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for the Psychiatry Clerkship

Jeopardy. for the Psychiatry Clerkship. And Now Here Is The Host. is proud to present. Insert Name Here. 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. Miscellaneous.

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for the Psychiatry Clerkship

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  1. 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 Miscellaneous Course of Illness Treatment Bipolar Depression 100 100 100 100 100 200 200 200 200 200 300 300 300 300 300 400 400 400 400 400 500 500 500 500 500 600 600 600 600 600 700 700 700 700 700 800 800 800 800 800 900 900 900 900 900

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

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

  12. 1,3 What is Bipolar I or II disorder? (In DSM4, only Bipolar I presented as a mixed episode) May present with mixed features

  13. 1,4 What isBipolar I disorder? A depressive episode is not a diagnostic requirement

  14. 1,5 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

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

  16. 1,7 What is Bipolar I? Patients are more likely to have a hypomanic episode with this type of Bipolar disorder

  17. 1,8 What is Bipolar I? Causes significant impairment in social or occupational function or necessitates psychiatric hospitalization

  18. 1,9 What is Bipolar I? Bipolar II-data is unclear The likelihood of a male or female having this illness is essentially equal

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

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

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

  22. 2,4 What is 18 y/o? Bipolar II: mid 20’s The average age of onset for Bipolar II is later than Bipolar I’s which is this age

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

  24. 2,6 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

  25. 2,7 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

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

  27. 2,9 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

  28. 3,1 What is divalproex (depakote)?? Lithium Depakote (Depakote) Olanzapine (Zyprexa) -------------------------------------------- Generally avoided in treatment of Bipolar pts with liver disease

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

  30. 3,3 What is 3? Rule of 1/3’s: 1/3 respond well, 1/3 partial respond, 1/3 respond poorly Lithium or Divalproex (depakote) monotherapy successfully treat manic episodes to resolution in 1 out of this many patients

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

  32. 3,5 What is Lithium + FGA/SGA or divalproex (depakote) + FGA/SGA? Lithium Lithium + FGA/SGA Divalproex (Depakote) Divalproex (Depakote) + FGA/SGA ------------------------------- The first choice for treating a severe acute manic episode is this

  33. 3,6 What is two? (And most of the time after one episode) Maintenance treatment should always be recommended after this number of manic episodes

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

  35. 3,8 What is Lithium? Lithium Depakote (Depakote) Olanzapine (Zyprexa) --------------------------------------------- This drug is generally avoided in treating bipolar patients with renal disease

  36. 3,9 What is Olanzapine (Zyprexa)? Lithium Depakote (Depakote) Olanzapine (Zyprexa) --------------------------------------- Generally avoided in treated bipolar patients who are obese

  37. 4,1 What is an affective switch to mania? The risk of this is lower if lithium is discontinued gradually over months rather abruptly over days

  38. 4,2 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

  39. 4,3 What are tricyclic antidepressants (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRI’s)? Since these type of antidepressants were introduced, studies have shown an increased switch rate & an increase in the number of rapid cycling cases

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

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

  42. 4,6 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

  43. 4,7 What is aripiprazole (abilify)? While often used as an adjunct treatment of major depression, this SGA is NOT shown to be beneficial in the treatment of bipolar depression

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

  45. 4,9 What is lamotrigine (lamictal)? This medication can be used to treat acute bipolar depression, for maintenance treatment, but NOT for an acute manic episode

  46. 5,1 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

  47. 5,2 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

  48. 5,3 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

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

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

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