Reference no: EM133869227

Bipolar disorder

CC: "I feel fantastic!"HPI: JD is a 30 year old female, brought into the clinic with her family. She is dressed in a brightly colored, provocative dress. She is also wearing heavy makeup and a large quantity of jewelry. She notes that she isn't sleeping much, but it's because she is so productive. She is working on creating a cure for cancer and starting a campaign for the republican primaries as she plans on becoming president of the universe. Patient unable to explain why she was brought in and wishes to be sent home. The patient denies suicidal ideation or homicidal ideation. Denies Auditory or Visual Hallucinations.

Current Meds: Ortho Evra Q 3 weeksCitalopram 20mg daily

Past Medications: None

Past Psych History: Major Depressive Episode - 4 months earlier diagnosed by PCP and placed on Citalopram at that time.

PMH: None

Family Medical and Psych History:

Father: DM

Mother: Bipolar disorderSister: Depression

Social History: The patient reports she is "high on life" and doesn't need anything

Allergies: NKA

Mental Status Exam

Appearance: flashy attire, heavy makeup Eye Contact: AverageActivity: Psychomotor agitation - difficult to get patient to sit for interviewMotor/Musculoskeletal: Normal Gait, (-) Abnormal gait, abnormal movement, tics, tremors

Attitude: Appropriate

Mood: Manic

Affect: Bright

Speech: Pressured, loud, spontaneous

Language: Articulate and Coherent

Thought Content: (-) AH/VH/SI/HI (+) Delusions (Feels she is working on creating a cure for cancer and starting a campaign for the republican primaries as she plans on becoming president of the universe).

Thought Process: Circumstantial

Abstract reasoning: Able to an abstract proverb

Orientation: A/O x3

2Knowledge: completed 12th grade

Judgment: Limited insight

Given all of the information you know about the treatment of bipolar mania, please provide a treatment recommendation for JD. There may be more than one correct answer for the questions below, as long as the justification provided is correct, rational, and sound. (Cite your sources)

1. Should JD still be considered to have a diagnosis of MDD? Why or why not?
2. Which medication effect, if any, might JD experiencing (see: CC) and how will that impact your plan?
3. Please compare and contrast the 3 types of first-line therapy for bipolar mania. Be sure to include at least 3 key differences between each of the therapies.

VPA -

Lithium -

Second Generation Antipsychotic

1. Which specific medication would be best to initiate in JD? Please list one.
2. Why did you select the above option over all of the other available first-line options? Please list two reasons.
3. What are your initiation dosing regimen, titration plan, and your goal dose of the medication selected for JD? Be very specific here. Include the timelines between increased doses
4. What should you tell JD regarding the timing of onset, and of effect? how long until effect may be seen?
5. How should the therapeutic response be evaluated?
6. Which potential side effects should be monitored in JD and what education would you provide?