DSM 5-TR diagnosis

Full Answer Section

        DSM-5-TR Diagnosis Based on the information provided, the most likely diagnosis according to the DSM-5-TR is Bipolar I Disorder, Single Manic Episode (American Psychiatric Association, 2022). Here's why this diagnosis is supported:

• Manic Episode: The patient exhibits several symptoms characteristic of a manic episode, including:
  • Psychomotor agitation (pacing)
  • Pressured speech (rapid, jumping from topic to topic)
  • Flight of ideas (rapidly shifting thoughts)
  • Grandiosity (believing she's "too important")
  • Decreased need for sleep (not sleeping for four nights)
  • Poor judgment (purchasing expensive vehicles impulsively)
  • Increased distractibility (speech wandering off point)
• Bipolar I Disorder: The presence of a manic episode without a current depressive episode is indicative of Bipolar I Disorder.
• MDD History: Her past history of MDD suggests a vulnerability to mood episodes, further supporting the Bipolar I diagnosis.

It is important to note that a comprehensive evaluation by a mental health professional is necessary to confirm the diagnosis and rule out other potential causes of her symptoms, such as substance use or medical conditions. Pharmacological Treatment: Lithium According mood disorder treatment guidelines, such as those established by the American Psychiatric Association (APA, 2020), lithium is considered the first-line medication for the treatment of mania in Bipolar I Disorder. Rationale for Lithium:

• Effectiveness: Lithium has a well-established track record of efficacy in controlling manic episodes and preventing future episodes (APA, 2020).
• Mood Stabilization: It acts as a mood stabilizer, helping to regulate both manic and depressive episodes.
• Long-Term Management: Lithium is effective for long-term management of Bipolar I Disorder, reducing the risk of relapse.

Non-Pharmacological Treatment: Psychoeducation Psychoeducation is a highly recommended non-pharmacological treatment for Bipolar I Disorder (APA, 2020). It focuses on educating the patient and their family about the disorder, including:

• Symptoms and phases of Bipolar I Disorder.
• Medication adherence and potential side effects.
• Healthy lifestyle choices to support mood stability (e.g., sleep hygiene, exercise, stress management).
• Early identification of warning signs of relapse.

Rationale for Psychoeducation:

• Empowerment: Providing knowledge about the disorder empowers the patient and family to manage the condition more effectively.
• Improved Adherence: Understanding the benefits and potential side effects of medication can contribute to improved medication adherence.
• Relapse Prevention: Learning to identify early warning signs of relapse allows for timely interventions to prevent full-blown episodes.

Cost-Effectiveness of Treatment: Lithium: Lithium is a generic medication, and its cost can vary depending on dosage and pharmacy. Using a local pharmacy search tool (e.g., GoodRx), the estimated cost of a 30-day supply of lithium carbonate tablets (300mg) ranges from $10 to $40. Lithium is typically well-tolerated, but regular blood tests are needed to monitor for potential side effects, adding to the overall cost of treatment. Psychoeducation: Psychoeducation can be delivered through individual or group therapy sessions. The cost can vary depending on insurance coverage and the therapist's fees. However, psychoeducation is a cost-effective intervention in the long run, as it can help to reduce hospitalizations and improve overall well-being. Patient Adherence: Lithium is generally well-tolerated, but potential side effects like hand tremors and thirst can lead to non-adherence. Psychoeducation can improve medication adherence by explaining the benefits and addressing concerns about side effects. Regular monitoring and follow-up appointments with a healthcare professional are also crucial for promoting adherence. Conclusion The presented case suggests a young woman experiencing a manic episode of Bipolar I Disorder. Lithium is a first-line medication for mania, and psychoeducation is a valuable non-pharmacological intervention. Considering cost-effectiveness, lithium is a relatively affordable option, and psychoeducation can significantly improve long-term outcomes. However, a comprehensive evaluation and patient-centered treatment plan are crucial for optimal management of Bipolar I Disorder  

Sample Solution

     

Clinical Case Summary

A 20-year-old woman with a history of Major Depressive Disorder (MDD) presents to the emergency department (ED) brought by her family. She exhibits symptoms of mania, including psychomotor agitation, pressured speech, racing thoughts, flight of ideas, and grandiosity. She recently made significant impulsive purchases and displays poor judgment. Additionally, she reports sleep disturbance and an inflated sense of self-importance.