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
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
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 class commonly used in primary care can increase lithium levels and toxicity risk?
What is NSAIDs, ACE, ARBs, and other renal affecting medications
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
A patient with bipolar disorder was recently discharged after psychiatric hospitalization. During what period after discharge is suicide risk particularly concerning according to the article?
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 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
Name three psychiatric comorbidities commonly associated with bipolar disorder that are associated with worse outcomes.
Anxiety disorders, impulse-control/ADHD disorders, and substance-use disorders
Before initiating lithium, name four baseline evaluations/laboratory tests that are particularly relevant to safe treatment.
What is renal function/BMP, TSH, ECG when appropriate, and pregnancy testing when relevant