Reference no: EM133562883

Question: Judy is a 35 yo Caucasian female who was admitted to the local inpatient psychiatric unit two months ago and discharged after 4 days to stabilize her symptoms. She was started on Lithium 300 mgs at night and Seroquel 300 mgs at night.

Judy was hospitalized when members of the Parent Teacher Committee became concerned after their last meeting. She arrived at the meeting wearing somewhat provocative clothing more suitable for an evening on the town. Hair neatly styled, bright blue eyeshadow, several necklaces, showy earrings and high heels. During the meeting, she seemed to talk a mile a minute and would frequently interrupt others. When finally asked to not talk over others, she became angry and let loose a string of cuss words. Her husband, who had been traveling for business the last week, was called and concerns were shared.

Upon arrival at the house, the husband was stunned by what he saw. There were 50 plus QVC packages just inside the entryway, some opened and others not. There was new yoga exercise equipment in the living room and the kitchen appeared as if a cookie factory had exploded, with empty dirtied containers all about. He found his wife in the bedroom, she had 1/2 painted their bedroom a bright orange and had begun rearranging the clothes closet but, was 1/2 finished with his suits still slung on the loveseat in the sitting area. When he asked, what was going on? She replied, "Welcome home, let's have sex!". He again stated, "what is going on?". She replied, "it's spring and we needed to do some spring housecleaning, plant some flowers, clean the garage, get the garden planned, paint the garage door and house shutters and get packed for a trip to Disney this weekend." (Which she booked in his absence.)

This is her first outpatient appointment with you since her inpatient stay. She arrived and is hyperverbal with pressured speech. She reports getting about 1-2 hours of sleep per night without the Seroquel. The gest is that she is never taking Seroquel again because she gained 10 lbs in one week. Outline your steps to treat this patient. NKDA. Only one inpatient psychiatric hospitalization. 2 kids- 11 yo female and 9 male. Ht. 5'6", Wt. 135 lbs. No prior medical hx. No hx of substance use.

Create a treatment plan based upon the case. It should include 7 clearly defined interventions.
The two-column table with the identified primary diagnosis and correct ICD 10 codes. Below the table--simply list any rule out differential diagnoses, including medical conditions, with brief rational or corresponding sxs.

Identify a specific medication with dosing.

Discussion of medication selection including neurotransmitter profile, mechanism of action and rational for this specific patient. This should be an in-depth discussion.
Pertinent labs for management of the client related to medication class and rational for each lab.

Identification of specific additional services i.e. case management, psychotherapy type.

Identify the most significant patient education/health promotion/disease management/prevention teaching for this patient.