Behavioral Science
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Mood Disorders 101<br />
How do you diagnose Bipolar II<br />
Disorder?<br />
Are there any drugs that induce mania?<br />
What is cyclothymic disorder?<br />
What is the prevalence of bipolar<br />
disorder?<br />
The patient has one or more major<br />
depressive episodes, plus one or more<br />
hypomanic episodes (but never any<br />
manic episodes).<br />
Yes, steroids and appetite suppressants<br />
are the main culprits. Cocaine (crack)<br />
and amphetamines may also induce it.<br />
Previously undiagnosed bipolar<br />
patients who have only been treated<br />
for a major depression may have their<br />
manic episodes precipitated by<br />
treatment with antidepressants.<br />
Cyclothymic patients meet criteria for<br />
dysthymic disorder and experience<br />
hypomanic episodes.<br />
Bipolar I has a lifetime prevalence of<br />
0.5% to 1% and a male to female ratio<br />
of 1:1. While, bipolar II has a lifetime<br />
prevalence of 0.5% and is more common<br />
in women than in men.<br />
CLINICAL VIGNETTES<br />
You are the third-year medical student on the psychiatry consult service. You and<br />
your resident are called to the ER for a patient who was recently admitted to the<br />
inpatient psychiatry service for depression and suicidal ideation. While in the<br />
hospital, he complained of having trouble sleeping and was given a medication to<br />
help both his depression and sleep problems. The patient also received a<br />
prescription for this medication when he was discharged. He now presents to the<br />
ER with a 3-hour history of a painful erection. What drug was the patient most<br />
likely given?<br />
Trazodone<br />
A patient you have been treating for depression with SSRIs comes to you for a<br />
checkup. When you ask how he is he says “The last 3 days have been fantastic!”<br />
and launches into a very long and tangential story about what he has been doing.<br />
The patient has been very productive at work, though that might have to do more<br />
with the small amount of sleep that he has been getting, but he claims that he is<br />
far too strong to need sleep. What is your new diagnosis?<br />
Bipolar, type II. This meets criteria for a hypomanic episode, but because of the<br />
lack of psychosis or need for hospitalization it is not yet mania. He is also very<br />
functional during this time.
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