A 35-Year-Old Man with a History of Bipolar Disorder Since

question 155

Multiple Choice

A 35-year-old man with a history of bipolar disorder since age 27 comes to the office for follow-up.  The patient was hospitalized 2 years ago for a manic episode and was discharged with a therapeutic dose of lithium; he continues to take the same dose and is engaged in weekly psychotherapy.  The patient says, "This is the best I've felt in years; work is going great, and I'm getting married in a few months.  I really don't want to get hospitalized again, but I also don't want to keep taking medication if I don't have to."  Prior medication trials include quetiapine and olanzapine with fluoxetine; both treatments were discontinued due to weight gain.  Medical history is noncontributory.  Vital signs and physical examination are unremarkable.  The patient appears euthymic and has a full range of affect.  Complete blood count, basic metabolic panel, and TSH are within normal limits; serum lithium level is within therapeutic range.  Which of the following is the most appropriate response to this patient?

• A)"Mood episodes are often triggered by stress or change; let's continue the medication for now and begin tapering it after your wedding."
• B)"Mood episodes in bipolar disorder are highly recurrent; I suggest continuing lithium at the current dose and monitoring for side effects."
• C)"Since you have had no mood episodes in the past 2 years and you meet regularly for therapy, it would be reasonable to decrease your dose."
• D)"We can try switching to a medication that you don't have to take daily; let's talk about the available long-acting injectable treatments."

---

Definitions:

Plant Asset

A long-term physical asset that is used as part of a company's operations to help in generating revenues, similar to a fixed asset but specifically related to manufacturing.

Land

Real property consisting of natural resources and geographic space, which has various uses such as agricultural, commercial, or residential.

Unearned Revenues

Income received by an individual or company for a service or product that has yet to be provided or delivered.

Current Assets

Assets that are expected to be converted into cash, sold, or consumed within one year or a business’s operating cycle, whichever is longer.