Review Question - QID 105825

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Bipolar Disorder Treatment Medical QID: 105825 (M3.PY.16.8)

QID 105825 (Type "105825" in App Search)

A 35-year-old female presents to the ED at the request of her husband after 3 weeks of erratic behavior. The patient has been staying up all night online shopping on eBay. Despite a lack of sleep, she is "full of energy" during the day at her teaching job, which she believes is "beneath [her], anyway." She has not sought psychiatric treatment in the past, but reports an episode of self-diagnosed depression 2 years ago. The patient denies thoughts of suicide. Pregnancy test is negative. The patient is acutely agitated and is pacing back and forth across the room and states she is going to leave. Which of the following is the best initial treatment?

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Valproate

56%

5/9

Valproate and venlafaxine

11%

1/9

Valproate and olanzapine

0/9

Haloperidol

22%

2/9

Electroconvulsive therapy

11%

1/9

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This patient with decreased need for sleep, ideas of grandiosity, and pressured speech is showing symptoms of an acute manic episode. First line management of an acute manic episode includes assessing the patient for suicidal idealization and treatment with a mood stabilizer (valproate) and an antipsychotic (olanzapine).

The patient meets the diagnostic criteria for Bipolar I (an episode of mania with or without episodes of depression), where mania is defined by having 3 of the following: grandiosity, decreased need for sleep, pressured speech, flight of ideas, distractibility, increase in goal-oriented activity, psychomotor agitation, and hedonism. Acute episodes are managed with a mood stabilizer (lithium or valproate) and an antipsychotic: olanzapine or quetiapine.

Incorrect Answers:
Answer 1: Therapy for acute manic episode includes a mood stabilizer and an anti-psychotic.
Answer 2: Antidepressants such as venlafaxine should not be started during an acute manic episode.
Answer 4: Haloperidol is a first line mood stabilizer in pregnant patients.
Answer 5: ECT should be reserved for patients with refractory or life threatening symptoms.

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