With regard to the epidemiology of suicide, which one of the following represents a lower risk for completed suicide?
Correct Answer B:
Knowing the epidemiology and demographics of suicide should assist the physician in clinical practice. Studies have shown that the general demographics for people at low risk for completed suicide are age under 45, female gender, non Caucasian race, living with others, and good health. The high-risk demographics are age over 45, male gender, Caucasian race, living alone, and poor health. However, parasuicidal individuals (those who have nonfatal suicide attempts) have different characteristics. For example, women under age 35 have more suicide attempts than do men over age 60.
What is the treatment of choice for bipolar disorder?
Correct Answer D:
Mood stabilizers are the most commonly prescribed medications for bipolar disorder. These medications help regulate and stabilize mood so that you don't swing between depression and mania. Lithium has been widely used as a mood stabilizer and is generally the first line of treatment for manic episodes.
Anti-seizure medications: the medications are used to prevent mood swings, especially in people with rapid cycling bipolar disorder. These medications, such as valproic acid (Depakene), divalproex (Depakote) and lamotrigine (Lamictal), also are widely used as mood regulators.
The use of antidepressants in bipolar disorder, although once common, is now controversial.
The development of a bipolar mood disorder is frequently associated with a history of:
Correct Answer E:
Bipolar disorders are characterized by mania and depression, which usually alternate. Exact cause is unknown. Heredity plays some role. There is also evidence of dysregulation of serotonin and norepinephrine. The development of a bipolar mood disorder is frequently associated with a history of dysthymic or mood disorder. Psychosocial factors may also be involved. Stressful life events are often associated with initial development of symptoms and later exacerbations, although cause and effect have not been established.
Which of the following management options would be least likely involved in the initial management of a nonpregnant bipolar patient in the manic phase?
Bipolar disorders are characterized by mania and depression, which usually alternate. Exact cause is unknown, but heredity, changes in the level of brain neurotransmitters, and psychosocial factors may be involved. Diagnosis is based on history. Treatment consists of drugs (eg lithium, neuroleptics), sometimes with psychotherapy. The first-line drugs for treating a manic episode during the acute phase are lithium and valproate.
Severely ill patients with acute mania typically require treatment with a medication combination. Lithium plus an antipsychotic (aripiprazole, haloperidol (or another first-generation antipsychotic), olanzapine, quetiapine, or risperidone) is recommended; however, valproate plus an antipsychotic is a reasonable alternative.
ECT is not indicated in the initial management of bipolar disorder. The severity of the symptoms, the lack of response to medications, or the presence of contraindications to certain medications necessitates the use of ECT.
You diagnose depression in a 27-year-old white male and prescribe bupropion (Wellbutrin). He returns for a follow-up visit 4 weeks later. He now reports less despondency, but says he has developed severe insomnia. He also tells you that his mind “races” all the time, and that he has received two speeding tickets in the past 2 weeks.
Which one of the following would be appropriate now?
Some depressed patients develop mania or hypomania when exposed to antidepressants. This variant is sometimes called bipolar III disorder. Medication is the key to stabilizing bipolar disorder. The initial treatment of mania usually includes lithium or valproic acid. If the patient is psychotic, a neuroleptic medication may also be given. Long-acting benzodiazepines may be used initially to treat agitation, but short-acting agents are not recommended. Tricyclic antidepressants should be avoided, as they may include rapid cycling of symptoms in these patients.
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