Reference no: EM133272123
CASE STUDY - BULIMIA NERVOSA
History - Lisa Kim is a 21-year-old female who came to a behavioral acute care hospital after referral by her outpatient psychiatrist for suicidal ideations and symptoms of an eating disorder. She reported that her depressive symptoms worsened after she was cut from the dance team 6 months ago. As a dance major, she expressed anxious feelings of inadequacy and obsessions with her image after that incident, and she is now binge eating and purging up to 8 times a week. She explains she tries to withhold food for as long as possible and then loses control and impulsively binges on large amounts of food usually in private. She then becomes overwhelmed with guilt and anxiety and purges afterward. In addition, she uses laxatives about three to four times a week and engages in self-injurious behavior by cutting her forearm. She has now dropped out of school and expresses suicidal ideations with a plan, saying "no one would miss me." She lives alone and admits to daily use of alcohol, drinking occasionally, but until she passes out about twice a week, and marijuana to help her depressive thoughts, calm her anxieties, and to regulate her appetite. She also smokes one pack per day for about two years.
On top of this, she has a diagnosis of bipolar disorder, type II Cluster B personality disorder trait, and she has been experiencing a depressive episode. She reports fatigue, weakness, dizziness, and low energy increasing the past couple weeks. Her LMP was 2 months ago, and her periods have been irregular.
Her parents were married for 23 years. Her father has a history of depression, and her maternal aunt was diagnosed with bipolar disorder. Both her maternal uncle and paternal aunt have a history of depression and substance use.
Current Medications - Bupropion SR 200mg PO BID for a year Escitalopram 20mg PO OD for 3 years
Ziprasidone 40mg PO BID for 3years
NKDA
Assessment - New diagnosis of bulimia nervosa (BN), severe, complicated by self-mutilating behaviors, a depressive episode associated with bipolar disorder type 2, and current misuse of multiple substances.
1. ???List down the patient's drug therapy problems.
2. ???What signs, symptoms, and laboratory values indicate the severity of the BN, secondary complications, and depression?
3. ???What are the goals of therapy?
4. ???What treatment strategies (pharmacological and nonpharmacological) are available and can be beneficial to the patient?
5. ???What drug, dosage form, route, schedule, and duration of therapy is appropriate in this patient? ???What pharmacologic alternatives would be appropriate as a back up?
6. ???What clinical and laboratory parameters are necessary for therapy monitoring to check outcomes and detect AEs?
7. ???What should you counsel your patient to ensure therapy success and minimize AE?