WBR266

Author	[[PageAuthor::Sapan Patel M.B.B.S]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Emergency Room
Sub Category	SubCategory::Psychiatry
Prompt	[[Prompt::The police bring a 22-year-old male into the emergency room after a disruption at the local college campus. According to his medical chart, he has been treated for a depressive episode in the past. He describes his mood as "great" but claims to have been awake for 4 days due to working on several inventions. He admits to rapid thoughts and believes that God has chosen him to be the next Messiah. In fact, angels have commanded him to steal from the student union in order to begin a new church. Which of the following drugs should be given to treat symptoms of this patient?]]
Answer A	AnswerA::Divalproex sodium
Answer A Explanation	AnswerAExp::Incorrect- It is an appropriate treatment for mania but it may take several days to weeks before significant therapeutic effects are achieved.
Answer B	AnswerB::Lamotrigine
Answer B Explanation	AnswerBExp::Incorrect- Lamotrigine is efficacious in bipolar depression and in the maintenance phase, but it is not particularly effective in treating the manic phase.
Answer C	AnswerC::Lithium
Answer C Explanation	AnswerCExp::Incorrect- It is an appropriate treatment for mania but it may take several days to weeks before significant therapeutic effects are achieved.
Answer D	AnswerD::Mirtazapine
Answer D Explanation	AnswerDExp::Incorrect- An antidepressant such as mirtazapine may worsen mania in a bipolar patient.
Answer E	AnswerE::Lorazepam
Answer E Explanation	AnswerEExp::Correct- Lorazepam or other high potency benzodiazepines are useful in the acute management of manic patients as the sedative effects are relatively rapid.
Right Answer	RightAnswer::E
Explanation	[[Explanation::This patient displays criteria for bipolar disorder, manic with psychotic features. Individuals intoxicated with cocaine classically show signs similar to mania. Frank psychotic symptoms can occur in up to 50% of individuals. Cocaine is a powerful nervous system stimulant. Its effects can last from 15–30 minutes to an hour, depending on dosage and the route of administration. Cocaine increases alertness, feelings of well-being and euphoria, energy and motor activity, feelings of competence and sexuality. Athletic performance may be enhanced in sports where sustained attention and endurance is required. Anxiety, paranoia and restlessness can also occur, especially during the comedown. With excessive dosage, tremors, convulsions and increased body temperature are observed.With excessive or prolonged use, the drug can cause itching, tachycardia, hallucinations, and paranoid delusions. Overdoses cause hyperthermia and a marked elevation of blood pressure, which can be life-threatening. Educational Objective: Lorazepam is used to treat manic symptoms associated with cocaine intoxication and it has relatively rapid course of action. Educational Objective: References: ]]
Approved	Approved::Yes
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