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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 Treatment Miscellaneous Bipolar Depression Course of Illness

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

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

1,3 In DSM4, this may present as a mixed episode of illness What is Bipolar I disorder? (In DSM5, Bipolar I & II may present as a mixed episode)

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

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

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

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

1,8 Psychiatric hospitalization eliminates the diagnostic time requirement for this What is Bipolar I?

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

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

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

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

2,4 The risk for completed suicide is highest when a patient experiences depression or this type of mood disturbance What is depressed & mixed

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

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)?

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)

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

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?

3,1 The response rate for Lithium is ~30% (poor) in treating bipolar patients with dysphoric (irritable) mania and this type(s) What is rapid cycling & mixed mania?

3,2 This medication can be rapidly loaded and patients who respond improve the most in the first 3 days What is divalproex (depakote)?

3,3 33% of patients treated for an acute manic episode with these 2 meds respond so well that all symptoms resolve What is Lithium and Divalproex (depakote)?

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

3,5 The first choice for treating an acute mixed manic episode of bipolar disorder is this What is divalproex (depakote)?

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)

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

3,8 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 What is 30% (fair/poor)?

3,9 Carbamazepine (Tegretol) may be more effective than lithium in treating bipolar disorder patients who present with this What is rapid cycling or mixed mania?

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?

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)

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)?

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

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

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)?

4,7 This medication can be used to treat acute bipolar mania or depression, maintenance treatment & to decrease the risk of suicidal behavior What is lithium?

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

4,9 This medication can be used to treat acute bipolar mania or depression, for maintenance treatment, but does NOT lower the risk for suicidal behavior What is quetiapine (seroquel)?

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?

5,2 To rapidly load a patient weighing 150 pounds with 20 mg/kg of divalproex (depakote), this amount of the medication prescribed What is 1,500 mg?

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)

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

5,5 Jessie Jackson Jr. appears to claim that these two symptoms of Bipolar disorder contributed to his illegal misuse of campaign funds What are grandiosity & dangerous pleasurable activities?

5,6 When a manic person is continually and unceasingly enthusiastic for interpersonal, sexual, or occupational interactions, the mood is described as this What is expansive?

5,7 If a manic person’s speech is marked by complaints, hostile comments, and angry tirades, the mood would most likely be this What is irritable?

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)

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