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Chapter 58. Bipolar Disorders

VV is a patient who was recently diagnosed with bipolar disorder before being discharged for a related hospitalization. VV reports a positive family history of mood disorders but denies hospitalizations of any family members. You explain to VV that it is possible that the family members were never hospitalized due to prominent symptoms of hypomania, characterized by which of the following?

a. Multiple hospitalizations

b. Psychotic episodes

c. Impairment in social functioning

d. Impairment in occupational functioning

e. An inflated self-esteem

Answer e is correct. The symptoms of hypomania and mania are similar with respect to the target signs and symptoms. Hypomania is less severe than mania. Inflated self-esteem can still be detected in hypomania.

Answer a is incorrect. These patients are often able to function well; therefore, they do not require hospitalization.

Answer b is incorrect. There is no psychosis (eg, auditory and visual hallucinations, delusions) involved in hypomanic states.

Answer c is incorrect. There is no impairment in social functioning.

Answer d is incorrect. There is no impairment in occupational functioning.

The treatment team asks you, the clinical pharmacist, for a consult on a patient with bipolar disorder. There is a question regarding whether or not the patient meets criteria for rapid cycling. You explain to the team that there needs to be a confirmed history of ____ or more manic or depressive episodes within a ___________ time period.

a. 2; 6-month

b. 2; 1-year

c. 3; 2-year

d. 4; 1-year

e. 4; 2-year

Answer d is correct. Rapid cycling is a term to describe when a patient experiences four or more episodes of depression or mania within a 12-month period. Rapid cycling is a specified term used in the DSM-IV-TR to describe the course of recurrent episodes. This term is used to specify bipolar disorder I and II but not depressive disorders such as MDD.

Answer a is incorrect. A 6-month period is not stated in the definition of rapid cycling.

Answer b is incorrect. The correct number of episodes required in a 12-month period is four, not two.

Answer c is incorrect. A 2-year period is not stated in the definition of rapid cycling; it is 1 year.

Answer e is incorrect. A 2-year period is not stated in the ...

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