Problem
Camilla is a 27 years of female who was referred by her PCP for mood swings.
Client reports she is doing well this last week after a 4 week period of feeling depressed with amotivation, anergia, anhedonia. Her Prozac was dc'd last week as she felt it was making her more tired.
On exam, mood is episodically irritable alternating with some euphoria. She has been sleeping 3-4 hours per night and endorses "lots of energy" during the day. She has been enjoying considerable online shopping and nightly socializing with her friends. She denies using any alcohol or substances. She has called in sick from work to engage in late night activities and is fearful she may lose her job for "feeling high" and being "really distracted by everything." She denies psychosis or suicidal ideation at this time.
Client gives PPH: first episode of depression in her late teens with suicidal ideation without attempt. This has occurred 4-5 times over the years and her PCP has prescribed different medications. Only within the last year did she begin to experience hypomania.
She denies any PMH
FH: paternal grandmother with h/o "mood swings" - "I think she was on medication. I know she went away to the hospital a couple of times."
Task
A. Describe the conditions that will need to be ruled out before a psychiatric diagnosis can be made.
B. Discuss your most likely diagnosis with the evidence to support your decision.
C. Discuss any diagnostic work up you think is necessary, provide your rational. This client will be placed on LiCO3 - what specific education is necessary, what specific labs tests prior and ongoing, potential drug interactions, safety concerns with the use of lithium. Ongoing labs you believe need to be monitored.
D. Outline your recommended treatment plan including medications, testing to r/o medical etiology, lab tests, education. Does the patient require psychiatric hospitalization? What's your rationale for your decision?
E. Site 4 references for diagnosis, treatment - specifically DSM - TR 5 and Stahl Essential Psychopharmacology Prescriber's Guide or Epocrates.