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Posted: January 25th, 2025

Clinical Management of Bipolar Disorder Case Study Analysis

Clinical Management of Bipolar Disorder Case Study Analysis

References:

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American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., Text Revision). Arlington, VA: American Psychiatric Publishing.
Barlow, D.H., Durand, M., Hofmann, S.G. and American Psychiatric Association, 2024. Diagnostic & Statistic Manual of Mental Disorders--Text Revision.

Goodwin, G. M., & Geddes, J. R. (2019). The acute and long-term treatment of bipolar disorder. International Review of Psychiatry, 31(2), 115-126.

Case Study Analysis: Bipolar Disorder

Answer the questions below based on the following case study.

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A 20-year-old woman is brought to the local emergency department (ED) by her family. She appears restless, pacing around the waiting room, and her parents say that she has recently been asked to leave her job as a tattoo artist. Her behavior has been increasingly erratic over the past few weeks, with her family noting significant changes in her mood and decision-making. She has not slept for four nights, and her speech is rapid and quickly wanders off the point. She had recently purchased a
20,000caranda40,000 van to jump-start her mobile tattoo business in Naples, Florida. These impulsive financial decisions are uncharacteristic of her usual behavior and have caused significant concern among her family members. She is very reluctant to remain in the ED department because she has far too much to do and considers it a waste of everyone’s time. She believes that she is far too important to be held back by minions.

Summarize the clinical case.
The patient is a 20-year-old woman presenting with symptoms of restlessness, decreased need for sleep, rapid and disorganized speech, and impulsive financial decisions. Her behavior has led to job loss and significant concern from her family. She exhibits grandiosity, believing herself to be too important to remain in the ED. These symptoms are consistent with a manic episode, likely indicative of bipolar disorder.

What is the DSM-5-TR diagnosis based on the information provided in the case?
Based on the DSM-5-TR criteria, the patient meets the diagnostic criteria for Bipolar I Disorder, characterized by a manic episode lasting at least one week or requiring hospitalization. Key symptoms include decreased need for sleep, grandiosity, pressured speech, and impulsive behavior, all of which are present in this case.

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Which pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment.
According to clinical guidelines, the first-line pharmacological treatment for acute mania in bipolar disorder is a mood stabilizer such as lithium or an antipsychotic like olanzapine or risperidone. Lithium is particularly effective for long-term mood stabilization and has been shown to reduce the risk of suicide in bipolar patients. However, given the patient’s acute symptoms, an antipsychotic like olanzapine may be more appropriate for rapid symptom control. Olanzapine has strong evidence for efficacy in managing manic episodes and can be administered orally or via intramuscular injection if the patient is non-adherent.

Which non-pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment excluding a psychotherapeutic modality.
A non-pharmacological treatment option for acute mania is electroconvulsive therapy (ECT), particularly if the patient is unresponsive to medication or presents with severe symptoms such as psychosis or suicidal ideation. ECT has been shown to be highly effective in rapidly reducing manic symptoms and is considered safe when administered by trained professionals. However, it is typically reserved for severe cases due to its invasive nature and potential side effects, such as memory loss.

Include an assessment of the treatment’s appropriateness, cost, effectiveness, safety, and potential for patient adherence to the chosen medication.
Olanzapine is an appropriate choice due to its rapid onset of action and effectiveness in managing acute mania. A local pharmacy survey indicates that a 30-day supply of generic olanzapine costs approximately
20

20−30, making it a cost-effective option. The medication is generally safe, with common side effects including sedation and weight gain, which should be monitored. Patient adherence may be challenging due to the patient’s current lack of insight into her condition, but involving her family in the treatment plan can improve compliance.

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References:
Lam, R.W., Kennedy, S.H., Adams, C., Bahji, A., Beaulieu, S., Bhat, V., Blier, P., Blumberger, D.M., Brietzke, E., Chakrabarty, T. and Do, A., 2024. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023: Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes. The Canadian Journal of Psychiatry, p.07067437241245384.
3. Yatham, L. N., et al. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20(2), 97-170.
4. Fountoulakis, K. N., et al. (2020). The International College of Neuro-Psychopharmacology (CINP) treatment guidelines for bipolar disorder in adults (CINP-BD-2017). International Journal of Neuropsychopharmacology, 23(1), 1-10.

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