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 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.
Expert Solution Preview
In this case study, we are presented with a 20-year-old woman who is brought to the emergency department by her family. She exhibits symptoms of restlessness, rapid speech, sleep deprivation, and grandiose beliefs. Based on this information, we will analyze the case, make a DSM-5-TR diagnosis, and determine the appropriate pharmacological and non-pharmacological treatments, considering factors such as appropriateness, cost, effectiveness, safety, and potential patient adherence.
1. Summarize the clinical case:
The 20-year-old woman in question is displaying symptoms consistent with a manic episode. She exhibits restlessness, rapid speech, sleeplessness for four nights, impulsivity (as evident from purchasing expensive vehicles for her tattoo business), and an inflated sense of self-importance. These symptoms collectively suggest a possible diagnosis of bipolar disorder.
2. DSM-5-TR diagnosis:
Based on the information provided, the DSM-5-TR diagnosis for this case would be Bipolar I Disorder, manic episode. This diagnosis is made because the patient exhibits symptoms that meet the criteria for a manic episode, including elevated mood, increased energy levels, decreased need for sleep, impulsivity, and grandiosity.
3. Pharmacological treatment:
In terms of pharmacological treatment, according to clinical guidelines, a mood stabilizer such as lithium would be the first-line choice for acute mania in bipolar disorder. Lithium has been proven to effectively control and stabilize mood episodes associated with bipolar disorder. It helps reduce the severity and frequency of manic episodes, thereby calming the patient’s overactive state. Additionally, lithium has a well-established safety profile and has been extensively studied for long-term use in bipolar disorder.
4. Non-pharmacological treatment:
In addition to pharmacological treatment, non-pharmacological interventions are also recommended for the management of bipolar disorder. In this case, psychoeducation would be an appropriate non-pharmacological treatment. Psychoeducation involves providing the patient and their family with information about the nature of bipolar disorder, its symptoms, available treatments, and strategies for managing the condition. By educating the patient and her family about bipolar disorder, they can better understand and cope with the illness, potentially improving treatment adherence and overall outcomes.
Excluding psychotherapy, another non-pharmacological modality that can be considered is social rhythm therapy. Social rhythm therapy focuses on stabilizing daily routines, sleep patterns, and social activities, which can help regulate mood and prevent the recurrence of manic or depressive episodes. By establishing regularity and stability in the patient’s daily life, social rhythm therapy aims to reduce stress and maintain stable mood states.
5. Assessment of treatment appropriateness, cost, effectiveness, safety, and potential for patient adherence:
The chosen medication, lithium, is appropriate for treating bipolar disorder due to its proven efficacy in stabilizing mood episodes. However, costs may vary depending on the location and specific pharmacy. To determine the most cost-effective choice for the patient, it would be necessary to research the local pharmacy prices for lithium.
Regarding effectiveness, lithium has been widely studied and has shown significant benefit in the treatment of bipolar disorder. It can help manage acute manic episodes, prevent recurrence of mood episodes, and enhance the long-term stability of mood. Safety-wise, lithium is generally well-tolerated, but regular monitoring of blood levels and potential side effects (e.g., renal and thyroid function) is necessary.
Patient adherence to medication is a crucial factor for treatment success. The potential for adherence to lithium may be facilitated by psychoeducation, which helps the patient and her family understand the importance of medication and regular monitoring. Additionally, involving the patient in treatment decision-making and addressing any concerns or side effects can enhance adherence.
Overall, lithium is a suitable choice for the pharmacological treatment of bipolar disorder in this case, considering its appropriateness, effectiveness, safety, and potential for patient adherence. However, local pharmacy research would be necessary to determine the most cost-effective option for the patient.