Title: for the Psychiatry Clerkship
1Jeopardy
- for the Psychiatry Clerkship
2And Now Here Is The Host . . .
is proud to present
Insert Name Here
3- The categories for todays Jeopardy on Bipolar
Disorder will be
4Bipolar I vs II
5Course of Illness
6Bipolar Depression
7Treatment
8Miscellaneous
9I vs II
Miscellaneous
Course of Illness
Treatment
Bipolar Depression
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10What is Bipolar I disorder?
Patients may experience delusions in this
11What is Bipolar II disorder?
Symptoms of this may be present for 4-6 days
12What is Bipolar I or II disorder? (In DSM4, only
Bipolar I presented as a mixed episode)
May present with mixed features
13 What is Bipolar I disorder?
A depressive episode is not a diagnostic
requirement
14What 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
15What is a Bipolar II diosrder?
This can easily be mistaken for cyclothymia
16What is Bipolar I?
Patients are more likely to have a hypomanic
episode with this type of Bipolar disorder
17What is Bipolar I?
Causes significant impairment in social or
occupational function or necessitates
psychiatric hospitalization
18What is Bipolar I? Bipolar II-data is unclear
The likelihood of a male or female having this
illness is essentially equal
19What are males?
This sex is more likely to have a first mood
disturbance be a manic episode
20What is 85? (80-90)
If the 1st mood disturbance is a manic episode
the risk of future mood episodes is this
percentage
21What is your identical twin?
If this relative is diagnosed with Bipolar
Disorder, your risk is 70
22What 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
23What is lengthens/increases?
With each ensuing episode, the length of time a
patient spends in a manic episode does this
24What 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
25What 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
26What is shortens/decreases?
For patients with bipolar disorder, as the total
number of mood episodes increases, the
interepisode interval does this
27What is give maintenance medication treatment?
The average lifetime number of manic episodes a
patient will have is 9-10 unless the physician
does this
28What is divalproex (depakote)??
Lithium Depakote (Depakote)
Olanzapine (Zyprexa) -----------------------------
--------------- Generally avoided in treatment of
Bipolar pts with liver disease
29What 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
30What 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
31What 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
32What 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
33What is two?
(And most of the time
after one episode)
Maintenance treatment should always be
recommended after this number of manic episodes
34What is Lithium?
For patients with bipolar disorder, treatment
with this medication appears to decrease the risk
of suicide
35What is Lithium?
Lithium Depakote (Depakote)
Olanzapine (Zyprexa) -----------------------------
---------------- This drug is generally avoided
in treating bipolar patients with renal disease
36What is Olanzapine (Zyprexa)?
Lithium Depakote (Depakote)
Olanzapine (Zyprexa) -----------------------------
---------- Generally avoided in treated bipolar
patients who are obese
37What is an affective switch to mania?
The risk of this is lower if lithium is
discontinued gradually over months rather
abruptly over days
38What 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
39What 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
40What is antidepressant monotherapy?
Use of this treatment regimen for patients with
bipolar I depression is contraindicated
41What is bupropion (wellbutrin)?
Of all the antidepresants, using this one appears
to carry the least risk of inducing a manic
episode
42What are lamotrigine (lamictal)
olanzapine/fluoxetine (symbyax)?
Medications that are recommended for treating
bipolar depression are lithium, quetiapine
(seroquel), lurasidone (latuda) and these two
medications
43What 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
44What is discontinue the antidepressant?
When using an antidepressant to treat bipolar
depression, this should be done after the episode
has remitted
45What is lamotrigine (lamictal)?
This medication can be used to treat acute
bipolar depression, for maintenance treatment,
but NOT for an acute manic episode
46What 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
47What 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
48Correction 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
49What is dialysis?
Lithium toxicity that is so severe as to be life
threatening is treated with this
50What are grandiosity dangerous pleasurable
activities?
Jessie Jackson Jr. appears to claim that these
two manic symptoms contributed to his illegal
misuse of campaign funds
51What is decreased need for sleep?
Often this symptom heralds the onset of a new
manic episode
52What is Mania then depression?
Mania then depression or Depression then
mania This happens 60 of the time
53What 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
54 What is none?
A laboratory finding that is diagnostic of a
manic episode is this