Bipolar disorder — MCQs

A 35-year-old man is brought to the emergency department by his wife. She was called by his coworkers to come and pick him up from work after he barged into the company’s board meeting and was being very disruptive as he ranted on about all the great ideas he had for the company. When they tried to reason with him, he became hostile and insisted that he should be the CEO as he knew what was best for the future of the company. The patient’s wife also noted that her husband has been up all night for the past few days but assumed that he was handling a big project at work. The patient has no significant past medical or psychiatric history. Which of the following treatments is most likely to benefit this patient’s condition?

A 19-year-old woman presents to an outpatient psychiatrist after 2 weeks of feeling “miserable.” She has been keeping to herself during this time with no desire to socialize with her friends or unable to enjoy her usual hobbies. She also endorses low energy, difficulty concentrating and falling asleep, and decreased appetite. You diagnose a major depressive episode but want to screen for bipolar disorder before starting her on an anti-depressant. Which of the following cluster of symptoms, if previously experienced by this patient, would be most consistent with bipolar I disorder?

A 25-year-old woman is brought to the emergency department by EMS after being found naked in a busy downtown square. The patient stated that she is liberating people from material desires and was found destroying objects. Her temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 22/min, and oxygen saturation is 98% on room air. Physical exam is deferred due to patient combativeness. The patient is given diphenhydramine and haloperidol and transferred to the psychiatric ward. On day 1 on the ward, the patient is no longer aggressive or agitated and has calmed down. She states that she feels severely depressed and wants to kill herself. The patient is started on a medication and monitored closely. On day 3 of the patient's stay in the hospital she is found in her room drawing up plans and states that she has major plans to revamp the current energy problems in the country. Which of the following is the most likely medication that was started in this patient?

A 14-year-old girl is presented by her mother who says she has trouble focusing. The patient’s mother says that, over the past 2 months, the patient has lost interest in her normal activities and has become more withdrawn. She no longer participates in activities she enjoys and says that she has contemplated suicide. The patient’s mother says that, at other times, she is hyperactive and can’t ever seem to be still. Before the onset of her depression, she had an 8 day period where she did not sleep and was constantly on the go. She was so energetic at school that she was suspended for a month. The patient is afebrile and vitals are within normal limits. Physical examination is unremarkable. Routine laboratory tests and a noncontrast computed tomography (CT) of the head are normal. Which of the following would be the best course of treatment in this patient?

A 29-year-old man comes to the physician with his wife because she has noticed a change in his behavior over the past 2 weeks. His wife reports that he is very distracted and irritable. His colleagues have voiced concerns that he has not been turning up for work regularly and behaves erratically when he does. Previously, her husband had been a reliable and reasonable person. The patient says that he feels “fantastic”; he only needs 4 hours of sleep each night and wakes up cheerful and full of energy each morning. He thinks that his wife is overreacting. The patient has been healthy except for a major depressive episode 5 years ago that was treated with paroxetine. He currently takes no medications. His pulse is 98/min, respirations are 12/min, and blood pressure is 128/62 mm Hg. Mental status examination shows frenzied speech and a flight of ideas. Which of the following is the strongest predisposing factor for this patient's condition?

A 33-year-old female with bipolar disorder, well controlled with lithium, presents to your clinic. She would like to discuss pregnancy and her medication. She is in a committed monogamous relationship and because her symptoms are well-controlled, would like to become pregnant. She is worried that her folate levels might be low despite taking multivitamins every day. She would like to know if she needs to wait before becoming pregnant. What is the single most appropriate recommendation at this stage?

A 33-year-old woman is brought to the physician by her husband because of persistent sadness for the past 2 months. During this period, she also has had difficulty sleeping and an increased appetite. She had similar episodes that occurred 2 years ago and 9 months ago that each lasted for 4 months. Between these episodes, she reported feeling very energetic and rested after 3 hours of sleep. She often went for long periods of time without eating. She works as a stock market trader and received a promotion 5 months ago. She regularly attends yoga classes on the weekends with her friends. On mental status examination, she has a blunted affect. She denies suicidal thoughts and illicit drug use. Which of the following is the most likely diagnosis?

A 23-year-old woman is brought to the physician by her father because of irritability, mood swings, and difficulty sleeping over the past 10 days. A few days ago, she quit her job and spent all of her savings on supplies for a “genius business plan.” She has been energetic despite sleeping only 1–2 hours each night. She was diagnosed with major depressive disorder 2 years ago. Mental status examination shows pressured speech, a labile affect, and flight of ideas. Throughout the examination, she repeatedly states “I feel great, I don't need to be here.” Urine toxicology screening is negative. Which of the following is the most likely diagnosis?

A 34-year-old man is brought to a psychiatric hospital by friends for erratic behavior. He has been up for the past several nights painting his apartment walls purple and reading the Bible out loud, as well as talking fast and making sexually provocative comments. Collateral information from family reveals 2 similar episodes last year. Mental status exam is notable for labile affect and grandiose delusions. Urine toxicology is negative. The patient is admitted and started on lithium for mania. His symptoms resolve within 2 weeks. How should this patient’s lithium be managed in anticipation of discharge?

A 19-year-old woman is brought to the physician by her parents because of irritable mood that started 5 days ago. Since then, she has been staying up late at night working on a secret project. She is energetic despite sleeping less than 4 hours per day. Her parents report that she seems easily distracted. She is usually very responsible, but this week she spent her paycheck on supplies for her project. She has never had similar symptoms before. In the past, she has had episodes where she felt too fatigued to go to school and slept until 2 pm every day for 2 weeks at a time. During those times, her parents noticed that she cried excessively, was very indecisive, and expressed feelings of worthlessness. Two months ago, she had an asthma exacerbation and was treated with bronchodilators and steroids. She tried cocaine once in high school but has not used it since. Vital signs are within normal limits. On mental status examination, she is irritable but cooperative. Her speech is pressured and her thought process is linear. Which of the following is the most likely diagnosis?