Rosh Psychiatry Board Practice Exam

A 23-year-old woman is hospitalized for acute mania. What represents the best choice of maintenance therapy after stabilization?

1. Psychotherapy alone

2. Psychotherapy and lithium 300 mg TID

3. Psychotherapy and valproate 250 mg TID

4. Psychotherapy and quetiapine 300 mg daily

The correct answer is: Psychotherapy and quetiapine 300 mg daily

The choice of maintenance therapy after stabilization for a patient with acute mania, especially in the context of bipolar disorder, requires careful consideration of the most effective treatment options available for long-term management. In this case, combining psychotherapy with quetiapine at a consistent dosage is particularly advantageous. Quetiapine is an atypical antipsychotic that has demonstrated efficacy in both the acute and maintenance treatment of bipolar disorder, particularly in managing mood episodes and stabilizing mood over time. The choice of quetiapine reflects its broad spectrum of action, which not only helps alleviate manic symptoms but also may prevent future manic or depressive episodes. While the other options present alternatives, they may not be as optimal for this specific scenario. Psychotherapy alone lacks the necessary pharmacological support required for effective long-term management post-mania stabilization. The use of lithium and valproate can be appropriate in some instances, but they may require more extensive monitoring for side effects and toxicity, and their specific dosing may need adjustment over time based on clinical response. Therefore, the selection of psychotherapy combined with quetiapine emphasizes a well-rounded approach that addresses both pharmacological stabilization and supportive therapeutic measures, making it the best choice for maintenance therapy in the context of this patient’s