USMLE® Step 1 style questions USMLE
USMLE® Step 2 style questions USMLE
A 17-year-old girl is brought to the emergency room by her parents after she was found trying to ingest bleach. She appears restless and agitated, and says that she is a terrible person who does not deserve to be alive. Her parents report that she had been more talkative and irritable than usual. However, since yesterday, she has been confused and withdrawn. She had not slept more than four hours a night for the last two weeks, and she was fired from her summer job due to making inappropriate sexual innuendos. She tells you that her bad behaviors have been broadcasted on the national news, and that the police are looking for her, however, neither of these things have happened. Which of the following is the most appropriate medication to be administered as a first-line therapy for her condition?
Maybe you’ve heard the term “bipolar” used flippantly to describe someone who’s moody, or who has mood swings, but the colloquial use of the term is really different from clinically diagnosed bipolar disorder.
Bipolar disorder, which used to be called manic depression, is a serious mental disorder that causes a person to have dramatic shifts in emotions, mood, and energy levels: moving from extreme lows to extreme highs.
But these shifts don’t happen moment to moment—they usually happen over several days or weeks.
There are a few different types of bipolar disorders, but there are some common features.
Individuals with this can feel hopeless and discouraged, lack energy and mental focus, and can have physical symptoms like eating and sleeping too much or too little.
But along with these lows, the thing that sets bipolar disorders apart from unipolar depression is that individuals can have periods of high moods, which are called manic episodes or hypomanic episodes, depending on their level of severity.
In a manic state, people can feel energetic, overly happy or optimistic, even euphoric with really high self-esteem.
And on the surface, these might seem like very positive characteristics, but when an individual is in a full manic episode, these symptoms can reach a dangerous extreme.
A person experiencing mania might invest all of their money in a risky business venture or behave recklessly.
Individuals might talk pressured speech, where they talk constantly at a rapid-fire pace, or they might have racing thoughts and might feel “wired,” as if they don’t need sleep.
Manic episodes can also include delusions of grandeur: for example, they might believe that they are on a personal mission from god, or that they have supernatural powers.
And they might make poor decisions without any regard for later consequences.
One way to understand these swings is by charting them on a graph.
So let’s say the y-axis is mood, with mania and depression being on the far ends of the axis, and the x-axis is time.
A neurotypical person (someone without a mental health disorder) might have normal ups and downs throughout their life, and they might even have some pretty serious lows once in a while, maybe after losing a job or moving to a new place and feeling lonely.
An individual with unipolar depression though, might have the normal highs, but they might have some crushing lows that last for a long period of time and may not have an obvious trigger.
The first type of bipolar disorder is called bipolar 1.
People diagnosed with bipolar 1 must have some major lows that last at least 2 weeks, and some major highs that last at least a week or require hospitalization.
That said, untreated manic episodes can last as long as 3-6 months.
Depression is seen in most cases, but is not required for a diagnosis.