Bipolar Disorder

Question 1

Bipolar I or Biplolar II:

Delusions

Answer 1

Bipolar I

Question 2

Bipolar I or Biplolar II:

Symptoms may be present for 4-6 days

Answer 2

Bipolar II

Question 3

Bipolar I or Biplolar II:

May present with mixed features

Answer 3

Both

Question 4

Bipolar I or Biplolar II:

Depressive Episode NOT a diagnostic requirement

Answer 4

Bipolar I

Question 5

Bipolar I or Biplolar II:

Patients are typically in depressed state 15x more than hypomanic state

Answer 5

Bipolar II

Bipolar I: depressed 2x more than manic)

Question 6

Bipolar I or Biplolar II:

Can be mistaken for cyclothymia

Answer 6

Bipolar II

Question 7

Bipolar I or Biplolar II:

More likely to have hypomanic episode

Answer 7

Bipolar I

Question 8

Bipolar I or Biplolar II:

Cause signfiicant impairment in social or occupational function, necessitating psychiatric hospitalization

Answer 8

Bipolar I

Question 9

Bipolar I or Biplolar II:

Equal likelihood between males and females

Answer 9

Bipolar I

Question 10

Gender more likely to have 1st mood disturbance be a manic episode

Answer 10

Males

Question 11

% risk of future mood episode if 1st mood disturbance is manic episode

Answer 11

85%

Question 12

What is the risk of bipolar disorder if your identical twin has it?

Answer 12

70%

Question 13

Average age of onset for Bipolar I and Bipolar II

Answer 13

Bipolar I: 18

Bipolar II: Mid-20s

Question 14

What happens to length of manic episode with each ensuing episode

Answer 14

Lengthens/Increases

Question 15

Which side of family, if affected, carries lower risk of bipolar disorder

Answer 15

Paternal Side (Father)

Question 16

After 1st mood disturbance in Major Depression, risk of future depression episode is:

Answer 16

50%
After 2 episodes: 70%
After 3 episodes : 90%

Question 17

For patients with bipolar disorder, as the total number of mood episodes increases, the interepisode
interval does this

Answer 17

Shortens/Decreases

Question 18

Average lifetime # of manic episodes a patient will have is? Unless what is done?

Answer 18

9-10 episodes

Need maintenance medication treatment

Question 19

Which medication is avoided in treating bipolar patients with liver disease?

Answer 19

Depakote

Question 20

Which medication can be rapidly loaded in bipolar patients, showing improvmeent in first 3 days

Answer 20

Depakote

Question 21

What is the Rule of 1/3 in Bipolar Disorder

Answer 21

Lithium or Depakote Monotherapy successfully treat manic episodes to resolution in 1/3 of patients

Rule: 1/3 respond well, 1/3 partial response, 1/3 respond poorly

Question 22

Lithium’s response rate in treating bipolar patients with euphoric mood, family history of the illness, and/or few lifetime episodes is this

Answer 22

70% (GOOD)

Question 23

Lithium       		
Lithium + FGA/SGA
Divalproex (Depakote)
Divalproex (Depakote) + FGA/SGA
-------------------------------
The first choice for treating a severe 
acute manic episode is this

Answer 23

Lithium + FGA/SGA or divalproex (depakote) + FGA/SGA

Question 24

When is maintenance treatment always recommended?

Answer 24

After 2 manic episodes

Usually given after 1 episode as well

Question 25

Which bipolar disorder medicaiton decreases risk of suicide?

Answer 25

Lithium

Question 26

Which medication is avoided in treating bipolar patients with renal disease?

Answer 26

Lithium

Question 27

Which medication is avoided in treating bipolar patients who are obse?

Answer 27

Olanzapine (Zyprexa)

Question 28

What can happen if Lithium is discontinued abruptly over days? How is this avoided

Answer 28

Affective Switch to Mania | Lower risk by discontinuing gradually over months

Question 29

What medication combination is effective in treating bipolar depression with no increased risk of switch to manic episode?

Answer 29

Symbyax: Olzanzapine +Fluoxetine

Question 30

Which antidepressants lead to increased switch rate and increased number of rapid cycling cases?

Answer 30

TCA and SNRIs

Question 31

What is contraindicated in treatment of bipolar I Depression

Answer 31

Antidepressant Monotherapy

Question 32

Which antidepressant has least risk of inducing a manic episode

Answer 32

Buproprion (Wellbutrin)

Question 33

What medications are recommended for treating bipolar depression

Answer 33

``` Lithium Quetiapine (Seroquel) Lurasidone (Latuda) Lamotrigine (Lamictal) Olanzapine/Fluoxetine (Symbyax) ```

Question 34

While often used as an adjunct treatment of major depression, this SGA is NOT shown to be beneficial in the treatment of bipolar depression

Answer 34

Aripiprazole (Abilify)

Question 35

When using an antidepressant to treat bipolar depression, this should be done after the episode has remitted

Answer 35

Discontinue the antidepressant

Question 36

What can Lamotrigine be used for?

Answer 36

Treat acute bipolar depression | Maintenance treatment

Question 37

What should Lamotrigine NOT be used for?

Answer 37

NOT for acute manic episode

Question 38

Which bipolar medication has the narrowest gap between therapeutic and toxic concentration in psychiatry

Answer 38

Lithium

Question 39

To rapidly load a patient weighing | 150 pounds with 20 mg/kg of divalproex (depakote), this amount of the medication is prescribed

Answer 39

1500mg

Question 40

% of bipolar patients who dies by suicide

Answer 40

16% (20x risk of general population)

Question 41

How is severe lithium toxicity treated

Answer 41

Dialysis

Question 42

What symptom is indicative of onset of new manic episode

Answer 42

decreased need for sleep

Question 43

Mania then depression or Depression then mania This happens 60% of the time

Answer 43

Mania then Depression

Question 44

Individuals in a manic episode frequently resist efforts to treat them because they do not recognize that they are ill which is called this

Answer 44

Anosognosia (lack of insight)