Bipolar disorders are chronic and recurrent mental illnesses. Patients with bipolar disorders often report interpersonal and/or occupational difficulties during the episodes (Blairy et al., 2004). People who are suffering from bipolar disorders often report that they have attempted suicide during their lifetime. Bipolar disorders are one of the leading causes of disability for people aged 15 to 44 years (McCarron, Xiong, & Bourgeois, 2009).
The objective data provided in case scenario suggested that Ms. IC might have a history of bipolar disorders. The signs and symptoms are as follows: her current medications (Trileptal, Abilify and Trazodone); little sleep for days; constant physical activity (overly talkative and speaking rapidly) and inappropriate dress, as well as impulsive behavior (purchased a new Mercedes in a weekend). Her presentations indicate that Ms. IC was experiencing an acute manic episode. So I am going to focus on manic episode in this paper, even though we know that bipolar disorders include manic, hypomanic and mixed episodes (McCarron, Xiong, & Bourgeois, 2009).
Two major conditions of manic episode based on DSM-IV-TR are as follows, first, patient experiences abnormal and persistent elevated, expansive or irritable mood that continue at least for one week. Second, during the manic episode, patients also show three or more of following symptoms: inflated self-esteem or grandiosity, more talkative than usual or pressure to keep talking, distractibility, excessive involvement in pleasurable activities that have a high potential for painful consequences, decreased need for help, flight of ideas or subjecti...
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...nician should order lab exams to ascertain her renal and liver are functioning properly, measure her weight and metabolic profiles, and test for pregnancy since the medications are not be prescribed if the patient is pregnant.
The medications prescribed for Ms. IC include: Lithium 300 mg TID for acute mania then increases 600mg as tolerated after reaches steady state level in 4-5 days, the target serum level is 0.6-1.2 mEq/L; Olanzapine 5mg BID and QHS for acute mania and insomnia then increases 5 mg weekly till reaches maximum dosage 20mg as tolerated; and order a Depo-Provera 150 mg/ 1ml IM injection for contraceptive as well as to discontinue Trileptal 300mg, Abilify 10 mg, Trazodone 300mg and ortho Tri-Cyclen. (Lexicomp, 2015; McCarron, Xiong, & Bourgeois, 2009). The clinician should also provide a comprehensive medication education to Ms. IC and her family.
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