Jeopardy Bipolar Flashcards by Amber Alberts

Bipolar I or Bipolar II:
Patients may experience
delusions in this

What is Bipolar I disorder?

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Bipolar I or Bipolar II:
Symptoms of this may be
present for 4-6 days

What is Bipolar II disorder?

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Bipolar I or Bipolar II:

May present with mixed features

What is Bipolar I or II disorder?

In DSM4, only Bipolar I presented as a mixed episode

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Bipolar I or Bipolar II:

A depressive episode is not a diagnostic requirement

What is Bipolar I disorder?

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Bipolar I or Bipolar II:
Patients are typically in depressed 
state 15 x’s more than a 
(hypo)manic state 
in this

What is Bipolar II disorder?

Bipolar I depressed ~2x’s more than manic

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Bipolar I or Bipolar II:
This can easily be mistaken
for cyclothymia

What is a Bipolar II diosrder?

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Bipolar I or Bipolar II:
Causes significant impairment in social or occupational function
or necessitates psychiatric hospitalization

What is Bipolar I?

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Bipolar I or Bipolar II:
The likelihood of a male or
female having this illness
is essentially equal

What is Bipolar I?

Bipolar II-data is unclear

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Bipolar: This sex is more likely to have a first mood disturbance be a manic episode

What are males?

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If the 1st mood disturbance is
a manic episode the risk of
future mood episodes is
this percentage

What is 85%? (80-90%)

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If this relative is diagnosed with Bipolar Disorder, your

risk is ~70%

What is your identical twin?

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The average age of onset for Bipolar II is later than

Bipolar I’s which is this age

What is 18 y/o?

Bipolar II: mid 20’s

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

What is lengthens/increases?

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For someone with a family history of bipolar disorder, the risk is lower if the affected relative is
on this side of the family

What is paternal side (father)?

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

What is 50%?
(After 2 episodes, risk is ~70%;
After 3 episodes, risk is ~90+%–definitely do maintenance treatment)

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

What is shortens/decreases?

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The average lifetime number of manic episodes a patient will
have is 9-10 unless the physician
does this

What is give maintenance medication treatment?

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Generally avoided in treatment of
Bipolar pts with liver disease

What is divalproex (depakote)??

This medication can be rapidly loaded and patients who respond improve the most in the first 3 days

What is divalproex (depakote)?

Lithium or Divalproex (depakote) monotherapy successfully treat manic episodes to resolution in
1 out of this many patients

What is 3?

Rule of 1/3’s: 1/3 respond well, 1/3 partial respond, 1/3 respond poorly

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

What is 70% (good/very good)

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

What is Lithium + FGA/SGA or divalproex (depakote) + FGA/SGA?

Maintenance treatment should always be recommended after this number of manic episodes

What is two? (And most of the time after one episode)

For patients with bipolar disorder, treatment with this medication appears to decrease the risk
of suicide

What is Lithium?

``` Lithium Depakote (Depakote) Olanzapine (Zyprexa) --------------------------------------------- This drug is generally avoided in treating bipolar patients with renal disease ```

What is Lithium?

``` Lithium Depakote (Depakote) Olanzapine (Zyprexa) --------------------------------------- Generally avoided in treated bipolar patients who are obese ```

What is Olanzapine (Zyprexa)?

The risk of this is lower if lithium is discontinued gradually over months rather abruptly over days

What is an affective switch to mania?

Even though this combination medication contains fluoxetine (prozac), it is effective in treating bipolar depression and has no increased risk of a switch to a manic episode

What is olanzapine/fluoxetine (symbyax)

Since these type of antidepressants were introduced, studies have shown an increased switch rate & an increase in the number of rapid cycling cases

What are tricyclic antidepressants (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRI’s)?

Use of this treatment regimen for patients with bipolar I depression is contraindicated

What is antidepressant monotherapy?

Of all the antidepresants, using this one appears to carry the least risk of inducing a manic episode

What is bupropion (wellbutrin)?

Medications that are recommended for treating bipolar depression are lithium, quetiapine (seroquel), lurasidone (latuda) and these two medications

What are lamotrigine (lamictal) & olanzapine/fluoxetine (symbyax)?

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

What is aripiprazole (abilify)?

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

What is discontinue the antidepressant?

This medication can be used to treat acute bipolar depression, for maintenance treatment, but NOT for an acute manic episode

What is lamotrigine (lamictal)?

Used in the treatment of bipolar disorder, this medication has the narrowest gap between therapeutic & toxic concentration of any drug routinely prescribed in psychiatry

What is lithium?

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

What is 1,500 mg?

The percentage of patients with bipolar disorder whose life ends by suicide is this

Correction: What is ~16% | (Is 20x’s the relative risk of the general population; about the same as major depression)

Lithium toxicity that is so severe as to be life threatening is treated with this

What is dialysis?

Jessie Jackson Jr. appears to claim that these two manic symptoms contributed to his illegal misuse of campaign funds

What are grandiosity & dangerous pleasurable activities?

Often this symptom heralds | the onset of a new manic episode

What is decreased need for sleep?

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

What is Mania then depression?

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

What is anosognosia? (or lack of insight)

A laboratory finding that is diagnostic of a manic episode | is this

What is none?