Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Review Question - QID 105713

In scope icon M 7 E
QID 105713 (Type "105713" in App Search)
A 47-year-old man with a 20-year history of bipolar disorder type I presents to clinic for a general health exam. He is accompanied by his wife. On greeting the patient, you notice he is easily distracted. His speech is pressured. The patient's wife reports that he has not had a normal night of sleep for the past several weeks and that she had to cancel his credit cards because he began spending recklessly. When asked about his sleep pattern, the patient gets agitated. The patient's wife reports that there have been no recent changes in his medication. He is on lithium for bipolar disorder and lisinopril for hypertension. The physical exam is benign and the patient's vital signs are within normal limits. Regarding this patient's medication regimen, what is the next step in management?

Discontinue all medications

0%

0/4

Begin fluoxetine

0%

0/4

Begin valproic acid

50%

2/4

Begin clozapine

50%

2/4

Begin venlafaxine

0%

0/4

Select Answer to see Preferred Response

bookmode logo Review TC In New Tab

If a patient is having a manic or psychotic episode while already on a mood stabilizer, the next treatment is an antipsychotic (such as clozapine), usually done in the inpatient setting.

Bipolar disorder is defined by the presence of at least 1 manic or hypomanic episode. Depressive symptoms may not initially be apparent, but almost always occur eventually. Standard of care is with a mood stabilizer such as lithium, valproic acid, or carbamazepine. In instances where a patient experiences symptoms while already on a stabilizing agent, an antipsychotic is required. This patient's symptoms are characteristic of a manic episode, which is usually marked by distractibility, irresponsibility, grandiosity, flight of ideas, psychomotor agitation, a decreased need for sleep, and pressured speech. This patient's symptoms are characteristic of a manic episode which is marked by at least 3 of the following criteria (4 if mood is only irritable): distractibility, irresponsibility, grandiosity, flight of ideas, psychomotor agitation, a decreased need for sleep, and pressured speech.

Incorrect Answers:
Answer 1: This patient is in the midst of a manic episode and delaying treatment would be ill-advised.
Answer 2: Beginning an SSRI such as fluoxetine could worsen this patient's mania.
Answer 3: This patient is having a manic episode while already on a mood stabilizer, so starting a different mood stabilizer such as valproic acid would not be as effective as starting an antipsychotic.
Answer 5: Beginning an SNRI such as venlafaxine could worsen this patient's mania.

ILLUSTRATIONS:
Authors
Rating
Please Rate Question Quality

2.9

  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon

(12)

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options