Which medication effect, if any, might JD experiencing (see: CC) and how will that impact your plan?

Module Quiz Wk 8 – Bipolar disorder
CC:“I feel fantastic!”
HPI:JD is a 30 year old female, brought into the clinic with her family. She is dressed in a brightly colored, provocative dress. She is also wearing heavy makeup and a large quantity of jewelry. She notes that she isn’t sleeping much, but it’s because she is so productive. She is working on creating a cure for cancer and starting a campaign for the republican primaries as she plans on becoming president of the universe. Patient unable to explain why she was brought in and wishes to be sent home. Patient denies suicidal ideation or homicidal ideation. Denies Auditory or VisualHallucinations.
Past Psych History:Major Depressive Episode – 4 months earlier diagnosed by PCPand placed on Citalopram at that time.
PMH: None
Family Medical andPsych HistoryFather: DMMother: Bipolar disorderSister: Depression
Social History:Patient reports she is “high on life” and doesn’t needanything
Allergies: NKA
Mental Status ExamAppearance: flashy attire, heavy makeupEye Contact: AverageActivity: Psychomotor agitation – difficult to get patientto sit for interviewMotor/Musculoskeletal: Normal Gait, (-) Abnormal gait,abnormal movement, tics, tremorsAttitude: AppropriateMood: ManicAffect: BrightSpeech: Pressured, loud, spontaneousLanguage: Articulate and CoherentThought Content: (-) AH/VH/SI/HI (+) Delusions (Feels she is working oncreating a cure for cancer and starting a campaign for the republican primariesas she plans on becoming president of the universe).Thought Process: CircumstantialAbstract reasoning: Able to abstract proverbOrientation: A/O x3Knowledge: completed 12th gradeJudgment: Limitedinsight
Given all of theinformation you know about the treatment of bipolar mania, please provide atreatment recommendation for JD. There may be more than one correct answerfor the questions below, as long as the justification provided is correct,rational, and sound. (Cite your sources)1. Should JD still be considered to have a diagnosis of MDD? Why or why not?
2. Which medication effect, if any, might JD experiencing (see: CC) and how will that impact your plan?
3. Please compare and contrast the 3 types of first line therapy for bipolar mania. Besure to include at least 3 key differences between each of the therapies.
a.VPA –b.Lithium–c.SecondGeneration Antipsychotic –
4. Which specific medication would be best toinitiate in JD? Please list one.
5. Why did you select the above option overall of the other available first line options?Please list two reasons.
6. What is your initiation dosing regimen,titration plan, and your goal dose of the medication selected for JD? Be very specific here. (I am also looking for timelines betweenincreased doses)
7. What should you tell JD regarding thetiming of onset, and of effect? Ie. howlong until effect may be seen?
8. How should the therapeutic response beevaluated?
9. Which potential side effects should bemonitored in JD and what education would you provide?