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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
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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 in
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 divalproex (depakote)??
Lithium
Depakote (Depakote)
Olanzapine (Zyprexa)
-------------------------------------------Generally avoided in treatment of
Bipolar pts with liver disease
3,1
What is divalproex (depakote)?
Lithium
Depakote (Depakote)
Olanzapine (Zyprexa)
--------------------------------------This medication can be rapidly loaded
and patients who respond improve
the most in the first 3 days
3,2
What is 3?
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
1 out of this many patients
3,3
What is 70% (good/very good)
Good or poor:
--------------------------Lithium’s response rate in treating
bipolar patients with euphoric mood,
family history of the illness, and/or
few lifetime episodes is this
3,4
What is Lithium + FGA/SGA or
divalproex (depakote) + FGA/SGA?
Lithium
Lithium + FGA/SGA
Divalproex (Depakote)
Divalproex (Depakote) + FGA/SGA
------------------------------The first choice for treating a severe
acute manic episode 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 Lithium?
Lithium
Depakote (Depakote)
Olanzapine (Zyprexa)
--------------------------------------------This drug is generally avoided in treating
bipolar patients with renal disease
3,8
What is Olanzapine (Zyprexa)?
Lithium
Depakote (Depakote)
Olanzapine (Zyprexa)
--------------------------------------Generally avoided in treated bipolar
patients who are obese
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) and
serotonin-norepinephrine reuptake inhibitors
(SNRI’s)?
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 aripiprazole (abilify)?
While often used as an adjunct
treatment of major depression,
this SGA is NOT shown to be
beneficial in the treatment of
bipolar depression
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 lamotrigine (lamictal)?
This medication can be used to
treat acute bipolar depression, for
maintenance treatment, but NOT
for an acute manic episode
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