Question

Refer to Chapter 6

IDENTIFYING INFORMATION: Patient is 37 years old, self-referred and currently separated from her husband of six years and living with two of her sons, ages 6 and 8. She reported that she has been working as an independent contractor in real estate. She complains of an on-and-off problem with eating disorder.

HISTORY OF PRESENT ILLNESS: Patient is a 37-year-old female who reported that she has no previous psychiatric history, but she has been taking some medication, different antidepressants on and off since the age of 20. She reported that there is a question of ADHD because she has very erratic behavior, becomes very distracted, has mind racing, multitasking and organization is very overwhelming, and she gets to the point that she starts getting depressed, starts eating, gaining weight, which results in her anxiety escalating. She says she follows the law of all or nothing. When I asked about mood swings, patient denied that but later in the interview we found that the patient definitely has mood swings and has a lot of energy and self-confidence even when she lost her job. She gets depressed, but has ongoing issues about being very distracted, about moving and traveling and spending money out of proportion, but according to the patient, she is not a spender. She reports that recently she started a new job and worries that she cannot comply with the job because of the situation. She is separated from her husband now and needs to be more financially independent. She reported that there have not been any auditory or visual hallucinations, paranoia or history of abuse. She reports that her childhood was okay, but she had a very unpredictable environment.

PSYCHIATRIC HISTORY: She reports she was treated for a while with Depakote and Zoloft in her mid-20s and then Prozac, which caused a lot of impulsivity to the point that she bought a ticket to a concert for all her friends, lost her credit cards and eventually had to seek bankruptcy. Wellbutrin was okay, but adding Effexor made it worse, which the PCP has been giving her. She denied any history of suicide attempt, but was hospitalized twice in 1998 for an eating disorder or, according to patient, no diagnosis. She reports around the age of 20, she tried multiple medications, but she did not sniff glue or other substance. She denies addiction to any substance currently.

MEDICAL HISTORY: Patient reports no medical history and no history of head injury, loss of consciousness or seizure.

ALLERGY: No known drug allergy.

FAMILY HISTORY: She reports one brother and one sister. There are no psychiatric diagnoses in the family. She reports mother had mood changes and was very quick tempered and moody. Father had high blood pressure and a heart attack at the age of 63.

SOCIAL HISTORY: Patient has been married for six years, but is currently separated. The 8-year-old child is from a different relationship.

Education: Patient reports that she completed three years of graphic design but could not finish and eventually went to technical school and finished that in one year. She reports she does not have a learning problem, but continuing is a problem for patient.

She reports that childhood was okay and there is no history of abuse, but she has a lot of difference of age with her parents, brother and sister.

Legal issues: She reports one misdemeanor, which was dropped. This for keeping her children in a car not being attended for 3-4 minutes. She has no legal issue currently.

MENTAL STATUS: Patient appeared modestly groomed, cooperative and good eye contact. Speech increased in rate, tone and mild fidgetiness; alert and oriented to time, place, person. Affect shows elevated mood. Patient reports she wants to finish her job and does not want to endanger her career. Thought process is pressured and circumstantial. Thought content: Negative auditory or visual hallucinations or paranoid delusion. Negative for suicidal ideation. Insight and judgment is okay. The patient's fund of knowledge is appropriate.

DIAGNOSIS:

AXIS I:         Bipolar disorder, type 2.

AXIS II:        Deferred.

AXIS III:       None

AXIS IV: Lack of primary support and financial issues, severe; and career issues, severe; and mental problems.

AXIS V:       GAF 70.

Patient is a 37-year-old who reports that she was diagnosed with bipolar and she is not sure what is going on. She is mainly focusing on distraction. We did assessment and mood questionnaire. The patient is in the spectrum of bipolar. We discussed with the patient about the symptoms and different medications and since she was comfortable with Wellbutrin, I started Wellbutrin 200 mg daily and added Lamictal 25 mg daily for two weeks and then increased to 50 mg. Risks and benefits discussed with the patient and she is to return to clinic in two weeks. The office emergency contact number has been given to the patient. She understands to call if any problems develop.

Homework:

What do you think is going on with this patient? What will the medications treat in her case?

Answer 1

Patient has Bipolar disease ( depression ) . Bipolar disease is a mental disorder in which their is episode of mood ranging from depression to mania .

The medications prescribed for this patient are :-

- Wellbutrin

- Lamictal

Wellbutrin is an antidepressant . It inhibits the reuptake of dopamine , norepinephrine and serotonin . It is used to treat depression .

Lamictal is used in Bipolar disease and Epilepsy . It acts by modulating CNS neurotransmission through many pathways only for depressive bipolar episodes .