Answer The Questions Below Based On The Case Study
Answer The Questions Below Based On the Following Case Studya 20 Year
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.
Summary of the Clinical Case
The presented clinical case involves a 20-year-old woman exhibiting symptoms indicative of a manic episode. She is exhibiting psychomotor agitation, impulsivity, elevated mood, decreased need for sleep, rapid speech, grandiosity, and distractibility. Her recent behaviors — including purchasing expensive vehicles and quitting her job as a tattoo artist — further suggest impulsivity and elevated self-esteem. She is uncooperative and dismissive of the need for evaluation, indicating possible manic features. The persistence of symptoms over several days without sleep, alongside her behavioral alterations, warrants further assessment for a mood disorder, most likely bipolar disorder, type I given the severity of manic symptoms.
DSM-5-TR Diagnosis
Based on the presented symptoms—persistently elevated or irritable mood, increased energy, decreased need for sleep, grandiosity, talkativeness, distractibility, and risky behaviors—the most appropriate DSM-5-TR diagnosis is Bipolar I Disorder, current episode manic. The episode appears to be severe, detectable through her physical, behavioral, and cognitive symptoms, such as flight of ideas and impulsivity, consistent with a manic episode. The denial of her condition and her reluctance to remain in the ED reflect the hallmark features of mania, particularly grandiosity and impulsivity, further supporting this diagnosis.
Pharmacological Treatment and Rationale
The primary pharmacological treatment for a manic episode, according to clinical guidelines, typically involves mood stabilizers. Lithium remains the first-line pharmacologic agent for bipolar disorder management, particularly for acute mania, due to its efficacy in controlling symptoms and its anti-suicidal properties. Additionally, second-generation antipsychotics, such as risperidone or olanzapine, are often used either alone or adjunctively to rapidly stabilize mood and psychotic symptoms. Considering her urgent presentation, a combination of a mood stabilizer and an antipsychotic may be appropriate.
Specifically, risperidone is frequently recommended given its proven efficacy for acute mania. Risperidone acts as an antagonist at dopamine D2 and serotonin 5-HT2 receptors, reducing psychosis, agitation, and mood symptoms effectively. Its rapid onset makes it suitable for managing acute episodes, and it generally has a tolerable side effect profile.
The rationale for this combination hinges on the need to stabilize mood promptly to prevent harm, improve functioning, and establish a baseline for further management. Lithium can be introduced once the patient stabilizes, which provides long-term mood stabilization and reduces subsequent episodes.
In choosing medication, considerations include the safety profile, tolerability, adherence potential, and cost. Risperidone is available in generic form, making it a cost-effective option. A typical starting dose is 1-2 mg daily, titrated as necessary.
Non-Pharmacological Treatment and Rationale
Beyond medication, non-pharmacological interventions are critical; however, excluding psychotherapy, lifestyle and psychoeducation interventions are essential. Psychoeducation helps patients and families understand bipolar disorder, recognize early warning signs of mood episodes, adhere to treatment plans, and implement lifestyle modifications that promote stability.
Given her age and potential lifestyle impairments, educating her about sleep hygiene, routine, substance avoidance, and stress management is vital. These interventions can reduce the severity and frequency of mood episodes, enhance medication adherence, and promote overall functioning. Psychoeducation is especially pertinent because young adults often have limited insight into their condition, and understanding their disorder can foster cooperation and self-management.
Furthermore, establishing a structured daily routine with regular sleep, activity, and medication schedules can help prevent relapse. Family involvement in psychoeducation sessions can also improve support systems and adherence. This approach aligns with clinical guidelines emphasizing psychoeducation combined with pharmacotherapy to optimize outcomes.
Assessment of Treatment Appropriateness, Cost, Safety, and Adherence
The choice of risperidone as a short-term intervention is appropriate due to its rapid efficacy in controlling agitation, psychosis, and manic mood symptoms. It has an acceptable safety profile, with common side effects including weight gain, extrapyramidal symptoms, and sedation, which should be monitored (Yatham et al., 2018). The likelihood of adherence is increased with the use of an oral medication that can be dosed flexibly and adjusted based on response and tolerability.
Cost considerations are crucial; for example, a 30-day supply of generic risperidone (1 mg to 2 mg daily) can be sourced from local pharmacies at approximately $10-20, making it affordable for patients with limited financial resources (GoodRx, 2024). Lithium, while effective, involves regular blood monitoring and potentially higher long-term costs due to labs and toxicity risks, making risperidone a more practical initial choice for acute management.
Overall, risperidone offers rapid symptom relief, is cost-effective, and has a manageable safety profile. The risk of adverse effects necessitates monitoring, but with proper follow-up, it remains a safe option for managing acute mania in young adults (Ketter et al., 2017). Ensuring patient understanding and involving family support can substantially improve adherence, which is critical in preventing relapse and promoting functional recovery.
Conclusion
This case exemplifies a classic presentation of bipolar I disorder, recent onset manic episode, in a young woman exhibiting elevated mood, impulsivity, decreased sleep, and grandiosity. Pharmacologically, risperidone is an effective, rapid-acting, and cost-efficient choice aligned with current guidelines, complemented by psychoeducation and lifestyle interventions to promote long-term stability. Close follow-up is imperative to manage side effects, adherence, and eventual transition to long-term mood stabilization strategies, such as lithium, to prevent recurrence.
References
- Yatham, L. N., Kennedy, S. H., O'Donovan, C., et al. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20(2), 97–137.
- Ketter, T. A., Chang, K. D., & Calabrese, J. R. (2017). Pharmacotherapy for bipolar disorder in young adults. Psychiatric Clinics of North America, 40(2), 267-282.
- GoodRx. (2024). Risperdal prices and comparison. Retrieved from https://www.goodrx.com/risperdal