A 20-year-old woman is brought to the local emergency department (ED) by her family.

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.
Submission Instructions:
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
All replies must be constructive and use literature where possible.
Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
Late work policies, expectations regarding proper citations, acceptable means of responding to peer feedback, and other expectations are at the discretion of the instructor.
You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

ANSWER
Summarize the clinical case.

A 20-year-old woman was brought to the emergency department by her family due to concerns about her behavior. She had been asked to leave her job as a tattoo artist, had not slept for four nights, and her speech was rapid and quickly wandered off the point. She had recently purchased expensive vehicles to start a mobile tattoo business and was very reluctant to stay in the ED, believing she had too much to do.

What is the DSM-5-TR diagnosis based on the information provided in the case?

Based on the information provided, the woman appears to be experiencing a manic episode characterized by elevated mood, increased energy, decreased need for sleep, racing thoughts, and grandiosity. These symptoms align with the diagnostic criteria for bipolar I disorder, manic episode, as outlined in the DSM-5-TR.

Which pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment.

Considering the woman’s manic episode, a mood stabilizer would be the primary pharmacological treatment. Mood stabilizers are effective in regulating mood and preventing future episodes of mania or depression. Lithium is a commonly prescribed mood stabilizer, and it has a strong evidence base for treating bipolar disorder.

Rationale for lithium:

Lithium has a well-established track record of efficacy in treating bipolar disorder, particularly in preventing manic episodes.

Lithium is relatively safe and well-tolerated with minimal side effects.

Lithium has a long half-life, allowing for once-daily dosing and improved patient compliance.

Which non-pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment excluding a psychotherapeutic modality.

In addition to medication, non-pharmacological treatments play a crucial role in managing bipolar disorder. Psychoeducation, which involves providing the patient with information about their condition, treatment options, and self-management strategies, is an essential non-pharmacological intervention.

Rationale for psychoeducation:

Psychoeducation empowers patients to understand their condition, make informed decisions about treatment, and recognize early warning signs of potential episodes.

Psychoeducation improves treatment adherence and overall outcomes.

Psychoeducation promotes self-management strategies such as maintaining a regular sleep schedule, engaging in regular exercise, and avoiding substance use.

Assessment of the treatment’s appropriateness, cost, effectiveness, safety, and potential for patient adherence to the chosen medication.

Appropriateness: Lithium is an appropriate pharmacological treatment for bipolar I disorder, particularly in the context of a manic episode. It has demonstrated efficacy and safety in numerous clinical trials.

Cost: Lithium is a relatively inexpensive medication, with generic formulations available at a lower cost than brand-name versions.

Effectiveness: Lithium is highly effective in preventing future manic episodes and reducing the severity of symptoms during manic episodes.

Safety: Lithium is generally well-tolerated, although it can cause side effects such as tremor, weight gain, and kidney problems. Regular monitoring of lithium levels is essential to minimize potential side effects.

Adherence: Lithium requires ongoing monitoring, which can be a barrier to adherence. However, psychoeducation and close collaboration with healthcare providers can significantly improve adherence rates.

Comparison of medication costs

Using a local pharmacy’s website, I found that the cost of 300 mg lithium carbonate tablets (generic) ranges from $6.99 to $24.99 per bottle. The brand-name equivalent, Lithobid, costs approximately $100 for a bottle of 300 mg tablets. Therefore, the generic formulation of lithium carbonate is the more cost-effective option for this patient.

Conclusion

The patient’s presentation suggests a manic episode of bipolar I disorder. Lithium is an appropriate and effective pharmacological treatment for this condition. Psychoeducation is an essential non-pharmacological intervention that can improve treatment outcomes and patient well-being. By combining pharmacological and non-pharmacological approaches, we can effectively manage the patient’s symptoms and promote long-term stability.