Jill, 24 y/o Hispanic female arrives in the emergency room where her parents brought her for evaluation. They are worried because she is giving away all her possessions and says she is planning to move to the South Pole so she can ”save the world” Her parents say that she has hardly been sleeping at all for the last 7 days, but she seems very energetic. They say she has appeared to be ”in a frenzy” lately. When you interview Jill you notice that she speaks very rapidly and is laughing uncontrollably. It is hard to get her to be quiet long enough for you to ask questions. She seems agitated and has difficulty sitting still.
Questions
- Summarize the clinical case including the significant subjective and objective data.
- Generate a primary and two differential diagnoses. Use the DSM5 and ICD 10 codes.
- Discuss a pharmacological treatment would you prescribe? Use the clinical guidelines to support the rationale for this treatment.
- Discuss non-pharmacological treatment would you prescribe? Use the clinical guidelines to support the rationale for this treatment.
- Describe a health promotion intervention that would be appropriate for this patient.
Your initial post should be at least 500words, formatted, and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
Clinical Case Summary
Jill is a 24-year-old Hispanic female brought to the emergency room by her parents for evaluation. Her parents are worried because she has been giving away all her possessions and planning to move to the South Pole to save the world. She has hardly been sleeping for the last 7 days and appears very energetic. According to her parents, Jill has been in a frenzy lately. During the interview, Jill speaks very rapidly, laughs uncontrollably, and is agitated, making it difficult to get her to be quiet long enough for the physician to ask questions. She has difficulty sitting still.
Significant Subjective Data
- Jill is giving away all her possessions and planning to move to the South Pole to save the world.
- Jill has hardly been sleeping for the last 7 days.
- Jill’s parents report that she has appeared to be “in a frenzy” lately.
- Jill speaks very rapidly, laughs uncontrollably, and is agitated.
Significant Objective Data
- Jill appears very energetic.
- Jill has difficulty sitting still.
Primary Diagnosis and Differential Diagnoses
Primary Diagnosis: Bipolar I Disorder, Current Episode Manic, Severe With Psychotic Features (DSM-5: 296.44, ICD-10: F31.2)
Differential Diagnosis 1: Schizophrenia, Current Episode Manic, With Psychotic Features (DSM-5: 295.40, ICD-10: F20.4)
Differential Diagnosis 2: Substance/Medication-Induced Bipolar and Related Disorder, With Manic Features, Unspecified Substance (DSM-5: 292.84, ICD-10: F19.245)
Pharmacological Treatment
The primary treatment for Bipolar I Disorder, Current Episode Manic, Severe With Psychotic Features, is a combination of mood stabilizers and antipsychotic medications. The American Psychiatric Association (APA) recommends the use of lithium, valproate, or carbamazepine as mood stabilizers and risperidone, olanzapine, or quetiapine as antipsychotic medications (American Psychiatric Association, 2020). In the case of Jill, the physician may prescribe a combination of lithium and risperidone. Lithium is an effective mood stabilizer that can reduce the symptoms of mania and prevent future episodes of mood swings. Risperidone is an atypical antipsychotic medication that can help control the psychotic features of the disorder.
Non-Pharmacological Treatment
Non-pharmacological treatment for bipolar disorder includes psychotherapy, such as cognitive-behavioral therapy (CBT) and family-focused therapy (FFT). CBT can help Jill identify and change negative thoughts and behaviors that may trigger mood swings. FFT can help Jill’s family members understand the disorder and learn how to provide support to Jill during her episodes (National Institute of Mental Health, 2021). In addition, the physician may recommend lifestyle changes, such as regular exercise, a healthy diet, and adequate sleep, to help stabilize Jill’s mood.
Health Promotion Intervention
One health promotion intervention that may be appropriate for Jill is psychoeducation. The physician can provide Jill and her family with information about bipolar disorder, including its causes, symptoms, and treatment options. This can help Jill and her family members better understand the disorder and improve their ability to cope with its symptoms. The physician can also provide information about healthy lifestyle choices that can help manage the symptoms of bipolar disorder, such as regular exercise, a balanced diet, and good sleep hygiene. Finally, the physician can encourage Jill to engage in activities that promote relaxation, such as yoga or mindfulness meditation, to help reduce stress and anxiety.
Conclusion
In summary, Jill presents with symptoms consistent with Bipolar I Disorder, Current Episode Manic, Severe With Psychotic Features. The primary treatment for this disorder is a combination of mood stabilizers and antipsychotic medications, with psychotherapy and lifestyle changes also being important components of treatment. In addition, health promotion interventions, such as psychoeducation and relaxation techniques, can be beneficial in helping Jill and her family members manage the disorder and improve their quality of life. Overall, early identification and treatment of bipolar disorder can greatly improve outcomes for individuals affected by this condition.