WG, a 31-year-old female, has been admitted to your inpatient unit from the ED where she presented unwillingly and accompanied by her husband. She is unable to provide a history right now, but her husband is able to give you the following information: He reports over the past 2 weeks the patient has been uncharacteristically energetic, starting tasks and not finishing them, exhibits hypersexuality, is highly distractible with speech that is “nonsensical”. Her speech has also been rapid and pressured. She only sleeps every second or third night and has abdicated all attempts at self care such as hygiene or grooming. The ED diagnosed her with a manic episode. There is no documented history of smoking, alcohol, or illicit substance use. There is no history of any psychiatric illness in the patient or her family. A full work up has been completed and all was normal with the exception of the abnormal findings listed in the table below:
Lab/Vitals Today
Blood pressure 150/90 (H)
Sodium 120 (L)
What do you recommend for treatment (focus on psychopharmacologic treatment) and monitoring of WG’s current symptoms? What, if any, considerations should be made?
Please be very specific in your answer and rationale. Do not go into detail about bipolar disorder at the expense of detail regarding the current treatment of the patient. Choose your treatments as you would if the patient were in front of you. Do not give vague or generalized treatment plans; choose a treatment and explain why you chose it instead of any other options. Include any and all considerations that accompany your choice of treatment plan. For instance, do any diagnostics need to be done prior to initiating a drug?
