Hospitalization for onset acute mania. The client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for the onset of acute mania.
She was diagnosed with bipolar I disorder.
Upon arrival in your office, 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, dance, and sing.
Did I tell you that I liked to cook?”
She weighs 110 lbs. and is 5′ 5″
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 find 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 find that the patient had genetic testing in the hospital (specifically Gene-Sight 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. Affect 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
BEGIN WITH LITHIUM 300MG DAILY
BEGIN WITH RISPERAL 1MG BID
BEGIN WITH 300MG OLANZAPINE AT HS