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Review Question - QID 109533

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QID 109533 (Type "109533" in App Search)
A 37-year-old African American man is brought to the emergency department by police. The patient refused to leave a petting zoo after closing. He states that he has unique ideas to revolutionize the petting zoo experience. The patient has a past medical history of multiple suicide attempts. His temperature is 99.5°F (37.5°C), blood pressure is 130/85 mmHg, pulse is 100/min, respirations are 16/min, and oxygen saturation is 99% on room air. The patient's cardiac and pulmonary exams are within normal limits. He denies any nausea, vomiting, shortness of breath, or systemic symptoms. The patient struggles to answer questions, as he is constantly changing the subject and speaking at a very rapid rate. The patient is kept in the emergency department overnight and is observed to not sleep and is very talkative with the nurses. Which of the following is the best long-term therapy for this patient?

Lithium

72%

128/179

Valproic acid

8%

14/179

Risperidone

14%

25/179

Haloperidol

6%

10/179

Diphenhydramine

1%

1/179

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This patient is presenting with classic symptoms for mania likely in the setting of bipolar disorder given his history of suicide attempts. The best long-term therapy for this patient is lithium.

Mania presents with symptoms of DIG FAST which includes Distractibility, Impulsivity, Grandiosity, Flight of ideas, Activity increase, Sleep decrease, and Talkativeness. Typically, mania occurs in the setting of substance abuse or bipolar disorder. The best long-term therapy of bipolar disorder is lithium which is the only drug shown to reduce mortality in these patients. Prior to starting lithium, thyroid and renal function tests should be taken as this drug is thyrotoxic and nephrotoxic.

Incorrect Answers:
Answer 2: Valproic acid is an appropriate mood stabilizer that can be used in bipolar disorder and is the drug of choice in bipolar patients with renal failure. This drug is not the best therapy of bipolar disorder, as it does not improve outcomes in mortality.

Answer 3: Risperidone is an atypical antipsychotic that is appropriate for management of acute mania. It is not appropriate long-term therapy for bipolar disorder.

Answer 4: Haloperidol is appropriate long-term therapy for schizophrenia.

Answer 5: Diphenhydramine can be used in the acute setting of mania, as it has a sedating effect. It is not appropriate long-term therapy for this condition.

Bullet Summary:
The best long-term and mortality-lowering therapy for bipolar disorder is lithium.

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