Mixed Features Episodes (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    00:00 So far we've talked about depression, we've talked about mania, we've talked about hypomania.

    00:08 But everything is not always so black and white.

    00:12 Sometimes we might find that someone is coming into the hospital and has a diagnosis of mania or hypomania and has fit all of that criteria.

    00:26 But there are some other features to this person's diagnosis, features that we don't typically think of when we think of a person who has a diagnosis of mania.

    00:39 So I want you to think of this SIG E CAPS as just a way of thinking about other possible criteria or symptoms that we might see in a person who has mania or hypomania.

    00:53 And if the person demonstrates even 3 of these different SIG E CAPS symptoms, we want to start thinking that perhaps this is mixed features.

    01:08 They still have mania or hypomania.

    01:12 But now we're going to say there are some other features mixed in with that diagnosis that are not what we typically anticipate.

    01:22 So although with mania, we think they're going to be awake all the time.

    01:26 If we have a manic patient who comes in and we see these sleep changes where they are sleeping more during the day, maybe less during the night, but sleeping during the day, or if they have loss of interest in their activities, which we would really be thinking depression at that point.

    01:47 If we have 3 of these, guilt, lack of energy, their concentration being reduced, their weight changing, they have some of their psychomotor retardation along with the agitation or maybe they have some suicidal thoughts and hopelessness and or homicidal ideation, then we're going to think that this person, although they meet all the criteria for mania or hypomania have mixed features, they have some depressive features that are also in this mix.

    02:26 Again, if you've have anyone who is suicidal or homicidal, as a nurse, you have a duty to warn.

    02:34 It is important to make sure that that person gets immediate help and that if they are threatening the life of another that that person is warned.

    02:44 So just as we said with mania hypomania, it's not always black and white.

    02:50 Sometimes people come in and they have depression.

    02:53 And that depression meets full criteria for the diagnosis of depression.

    02:59 But they have 3 different symptoms at least from the next list that I give you, which we'll call the DIG FAST issue.

    03:10 So distractibility.

    03:12 We don't expect a person with depression to have this increased distractibility.

    03:17 We don't expect them to have this irresponsibility or uninhibited behaviors.

    03:24 We don't expect them to have grandiosity.

    03:27 If they do have these symptoms during their depression, if they have flight of ideas, if they are showing that they have anxiety, weight loss, that they have this increased libido, decrease in sleep or increase in talkativeness.

    03:46 All symptoms and signs that we associate with mania or hypomania and they actually fit the depressive criteria.

    03:56 We would say, this is a person with depression with mixed features.

    04:03 It's not a clear cut thing.

    04:05 Human beings are not black/white.

    04:09 It is a little bit of everything in there.

    04:13 So what do we do for people who have bipolar 1, bipolar 2, cyclothymic disorder, or depression with mixed features, or mania with mixed features?

    About the Lecture

    The lecture Mixed Features Episodes (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Mood Disorders: Major Depressive and Bipolar Disorders (Nursing).

    Included Quiz Questions

    1. The client with a diagnosis of mania who is presenting with psychomotor retardation, suicidal ideation, and a lack of energy
    2. The client with a diagnosis of mania who is presenting with poor sleep and decreased appetite
    3. The client with a diagnosis of hypomania who is presenting with reduced cognition
    4. The client with a diagnosis of mania who is presenting with increased energy, pressured speech, and loss of appetite
    1. Grandiosity
    2. Flight of ideas
    3. Activity increase
    4. Catatonia

    Author of lecture Mixed Features Episodes (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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