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Bipolar disorder — MCCQE Part 1 MCQ

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EasyDepressionBipolar disorderMCCQE Part 1

A 29-year-old man presents with depression but describes previous episodes of decreased need for sleep, grandiosity and impulsive spending lasting 1 week. Which of the following is the most appropriate next step?

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Correct answer: D — Avoid antidepressant monotherapy and assess for bipolar disorder with mood-stabilising treatment planning

Avoid antidepressant monotherapy and assess for bipolar disorder with mood-stabilising treatment planning is the single best answer because the age, timing, examination findings and investigations in the vignette fit Bipolar disorder better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to CANMAT bipolar disorder guidelines, with attention to acuity, safety-netting and local provincial pathways.

Reference: CANMAT bipolar disorder guidelines