Bipolar Jeopardy

Question 1

Bipolar I

Answer 1

@18yo
\+delusions
Depressive episode is not dx requirement
More likely to have hypomanic episode
Significant impairment in social or occupational function
Need psychiatric hospitalization

Question 2

Bipolar II

Answer 2

@mid 20s
F = M
Sx for 4-6 days
Pt in depressed state 15 x more than (hypo)manic state
Mistaken for cyclothymia

Question 3

Bipolar I or II

Answer 3

may present with mixed features

Question 4

males

Answer 4

manic episode = most likely to have first mood disturbance

Question 5

If the 1st mood disturbance is

a manic episode the risk of future mood episodes is ?

Answer 5

85%

Question 6

Identical Twin diagnosed with Bipolar Disorder, your risk is?

Answer 6

70%

Question 7

With each ensuing episode, the length of time a patient spends in a manic episode ?

Answer 7

Increases / Lengthens

Question 8

family history of bipolar disorder

Answer 8

Inc risk if +maternal

lower risk if +paternal

Question 9

After the first mood disturbance in Major Depression, the risk of future depression episodes
is?

Answer 9

50%

After 2 episodes, risk is ~70%
After 3 episodes, risk is ~90+%–definitely do maintenance treatment to avoid # of manic episodes)

Question 10

For patients with bipolar disorder, as the total number of mood episodes increases, the inter episode interval?

Answer 10

decreases/shortensy

Question 11

Divalproex

Depakote

Answer 11

Avoid in bipolar pts with LIVER disease

Rapidly loaded

Pts improve most in first 3 days

rx of 1500 mg to rapidly load a patient weighing
150 pounds with 20 mg/kg of rx

Question 12

Lithium or Divalproex

rule of 1/3

Answer 12

1/3 respond well
1/3 partial respond
1/3 respond poorly

Question 13

Lithium

Answer 13

response rate = VERY GOOD

decrease risk of suicide

avoided in treating bipolar patients with RENAL disease

discontinued gradually to avoid affective switch to mania

Narrow therapeutic range
Cardiotoxicity

treating bipolar patients with euphoric mood, family history of the illness, and/or few lifetime episodes

Question 14

TX severe acute manic episode

Answer 14

Lithium + FGA/SGA

or

divalproex (depakote) + FGA/SGA?

Question 15

maintenance tx

Answer 15

recommended after 1 or 2 manic episodes

Question 16

Olanzapine

Zyprexa

Answer 16

avoid in OBESE pts

Question 17

olanzapine/fluoxetine

Symbyax

Answer 17

TX for bipolar depression

NO risk for a switch to mania

Question 18

tricyclic antidepressants (TCAs)
serotonin-norepinephrine reuptake inhibitors (SNRI’s)

Answer 18

Increased switch rate

Increase in the number of rapid cycling cases

Question 19

antidepressant monotherapy

Answer 19

Contraindicated in pts with bipolar I depression

Question 20

Buproprion

Answer 20

least risk of inducing a manic episode

Question 21

TX x bipolar depression

Answer 21

Lithium
Quetiapine 
Lurasidone
Lamotrigine
Olanzapine/fluoxetine

discontinue antidepressant after episode

Question 22

Aripiprazole

abilify

Answer 22

this SGA is NOT shown to be beneficial in the treatment of bipolar depression

Question 23

Lamotrigine

lamictal

Answer 23

treat acute bipolar depression
maintenance treatment

NOT for an acute manic episode

Question 24

suicide risk in bipolar pts

Answer 24

16% (~major depression)

20x more than general population

Question 25

lithium toxicity tx

Answer 25

dialysis

Question 26

sx of bipolar manic episode

Answer 26

Grandiosity
Dangerous pleasurable activities
Dec need for sleep

Question 27

Mania then depression happens in

Answer 27

60% of time

Question 28

anosognosia

Answer 28

pt do not recognize that they are ill

Question 29

lab finding diagnosis of manic episode

Answer 29

NONE