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Management of Bipolar Disorders in Prison Populations

Introduction

1. Bipolar disorder is a recurrent illness, and 90% of patients will have more than one episode in their lifetime, lasting from a few weeks to several months.

A. True

B. False


2. Which of the following is a risk factor for the development of bipolar disorder?

A. A family history of mood disorders

B. Perinatal stress

C. Head trauma

D. All of the above


Screening and Diagnosis

3. A complete physical examination is recommended to confirm a bipolar diagnosis and to rule out any underlying comorbidities, such as:

A. Diabetes

B. Hypothyroidism

C. Lupus

D. Renal failure


Assessment

4. Substance abuse can contribute to or precipitate a relapse, and can be a reason for the patient’s lack of response to medication.

A. True

B. False


5. Suicide attempts occur in up to _____ of patients with bipolar disorder, making it important to assess each patient’s risk of suicide.

A. 90%

B. 70%

C. 50%

D. 30%


6. To evaluate suicide risk, the clinician should specifically ask the patient:

A. Do you ever feel so bad that you wish you were dead?

B. Do you ever think of hurting yourself or taking your own life?

C. Do you currently have a plan?

D. All of the above.


Treatment Challenges

7. Which of the following will facilitate the development of a productive clinical-patient relationship?

A. Maintaining excellent interpersonal boundaries.

B. Behaving honestly and predictably.

C. Being available during times of crisis.

D. All of the above.


8. When a patient refuses treatment, the treatment cannot be provided, even in an emergency.

A. True

B. False


Treatment Regimens

9. Despite clinical differences between manic and hypomanic episodes, they are treated with the same medication.

A. True

B. False


10. When the medication is taken regularly at proper dosages, and drug levels are within the therapeutic range, a large percentage of patients will respond to a single medication for mania or mixed episode.

A. True

B. False


11. Which of the following is a first-line monotherapy for acute mania, hypomania, or mixed episode?

A. Lithium

B. Clozapine

C. Carbamazepine

D. Haloperidol


12. The goal of maintenance therapy is to:

A. Reduce residual symptoms.

B. Delay and prevent recurrence of new mood episodes.

C. Reduce the risk of suicide.

D. All of the above.


13. Which of the following is not a recommended monotherapy for maintenance treatment?

A. Lithium

B. Benzodiazepine

C. Risperidone

D. All of the above


Medications Used in the Treatment of Bipolar Disorder

14. Lithium may require a month or more before an initial response is seen in a manic episode.

A. True

B. False


15. When patients dramatically decrease their _____ intake, lithium levels in the body will rise and potentially become toxic.

A. Sodium

B. Calcium

C. Potassium

D. Magnesium


16. Which of the following is a drug of abuse and should generally not be prescribed in the correctional setting?

A. Olanzapine

B. Ziprasidone

C. Quetiapine

D. All of the above


17. Of the SSRIs, paroxetine has the most data supporting its efficacy in bipolar major depression.

A. True

B. False


Non-Medication Interventions for Bipolar Disorder

18. Electroconvulsive Therapy is considered first-line therapy in patients with all of the following, except for:

A. Severe suicidality

B. Major depression

C. Manic delirium

D. Severe psychosis


Special Populations

19. Which of the following is recommended as the first-line treatment of mania and hypomania in pregnant patients?

A. Valproate

B. Lamotrigine

C. Haloperidol

D. Carbamazepine


20. Older bipolar patients have been found to experience no difference in which of the following compared to younger patients?

A. Depressive symptomatology

B. Manic and psychotic symptoms

C. Suicide attempts

D. All of the above


Appendix 8A. Side Effects of Second-Generation Antipsychotics (SGAs)

21. Which of the following is considered a serious reaction to SGAs?

A. Respiratory disorders

B. Diarrhea

C. Syncope

D. Visual disturbances


Appendix 8B. Monitoring for Second-Generation Antipsychotics (SGAs)

22. Which of the following should be monitored on a quarterly basis?

A. Weight and body mass index

B. Fasting glucose

C. Blood pressure

D. All of the above


Appendix 9. Neuroleptic Malignant Syndrome

23. NMS is a potentially fatal condition that can occur in any patient taking antipsychotic medication.

A. True

B. False


Appendix 10A. Side Effects of First-Generation Antipsychotics (FGAs)

24. Which of the following side effects is related to dopamine blockage?

A. Muscle rigidity

B. Tremor

C. Rabbit syndrome

D. All of the above


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