Bipolar Disorder 15 points total cc Our mother died three we

Bipolar Disorder (15 points total)

cc. “Our mother died three weeks ago and we lost our father several months ago. I think that my sister was depressed and just wanted to be with them.”

HPI. B.J. is a 31 y/o F who was brought to the hospital by ambulance. She was found slumped over in her car in front of the funeral home where memorial services for both her father and mother had been recently held. There were two empty bottles of sleeping pills on the seat beside her and a note that read, “I am going to be with my mom and dad. It is just too sad being here without them. I love you all and you will be in my prayers.” When she was found by the director of the funeral home, her hair was oily and unkempt and she smelled as if she had not bathed in a long time. She was dressed in a dirty, orange tee shirt, jeans, and tennis shoes.

Recently, per patient’s sister, B.J. would call her at odd times of the day, such as 3am just to talk. She would ramble on the phone, become sarcastic and hostile and hang up. She preached about religion and her bad parents and sex. She would also go on 2-3 day shopping sprees and max out credit cards. She was recently started on Lithium which was starting to work. B.J. has not been coping well with the death of her parents.

PMH. Episodes of depression first occurred when the patient was a junior in high school and led to psychiatric admissions at 15 and 19 years of age. She met her first husband in the psychiatric ward of the hospital at age 19 following a suicide attempt. The patient was treated with antidepressants and psychotherapy and discharged on both occasions after approximately 5 weeks. She was a foster child with abusive caregivers, biological parents were alcoholics. Patient was diagnosed with bipolar disorder 6 years ago. After her 3^rd baby, she went into depression. Per sister, patient “got weird” after being started on Paxil.

SH. 3 daughters, currently in second marriage, has worked as a nurses aid and health insurance adjuster. Smoked 1 ppd for nearly 15 years, history of alcohol abuse with DUIs, history of IVDA but has not used for more than 10 years.

FH.      Strong history of mental illness-paternal grandmother suffered from depression, two maternal aunts diagnosed with bipolar disorder

Both parents had a long history of alcohol abuse

Father was previously diagnosed with pancreatitis and then diabetes mellitus

Mother has been relatively well and died from a “broken heart”

Patient has 3 living brothers, 3 sisters and 3 daughters

One brother died from AMI at age 34, another brother died at age 6 months

Meds.             Lithium 600mg PO QAM and 600mg PO QHS

Sumatriptan 50-200mg PO PRN

Allergies: Aspirin (swelling of the face)

ROS. Migraine headaches, 2-3x/month. (-) aura but (+) for nausea, vomiting and photophobia

PE and Lab Tests.

General. Tired looking patient, white female in NAD. Pt is very pale and there are “dark rings” under her eyes.

Skin. Comedones on forehead, nose and chin with several cystic lesions on chin (c/w acne), normal turgor, no evidence of rash, ecchymosis, petechiae or cyanosis

Eyes. PERRLA. EOMI.

Throat. Dry mucous membranes

Heart. RRR, S1 & S2 normal without additional cardiac sounds

Lungs. CTA bilaterally

Abd. (+) bowel sounds, no pain or tenderness, soft, non-distended; (1) hepatomegaly, splenomegaly, masses or bruits

MS/Ext. Full ROM. Distal pulses normal at 2+ bil. (-) edema, cyanosis or clubbing.

Neuro. Slightly lethargic but oriented to person, place and time. DTRs full and symmetric. Babinski negative bil. Normal strength throughout. Tone and sensation normal. CNs II-XII intact. Speech without dysarthria. Gross and fine motor coordination are normal. Cerebellar: finger-to-nose and heel-to-shin WNL. Able to toe and tandem walk without difficulty.

Question 5. Does this patient have any signs of abnormal hepatic function? (2 pts)

Question 6. Identify two abnormal blood laboratory test results and propose a reasonable explanation for these results. (2 pts)

Question 7. Brain damage may have occurred from this patient’s most recent suicide attempt. List 2 symptoms of brain damage. (2 pts)

Question 8. Does this patient require inpatient treatment or is outpatient therapy totally appropriate? (1 pt)

Solution

5. yes she might have abnormal hepatic function. She is slightly lethargic and also has nausea and vomiting which may be due to hepatic dysfunction. She does not seem to have hepatomegaly.

6. Blood results of this patient is not given. However she might have abnormal bilirubin, SGOT (serum glutamic oxaloacetic transaminase) and SGPT (serum glutamic pyruvic transaminase) which are liver function tests.

7. symptoms of brain damage in her may be lethargy, photophobia, nausea, vomiting

8. Her appropriate treatment option would be inpatient management as she is at a very risk of harming herself.