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Discontinue all medications
0%
0/4
Begin fluoxetine
Begin valproic acid
50%
2/4
Begin clozapine
Begin venlafaxine
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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.
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