### Concept Map Template
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**Primary Diagnosis: Bipolar Disorder with Acute Psychotic Episode**
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### 1. Describe the pathophysiology of the primary diagnosis in your own words. What are the patient’s risk factors for this diagnosis?
**Pathophysiology of Bipolar Disorder with Acute Psychotic Episode:**
Bipolar disorder is a chronic mental health condition characterized by extreme mood swings, including manic (or hypomanic) episodes and depressive episodes. The pathophysiology involves complex interactions between genetic predisposition, neurotransmitter imbalances, and environmental factors. During manic episodes, there is an overactivity of neurotransmitters such as dopamine and norepinephrine, whereas depressive episodes often involve deficiencies in these neurotransmitters. Acute psychotic episodes can occur during severe manic or depressive phases, marked by delusions, hallucinations, and impaired reality testing.
**Causes:**
– Genetic predisposition
– Neurochemical imbalances
– Environmental stressors
– Traumatic events
– Substance abuse
**Risk Factors (genetic/ethnic/physical):**
– Family history of bipolar disorder or other psychiatric conditions
– Caucasian ethnicity has been linked to higher rates of bipolar disorder, but it affects all ethnicities.
– Substance abuse
– High levels of stress
– Major life changes or traumatic experiences
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### 2. What are the patient’s signs and symptoms for this diagnosis? How does the diagnosis impact other body systems and what are the possible complications?
**Signs and Symptoms – Common presentation:**
– Elevated mood or irritability (mania)
– Decreased need for sleep
– Grandiosity or inflated self-esteem
– Increased talkativeness or pressured speech
– Racing thoughts
– Distractibility
– Increased goal-directed activity or psychomotor agitation
– Risky behaviors (e.g., excessive spending, sexual indiscretions)
– Delusions or hallucinations during psychotic episodes
**How does the diagnosis impact each body system? Complications:**
– **Neurological System:** Cognitive impairments, difficulty in concentrating, and memory issues.
– **Cardiovascular System:** Potential for increased heart rate and hypertension during manic episodes.
– **Metabolic System:** Weight gain due to medication side effects, potential for diabetes.
– **Endocrine System:** Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis.
– **Musculoskeletal System:** Increased risk of accidents and physical injuries during manic episodes.
– **Complications:** Suicidal ideation, substance abuse, relationship issues, occupational problems, financial difficulties, and increased risk of comorbid psychiatric disorders (e.g., anxiety disorders).
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### 3. What are other potential diagnoses that present in a similar way to this diagnosis (differentials)?
– Major depressive disorder with psychotic features
– Schizophrenia or schizoaffective disorder
– Borderline personality disorder
– Attention-deficit/hyperactivity disorder (ADHD)
– Substance-induced mood disorder
– Thyroid dysfunction (e.g., hyperthyroidism)
– Anxiety disorders with panic attacks
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### 4. What diagnostic tests or labs would you order to rule out the differentials for this patient or confirm the primary diagnosis?
– **Psychiatric evaluation**: Comprehensive clinical assessment by a psychiatrist.
– **Mood disorder questionnaire (MDQ)**: Screening tool for bipolar disorder.
– **Complete blood count (CBC)**: To rule out anemia or infections.
– **Thyroid function tests (T3, T4, TSH)**: To rule out thyroid dysfunction.
– **Toxicology screen**: To rule out substance-induced mood disorders.
– **Electrolyte panel**: To check for electrolyte imbalances.
– **Liver function tests**: To assess the impact of medications on the liver.
– **Brain imaging (MRI or CT scan)**: If neurological symptoms are present to rule out brain lesions or structural abnormalities.
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### 5. What treatment options would you consider? Include possible referrals and medications.
**Treatment Options:**
– **Medications:**
– **Mood Stabilizers:** Lithium 300 mg orally three times a day. Continue monitoring serum lithium levels.
– **Antipsychotics:** Risperidone 2 mg orally twice a day. Start with 2 mg twice daily and adjust based on response and tolerability.
– **Antidepressants:** Discontinue imipramine due to risk of triggering manic episodes.
– **Therapeutic Interventions:**
– **Cognitive Behavioral Therapy (CBT):** To address thought patterns and behaviors.
– **Psychoeducation:** For patient and family to understand the disorder and treatment adherence.
– **Supportive Therapy:** To provide emotional support and coping strategies.
– **Referrals:**
– **Psychiatrist:** For medication management and regular follow-up.
– **Therapist or Counselor:** For psychotherapy sessions.
– **Social Worker:** To assist with housing, financial, and social support services due to homelessness.
– **Monitoring:**
– Regular follow-ups for medication adjustment and side effect monitoring.
– Routine blood tests to monitor lithium levels and overall health.
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### References
– American Psychiatric Association. (2013). Practice guideline for the treatment of patients with bipolar disorder (second edition). *American Journal of Psychiatry, 160*(4), 1-50.
– Malhi, G. S., Gessler, D., & Outhred, T. (2017). The use of lithium for the treatment of bipolar disorder: Recommendations from clinical practice guidelines. *Journal of Affective Disorders, 217*, 266-280.
– Post, R. M., & Leverich, G. S. (2008). Treatment of bipolar depression. *Journal of Clinical Psychiatry, 69*(11), e18.
Concept Map Template
Primary Diagnosis: ___________________________________________________________
1. Describe the pathophysiology of the primary diagnosis in your own words. What are the patient’s risk factors for this diagnosis?
| Pathophysiology of Primary Diagnosis | |
| Causes | Risk Factors (genetic/ethnic/physical) |
2. What are the patient’s signs and symptoms for this diagnosis? How does the diagnosis impact other body systems and what are the possible complications?
| Signs and Symptoms – Common presentation | How does the diagnosis impact each body system? Complications? |
3. What are other potential diagnosis that present in a similar way to this diagnosis (differentials)?
4. What diagnostic tests or labs would you order to rule out the differentials for this patient or confirm the primary diagnosis?
5. What treatment options would you consider? Include possible referrals and medications.
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