NRNP-6670-wk-5-assignment. HPI and clinical impression.

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HPI and clinical impression
Jane is a 34-year-old Caucasian woman who has been experiencing acute social phobia, unable to mingle and interact with people at work and in public places. She said she could not understand where her recent irritability came from and got emotional to the point of crying during the therapy session. Her mood oscillated between intensely emotional to almost absent minded during the session as her mind wandered off in the middle of a sentence. She was also quite restless and admitted suffering a level of insomnia as she sometimes feels like waking up and walking around the neighborhood in the middle of the night. She admitted this restlessness was also affecting her job because she sometimes feels the urge to walk around in the middle of the work day, which eats into her productivity and cause friction with her employer. Unusually, during these walks, whether day or night, she says she experiences an elevated mood, greeting everyone and even stopping to chat and exchange pleasantries with whoever is willing to have a brief exchange. On such occasions it is not strange for her to burst out laughing after remembering something funny from the past which seemed humorous.
Under the DSM-5 diagnostic criteria, bipolar 2 disorder was the diagnosis for Jane, fulfilling criterion A based on her persistent and abnormal irritability, elevated moods and increased energy (APA, 2013). She also fulfills criterion B based on her talkativeness, self-esteem and insomnia, which are also out of character. Manic depression and mood disruptions also fulfills criterions C and D. That notwithstanding, the disruptions are not serious enough to warrant hospitalization in addition to the fact that she does not fulfil criterions E and F on substance abuse, medication or any other treatments.
Psychopharmacologic treatments and therapeutic end points
Anti-psychotic treatments to minimize delusions and stabilize Jane’s moods would be the first line of defense in dealing with her bipolar disorder. Quetiapine taken orally at a dosage level of 50mg daily could help relieve the manic depression episodes’ subject to the patient’s tolerance. To stabilize Jane’s moods Lithium BID at 300mg daily would be helpful, evening out the highs and lows that have been disrupting her behavior at home and work (Ketter et.al., 2016). The combination of quetiapine and lithium helps the patient overcome the mania and depression characteristic of bipolar disorder through battling psychotic behavior and unpredictable moods. Lithium is one if the leading stabilizers that the FDA has approved for the treatment of moodi...