic episodes + depressive episodes; hypomania does not cause marked impairment.
• Mood episode duration: MANIA ≥7 days; HYPOMANIA ≥4 days; DEPRESSION ≥2 weeks.
• Manic/hypomanic core features: ELEVATED mood (not always happiness—often irritable), DECREASED NEED FOR SLEEP (feeling rested after 3 hours), GRANDIOSITY, PRESSURED SPEECH, FLIGHT OF IDEAS, DISTRACTIBILITY.
• During mania: increased goal-directed activity, excessive involvement in high-risk activities (spending sprees, hypersexuality, substance abuse, risky investments).
• Manic client becomes EXHAUSTED and DEHYDRATED because they do not stop to eat, drink, or rest.
• Judgment is SEVERELY IMPAIRED during mania — client cannot recognize consequences (financial, legal, sexual, reputational).
• Bipolar I has higher suicide risk than MDD; suicide often occurs during depressive episodes following mania.
• Rapid cycling: ≥4 mood episodes/year; associated with worse prognosis and treatment resistance.

Key Definitions

Diagrams To Know

• Mood spectrum: depression → baseline → hypomania → mania
• Bipolar I vs Bipolar II diagnostic criteria comparison

Section Title

Nursing Interventions for Mania

Important Facts

• REDUCE ENVIRONMENTAL STIMULATION: quiet, calm setting with few people; manic client is hyperaware and overstimulated.
• PROVIDE FIRM, CONSISTENT LIMITS on manipulative, intrusive, or boundary-violating behavior in matter-of-fact, non-punitive tone.
• MEET PHYSIOLOGIC NEEDS (Maslow priority): client forgets to eat, drink, sleep because of high activity; offer HIGH-CALORIE FINGER FOODS and fluids that can be consumed on-the-go (sandwiches, milkshakes, juice).
• CHANNEL ENERGY into safe, non-competitive, simple activities; avoid activities requiring sustained concentration or competition (which triggers irritability).
• MONITOR for exhaustion and dehydration; may require IV fluids if severe.
• PROTECT from consequences of poor judgment: manage finances, prevent inappropriate sexual behavior, limit Internet/phone access if risky.
• Do NOT engage in debate or power struggles; use clear directives and redirection.
• Avoid overstimulating activities: large groups, competitive games, music, television.
• Sleep deprivation fuels mania — establish rest periods even if client refuses.
• Monitor for aggression or psychosis; manic clients with psychotic features (grandiose delusions) may become hostile if challenged.

Key Definitions

Diagrams To Know

• Escalation pathway in mania and de-escalation interventions
• Manic client care flow: observation → limit-setting → need met → energy channeled

Common Values

Section Title

Antidepressants — SSRIs (First-Line)

Important Facts

• SSRI ONSET: 2–4 weeks for therapeutic effect (not immediate); counsel client to continue despite early lack of response.
• FIRST-LINE for MDD: safest, best tolerated, fewer drug interactions than TCAs or MAOIs.
• Early side effects (first 1–2 weeks): nausea, insomnia, sexual dysfunction, headache, agitation; usually subside.
• CRITICAL: During first 2–4 weeks, watch for INCREASED SUICIDAL IDEATION in young adults (FDA black box warning); energy returns before mood improves.
• NEVER combine SSRI + MAOI directly: causes SEROTONIN SYNDROME (hyperthermic crisis); allow WASHOUT PERIOD: 2 weeks between SSRI/MAOI, 5 WEEKS after fluoxetine (long half-life).
• Do NOT stop abruptly: causes SSRI discontinuation syndrome (flu-like symptoms, dizziness, paresthesia, brain zaps); taper gradually.
• Drug interactions: SSRIs inhibit cytochrome P450 enzymes; caution with drugs metabolized by CYP2D6 or CYP3A4 (certain antiarrhythmics, antipsychotics).
• Sexual dysfunction: occurs in 20–40% of patients; may warrant switch to different agent or addition of cyproheptadine.
• Hyponatremia (SIADH): especially in elderly; monitor sodium, symptoms of hyponatremia (confusion, weakness, lethargy, seizures).
• Pregnancy/breastfeeding: generally considered safe; inform client of minimal fetal risk but risk of untreated depression.

Key Definitions

Diagrams To Know

• SSRI mechanism of action (serotonin reuptake blockade)
• SSRI timeline: onset 2-4 weeks with danger period for suicidal ideation

Common Values

Section Title

Antidepressants — Tricyclic Antidepressants (TCAs)

Important Facts

• Onset: 2–4 weeks (same as SSRIs).
• HIGHEST RISK: CARDIOTOXICITY in overdose — dysrhythmias (QT prolongation, conduction delays) are LEADING CAUSE OF DEATH in TCA overdose.
• Because of overdose danger in suicidal clients, DISPENSE LIMITED QUANTITIES (e.g., 1-week supply at a time); monitor for hoarding.
• ANTICHOLINERGIC SIDE EFFECTS (prominent): dry mouth, blurred vision, constipation, urinary retention, orthostatic hypotension, tachycardia, confusion.
• GI effects: weight gain, constipation (monitor for fecal impaction).
• Sedation: therapeutic for insomnia; give larger dose at bedtime.
• Orthostatic hypotension: major concern in elderly and medically ill; assess for dizziness, falls; educate on position changes.
• NEVER combine with MAOI: risk of serotonin syndrome.
• Drug interactions: TCAs potentiated by CNS depressants, anticholinergics; caution with sympathomimetics (hypertension risk).
• EKG baseline before starting; monitor if high doses or concurrent cardiac disease.
• Therapeutic drug levels exist for some TCAs (e.g., nortriptyline); monitoring may guide dosing.

Key Definitions

Diagrams To Know

• TCA mechanism (norepinephrine + serotonin reuptake blockade)
• Anticholinergic side effects spectrum

Common Values

Section Title

Antidepressants — Monoamine Oxidase Inhibitors (MAOIs)

Important Facts

• MAOI ONSET: 2–4 weeks (same delay as other antidepressants).
• Reserved for TREATMENT-RESISTANT depression: when SSRIs and other agents fail.
• CRITICAL: TYRAMINE-FREE DIET IS ESSENTIAL — tyramine + MAOI → HYPERTENSIVE CRISIS (can be FATAL).
• TYRAMINE-RICH FOODS TO AVOID: aged cheeses (cheddar, blue, brie, mozzarella aged >few days), cured/smoked/aged meats (salami, pepperoni, sausage, bacon, ham, anchovies, caviar), fermented soy products (soy sauce, tofu, miso), sauerkraut, fermented/aged foods, TAP OR DRAFT BEER (bottled OK in moderation), RED WINE especially Chianti, overripe/spoiled foods, yeast extracts.
• SAFE FOODS: fresh meats, fish, poultry; fresh fruits/vegetables; milk, yogurt, fresh cheese (ricotta, cream cheese); whole grain breads; pasta; rice.
• OTC COLD/COUGH/DECONGESTANT MEDICATIONS: AVOID (contain sympathomimetics — phenylephrine, pseudoephedrine, phenylpropanolamine).
• NEVER combine MAOI + SSRI/TCA/other serotonergic agent without WASHOUT: 2 weeks for most SSRIs, 5 weeks for fluoxetine; risk of SEROTONIN SYNDROME.
• Teach client to RECOGNIZE HYPERTENSIVE CRISIS SIGNS: severe occipital headache, palpitations, neck stiffness, sweating, chest pain, shortness of breath; SEEK EMERGENCY CARE IMMEDIATELY.
• If hypertensive crisis occurs: STOP MAOI, emergency medical evaluation; may require phentolamine (alpha blocker) or nifedipine to lower BP.
• Sexual dysfunction and weight gain common.
• Hepatotoxicity risk: monitor LFTs; contraindicated in liver disease.

Key Definitions

Diagrams To Know

• MAOI mechanism (MAO inhibition, monoamine accumulation)
• Tyramine interaction pathway: tyramine + MAOI → sympathomimetic surge → hypertensive crisis
• Foods to avoid with MAOI (visual chart)

Common Values

Section Title

Serotonin Syndrome — Critical Emergency

Important Facts

• CAUSE: combining serotonergic drugs (SSRI + MAOI most common; also SSRI + tramadol, SSRI + triptan for migraine, SSRI + St. John's wort, SSRI + DXM in cough syrup).
• ONSET: typically within 24–72 hours of dose increase or starting new serotonergic agent.
• TRIAD OF SYMPTOMS:
• 1. MENTAL STATUS CHANGES: agitation, anxiety, confusion, disorientation, hallucinations, coma.
• 2. AUTONOMIC INSTABILITY: hyperthermia (fever often >38.5°C), tachycardia, tachypnea, hypertension or hypotension, diaphoresis (profuse sweating), flushing.
• 3. NEUROMUSCULAR ABNORMALITIES: tremor, hyperreflexia, muscle rigidity, clonus (spontaneous or inducible), myoclonus, ataxia, nystagmus, seizures.
• SEVERITY can range from MILD (mild tremor, agitation) to LIFE-THREATENING (severe hyperthermia, seizures, rhabdomyolysis, DIC, coma, death).
• Diagnosis: clinical; no specific lab test.
• Management: IMMEDIATE STOP of offending drug(s); SUPPORTIVE CARE (cooling measures, hydration, cardiac monitoring); give CYPROHEPTADINE (serotonin antagonist), 12 mg load then 2 mg q6h PO or per NG tube.
• Monitor for complications: rhabdomyolysis (dark urine, elevated CK), acute kidney injury, coagulopathy, seizures.
• Prognosis: most resolve within 24 hours of stopping drug; mild cases may resolve with supportive care alone.
• PREVENTION: adequate washout period between serotonergic drugs; educate patient and provider about drug interactions.

Key Definitions

Diagrams To Know

• Serotonin syndrome symptom triad and severity scale
• Decision tree: suspect serotonin syndrome → stop drug → supportive care + cyproheptadine

Formulas

Common Values

Section Title

Lithium Carbonate — Mood Stabilizer (HIGHEST YIELD TOPIC)

Important Facts

• THERAPEUTIC SERUM LEVEL: 0.6–1.2 mEq/L (maintenance); acute mania may use upper end (~1.5 mEq/L) under close supervision.
• TOXICITY THRESHOLD: levels ≥1.5 mEq/L; SEVERE toxicity >2.0 mEq/L; LIFE-THREATENING >2.5–3.0 mEq/L.
• MUST DRAW LEVEL 12 HOURS AFTER LAST DOSE (trough) — NOT at peak; peak is 2–4 hours post-dose.
• EARLY/MILD TOXICITY (1.5–2.0 mEq/L): nausea, vomiting, diarrhea, fine hand tremor, muscle weakness, thirst (polyuria), drowsiness, slurred speech.
• MODERATE-SEVERE TOXICITY (>2.0 mEq/L): coarse tremor, ataxia, confusion, muscle twitching, hyperreflexia, nystagmus, seizures, progression to coma, cardiovascular collapse.
• MECHANISM OF SODIUM-LITHIUM RELATIONSHIP: Lithium is transported via sodium channels and reabsorbed in renal proximal tubule like sodium. Low sodium diet, dehydration, sweating, vomiting, diarrhea, diuretics → sodium loss → kidneys reabsorb more lithium → serum lithium RISES.
• CRITICAL TEACHING: Maintain CONSISTENT, NORMAL sodium intake; avoid sudden dietary salt changes and crash diets. Maintain ADEQUATE HYDRATION (2–3 liters/day). Be cautious in hot weather and heavy exercise (fluid/sodium loss from perspiration).
• NSAIDs and THIAZIDE DIURETICS RAISE lithium levels; ACE inhibitors and loop diuretics may also increase levels. Monitor closely if these drugs added.
• Onset of mood-stabilizing effect: 1–3 weeks; acute mania often treated with adjunctive antipsychotic or benzodiazepine in interim.
• Baseline tests: serum creatinine (renal function), TSH, EKG if high risk. Periodic monitoring (renal/thyroid function) because lithium can cause hypothyroidism and affects kidneys with chronic use.
• Do NOT stop abruptly: risk of rebound mania or rapid cycling; taper gradually over 1–2 weeks.
• Take with food to reduce GI upset.
• If toxicity suspected: STOP lithium immediately; check serum level stat; IV hydration and support; severe toxicity may require HEMODIALYSIS to remove lithium.
• Pregnancy: teratogenic (associated with Ebstein's anomaly, cardiac defects); requires careful risk/benefit discussion.
• Polyuria and polydipsia (thirst) are common side effects; educate patient this is expected and not a sign of toxicity (unless accompanied by tremor, confusion).

Key Definitions

Diagrams To Know

• Lithium toxicity severity scale with symptoms and serum levels
• Sodium-lithium reabsorption mechanism in kidney
• Lithium monitoring timeline and level interpretation chart

Reactions Or Equations

Section Title

Other Mood Stabilizers & Antipsychotics for Mania

Important Facts

• VALPROIC ACID (DIVALPROEX): effective for acute mania and maintenance; monitor liver function (LFTs) and platelet count (thrombocytopenia risk); risk of pancreatitis (monitor amylase); TERATOGENIC (avoid in pregnancy, especially 1st trimester).
• CARBAMAZEPINE: effective for acute mania, especially with aggression; monitor for agranulocytosis (low WBC) and Stevens-Johnson syndrome (serious rash); AUTOINDUCES its own metabolism (increases clearance over time), requiring dose adjustments; many drug interactions.
• LAMOTRIGINE: used for bipolar depression (less for mania); SERIOUS RISK of Stevens-Johnson syndrome and toxic epidermal necrolysis, especially if rapid titration; MUST TITRATE SLOWLY; associated with rash in 10% of patients.
• ATYPICAL ANTIPSYCHOTICS (quetiapine, olanzapine, aripiprazole, risperidone): effective for acute mania and maintenance; FDA-approved for bipolar mania; often used adjunctively with mood stabilizer; monitor for weight gain, metabolic syndrome, tardive dyskinesia.
• Benzodiazepines (lorazepam, clonazepam) used for acute agitation/mania while waiting for mood stabilizer effect (lithium takes 1–3 weeks); short-term bridge therapy.

Key Definitions

Diagrams To Know

• Comparison of mood stabilizer classes and clinical use
• Timeline: acute mania management with benzodiazepine bridge + mood stabilizer initiation

Common Values

Section Title

Electroconvulsive Therapy (ECT) — Rapid-Acting Treatment

Important Facts

• INDICATIONS: severe depression (especially with psychotic features or high suicide risk), treatment-resistant depression (failed 2–3 antidepressant trials), depression during pregnancy (safer than prolonged pharmacotherapy), catatonia, mania (less common).
• RAPID EFFECT: symptom improvement often within 3–5 treatments (days to 1–2 weeks), versus weeks to months for medication.
• MECHANISM: brief electrical current induces controlled generalized seizure under anesthesia; exact mechanism unclear but likely involves monoamine, GABA, and HPA axis changes.
• PROCEDURE: NPO (fasting) typically after midnight; general anesthesia (propofol or methohexital); MUSCLE RELAXANT succinylcholine given to prevent physical convulsion injury; stimulating electrodes applied (bilateral or unilateral); seizure duration 20–60 seconds; patient wakes within minutes.
• PRIOR PREPARATION: obtain INFORMED CONSENT (critical — some patients hesitant due to stigma/misconceptions); ensure NPO; remove dentures, jewelry, hairpins, contact lenses; have patient void; take baseline vital signs; place IV; give anticholinergic (atropine) to reduce salivation/secretions.
• AFTER ECT: position patient on SIDE to maintain airway and prevent aspiration; monitor vital signs, SpO2, and respiratory status; reorient frequently (confusion is common); monitor for nausea.
• MOST COMMON SIDE EFFECT: transient CONFUSION and SHORT-TERM MEMORY LOSS, especially after first few treatments; usually resolves after series ends or shortly thereafter.
• REASSURANCE: confusion and memory loss are TEMPORARY and expected; brain imaging, cognition testing show no permanent damage; memory typically returns fully.
• Relative contraindications: recent MI, uncontrolled hypertension, pheochromocytoma, increased intracranial pressure (brain tumor, space-occupying lesion); can often be managed with precautions.
• Success rate: ~70–80% for severe depression; higher than medication for acute, severe, or psychotic depression.
• Maintenance ECT: some patients require periodic ECT treatments to prevent relapse; alternative if medications ineffective.

Key Definitions

Diagrams To Know

• ECT procedure timeline: pre-ECT preparation → anesthesia/seizure induction → post-ECT recovery
• ECT effectiveness compared to medications over time

Section Title

RA 11036 (Mental Health Act) — Philippine Legal/Ethical Framework

Important Facts

• RA 11036 mandates HUMANE TREATMENT and protects HUMAN RIGHTS of persons with mental health conditions.
• INVOLUNTARY ADMISSION/TREATMENT: permitted for imminent risk of self-harm (suicide) or harm to others, with documented evaluation by licensed mental health professional, informed consent process, and family notification.
• RESTRAINT/SECLUSION: permitted only as last resort for imminent safety risk, with documented justification, regular monitoring, and time limits; NOT for discipline or convenience.
• ANTI-DISCRIMINATION: protects persons with mental health conditions from discrimination in employment, education, housing, and healthcare.
• CONFIDENTIALITY: patient records protected; disclosure permitted only with informed consent or legal order.
• RIGHT TO TREATMENT, REHABILITATION, AND RECOVERY: RA 11036 emphasizes reintegration and community mental health services, not prolonged institutionalization.
• ROLE OF NURSE: advocate for patient rights, ensure informed consent, document all involuntary actions with justification, monitor for abuse or violation of rights, connect patient to community mental health services upon discharge.

Key Definitions

Diagrams To Know

• RA 11036 involuntary admission flowchart: indication → evaluation → consent/notification → documentation

Section Title

Patient & Family Teaching — Key Messages

Important Facts

• ANTIDEPRESSANT TEACHING: Takes 2–4 weeks for full effect; do not stop abruptly (risk of discontinuation syndrome); watch for increased suicidal thoughts early in treatment; call provider if worsening thoughts, severe side effects.
• LITHIUM TEACHING: Maintain CONSISTENT, normal salt intake and ADEQUATE fluids (2–3 liters/day); be cautious in hot weather and with exercise (dehydration raises lithium level); report signs of toxicity (nausea, tremor, confusion, slurred speech); regular blood tests required; never stop abruptly.
• MAOI TEACHING: Avoid ALL aged cheeses, cured/smoked meats, fermented soy products, draft beer, red wine, yeast extracts; avoid OTC cold/decongestant medicines; report severe headache, chest pain, palpitations (hypertensive crisis signs) to ER immediately.
• SUICIDE WARNING SIGNS: Increase in risky behavior, giving away possessions, talking about being burden, sudden calm after depression, increased substance use, withdrawing from support; encourage patient to call crisis line, talk to trusted person, or go to ER.
• MANIA/BIPOLAR EDUCATION: Importance of mood stabilizer adherence even when feeling well; early signs of relapse (decreased sleep, increased spending, risky behavior); risk of suicide during depressive phase; regular follow-up appointments and blood monitoring essential.
• ECT TEACHING: Confusion and memory loss after ECT are temporary and expected; most recover full memory; ECT is safe, effective option for severe depression; does not affect intelligence or personality.
• RECOVERY EXPECTATION: Mood disorders are chronic, recurrent; recovery is possible with medication, therapy, and lifestyle; relapse prevention involves continued treatment, sleep/stress management, and recognizing early warning signs.

Item

SUICIDE IS THE HIGHEST PRIORITY in mood disorders. ASK DIRECTLY: 'Are you thinking of killing yourself?' Assess for PLAN, METHOD, MEANS. Implement safety: remove hazards, one-to-one observation for high risk, never promise confidentiality on suicidal disclosure. Risk INCREASES when ENERGY RETURNS early in treatment.

Rank

1

Item

MDD diagnostic criteria: Depressed mood OR anhedonia ≥2 weeks PLUS ≥5 additional symptoms from SIG E CAPS (Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicide). Can include psychotic features.

Rank

2

Item

Bipolar I = at least ONE MANIC EPISODE (≥7 days, severe, hospitalization often needed). Bipolar II = NEVER full mania; defined by hypomanic episodes (4+ days, no marked impairment) + major depression. Key difference: Bipolar II never has full mania.

Rank

3

Item

LITHIUM THERAPEUTIC LEVEL: 0.6–1.2 mEq/L (maintenance). TOXICITY: >1.5 mEq/L (early); >2.0 mEq/L (severe); >2.5–3.0 mEq/L (life-threatening). DRAW LEVEL 12 HOURS AFTER LAST DOSE. Lithium follows sodium: low sodium/dehydration → lithium rises → toxicity. Teach consistent salt intake + 2–3 L fluid/day.

Rank

4

Item

LITHIUM TOXICITY SIGNS (escalating): Early (1.5–2.0 mEq/L): nausea, vomiting, diarrhea, fine tremor, thirst, polyuria, drowsiness. Severe (>2.0 mEq/L): coarse tremor, ataxia, confusion, muscle twitching, hyperreflexia, nystagmus, seizures, coma. If suspected, STOP lithium, check level stat, support care, consider hemodialysis.

Rank

5

Item

SSRI + MAOI = SEROTONIN SYNDROME (hyperthermic emergency). Manifestations: mental status changes (agitation, confusion), autonomic instability (hyperthermia, tachycardia, diaphoresis), neuromuscular (tremor, hyperreflexia, clonus). Management: STOP drug(s), supportive care, CYPROHEPTADINE (12 mg load, 2 mg q6h). Washout: 2 weeks (most SSRIs), 5 weeks (fluoxetine).

Rank

6

Item

MAOI DIETARY RESTRICTION: Avoid aged cheeses, cured/smoked/aged meats, fermented soy (soy sauce, tofu, miso), sauerkraut, draft beer, red wine, yeast extracts. Tyramine + MAOI = HYPERTENSIVE CRISIS (severe headache, neck stiffness, BP >180 mmHg, stroke/MI risk) → EMERGENCY. Also avoid OTC cold/decongestant meds (sympathomimetics).

Rank

7

Item

Antidepressants (SSRI, TCA, MAOI) take 2–4 WEEKS for full effect. NEVER stop abruptly (discontinuation syndrome). Watch for EARLY SUICIDAL IDEATION in first weeks as energy returns. Teach adherence, explain delay, monitor closely.

Rank

8

Item

Manic client nursing care: REDUCE environmental stimulation (quiet, calm, few people). Meet basic needs (high-calorie finger foods, fluids on-the-go, prevent exhaustion/dehydration). Set FIRM LIMITS on intrusive/manipulative behavior. Channel energy into safe, non-competitive activities. PROTECT from consequences of poor judgment (financial, sexual, legal).

Rank

9

Item

ECT (electroconvulsive therapy): Indicated for severe/treatment-resistant depression, depression with psychosis, high-suicide-risk depression. RAPID effect (3–5 treatments → symptom improvement). Transient confusion & short-term memory loss expected (temporary). Requires informed consent, NPO, muscle relaxant (succinylcholine), positioning on side post-ECT, frequent reorientation.

Rank

10

Tip

LITHIUM LEVEL TIMING: Students mistake peak for trough. ALWAYS draw at 12 hours post-dose for accurate therapeutic/toxic assessment. Peak levels falsely elevate and will mislead dosing. Write this on your hand if needed.

Tip

BIPOLAR I vs II: The ONE key difference is the PRESENCE OF FULL MANIA. If client has ever had a full manic episode (≥7 days, severe impairment, hospitalization often needed) = Bipolar I. If ONLY hypomanic episodes (4+ days, no marked impairment, no hospitalization) = Bipolar II. No full mania ever in Bipolar II.

Tip

SEROTONIN SYNDROME is a CLINICAL DIAGNOSIS (no lab test). If you see the TRIAD (mental status change + autonomic instability + neuromuscular signs) in a patient on serotonergic drugs (SSRI, MAOI, tramadol, triptan, St. John's wort), think serotonin syndrome immediately. Stop the drug and give supportive care + cyproheptadine.

Tip

ECT SIDE EFFECTS: Confusion and memory loss after ECT are TEMPORARY and EXPECTED — many students mistakenly think they're signs of damage. Reassure patient. Memory returns fully in days to weeks. This is a testable concept on NLE; know it solidly.

Tip

SUICIDE ASSESSMENT: Asking about suicidal thoughts does NOT plant the idea — it opens the door to honesty and shows you care. ALWAYS ask directly. Assess the TRIAD (plan/method/means). A specific, lethal, available plan = HIGH RISK. Prior attempts = STRONGEST PREDICTOR. One-to-one observation for high risk; never leave alone; never promise confidentiality.

Rows

Columns

• Feature
• Major Depressive Disorder
• Bipolar I
• Bipolar II

Table Title

MDD vs Bipolar I vs Bipolar II — Diagnostic Comparison

Rows

Columns

• Class
• Examples
• Onset
• Mechanism
• Advantages
• Major Disadvantages
• Critical Caution

Table Title

Antidepressant Classes — Key Comparison for NLE

Rows

Columns

• Serum Level (mEq/L)
• Severity Category
• Characteristic Signs & Symptoms

Table Title

Lithium Toxicity — Signs by Severity & Serum Level

Rows

Columns

• Aspect
• Key Information

Table Title

Serotonin Syndrome — Causes, Manifestations, Management (NLE GOLD STANDARD)

Rows

Columns

• Drug Class/Example
• Mechanism
• Indication
• Onset
• Key Monitoring
• Major Side Effects / Cautions

Table Title

Mood Stabilizers — Classes, Mechanisms, Monitoring