1. for the Psychiatry Clerkship
Jeopardy
for the Psychiatry Clerkship

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

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

4. Bipolar I vs II

5. Course of Illness

6. Bipolar Depression

7. Treatment

8. Miscellaneous

9. I vs II
Course of Illness
Treatment
Bipolar Depression
Miscellaneous
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10. Patients may experience
What is Bipolar I disorder?
Patients may experience
delusions in this
Row 1, Col 1

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

12. 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)
In DSM4, this may present as a
mixed episode of illness
1,3

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

14. Patients are typically in depressed state 15 x’s more than a
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

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

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

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

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

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

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

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

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

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

24. on this side of the family
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

25. 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

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

27. The average lifetime number of manic episodes a patient will
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

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

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

30. 33% of patients treated for an acute manic episode with these
What is Lithium and Divalproex (depakote)?
33% of patients treated for an
acute manic episode with these
2 meds respond so well that
all symptoms resolve
3,3

31. lifetime episodes is this
What is 70% (good/very good)
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
3,4

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

33. 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

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

35. Lithium’s response rate in treating bipolar patients with a history
What is 30% (fair/poor)?
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
3,8

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

37. 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

38. 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

39. What are tricyclic antidepressants (TCAs)?
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

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

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

42. 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

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

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

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

46. 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

47. To rapidly load a patient weighing
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

48. 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

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

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

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

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

53. 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

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