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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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