This essay focuses on paranoid thought processes.. A  physician who report her to be in overall good health. Lab studies were all within normal limits. You find that the patient had genetic testing in the hospital

paranoid thought processes

The client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania.

She was diagnosed with bipolar I disorder.

Upon arrival in your office, she is quite “busy,” playing with things. On your desk and shifting from side to side in her chair. She informs you that “they said I was bipolar, I don’t believe that, do you?. I just like to talk, and dance, and sing. Did I tell you that I liked to cook?.”  She weights 110 lbs. and is 5’5”    SUBJECTIVE  Patient reports “fantastic” mood.

Reports that she sleeps about 5 hours/night to which she adds “I hate sleep, it’s no fun.”    You review her hospital records and find that she has been medically work up . A  physician who report her to be in overall good health. Lab studies were all within normal limits. You find that the patient had genetic testing in the hospital (specifically GeneSight testing). As none of the medications that they were treating her with seem to work.

Genetic testing reveals that she is positive for CYP2D6*10 allele.

Patient confesses that she stopped taking her lithium since she was discharged two weeks ago.    MENTAL STATUS EXAM  The patient is alert, orient to person, place, time, and event. She is dress quite oddly- wearing what appears to be an evening gown to her appointment. Speech is rapid, pressured, tangential. Self-report Bmood is euthymic. Affect broad. Patient denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent.

Judgment is grossly intact, but insight is clearly impair. She is currently denying suicidal or homicidal ideation.  The Young Mania Rating Scale (YMRS) score is 22.    Results of the interactive exercise:   Decision point One.  I chose to start Lithium 300 mg orally BID over Risperdal 1mg orally BID or Seroquel XR 100 mg orally at HS. Results of the decision point one. Client returns to clinic in four weeks. Client informs you that she has been taking her drug “off and on” only when she “feels like she needs it.”

Today’s presentation is similar to the first day you met her.   Decision point two:

I chose to assess the rationale for non-compliance to elicit reason for non-compliance and educate client Re.  Drug effects, and pharmacology over increasing Lithium to 450 mg orally BID. Or switching to Depakote ER 500 mg orally at HS. Results of the decision point two.

Client states that she stops taking it until these symptoms abate. At which point she re-starts only to experience the symptoms again.   Decision point three:  I chose to change Lithium to Sustain Release preparation. At same dose and frequency over changing to Depakote ER 500 mg orally at HS. Or changing to Trileptal 300 mg orally BID.