Diagnosis
A patient has major depressive episodes and hypomanic episodes but has never experienced mania. What is the diagnosis?
What classic mood stabilizer is used for both acute mania and maintenance therapy?
Approximately what percentage of the world's population is affected by bipolar disorders?
What is >1%
What two organ systems require routine laboratory monitoring in patients taking lithium?
What is renal and thyroid function
What screening questionnaire can help evaluate a patient for bipolar disorder but cannot confirm the diagnosis?
What is Mood Disorder Questionnaire (MDQ)
A patient has 3 years of alternating depressive and hypomanic symptoms but has never met full criteria for either episode. What is the diagnosis?
What is cyclothymic disorder
What anticonvulsant mood stabilizer is effective for maintenance therapy but not acute mania?
What is the approximate mean age of onset for Bipolar I disorder?
What is 18 years old
What potentially life-threatening skin reaction should patients starting lamotrigine be counseled about?
What is Stevens-Johnson syndrome/toxic epidermal necrolysis
A patient develops new manic symptoms shortly after starting prednisone. What type of mania should be considered?
What is secondary/medication-induced mania
What type of bipolar disorder requires at least one lifetime manic episode?
What is Bipolar 1
Why should antidepressant monotherapy generally be avoided in Bipolar I disorder?
What is it can precipitate/worsen mania or mixed features
Approximately what proportion of patients diagnosed with bipolar disorder will attempt suicide during their lifetime?
What is about 33% (1/3)
A patient taking lithium develops polyuria, tremor, and worsening renal function. What medication classes commonly used in primary care can increase lithium levels and toxicity risk?
What are NSAIDs, ACE, ARBs, and other renal affecting medications
Name three common baseline laboratory tests that may be obtained when evaluating a patient with suspected bipolar disorder.
What are CBC, CMP, and TSH
A patient has elevated mood, decreased need for sleep, pressured speech, and increased goal-directed activity for 5 days, without psychosis, hospitalization, or marked functional impairment. What type of episode is this?
What is hypomanic episode
A patient presents with acute bipolar depression. Name one antipsychotic that is as effective as monotherapy.
What is Quetiapine or Cariprazine
26% of suicides among patients with bipolar disorder occur within what period following hospital discharge?
What is the first 6 weeks after discharge
A patient taking an atypical antipsychotic needs routine metabolic monitoring. Name three metabolic parameters that should be followed.
What is weight/waist circumference, fasting glucose, and lipid profile
A 55-year-old with no psychiatric history develops new-onset mania and focal neurologic findings. What important category of causes must be investigated?
What is secondary neurologic/medical causes of mania
A patient with apparent major depression reports simultaneous racing thoughts, decreased need for sleep, increased energy, and impulsivity. What specifier should you consider, and why does recognizing it matter for treatment?
What is Mixed features
Antidepressant monotherapy is contraindicated in mixed features because of concern for worsening/precipitating manic symptoms.
A patient presents with severe acute mania requiring hospitalization. Name one evidence-supported combination therapy for acute mania.
What is Lithium + quetiapine/risperidone OR valproate + quetiapine/risperidone
What three categories of psychiatric comorbidity are commonly associated with bipolar disorder?
What are anxiety disorders, impulse-control/ADHD disorders, and substance-use disorders
A patient taking valproate develops new lethargy and altered mental status. What additional laboratory test should be obtained?
What is serum ammonia level
A patient presents with their first episode of psychosis and possible mania. In addition to routine laboratory evaluation, what two diagnostic studies should be considered?
What are EEG and brain imaging