Module Quiz Wk 8 – 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. Patient denies suicidal ideation or homicidal ideation. Denies Auditory or Visual Hallucinations.
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Current Meds:
Ortho Evra Q 3 weeks
Citalopram 20mg daily
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Past Medications:
None
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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 disorder
Sister: Depression
Social History:
Patient reports she is “high on life” and doesn’t need anything
Allergies: NKA
Mental Status Exam
Appearance: flashy attire, heavy makeup
Eye Contact: Average
Activity: Psychomotor agitation – difficult to get patient to sit for interview
Motor/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 abstract proverb
Orientation: A/O x3
Knowledge: 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.
a. VPA –
b. Lithium -
c. Second Generation Antipsychotic –
4. Which specific medication would be best to initiate in JD? Please list one.
5. Why did you select the above option over all of the other available first line options? Please list two reasons.
6. What is your initiation dosing regimen, titration plan, and your goal dose of the medication selected for JD? Be very specific here. (I am also looking for timelines between increased doses)
7. What should you tell JD regarding the timing of onset, and of effect? Ie. how long until effect may be seen?
8. How should the therapeutic response be evaluated?
9. Which potential side effects should be monitored in JD and what education would you provide?
