for the Psychiatry Clerkship

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Jeopardy

• for the Psychiatry Clerkship

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And Now Here Is The Host . . .
is proud to present
Insert Name Here
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• The categories for todays Jeopardy on Bipolar
  Disorder will be

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Bipolar I vs II
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Course of Illness
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Bipolar Depression
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Treatment
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Miscellaneous
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I vs II
Miscellaneous
Course of Illness
Treatment
Bipolar Depression
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What is Bipolar I disorder?
Patients may experience delusions in this

• Row 1, Col 1

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

• 1,2

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

• 1,3

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

• 1,4

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What is Bipolar II disorder? Bipolar I depressed
2xs more than manic
Patients are typically in depressed state 15 xs
more than a (hypo)manic state in this

• 1,5

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

• 1,6

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

• 1,7

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What is Bipolar I?
Causes significant impairment in social or
occupational function or necessitates
psychiatric hospitalization

• 1,8

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

• 1,9

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

• 2,1

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

• 2,2

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

• 2,3

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

• 2,4

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

• 2,5

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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

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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

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

• 2,8

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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

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

• 3,1

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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

• 3,2

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What is 3? Rule of 1/3s 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

• 3,3

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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

• 3,4

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What is Lithium FGA/SGA or
divalproex (depakote)
FGA/SGA?
Lithium Lithium FGA/SGA Divalproe
x (Depakote) Divalproex (Depakote)
FGA/SGA ------------------------------- The first
choice for treating a severe acute manic episode
is this

• 3,5

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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

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

• 3,7

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

• 3,8

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What is Olanzapine (Zyprexa)?
Lithium Depakote (Depakote)
Olanzapine (Zyprexa) -----------------------------
---------- Generally avoided in treated bipolar
patients who are obese

• 3,9

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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

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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

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What are tricyclic antidepressants (TCAs) and
serotonin-norepinephrine reuptake inhibitors
(SNRIs)?
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

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

• 4,4

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

• 4,5

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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

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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

• 4,7

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

• 4,8

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

• 4,9

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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

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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

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Correction What is 16 (Is 20xs
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

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

• 5,4

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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

• 5,5

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What is decreased need for sleep?
Often this symptom heralds the onset of a new
manic episode

• 5,6

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What is Mania then depression?
Mania then depression or Depression then
mania This happens 60 of the time

• 5,7

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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

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

• 5,9