Reference no: EM133657691
Case: Michael is a 25-year-old unemployed man who presents at your private practice accompanied by his mother, whom he lives with, for a psychiatric evaluation. He is 5'10 and weighs 250 lbs. He is on disability due to his mental health diagnosis of bipolar disorder. His current medication is Depakote ER 500 mg, two QHS, and sertraline 150 m. His sertraline dose was increased one month ago by his PCP after he complained of symptoms of depression.
He has been on Depakote for the past six months and has gained 15 lbs. since he started. His last lab work was approximately three months ago, and he does not know the level. H does not do any form of exercise and spends most of his time sitting on his couch. eviously, he has been prescribed numerous psychiatric medications, including Tegretol and lamotrigine, which he only took a short while, and he states ineffective. H has also been prescribed Seroquel in the past, which he states caused too much sedation, and Abilify, which caused akathisia. Y ars ago, he was prescribed Haldol and Thorazine while hospitalized, and these caused tremors and drooling.
He has had three psychiatric hospitalizations. T.'s last one was one year ago; he states over the past month, he has been more irritable and sleeping less; he denies suicidal thoughts. Over the past few weeks, he has heard his name called out and seen shadows. The racing thoughts in his head are so loud at times, he feels like they are someone else's voice. He is currently sleeping only three hours a night for the past week. He describes feeling paranoid that people are watching him or talking about him. He has started reading the bible and is being told by God which passages to underline. His family psychiatric history includes his father and brother having bipolar disorder.
He is given a diagnosis of Bipolar I Disorder, with the most recent episode manic with psychotic features.
- What are your pharmacological goals for Michael? What specific symptoms are you targeting with the current medication?
- What changes, if any, would you make in her current medication regimen? Explain the mechanism of action of any new medication you would prescribe.
- Write out the prescription you will give this client. Be sure to include medication name(s), strength, the number of pills dispensed, instructions for taking, and several refills given.
- If you should continue him on Depakote, what lab studies and physical monitoring do you think should be done?
- If you should continue him on Depakote, provide your rationale for keeping or changing the dose the same.
- If you should decide to prescribe an antipsychotic, discuss the recommendations for laboratory studies and physical monitoring.
- What antipsychotic would you choose and why? Write out a sample prescription.
- If you decide to switch to Lithium, list the recommendations for laboratory monitoring and the serum levels you must monitor. Write out a sample prescription.
- Depending on the medication(s) you choose, what teaching information is essential for this client to help her adhere?
- What are your follow-up plans?