Posted: September 6th, 2023
A 20-year-old woman is brought to the local emergency department (ED)
Module 4 discussion. Answer the questions below based on the following case study.
A 20-year-old woman 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 three 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? Include the rationale for this treatment.
Which non-pharmacological treatment would you prescribe? 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.
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All replies must be constructive and use literature where possible
Clinical Case Summary:
A 20-year-old woman is brought to the ED by her family because she is showing symptoms of restlessness, pacing around, rapid speech that quickly wanders off the point, and not sleeping for three nights. She had been asked to leave her job as a tattoo artist, and she had recently purchased a $20,000 car and a $40,000 van to jump-start her mobile tattoo business. She is reluctant to remain in the ED department, feeling that she has far too much to do, and considers it a waste of everyone’s time. The patient believes she is far too important to be held back by anyone.
DSM 5-TR Diagnosis:
Based on the given information, the patient is likely experiencing a manic episode, a symptom of bipolar disorder. According to DSM-5 criteria, a manic episode is defined as a distinct period of abnormally and persistently elevated, expansive, or irritable mood and increased energy or activity, lasting at least one week and present most of the day, nearly every day. The patient also meets the criteria of experiencing three or more symptoms such as inflated self-esteem or grandiosity, decreased need for sleep, excessive involvement in pleasurable activities, racing thoughts, and rapid speech.
The first-line treatment for a manic episode is mood stabilizers such as lithium or anticonvulsants such as valproate or carbamazepine. However, lithium requires regular blood monitoring and has potential side effects like tremors, frequent urination, and weight gain. Valproate and carbamazepine may cause side effects such as dizziness, sedation, or cognitive slowing. As the patient is currently experiencing a manic episode, an antipsychotic medication such as risperidone may be a suitable option. Risperidone is FDA approved for the treatment of manic and mixed episodes of bipolar disorder in adults. It works by blocking the dopamine receptors, which are believed to be responsible for the manic symptoms. Risperidone has a relatively low incidence of extrapyramidal side effects and weight gain compared to other antipsychotics. However, it may cause drowsiness and orthostatic hypotension.
In addition to pharmacological intervention, the patient could benefit from behavioral interventions that aim to increase her understanding of bipolar disorder, her symptoms, and how to manage them effectively. Psychoeducation is a non-pharmacological treatment that involves educating patients and their families about the symptoms and management of bipolar disorder. Psychoeducation is a low-cost intervention and is shown to be effective in reducing symptoms and improving medication adherence. The patient’s family could be included in this intervention to improve their understanding of the patient’s illness and how they can support her. Furthermore, the patient could be encouraged to adopt a regular sleep pattern and reduce stress levels. A regular exercise program could also be beneficial for managing her manic symptoms.
Assessment of Treatment:
Risperidone is relatively inexpensive, with a monthly cost of around $10-$15 at a local pharmacy. The potential side effects of drowsiness and orthostatic hypotension should be discussed with the patient, and she should be advised not to drive or operate heavy machinery until she knows how the medication affects her. As risperidone is an antipsychotic medication, there is a potential for misuse, and the patient’s adherence to the medication should be monitored regularly. However, risperidone has shown to be effective in reducing manic symptoms in patients with bipolar disorder. The non-pharmacological intervention of psychoeducation is low-cost, effective, and has a high potential for patient adherence. The involvement of the patient’s family in psychoeducation could increase the effectiveness of the intervention.