MH701 Antipsychotics Latest Practice Questions
2025 | Verified and Graded A+
Define bipolar I - Manic episodes, with or without psychosis, and/or major depression.
Define bipolar II - Hypomanic episode with major depression, no history of manic or
mixed episode.
Define cyclothymia - Hypomanic & depressive symptoms that do not meet criteria for
bipolar II disorder; no major depressive episodes.
Define bipolar disorders otherwise not specified. - Does not meet criteria for major
depression, bipolar I or II disorder, or cyclothymia (less than 1 week of manic sx without
psychosis or hospitalization.
Extreme mood swings that occur hourly or daily, should consider what? - Other medical
or psychiatric diagnosis should be considered. Hypothyroidism, PTSD, borderline personality
disorder.
Mania after 40 is most likely what? - medical or substance use.
Newly diagnosed mania is uncommon in who? - children and adults over 65 years.
When do patients with bipolar usually present? - depressive phase, not manic.
co-morbidity with bipolar: - anxiety disorders, substance use disorders, personality
disorders.
etiology of bipolar - kindling theory is prominent theory
kindling theory of bipolar etiology - multiple factors that potentially interact & lower the
threshold at which mood changes occur. Eventually a mood episode can start itself and become
recurrent. Recurrent mood episodes are associated with repeated physiological insults that add
up and kindle, like a spark bursting into flames. This could compromise endogenous
compensatory mechanisms leading to cell apoptosis that in turn causes requiring of the brain
circuits involved in mood regulation and cognition. This could render one more vulnerable to
the effects of stressors, increasing risk of future episodes and thus perpetuating the vicious
spiral.
Bipolar etiology: Environmental - 1. Sleep deprivation = trigger mania.
2. Hypersomnia= trigger MDD.
,3. traumatic and/or abusive events in childhood.
4. Potential that those with diurnal pattern are affected mostly by fluctuating light and
temperature.
Bipolar etiology: Biological: - 1. Genetics: studies have shown identical twins are far more
concordant for mod disorders than fraternal twins.
2. Overall heritability of bipolar spectrum has been put at 0.71.
3. Between 4 & 24% of first degree relatives of individuals with bipolar I disorder are also
diagnosed with bipolar I disorder.
Bipolar etiology: Neural processes: - 1. Hypersensitivity of melatonin receptors.
2. Structural abnormalities of the amygdala, hippocampus, and pre-frontal cortex.
3. Larger lateral ventricles.
Bipolar etiology: White matter hypothesis - Endocrine models- hypothyroidism can cause
depression and/or mood instability. Abnormalities have been found in hypothalamus-pituitary-
axis due to repeated stress.
Goals of pharmacological treatment for mood disorders: - 1. Should be directed toward
several goals. First, the patient's safety must be guaranteed.
2. a complete diagnostic evaluation of the patient is necessary.
3. A treatment plan that addresses not only the immediate symptoms but also the patient's
prospective well-being should be initiated.
First line pharmacology for bipolar is: - Mood stabilizers
Risk for suicide with bipolar what is used? - Lithium. Risk of suicide is reduced 13-fold
with long-term maintenance with lithium.
****Bipolar depression, what pharmacological treatment? - Quetiapine (SGA),
olanzapine-fluoxetine (SGA-SSRI), and lurasidone (SGA) have all demonstrated consistent
efficacy in bipolar depression and are approved for this stage of the disorder.
***What med is preferred for rapid cycling disorders? - Depakote.
Hypomanic episodes and mild depressive episodes are generally managed with? - a
single mood stabilizer.
Acute mania and severe depression may require? - 2-3 medications
,****Acute Mania agents can be used alone or in combination to bring the patient down from
the high, such as? - Lithium, Valproate, carbamazepine/oxycarbamazapine,
Clonazepam/lorazepam, atypical antipsychotics.
***Acute bipolar depression is treated with? (4 answers) - 1. Use of antidepressants
should be avoided or used short term only with a mood stabilizer. Anti-depressant mono-
therapy may precipitate mania or induce rapid-cycling disorders.
2. Anti-depressant drugs are often enhanced by s mood stabilizer in the first line of treatment
for a first or isolated episode of bipolar depression. Symbyax (olanzapine and fluoxetine) has
been shown to be effective in treating acute bipolar depression for n 8 week period without a
switch to mania or hypomania.
3. Many patients who are bipolar in the depressed phase do not respond to treatment with
standard anti-depressants. In this instance, lamotrigine or low dose ziprasidone (20-80 mg/d)
may prove effective.
4.ECT may also be useful for patients with bipolar depression who do not respond to lithium or
other mood stabilizers and their adjuncts, particularly in cases where intense suicide presents as
a medical emergency.
****Maintenance treatment of bipolar: - 1. Preventing recurrences of mood episodes is
he greatest challenge for clinicians. Not only must the chosen regimen achieve it's primary goal-
sustained euthermia, but the medications should not produce unwanted side effects that affect
functioning. Sedation, cognition, impairment, tremor, weight gain and rash are some side effects
that lead to treatment discontinuation.
2. Lithium, carbamazepine, and valproic acid , alone or in combination, are the most widely
used agents in the long-term treatment of patients with bipolar disorder. Lamotrigine has
prophylactic anti-depressant and potentially mood stabilizing properties.
***Lamotrigine use: How? What to watch for? - 1. Lamotrigine appears to have superior
acute and prophylactic anti-depressant properties compared to antimanic properties.
2. Very slow increases of Lamotrigine (Lamictal)help avoid the rare side effects of lethal rash. A
dose of 200 mg per day appears to be the average in many studies. The incidence of severe rash
(Steven-Johnsons syndrome: a topical epidermal necrolysis), is now thought to be
approximately 2 in 10,000 adults and 4 in 10 children.
What can happen with Lithium use? - Many patients with lithium develop
hypothyroidism, and many patients with bipolar disorder have idiopathic thyroid dysfunction.
, Difference between mania and hypomania? - `Hypomania not as extreme, can usually
function.
Mania not able to function and be around people.
Different diagnosis for bipolar - Bipolar I, manic episode
Bipolar I, depressed episode
Bipolar II, manic episode
Bipolar II, depressed episode
Define cyclothymia - at least a 2 year period of hypomania and depressive symptoms. No
more than 2 month remission of sx.
acronym for bipolar - DIGFAST
D: distractibility
I: Irresponsibility
G: grandiosity
F: flight of ideas
A: agitation.
S: sleep
T: talkativeness
1 fun week
Lithium use: dose: therapeutic level - 0.5-1.5 mEq/l
FDA approved for manic episode and maintenance treatment of manic-depressive patients with
history of mania.
Off label: bipolar depression and adjunct MDD.
pharmacological actions of lithium - 1. Rapidly absorbed by oral administration.
2. Peak serum concentrations occurring 1-1.5 hours with standard preps. 4-5 hours with
controlled release.
3. Excreted by kidneys.
4. Half-life 18-24 hours in young adults, shorter in children and longer in older adults.
2025 | Verified and Graded A+
Define bipolar I - Manic episodes, with or without psychosis, and/or major depression.
Define bipolar II - Hypomanic episode with major depression, no history of manic or
mixed episode.
Define cyclothymia - Hypomanic & depressive symptoms that do not meet criteria for
bipolar II disorder; no major depressive episodes.
Define bipolar disorders otherwise not specified. - Does not meet criteria for major
depression, bipolar I or II disorder, or cyclothymia (less than 1 week of manic sx without
psychosis or hospitalization.
Extreme mood swings that occur hourly or daily, should consider what? - Other medical
or psychiatric diagnosis should be considered. Hypothyroidism, PTSD, borderline personality
disorder.
Mania after 40 is most likely what? - medical or substance use.
Newly diagnosed mania is uncommon in who? - children and adults over 65 years.
When do patients with bipolar usually present? - depressive phase, not manic.
co-morbidity with bipolar: - anxiety disorders, substance use disorders, personality
disorders.
etiology of bipolar - kindling theory is prominent theory
kindling theory of bipolar etiology - multiple factors that potentially interact & lower the
threshold at which mood changes occur. Eventually a mood episode can start itself and become
recurrent. Recurrent mood episodes are associated with repeated physiological insults that add
up and kindle, like a spark bursting into flames. This could compromise endogenous
compensatory mechanisms leading to cell apoptosis that in turn causes requiring of the brain
circuits involved in mood regulation and cognition. This could render one more vulnerable to
the effects of stressors, increasing risk of future episodes and thus perpetuating the vicious
spiral.
Bipolar etiology: Environmental - 1. Sleep deprivation = trigger mania.
2. Hypersomnia= trigger MDD.
,3. traumatic and/or abusive events in childhood.
4. Potential that those with diurnal pattern are affected mostly by fluctuating light and
temperature.
Bipolar etiology: Biological: - 1. Genetics: studies have shown identical twins are far more
concordant for mod disorders than fraternal twins.
2. Overall heritability of bipolar spectrum has been put at 0.71.
3. Between 4 & 24% of first degree relatives of individuals with bipolar I disorder are also
diagnosed with bipolar I disorder.
Bipolar etiology: Neural processes: - 1. Hypersensitivity of melatonin receptors.
2. Structural abnormalities of the amygdala, hippocampus, and pre-frontal cortex.
3. Larger lateral ventricles.
Bipolar etiology: White matter hypothesis - Endocrine models- hypothyroidism can cause
depression and/or mood instability. Abnormalities have been found in hypothalamus-pituitary-
axis due to repeated stress.
Goals of pharmacological treatment for mood disorders: - 1. Should be directed toward
several goals. First, the patient's safety must be guaranteed.
2. a complete diagnostic evaluation of the patient is necessary.
3. A treatment plan that addresses not only the immediate symptoms but also the patient's
prospective well-being should be initiated.
First line pharmacology for bipolar is: - Mood stabilizers
Risk for suicide with bipolar what is used? - Lithium. Risk of suicide is reduced 13-fold
with long-term maintenance with lithium.
****Bipolar depression, what pharmacological treatment? - Quetiapine (SGA),
olanzapine-fluoxetine (SGA-SSRI), and lurasidone (SGA) have all demonstrated consistent
efficacy in bipolar depression and are approved for this stage of the disorder.
***What med is preferred for rapid cycling disorders? - Depakote.
Hypomanic episodes and mild depressive episodes are generally managed with? - a
single mood stabilizer.
Acute mania and severe depression may require? - 2-3 medications
,****Acute Mania agents can be used alone or in combination to bring the patient down from
the high, such as? - Lithium, Valproate, carbamazepine/oxycarbamazapine,
Clonazepam/lorazepam, atypical antipsychotics.
***Acute bipolar depression is treated with? (4 answers) - 1. Use of antidepressants
should be avoided or used short term only with a mood stabilizer. Anti-depressant mono-
therapy may precipitate mania or induce rapid-cycling disorders.
2. Anti-depressant drugs are often enhanced by s mood stabilizer in the first line of treatment
for a first or isolated episode of bipolar depression. Symbyax (olanzapine and fluoxetine) has
been shown to be effective in treating acute bipolar depression for n 8 week period without a
switch to mania or hypomania.
3. Many patients who are bipolar in the depressed phase do not respond to treatment with
standard anti-depressants. In this instance, lamotrigine or low dose ziprasidone (20-80 mg/d)
may prove effective.
4.ECT may also be useful for patients with bipolar depression who do not respond to lithium or
other mood stabilizers and their adjuncts, particularly in cases where intense suicide presents as
a medical emergency.
****Maintenance treatment of bipolar: - 1. Preventing recurrences of mood episodes is
he greatest challenge for clinicians. Not only must the chosen regimen achieve it's primary goal-
sustained euthermia, but the medications should not produce unwanted side effects that affect
functioning. Sedation, cognition, impairment, tremor, weight gain and rash are some side effects
that lead to treatment discontinuation.
2. Lithium, carbamazepine, and valproic acid , alone or in combination, are the most widely
used agents in the long-term treatment of patients with bipolar disorder. Lamotrigine has
prophylactic anti-depressant and potentially mood stabilizing properties.
***Lamotrigine use: How? What to watch for? - 1. Lamotrigine appears to have superior
acute and prophylactic anti-depressant properties compared to antimanic properties.
2. Very slow increases of Lamotrigine (Lamictal)help avoid the rare side effects of lethal rash. A
dose of 200 mg per day appears to be the average in many studies. The incidence of severe rash
(Steven-Johnsons syndrome: a topical epidermal necrolysis), is now thought to be
approximately 2 in 10,000 adults and 4 in 10 children.
What can happen with Lithium use? - Many patients with lithium develop
hypothyroidism, and many patients with bipolar disorder have idiopathic thyroid dysfunction.
, Difference between mania and hypomania? - `Hypomania not as extreme, can usually
function.
Mania not able to function and be around people.
Different diagnosis for bipolar - Bipolar I, manic episode
Bipolar I, depressed episode
Bipolar II, manic episode
Bipolar II, depressed episode
Define cyclothymia - at least a 2 year period of hypomania and depressive symptoms. No
more than 2 month remission of sx.
acronym for bipolar - DIGFAST
D: distractibility
I: Irresponsibility
G: grandiosity
F: flight of ideas
A: agitation.
S: sleep
T: talkativeness
1 fun week
Lithium use: dose: therapeutic level - 0.5-1.5 mEq/l
FDA approved for manic episode and maintenance treatment of manic-depressive patients with
history of mania.
Off label: bipolar depression and adjunct MDD.
pharmacological actions of lithium - 1. Rapidly absorbed by oral administration.
2. Peak serum concentrations occurring 1-1.5 hours with standard preps. 4-5 hours with
controlled release.
3. Excreted by kidneys.
4. Half-life 18-24 hours in young adults, shorter in children and longer in older adults.
