Examqo › Examqo library › Psychiatry › Mood disorders · IMLE
Bipolar disorder
A single manic episode is enough for bipolar I disorder; treatment rests on a mood stabiliser — lithium is the foundation and reduces suicide — and an antidepressant alone is forbidden.
Why it matters in the exam
Questions test the distinction between mania (at least a week, or any duration if admission is needed, with severe impairment or psychosis) and hypomania (at least 4 days, without severe impairment and without psychosis), and between type I and type II (hypomania and major depression, never full mania). Cyclothymia is mild fluctuation over two years. Before the diagnosis, substances (cocaine, amphetamines, steroids) and hyperthyroidism are excluded.
A large part of the questions is about lithium: the therapeutic range, the signs of toxicity, the drugs that raise its level (thiazides, ACE inhibitors, NSAIDs) and dehydration, and the long-term side effects — hypothyroidism, nephrogenic diabetes insipidus, hypercalcaemia and kidney damage. The other drugs are asked too: valproate causes neural tube defects, so it is avoided in women of reproductive age; lamotrigine needs slow up-titration because of Stevens-Johnson syndrome; carbamazepine causes agranulocytosis and SIADH. In bipolar depression quetiapine, lurasidone or lamotrigine are preferred.
Key points
- Type I = at least one mania; type II = hypomania and major depression.
- Mania at least a week; hypomania at least 4 days.
- Lithium: level 0.6–1.2; toxicity above 1.5.
- Lithium reduces suicide; monitor TSH, creatinine and calcium.
- In bipolar depression: quetiapine, lurasidone, lamotrigine — not an antidepressant alone.
Summary table
| Condition | Definition | Treatment | Exam notes |
|---|---|---|---|
| Mania (type I) | At least a week of elevated or irritable mood with increased energy, or any duration with admission | Lithium or valproate, and/or an atypical antipsychotic; stop antidepressants | Psychosis possible; reduced need for sleep without fatigue |
| Hypomania (type II) | At least 4 days, without severe impairment and without psychosis | Mood stabiliser; the main burden is depression | Type II is not milder — much time is spent depressed |
| Bipolar depression | A depressive episode in a bipolar patient | Quetiapine, lurasidone, lamotrigine or lithium | Antidepressant alone → risk of switching to mania |
| Lithium level | Therapeutic 0.6–1.2 mmol/L | Above 1.5 — toxicity; above 2.5 — consider dialysis | Coarse tremor, ataxia, vomiting, confusion |
| Lithium monitoring | Before treatment and regularly | TSH, creatinine, calcium, drug level | Hypothyroidism and nephrogenic diabetes insipidus |
| Valproate, lamotrigine, carbamazepine | Other mood stabilisers | By situation | Valproate: anomalies, liver, pancreas; lamotrigine: rash; carbamazepine: agranulocytosis, SIADH |
Free exam questions
מה הסימפטום ש לא משותף ל- ADHD ו- Bipolar Disorder בגיל ילדות? (the question as examined, in Hebrew)
- א. פטפטנות
- ב. הסחת דעת
- ג. היפראקטיביות
- ד. צורך מועט בשינה
בת 40 ., לאחר היסטרקטומיה, מתקבלת במאניה רוגזת למחלקה סגורה מה הטיפול המועדף ?במצבה (the question as examined, in Hebrew)
- א. Lamotrigine
- ב. Lithium
- ג. Carbamazepine
- ד. Valproic Acid עמוד 18 יש לבחור בתשובה אחת בלבד עבור כל שאלה
Which of the following treatments is most recommended for managing HALLUCINOGEN PERSISTENT PERCEPTION DISORDER (HPPD)?
- A. CLONAZEPAM
- B. LITHIUM
- C. ALPRAZOLAM
- D. FLUOXETINE
Example question from the licensing exam (IMLE)
A 30-year-old single man is diagnosed with schizophrenia and diabetes type 1. He is treated with haloperidol and insulin. Aripiprazole was added 2 months ago. He is brought to the emergency room with an acute change in his condition, angry, psychomotor restlessness, and aggressive. His thoughts are unorganized and he is not oriented regarding time or place. Which of the following is the most likely explanation for his condition?
- A. Adverse effect of aripiprazole
- B. Manic state
- C. Exacerbation of schizophrenia
- D. Hypoglycemia
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
The full version is open to subscribers of: Medical licensing exam (IMLE), Psychiatry, Family medicine, Occupational medicine.
Subscriber? Read the full topic Plans and prices 25 free questions
Sources
- DSM-5-TR, American Psychiatric Association, 2022 — Bipolar and Related Disorders
- CANMAT/ISBD Guidelines for the Management of Patients with Bipolar Disorder, 2018, with 2023 update — Acute mania; bipolar depression; maintenance
- NICE guideline CG185, 2014, updated 2023 — Bipolar disorder: assessment and management
- Kaplan and Sadock's Synopsis of Psychiatry, 12th edition (2021) — Mood Disorders
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.