A Patient with Bipolar-II Disorder

By Mirza Baig, MS-IV; Martin Kommor, MD; Veena Bhanot, MD

A man in his 30s with a history of bipolar-II disorder presented with severe anxiety and suicidal ideations. Symptoms at admission included decreased sleep, concentration, and libido, increased energy, rapid speech, racing thoughts, and feelings of irritability, frustration, hopelessness, and helplessness. The patient also described panic attack symptoms progressing in frequency and severity, with symptoms of substernal chest pain, nausea, vomiting, diaphoresis, palpitations, dyspnea, and lightheadedness.

ABOUT THE AUTHORS

Mirza Baig, MS-IV, is obtaining an MD degree at West Virginia University School of Medicine, Charleston, West Virginia. Martin Kommor, MD, is Chairman and Associate Professor, West Virginia University Department of Psychiatry, Charleston. Veena Bhanot, MD, is Associate Professor, West Virginia University Department of Psychiatry, Charleston.

Address correspondence to: Mirza Baig, MS-IV, 3000 Staunton Avenue SE, #42, Charleston, WV 25304.

Dr. Baig; Dr. Kommor; and Dr. Bhanot have disclosed no relevant financial relationships.

doi: 10.3928/00485718-20090924-01

EDUCATIONAL OBJECTIVES

1. State the prevalence, prognosis, and treatment challenges of patients with comorbid bipolar and anxiety disorders.

2. Name evidence in the literature of the significance of bipolar- and anxiety-related comorbidities upon prognosis and treatment.

3. Recognize that such comorbidities may require alternative treatment plans for effective management.

This CME activity is primarily targeted to patient-caring physicians specializing in psychiatry. Physicians can receive AMA PRA Category 1 Credits™ by reading the CME articles in Psychiatric Annals and successfully completing the quiz at the end of the articles. Complete instructions are given subsequently. Educational objectives are found at the beginning of each CME article.

CME ACCREDITATION

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Vindico Medical Education and Psychiatric Annals. Vindico Medical Education is accredited by the ACCME to provide continuing medical education for physicians.

Vindico Medical Education designates this educational activity for a maximum of 3 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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In accordance with the Accreditation Council for Continuing Medical Education's Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of the planners, teachers, and authors involved in the development of CME content. An individual has a relevant financial relationship if he or she has a financial relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears at the beginning of each CME-accredited article in this issue.

UNLABELED AND INVESTIGATIONAL USAGE

The audience is advised that this continuing medical education activity may contain references to unlabeled uses of FDA-approved products or to products not approved by the FDA for use in the United States. The faculty members have been made aware of their obligation to disclose such usage.

RESPONSIBILITY FOR STATEMENTS

All opinions expressed by authors and quoted sources are their own and do not necessarily reflect the opinions of the editors, publishers, or editorial boards of Psychiatric Annals or its employees, Vindico Medical Education or its employees, or the University of New Mexico. The acceptance of advertising in no way implies endorsement by the editors, publishers, or editorial boards of Psychiatric Annals.

The material presented at or in any Psychiatric Annals or Vindico Medical Education continuing education activity does not necessarily reflect the views and opinions of Vindico Medical Education or Psychiatric Annals. Neither Psychiatric Annals, Vindico Medical Education, nor the faculty endorse or recommend any techniques, commercial products, or manufacturers. The faculty/authors may discuss the use of materials and/or products that have not yet been approved by the U.S. Food and Drug Administration. Articles are intended for informational purposes only and should not be used as the basis of patient treatment. All readers and continuing education participants should verify all information before treating patients or utilizing any product.

Copyright © 2009 by SLACK Incorporated. All rights reserved. No part of this publication may be reproduced without prior written consent of the publisher.

INSTRUCTIONS

1. Review the stated learning objectives of the CME articles and determine if these objectives match your individual learning needs. You must read each of the CME articles in this issue carefully in order to take the quiz. Do not neglect the tables and other illustrative materials as they have been selected to enhance your knowledge and understanding.
2. The cost of taking the CME quiz is $25; you must pay this fee prior to completing the quiz online.
3. The quiz questions have been designed to provide a useful link between the CME articles in the issue and your everyday practice. Read each question and choose the correct answer by checking the box next to your desired answer.
4. After you answer all questions, your quiz is graded. A score of at least 80% is required to pass
5. If you passed the quiz, you will receive by mail a CME certificate of within 4 to 6 weeks. If you failed the quiz, you may retake the quiz at another time by returning to the CME articles and then registering again for the quiz.

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Bipolar Disorder

A Tribute to Robert Post’s Bipolar ‘Perfect Storm’
Jan Fawcett, MD

Bipolar Disorder, with a Focus on Childhood-onset Bipolar Disorder
Robert M. Post, MD

 Childhood-onset Bipolar Disorder: The Perfect Storm
Robert M. Post, MD

 Survey of Expert Treatment Approaches for Children with Bipolar Disorder-not otherwise specified and Bipolar-I Presentations
Robert M. Post, MD; Janet Wozniak, MD

 Hypercalcemia, Cinacalcet, and Bipolar Schizoaffective Disorder
Julia Moukharskaya, MD, PhD; Anna Marino, MD; Christopher Miller, MD; Shantha G. Pandian, MD; Juan F. Rodriguez, MD; Alan N. Peiris, MD, PhD, MRCP

The Narcissistic-masochistic Character
Arnold M. Cooper, MD