MOOD DISORDERS - Bipolar Disorder

Question 1

Outpatient intervention most likely to
help maintain symptoms of control in
patient recently stabilized from first
episode mania? (2x)

Answer 1

Family-focused psychoeducation

Question 2

Treatment of Early Age Mania (TEAM)
recommendations for most effective
medication in pediatric mania? (2x)

Answer 2

Risperidone (over Depakote and

Lithium)

Question 3

Most likely presentation of bipolar
symptoms in an adolescent with history of
ADHD, increased mood labiliy, dysregulated
sleep, impulsivity, risky behavior, maternal
aunt with bipolar I and cousins with ADHD?

Answer 3

Fluctuate with episodic mood changes

Question 4

What risk factor best predicts development
of hypomania or mania in children with a
bipolar parent?

Answer 4

Subthreshold hypomanic episodes

Question 5

Current research evidence of oxcarbazepine

in children with Bipolar disorder

Answer 5

Not superior to placebo

Question 6

Vignette: 16 yo with bipolar disorder,
experiencing manic episode despite trials of
two atypical antipsychotics, also on
combined lithium and antidepressant trial
for 6 weeks each. Parents, patient, and
treatment team agree to start ECT after
lithium is tapered and discontinued. A:
Patient’s lithium has tapered off, and ECT
has begun. After 6 unilateral ECT
treatments twice per week, patient is still
manic. Most appropriate next step in
treatment? B: Following this decision,
patient starts to respond to treatment,
manic symptoms improve. Within 24 hours
of ECT treatment, most common side effect?

Answer 6

A: Switch from unilateral to bilateral ECT B:

Headaches

Question 7

16 yo with bipolar disorder on valproate
with suicide attempt due to atypical
psychotic symptoms. EEG shows diffuse
slowing. Diagnosis?

Answer 7

encephalopathy

Question 8

16 yo with bipolar disorder previously
stable on lithium, now sleeping 3 hours,
high energy, racing thoughts, irritable with
friends, sent to principal for being rude to
teacher, recently decided diagnosis is
wrong and doesn’t want to take meds. Next
step?

Answer 8

Educate about negative impact of

symptoms on daily function

Question 9

Distinguishing factor of youth bipolar

disorder vs ADHD?

Answer 9

Grandiosity

Question 10

Best treatment for 17 yo bipolar in full
blown manic episode, HR dipping below 50,
stopped eating and drinking, VPA +
Antipsychotics lead to severe dystonic
reactions?

Answer 10

ECT

Question 11

Best medication for 12 yo patient who
attempts to jump out window, believes he is
a superhero, no sleep in 5 days, on a
mission, strong family history of bipolar?

Answer 11

Risperidone