Assignment: Assessing and Treating Patients With Bipolar Disorder

12/19/21, 5:03 PM Psychopharmacologic Approaches to Treatment of Psychopathology

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Bipolar Therapy Client of Korean Descent/Ancestry

BACKGROUND INFORMATION The client is a 26-year-old woman of Korean descent who presents to her �rst

appointment following a 21-day hospitalization for onset of acute mania. She was

diagnosed with bipolar I disorder.

Upon arrival in your o�ce, she is quite “busy,” playing with things on your desk and

shifting from side to side in her chair. She informs you that “they said I was bipolar, I

don’t believe that, do you? I just like to talk, and dance, and sing. Did I tell you that I liked

to cook?”

She weights 110 lbs. and is 5’ 5”

SUBJECTIVE

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Patient reports “fantastic” mood. Reports that she sleeps about 5 hours/night to which

she adds “I hate sleep, it’s no fun.”

You reviewed her hospital records and �nd that she has been medically worked up by a

physician who reported her to be in overall good health. Lab studies were all within

normal limits. You �nd that the patient had genetic testing in the hospital (speci�cally

GeneSight testing) as none of the medications that they were treating her with seemed to

work.

Genetic testing reveals that she is positive for CYP2D6*10 allele.

Patient did well enough on Lithium to be discharged from the hospital but admits she

has not been taking it as prescribed. When further questioned on the subject, she

provides no additional details.

MENTAL STATUS EXAM The patient is alert, oriented to person, place, time, and event. She is dressed quite

oddly- wearing what appears to be an evening gown to her appointment. Speech is rapid,

pressured, tangential. Self-reported mood is euthymic. A�ect broad. Patient denies visual

or auditory hallucinations, no overt delusional or paranoid thought processes readily

apparent. Judgment is grossly intact, but insight is clearly impaired. She is currently

denying suicidal or homicidal ideation.

The Young Mania Rating Scale (YMRS) score is 22

RESOURCES § Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype

a�ects the pharmacokinetics of controlled-release paroxetine in healthy Chinese

subjects: comparison of traditional phenotype and activity score systems. European

Journal of Clinical Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6

Decision Point One Select what the PMHNP should do:

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Begin Lithium 300 mg orally BID

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Begin Risperdal 1 mg orally BID

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Begin Seroquel XR 300 mg orally at HS

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