Board Review: bipolar d/o

Sample questions, content review & pt scenario

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Question 1: A 25-year-old male presents with symptoms of elevated mood, increased energy, decreased need for sleep, and impulsivity. He has a history of depressive episodes. What is the most likely diagnosis for this patient? A. Cyclothymic disorder B. Bipolar I disorder C. Bipolar II disorder D. Major depressive disorder

Question 2: Which medication is considered first-line treatment for acute mania in bipolar disorder? A. Fluoxetine B. Bupropion C. Lithium D. Sertraline

Question 3: Which of the following medications is an atypical antipsychotic commonly used as a mood stabilizer in the treatment of bipolar disorder? A. Risperidone B. Carbamazepine C. Valproic acid D. Lamotrigine

Question 4: What is the primary difference between bipolar I disorder and bipolar II disorder? A. The presence of psychotic features B. The severity of depressive episodes C. The presence of manic episodes D. The duration of hypomanic episodes

Question 5: A patient diagnosed with bipolar disorder experiences rapid cycling. Which of the following best describes rapid cycling? A. Four or more mood episodes within a week B. Four or more mood episodes within a month C. Four or more mood episodes within six months D. Four or more mood episodes within a year

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Question 1: A 25-year-old male presents with symptoms of elevated mood, increased energy, decreased need for sleep, and impulsivity. He has a history of depressive episodes. What is the most likely diagnosis for this patient?

A. Cyclothymic disorder

B. Bipolar I disorder

C. Bipolar II disorder

D. Major depressive disorder

Answer: B. Bipolar I disorder Rationale: Bipolar I disorder is characterized by the presence of at least one manic episode, with or without a history of depressive episodes. The patient's symptoms of elevated mood, increased energy, and decreased need for sleep suggest a manic episode.

Question 2: Which medication is considered first-line treatment for acute mania in bipolar disorder?

A. Fluoxetine

B. Bupropion

C. Lithium

D. Sertraline

Answer: C. Lithium Rationale: Lithium is a mood stabilizer and is considered the first-line treatment for acute mania in bipolar disorder. Antidepressants, such as fluoxetine and sertraline, and atypical antidepressants, such as bupropion, are not typically used to treat mania.

Question 3: Which of the following medications is an atypical antipsychotic commonly used as a mood stabilizer in the treatment of bipolar disorder?

A. Risperidone

B. Carbamazepine

C. Valproic acid

D. Lamotrigine

Answer: A. Risperidone Rationale: Risperidone is an atypical antipsychotic that is commonly used as a mood stabilizer in the treatment of bipolar disorder. Carbamazepine, valproic acid, and lamotrigine are other mood stabilizers, but they are not atypical antipsychotics.

Question 4: What is the primary difference between bipolar I disorder and bipolar II disorder?

A. The presence of psychotic features

B. The severity of depressive episodes

C. The presence of manic episodes

D. The duration of hypomanic episodes

Answer: C. The presence of manic episodes Rationale: The primary difference between bipolar I and bipolar II disorder is the presence of manic episodes. Bipolar I disorder is characterized by at least one manic episode, while bipolar II disorder is characterized by at least one hypomanic episode and one major depressive episode.

Question 5: A patient diagnosed with bipolar disorder experiences rapid cycling. Which of the following best describes rapid cycling?

A. Four or more mood episodes within a week

B. Four or more mood episodes within a month

C. Four or more mood episodes within six months

D. Four or more mood episodes within a year

Answer: D. Four or more mood episodes within a year Rationale: Rapid cycling is defined as the occurrence of four or more mood episodes (mania, hypomania, or depression) within a 12-month period. Rapid cycling can occur in both bipolar I and bipolar II disorders and is associated with a poorer prognosis.

Bipolar disorder, formerly known as manic-depressive illness, is a mental health condition characterized by extreme mood swings, including emotional highs (mania or hypomania) and lows (depression). The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies bipolar disorder into three primary types: bipolar I disorder, bipolar II disorder, and cyclothymic disorder.

1. Bipolar I Disorder: This type is characterized by the presence of at least one manic episode, which may be preceded or followed by hypomanic or major depressive episodes. Manic episodes last for at least one week and involve elevated, expansive, or irritable mood, increased energy, and a decreased need for sleep. Symptoms are severe enough to cause marked impairment in social or occupational functioning and may require hospitalization.

2. Bipolar II Disorder: This type is diagnosed when a person has experienced at least one major depressive episode and at least one hypomanic episode, but has never had a full manic episode. Hypomanic episodes are similar to manic episodes but are less severe and shorter in duration, typically lasting at least four days.

3. Cyclothymic Disorder: This type involves periods of hypomanic symptoms and depressive symptoms that do not meet the criteria for a major depressive episode. Symptoms must persist for at least two years in adults or one year in children and adolescents, with no more than two months symptom-free.

Epidemiology:

1. Age of onset: The average age of onset for bipolar disorder is around 25 years old, although it can occur at any age, including childhood and late adulthood. The onset of symptoms tends to be earlier in bipolar I disorder compared to bipolar II disorder.

2. Prevalence: Bipolar disorder affects approximately 2.8% of the adult population worldwide. The prevalence of bipolar I disorder is estimated at around 1%, while bipolar II disorder is estimated to affect about 1.1% of the population. Cyclothymic disorder is less common, with a prevalence of around 0.4-1%.

3. Gender: Bipolar disorder affects both males and females equally, with no significant differences in prevalence between the two genders. However, there may be some differences in the presentation of symptoms, with women more likely to experience rapid cycling and mixed episodes, while men may have more severe manic episodes.

4. Heritability: Bipolar disorder has a strong genetic component, with heritability estimates ranging from 60-80%. This means that a significant proportion of the risk for developing bipolar disorder can be attributed to genetic factors. Having a close relative, such as a parent or sibling, with bipolar disorder increases the risk of developing the condition.

5. Comorbidity: Individuals with bipolar disorder often have other mental health conditions, such as anxiety disorders, attention deficit hyperactivity disorder (ADHD), or substance use disorders. Additionally, they may experience medical conditions, such as cardiovascular disease, diabetes, and obesity, at higher rates compared to the general population.

6. Treatment-seeking: Many individuals with bipolar disorder do not receive appropriate diagnosis and treatment. It is estimated that about 50% of people with bipolar disorder do not receive proper care, often due to misdiagnosis or lack of awareness about the condition. Early diagnosis and treatment are crucial for managing symptoms and improving long-term outcomes.

Patient Scenario: Manic Episode

Mr. Johnson is a 28-year-old man who presents to the mental health clinic with symptoms consistent with a manic episode. He reports having excessive energy, a decreased need for sleep, racing thoughts, and engaging in impulsive and risky behaviors, such as excessive spending and reckless driving, for the past week. He also mentions a history of mood swings, but he has never sought treatment before. Upon evaluation, the PMHNP diagnoses Mr. Johnson with a manic episode, likely part of bipolar I disorder, and decides to initiate treatment.

Before starting treatment, the PMHNP orders a series of labs and assessments to rule out potential medical or substance-induced causes of Mr. Johnson's symptoms. These tests include: