DSM-5 Diagnosis of a 20-yr-old Woman with Bipolar Disorder

Chapter 11, Case 1: Clinical Summary

The presented case describes a 20-year-old woman brought to the ED following a series of psychological problems. The patient’s family explain that the patient has not slept for three nights and was recently asked to leave her job. In the ED, the patient presents with symptoms of psychomotor agitation like rapid speech, pacing around the room, and restlessness. The patient appears to have grandiosity whereby she thinks she is too important to be held back by minions. She also displays symptoms of risk-taking behaviors evidenced by the recent purchase of a $20,000 car and a $40,000 van to jump-start her mobile tattoo business. These symptoms indicate that the patient has a mental health disorder that should be diagnosed and treated.

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DSM-5 Diagnosis

According to the symptoms observed, the most appropriate diagnosis for the patient is bipolar disorder. This condition is characterized by severe mood changes that are accompanied by energy and activity level changes (American Psychiatric Association, 2013). According to the DSM-5 diagnostic criteria, individuals must experience at least one episode of mania along with a history of depressive episodes (American Psychiatric Association, 2013). The manic episode must last for at least one week and must lead to a change in mood or energy level activities.

The symptoms of bipolar disorder are easily noticeable because of the severe mood changes and energy level activities. Patients present with increased talkativeness, heightened self-esteem or grandiosity, lack of sleep, racing thoughts, shortened attention spans, and increased risk-taking behaviors (American Psychiatric Association, 2013). These individuals also are easily distracted, have increased thoughts on goal-oriented activities, and can engage in activities that hold painful consequences like unrestrained buying sprees. The patient presents with several of these symptoms including psychomotor agitation, lack of sleep, grandiosity, and unrestrained spending. These symptoms are consistent with the DSM-5 diagnostic criteria for bipolar disorder.

Pharmacological Treatment

One of the most effective treatments for bipolar disorder is lithium, a mood stabilizer used to manage mania. I will prescribe lithium 300 mg PO, taken twice daily. This drug is FDA approved for the management of bipolar disorder and maintenance therapy in patients with a history of mania (Volkman et al., 2020). According to evidence-based research, lithium is the agent of the first hour and it remains effective in preventing relapse. Lithium takes about 1 to 3 weeks to show desired effects and remission of symptoms (Volkman et al., 2020). Sometimes increasing the dosage can be a good strategy for nonresponders but severe side effects are expected with higher doses. The cost of lithium 300 mg ER (60 tablets) is $10.49 in Rite Aid pharmacy in Pensacola, Florida. The common side effects of the drug include nausea, vomiting, tremors in the hands, and ataxia.

Non-Pharmacological Treatment

Electroconvulsive therapy (ECT) has a unique role in the management of bipolar disorder. This approach is preferred for severe bipolar cases that have failed to respond to medication and psychotherapy. Studies demonstrate that ECT has a response rate of 65 to 80% but this depends on certain patient factors like age (Popielek et al., 2019). The risks of using ECT for bipolar include temporary memory loss, heart problems, and complications of anesthesia. Overall, ECT is an approach that is used to manage major depression and bipolar disorder, although the strength of evidence is low.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Author.

Popiolek, K., Bejerot, S., Brus, O., Hammar, Å., Landén, M., Lundberg, J., Nordanskog, P., & Nordenskjöld, A. (2019). Electroconvulsive therapy in bipolar depression – effectiveness and prognostic factors. Acta Psychiatrica Scandinavica, 140(3), 196–204. https://doi.org/10.1111/acps.13075

Volkmann, C., Bschor, T., & Köhler, S. (2020). Lithium treatment over the lifespan in bipolar disorders. Frontiers in Psychiatry, 11, 377.

https://doi.org/10.3389/fpsyt.2020.00377