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for the Psychiatry Clerkship And Now Here Is The Host . . . is proud to present Insert Name Here The categories for today’s Jeopardy on Bipolar Disorder will be: Bipolar I vs II Course of Illness Bipolar Depression Treatment Miscellaneous I vs II Course of Illness 100 100 100 100 100 200 200 200 200 200 300 300 300 300 300 400 400 400 400 400 500 500 500 500 500 600 600 600 600 600 700 700 700 700 700 800 800 800 800 800 900 900 900 900 900 Treatment Bipolar Depression Miscellaneous What is Bipolar I disorder? Patients may experience delusions in this Row 1, Col 1 What is Bipolar II disorder? Symptoms of this may be present for 4-6 days 1,2 What is Bipolar I or II disorder? (In DSM4, only Bipolar I presented as a mixed episode) May present with mixed features 1,3 What is Bipolar II disorder? Must make diagnosis of past/present episodes of Major Depression for this 1,4 What is Bipolar II disorder? Bipolar I depressed ~2x’s more than manic Patients are typically in depressed state 15 x’s more than a (hypo)manic state in this 1,5 What is a Bipolar II diosrder? This can easily be mistaken for cyclothymia 1,6 What is Bipolar I? A depressive episode is not a diagnostic requirement 1,7 What is Bipolar I? Causes significant impairment is social or occupational function or necessitates psychiatric hospitalization 1,8 What is Bipolar I? Bipolar II F > M The likelihood of a male or female having this illness is essentially equal 1,9 What are males? This sex is more likely to have a first mood disturbance be a manic episode 2,1 What is 85%? (80-90%) If the 1st mood disturbance is a manic episode the risk of future mood episodes is this percentage 2,2 What is your identical twin? If this relative is diagnosed with Bipolar Disorder, your risk is ~70% 2,3 What is mania with mixed features The risk for completed suicide is highest when a patient experiences major depression, bipolar depression, or this type of mood disturbance 2,4 What is lengthens/increases? With each ensuing episode, the length of time a patient spends in a manic episode does this 2,5 What is paternal side (father)? For someone with a family history of bipolar disorder, the risk is lower if the affected relative is on this side of the family 2,6 What is 50%? (After 2 episodes, risk is ~70%; After 3 episodes, risk is ~90+%--definitely do maintenance treatment) After the first mood disturbance in Major Depression, the risk of future depression episodes is this 2,7 What is shortens/decreases? For patients with bipolar disorder, as the total number of mood episodes increases, the interepisode interval does this 2,8 What is give maintenance medication treatment? The average lifetime number of manic episodes a patient will have is 9-10 unless the physician does this 2,9 What is mania with rapid cycling & mixed features? Lithium has a ~30% (poor) response rate when treating manic episodes with dysphoric/irritable mood or manic episodes with these features 3,1 What is divalproex (depakote)? This medication can be rapidly loaded and patients who respond improve the most in the first 3 days 3,2 What is 33%? Rule of 1/3’s: 1/3 respond well, 1/3 partial respond, 1/3 respond poorly Lithium or Divalproex (depakote) monotherapy successfully treat manic episodes to resolution in this % of patients 3,3 What is 70% (good/very good) Good or poor: Lithium’s response rate in treating bipolar patients with a family history of the illness or who have had few lifetime episodes is this 3,4 What is divalproex (depakote)? The first choice for treating an acute manic episode with mixed features is this 3,5 What is two? (And most of the time after one episode) Maintenance treatment should always be recommended after this number of manic episodes 3,6 What is Lithium? For patients with bipolar disorder, treatment with this medication appears to decrease the risk of suicide 3,7 What is 30% (fair/poor)? Good or poor: Lithium’s response rate in treating bipolar patients with a history of substance abuse or a mood episode sequence of depression then mania is this 3,8 What is rapid cycling or mixed features? Carbamazepine (Tegretol) may be more effective than lithium in treating bipolar disorder patients who present with mania with this feature 3,9 What is an affective switch to mania? The risk of this is lower if lithium is discontinued gradually over months rather abruptly over days 4,1 What is olanzapine/fluoxetine (symbyax) 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 4,2 What are tricyclic antidepressants (TCAs)? Since these type of antidepressants were introduced, studies have shown an increased switch rate & an increase in the number of rapid cycling cases 4,3 What is antidepressant monotherapy? Use of this treatment regimen for patients with bipolar I depression is contraindicated 4,4 What is bupropion (wellbutrin)? Of all the antidepresants, using this one appears to carry the least risk of inducing a manic episode 4,5 What are lamotrigine (lamictal) & olanzapine/fluoxetine (symbyax)? Medications that are recommended for treating bipolar depression are lithium, quetiapine (seroquel), lurasidone (latuda) and these two medications 4,6 What is lithium? This medication can be used to treat acute bipolar mania or depression, maintenance treatment & to decrease the risk of suicidal behavior 4,7 What is discontinue the antidepressant? When using an antidepressant to treat bipolar depression, this should be done after the episode has remitted 4,8 What is quetiapine (seroquel)? This medication can be used to treat acute bipolar mania or depression, for maintenance treatment, but does NOT lower the risk for suicidal behavior 4,9 What is lithium? Used in the treatment of bipolar disorder, this medication has the narrowest gap between therapeutic & toxic concentration of any drug routinely prescribed in psychiatry 5,1 What is 1,500 mg? To rapidly load a patient weighing 150 pounds with 20 mg/kg of divalproex (depakote), this amount of the medication is prescribed 5,2 Correction: What is ~16% (Is 20x’s the relative risk of the general population; about the same as major depression) The percentage of patients with bipolar disorder whose life ends by suicide is this 5,3 What is dialysis? Lithium toxicity that is so severe as to be life threatening is treated with this 5,4 What are grandiosity & dangerous pleasurable activities? Jessie Jackson Jr. appears to claim that these two manic symptoms contributed to his illegal misuse of campaign funds 5,5 What is decreased need for sleep? Often this symptom heralds the onset of a new manic episode 5,6 What is Mania then depression? Mania then depression or Depression then mania This happens 60% of the time 5,7 What is anosognosia? (or lack of insight) Individuals in a manic episode frequently resist efforts to treat them because they do not recognize that they are ill which is called this 5,8 What is none? A laboratory finding that is diagnostic of a manic episode is this 5,9