hallway

[Audio] Introduction Hello, I am Tinika McCoy, a student pursuing my PMHNP, I would like to briefly discuss a case, which is quite challenging. It's about a patient with complex psychiatric and medical issues. I have drawn out some specific questions I would like to ask regarding treatment adjustments and care planning. Patient Information Patient Initials: J.R. Age/Gender: 35-year-old male Diagnosis: Bipolar I Disorder, most recent episode manic, with psychotic features; comorbid alcohol use disorder in early remission. Questions for the Colleague 1. Considering J.R.'s partial responsiveness to mood stabilizers and his concerns regarding weight gain, what other alternatives would you consider for pharmacological treatment? 2. What can we do to help him get over this ongoing mistrust of the providers, which appears to be the barrier to him engaging readily in the therapeutic process? 3. Would you suggest the inclusion of a specific therapy modality to treat his bipolar disorder and his alcohol use disorder? History of Present Illness J.R. came in with very acute manic symptoms: he was grandiose, had a pressured speech, a decreased need for sleep, and described impulsive spending. One more thing about him is that he hears voices pushing him to do risky things, which he acknowledges as despondent. All of these have happened in three weeks following the stopping of his medication. He denies current alcohol use while admitting cravings now and then (National Institute on Drug Abuse, 2024)..

[Audio] Past Psychiatric History Bipolar disorder is a diagnosis J.R. received at 25 years old. He has also undergone lithium treatment, but he stopped using it due to weight gain and has used lamotrigine, which was partially effective but not optimized. J.R. has also received CBT, although he was tangentially involved because of mistrust toward providers. He has had a single hospitalization in the past for mania. Developmental History J.R. was brought up in a stable household but struggled with emotional regulation and impulsivity starting at the age of eleven. His symptoms became aggravated in collage college, leading to his first manic episode (Marzani & Neff, 2021). Social History The patient lives alone and is a professional engineer. He struggles with alcoholism, especially during periods of mania, but has been in remission for six months. When interviewed, he claimed to possess minuscule social support, saying that he has no connection with family or friends owing to suspicion and conflicts with others. Family History Psychiatric: The Father was diagnosed with major depressive disorder, and the maternal uncle with schizophrenia. Medical: Mother has type 2 diabetes but no other significant medical history. Objective Data Labs: Thyroid function tests are regular; lithium level is unavailable as he discontinued use. Liver function tests are within normal limits. Vitals: BP 130/85, HR 88, BMI 29..

[Audio] Mental Status Exam: Appearance: Disheveled, with poor grooming. Behavior: Cooperative but occasionally guarded. Speech: Pressured. Mood: Euphoric. Affect: Labile. Thought Process: Tangential. Thought Content: Grandiose delusions; auditory hallucinations. Insight/Judgment: Poor. Restating Questions 1. Considering J.R.'s partial responsiveness to mood stabilizers and his concerns regarding weight gain, what other alternatives would you consider for pharmacological treatment? 2. What can we do to help him get over this ongoing mistrust of the providers, which appears to be the barrier to him engaging readily in the therapeutic process? 3. Would you suggest the inclusion of a specific therapy modality to treat his bipolar disorder and his alcohol use disorder?.