Clinical Case Summary
A 20-year-old woman is brought to the local emergency department (ED) by her family due to her increasingly erratic behavior. She appears restless, pacing around the waiting room, and her parents report that she was recently fired from her job as a tattoo artist. She has not slept for four nights, and her speech is rapid and tangential. She recently made extravagant purchases, including a $20,000 car and a $40,000 van, to support her mobile tattoo business in Naples, Florida. Despite her condition, she is reluctant to stay in the ED, believing that she has more important things to attend to and considering others as beneath her.
DSM-5 Diagnosis
Based on the information provided, the DSM-5-TR diagnosis for the woman is likely “Bipolar I Disorder, Current Episode Manic” (American Psychiatric Association, 2013).
Pharmacological Treatment
According to clinical guidelines, pharmacological treatment for acute manic episodes of Bipolar I Disorder often involves mood stabilizers or antipsychotic medications. Lithium, a mood stabilizer, is commonly prescribed to stabilize mood and reduce the intensity of manic symptoms (Yatham et al., 2018). The rationale for this treatment is to help manage the woman’s manic symptoms, stabilize her mood, and prevent further escalation of her behavior.
Non-Pharmacological Treatment
A non-pharmacological approach that could be considered is psychoeducation for the woman and her family. Psychoeducation involves providing information about bipolar disorder, its symptoms, treatment options, and strategies for managing the condition. It can empower both the patient and family members to better understand the illness, recognize early signs of episodes, and facilitate treatment adherence (Mantere et al., 2020).
Assessment of Treatment
The appropriateness of lithium treatment should be evaluated based on the woman’s medical history and any potential interactions with other medications. The effectiveness of lithium in stabilizing her mood and reducing manic symptoms should be closely monitored. As for safety, regular monitoring of her kidney and thyroid function, which can be affected by lithium, is essential. Adherence to medication can be challenging, especially during manic episodes; hence, involving her family in treatment decisions and adherence strategies is crucial.
Using a local pharmacy, the cost of lithium can be researched to identify the most cost-effective option for the patient. Additionally, potential side effects and risks associated with lithium should be discussed with the patient and her family to ensure informed decision-making.
In conclusion, the case of the 20-year-old woman highlights the characteristic symptoms of a manic episode in Bipolar I Disorder. A comprehensive treatment approach involves both pharmacological (e.g., lithium) and non-pharmacological interventions (e.g., psychoeducation) to manage her manic symptoms, stabilize her mood, and prevent future episodes. Close monitoring, involving her family, and addressing potential barriers to treatment adherence are integral to her overall care.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Author.
Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., … & Canadian Network for Mood and Anxiety Treatments (CANMAT). (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20(2), 97-170.
Mantere, O., Suominen, K., Leppämäki, S., Valtonen, H., Arvilommi, P., & Isometsä, E. (2020). The clinical characteristics and treatment of bipolar disorder patients with and without co-morbid anxiety disorders. Journal of Affective Disorders, 276, 226-233.
