Examkin

Question

Difficulty: EasyBipolar and Related Disorders

A 34-year-old man presents via telehealth for a follow-up visit. Over the past four weeks, he has experienced persistent low mood, hypersomnia, extreme fatigue, and a loss of interest in his usual activities. Five years ago, he was hospitalized for an episode characterized by grandiosity, pressured speech, and a significantly decreased need for sleep. He has not taken any medications for the past six months. Which of the following are appropriate pharmacological treatments for this patient's current condition? (Select all that apply)

  1. QuetiapineAnswer
  2. LurasidoneAnswer
  3. C
    Escitalopram monotherapy
  4. D
    Venlafaxine monotherapy
  5. Olanzapine and fluoxetine combinationAnswer

Answer

The correct treatments are quetiapine, lurasidone, and the olanzapine and fluoxetine combination.
The patient's history of a manic episode requiring hospitalization confirms a diagnosis of bipolar I disorder. He is currently presenting with an acute bipolar depressive episode. The goal of treatment is to alleviate depressive symptoms without inducing a manic switch. Quetiapine, lurasidone, and the olanzapine-fluoxetine combination are all first-line, FDA-approved treatments for acute bipolar depression. They provide both mood-stabilizing and antidepressant effects.

Step-by-Step Solution

1
Diagnose the patient's underlying psychiatric disorder based on his history.
The patient has a history of an episode featuring grandiosity, pressured speech, and decreased need for sleep leading to hospitalization, which defines a manic episode. Therefore, his overarching diagnosis is bipolar I disorder.
Accurate diagnosis of bipolar disorder is necessary because depressive episodes in bipolar disorder must be treated differently than unipolar major depressive disorder.
2
Identify the patient's current clinical state.
The patient is currently experiencing a major depressive episode (low mood, hypersomnia, fatigue, anhedonia).
Treatment selection depends on the current phase of bipolar disorder (e.g., acute mania, acute depression, or maintenance).
3
Select appropriate pharmacotherapy for acute bipolar depression.
Appropriate options include quetiapine, lurasidone, or the olanzapine-fluoxetine combination. Antidepressant monotherapy must be avoided.
Antidepressant monotherapy can precipitate a manic switch in patients with bipolar disorder.

Key Concept

Acute depressive episodes in bipolar I disorder should be treated with specific second-generation antipsychotics (e.g., quetiapine, lurasidone) or combinations (e.g., olanzapine-fluoxetine) rather than antidepressant monotherapy, which carries a high risk of inducing mania.
Rate this question

Topics

Bipolar and Related Disorders

More questions from this topic