A 20-year-old woman with a past history of MDD is brought to the local emergency department (ED) by her family. She appears restless, pacing around the waiting room, and her parents say that she has recently been asked to leave her job as a tattoo artist. She has not slept for four nights, and her speech is rapid and quickly wanders off the point. She had recently purchased a $20,000 car and a $40,000 van to jump-start her mobile tattoo business in Naples, Florida. She is very reluctant to remain in the ED department because she has far too much to do and considers it a waste of everyone’s time. She believes that she is far too important to be held back by minions.
- Summarize the clinical case.
- What is the DSM 5-TR diagnosis based on the information provided in the case?
- Which pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment.
- Which non-pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment excluding a psychotherapeutic modality.
- Include an assessment of the treatment’s appropriateness, cost, effectiveness, safety, and potential for patient adherence to the chosen medication. Use a local pharmacy to research the cost of the medication and provide the most cost-effective choice for the patient. Use great detail when answering questions 3-5.
post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
### Clinical Case Summary
The clinical case involves a 20-year-old woman with a history of Major Depressive Disorder (MDD) who presents to the emergency department (ED) in a manic episode. She exhibits symptoms of restlessness, rapid speech, decreased need for sleep, grandiose ideas (such as purchasing vehicles for a business venture), and a sense of elevated self-importance. These symptoms suggest a possible diagnosis of Bipolar I Disorder, given the presence of both manic and depressive episodes in her history.
### DSM-5 Diagnosis
Based on the information provided, the DSM-5 diagnosis for this patient is likely **Bipolar I Disorder, current episode manic, severe with psychotic features**. This diagnosis fits due to the presence of manic symptoms lasting at least one week, which significantly impair her functioning and include psychotic features (believing she is too important to be held back).
### Pharmacological Treatment
According to clinical guidelines for Bipolar I Disorder, especially for acute manic episodes, a first-line treatment option would be **Lithium**. Lithium is effective in reducing the severity and frequency of manic episodes. It works by modulating neurotransmitter release and enhancing neurotransmitter reuptake. The recommended starting dose for acute mania is typically 600-900 mg/day in divided doses, with serum levels monitored closely to maintain therapeutic levels (0.8-1.2 mEq/L).
**Rationale**: Lithium is chosen for its proven efficacy in treating acute mania and stabilizing mood in bipolar disorder. It also helps reduce the risk of suicide, which is crucial in bipolar patients experiencing manic episodes. Monitoring of serum levels is essential to avoid toxicity and optimize therapeutic benefits.
**Assessment of Treatment**:
– **Appropriateness**: Lithium is appropriate as a first-line treatment for acute mania as per clinical guidelines.
– **Cost**: The cost of Lithium can vary widely. Checking with local pharmacies, generic forms of Lithium carbonate may cost around $10-$30 per month, making it relatively affordable compared to newer mood stabilizers.
– **Effectiveness**: Lithium has shown to be effective in reducing manic symptoms and preventing relapse in bipolar disorder patients.
– **Safety**: It is generally safe when monitored properly for renal function, thyroid function, and serum levels to prevent toxicity.
– **Potential for Adherence**: Adherence may be challenging due to the need for regular blood tests and potential side effects like polyuria, tremors, and weight gain. Patient education and regular follow-ups can improve adherence.
### Non-Pharmacological Treatment
A non-pharmacological treatment option, excluding psychotherapy, would be **Psychoeducation**. Psychoeducation involves providing structured information about the nature of bipolar disorder, its symptoms, treatment options, and strategies for self-management. It also includes educating family members about the disorder to enhance support and understanding.
**Rationale**: Psychoeducation helps the patient and her family understand the illness better, improve medication adherence, recognize early warning signs of relapse, and reduce stigma associated with mental illness. It empowers the patient to actively participate in her treatment plan and improve long-term outcomes.
### Conclusion
In conclusion, managing Bipolar I Disorder in this young woman involves pharmacological treatment with Lithium for acute mania and psychoeducation as a non-pharmacological intervention. Lithium is cost-effective, effective in treating acute mania, but requires careful monitoring for safety and adherence. Psychoeducation complements pharmacotherapy by enhancing patient and family understanding and support. This comprehensive approach aims to stabilize mood, reduce symptoms, and improve overall functioning in the context of Bipolar I Disorder.
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