Posted: April 6th, 2023

Module 4 discussion A 20-year-old woman is brought to the local

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.
Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in the current APA style with support from at least 2 academic sources. Less than 20 % similarity
All replies must be constructive and use literature where possible

Clinical Case Summary:
The patient, a 20-year-old woman, is brought to the emergency department (ED) by her family. She appears restless, pacing around the waiting room, and has not slept for three nights. Her speech is rapid and wanders off the point, and she was recently fired from her job as a tattoo artist. She has purchased a $20,000 car and a $40,000 van to start her mobile tattoo business in Naples, Florida. She is reluctant to stay in the ED department as she considers it a waste of everyone’s time, and believes that she is too important to be held back by others.

DSM-5-TR Diagnosis:
Based on the information provided, the patient’s symptoms meet the criteria for a manic episode. According to DSM-5-TR, a manic episode is defined by a period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week, or any duration if hospitalization is necessary. The patient’s symptoms of restlessness, rapid speech, and inflated sense of self-importance are consistent with a manic episode.

Pharmacological Treatment:
The recommended pharmacological treatment for manic episodes is mood stabilizers such as lithium, valproate, carbamazepine, or atypical antipsychotics. Lithium is a first-line medication for treating acute manic episodes due to its proven efficacy and safety profile. It works by modulating neurotransmitter systems that are involved in the regulation of mood and behavior. Lithium has a narrow therapeutic index, and serum levels must be monitored closely to avoid toxicity. Based on the patient’s symptoms and the recommended treatment, I would prescribe lithium as the primary medication.

Non-pharmacological Treatment:
In addition to medication, non-pharmacological treatments are also essential for managing manic episodes. Psychotherapy, such as cognitive-behavioral therapy (CBT), can be effective in helping patients with bipolar disorder recognize and manage their symptoms. However, excluding psychotherapeutic modalities, I would recommend psychoeducation as a non-pharmacological treatment. Psychoeducation involves educating the patient and their family about the symptoms of bipolar disorder, medication adherence, lifestyle changes, and warning signs of relapse.

Assessment of Treatment:
The appropriateness of lithium as the primary medication is supported by its proven efficacy in treating acute manic episodes. The cost of lithium varies depending on the dose, formulation, and pharmacy. Using a local pharmacy, the cost of a 300mg lithium carbonate tablet is approximately $0.20. However, it is important to note that lithium requires regular blood monitoring to avoid toxicity, which can increase the overall cost of treatment.
The effectiveness of lithium in treating manic episodes is well-established, and it has been shown to reduce the risk of relapse in bipolar disorder. However, patient adherence to medication can be a significant challenge. Adverse effects such as weight gain, tremors, and gastrointestinal distress can decrease patient adherence to lithium. It is therefore important to monitor patients regularly for adverse effects and adjust the dosage accordingly.
The safety of lithium is also a concern due to its narrow therapeutic index. Close monitoring of serum lithium levels is essential to prevent toxicity. Regular blood monitoring can be inconvenient and uncomfortable for patients, which can decrease adherence to treatment.
Overall, lithium is a cost-effective and effective treatment for acute manic episodes. However, regular blood monitoring and the risk of adverse effects and toxicity must be carefully considered and managed.

References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Parker, G., & Paterson, A. (2014). Lithium: An update. Australian prescriber, 37(3), 89-93.

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