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for the Psychiatry Clerkship

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Created by Jerry Myers is 1998 for a class. – PowerPoint PPT presentation

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Title: for the Psychiatry Clerkship


1
Jeopardy
  • for the Psychiatry Clerkship

2
And Now Here Is The Host . . .
is proud to present
Insert Name Here
3
  • The categories for todays 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
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10
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
What is Bipolar I or II disorder? (In DSM4, only
Bipolar I presented as a mixed episode)
May present with mixed features
  • 1,3

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

14
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

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

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

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

18
What is Bipolar I? Bipolar II-data is unclear
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 risk of future mood episodes is this
percentage
  • 2,2

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

22
What is 18 y/o? Bipolar II mid 20s
The average age of onset for Bipolar II is later
than Bipolar Is which is this age
  • 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
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
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 divalproex (depakote)??
Lithium Depakote (Depakote)
Olanzapine (Zyprexa) -----------------------------
--------------- Generally avoided in treatment of
Bipolar pts with liver disease
  • 3,1

29
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

30
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

31
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

32
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

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

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

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

41
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 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

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

49
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 manic symptoms contributed to his illegal
misuse of campaign funds
  • 5,5

51
What is decreased need for sleep?
Often this symptom heralds the onset of a new
manic episode
  • 5,6

52
What is Mania then depression?
Mania then depression or Depression then
mania This happens 60 of the time
  • 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
What is none?
A laboratory finding that is diagnostic of a
manic episode is this
  • 5,9
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