2. for the Psychiatry Clerkship

3. is proud to present And Now Here Is The Host... Insert Name Here

4. The categories for today’s Jeopardy on Bipolar Disorder will be:

5. Bipolar I vs II

6. Course of Illness

7. Bipolar Depression

8. Treatment

9. Miscellaneous

10. 100 200 300 800 700 500 800 I vs II Treatment Miscellaneous 100 700 500 700 400 800 600 100 900 300 500 800 Bipolar Depression 100 900 500 400 300 200 300 400 600 800 200 300 600 200 500 400 700 600 200 400 700 600 Course of Illness

11. Row 1, Col 1 Patients may experience delusions in this What is Bipolar I disorder?

12. 1,2 Symptoms of this may be present for 4-6 days What is Bipolar II disorder?

13. 1,3 May present with mixed features What is Bipolar I or II disorder? (In DSM4, only Bipolar I presented as a mixed episode)

14. 1,4 Must make diagnosis of past/present episodes of Major Depression for this What is Bipolar II disorder?

15. 1,5 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

16. 1,6 This can easily be mistaken for cyclothymia What is a Bipolar II diosrder?

17. 1,7 A depressive episode is not a diagnostic requirement What is Bipolar I?

18. 1,8 Causes significant impairment in social or occupational function or necessitates psychiatric hospitalization What is Bipolar I?

19. 1,9 The likelihood of a male or female having this illness is essentially equal What is Bipolar I? Bipolar II F > M

20. 2,1 This sex is more likely to have a first mood disturbance be a manic episode What are males?

21. 2,2 If the 1 st mood disturbance is a manic episode the risk of future mood episodes is this percentage What is 85%? (80-90%)

22. 2,3 If this relative is diagnosed with Bipolar Disorder, your risk is ~70% What is your identical twin?

23. 2,4 The risk for completed suicide is highest when a patient experiences major depression, bipolar depression, or this type of mood disturbance What is mania with mixed features

24. 2,5 With each ensuing episode, the length of time a patient spends in a manic episode does this What is lengthens/increases?

25. 2,6 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)?

26. 2,7 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)

27. 2,8 For patients with bipolar disorder, as the total number of mood episodes increases, the interepisode interval does this What is shortens/decreases?

28. 2,9 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?

29. 3,1 Lithium Depakote (Depakote) Olanzapine (Zyprexa) -------------------------------------------- Generally avoided in treatment of Bipolar pts with liver disease What is divalproex (depakote)??

30. 3,2 Lithium Depakote (Depakote) Olanzapine (Zyprexa) --------------------------------------- This medication can be rapidly loaded and patients who respond improve the most in the first 3 days What is divalproex (depakote)?

31. 3,3 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

32. 3,4 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 What is 70% (good/very good)

33. 3,5 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?

34. 3,6 Maintenance treatment should always be recommended after this number of manic episodes What is two? (And most of the time after one episode)

35. 3,7 For patients with bipolar disorder, treatment with this medication appears to decrease the risk of suicide What is Lithium?

36. 3,8 Lithium Depakote (Depakote) Olanzapine (Zyprexa) --------------------------------------------- This drug is generally avoided in treating bipolar patients with renal disease What is Lithium?

37. 3,9 Lithium Depakote (Depakote) Olanzapine (Zyprexa) --------------------------------------- Generally avoided in treated bipolar patients who are obese What is Olanzapine (Zyprexa)?

38. 4,1 The risk of this is lower if lithium is discontinued gradually over months rather abruptly over days What is an affective switch to mania?

39. 4,2 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)

40. 4,3 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)?

41. 4,4 Use of this treatment regimen for patients with bipolar I depression is contraindicated What is antidepressant monotherapy?

42. 4,5 Of all the antidepresants, using this one appears to carry the least risk of inducing a manic episode What is bupropion (wellbutrin)?

43. 4,6 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)?

44. 4,7 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)?

45. 4,8 When using an antidepressant to treat bipolar depression, this should be done after the episode has remitted What is discontinue the antidepressant?

46. 4,9 This medication can be used to treat acute bipolar depression, for maintenance treatment, but NOT for an acute manic episode What is lamotrigine (lamictal)?

47. 5,1 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?

48. 5,2 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?

49. 5,3 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)

50. 5,4 Lithium toxicity that is so severe as to be life threatening is treated with this What is dialysis?

51. 5,5 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?

52. 5,6 Often this symptom heralds the onset of a new manic episode What is decreased need for sleep?

53. 5,7 Mania then depression or Depression then mania This happens 60% of the time What is Mania then depression?

54. 5,8 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)

55. 5,9 A laboratory finding that is diagnostic of a manic episode is this What is none?