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Instructions:
Please read and respond to at least two of your peers’ initial postings. You may want to consider the following questions in your responses to your peers:
· Compare and contrast your initial posting with those of your peers.
· How are they similar or how are they different?
· What information can you add that would help support the responses of your peers?
· Ask your peers a question for clarification about their post.
· What most interests you about their responses?
Please be sure to validate your opinions and ideas with citations and references in APA format.
Oct 9 12:59am| Last reply Oct 10 12:39am
Reply from April Williams
Sam’s symptoms are most consistent with Bipolar I Disorder, current episode manic (National Institute of Mental Health [NIMH], 2024):
· “resounding moment,”
· grandiosity “I should be teaching my professors.”
· long hours awake, energized
· engaging strangers in philosophical conversations
· alcohol, sexual activity, reckless spending
· withdrawal from college, legal trouble
· no hallucinations or delusions
According to the NIMH (2024), bipolar disorder is a serious mental disability that causes “unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks.”.
Per NIMH (2024)and clinical guidelines, treatment involves mood stabilization and sometimes adjunctive therapy:
· Mood stabilizers
· Lithium (gold standard, reduces suicide risk)
· Valproate (Depakote).
· Carbamazepine, Lamotrigine (more for bipolar depression/maintenance).
For acute mania in a 19-year-old:
· Lithium carbonate is first-line (unless contraindicated)
· initial dose: 300 mg orally 2–3 times daily
· adjust to therapeutic serum level: 0.6–1.2 mEq/L.
· Monitor: renal function, thyroid function, and lithium levels.
Reference
National Institute of Mental Health. (2024). Bipolar Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/bipolar-disorderLinks to an external site.
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Oct 9 12:52am
Reply from Makeda Thomas
Makeda Thomas, Discussion Week 6:
Probable Diagnosis
Based on Sam’s presentation, the most likely diagnosis is Bipolar I Disorder, current episode manic, without psychotic features, as defined by the DSM-5 (Preda, 2024). Sam exhibits hallmark symptoms of mania, including grandiosity, decreased need for sleep, pressured speech, risky behaviors (e.g., impulsive spending, hypersexuality, alcohol use), and flight of ideas. His belief that he is more advanced than his professors and his impulsive shift in academic focus reflect elevated mood and inflated self-esteem. Although he was arrested for a “psychotic break,” there is no evidence of hallucinations or delusions at present, which supports a manic episode without psychotic features.
Importantly, Sam has a prior diagnosis of Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD), which may have represented early manifestations of bipolar spectrum illness. Bipolar disorder often emerges in late adolescence or early adulthood, and misdiagnosis as unipolar depression is common in early stages (Yang et al., 2023).
Medication Classifications for Bipolar I Disorder
Pharmacologic treatment of acute mania typically involves one or more of the following classes:
· Mood stabilizers: Lithium, valproate, carbamazepine (Marzani & Price, 2021)
· Second-generation antipsychotics (SGAs): Olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone (Marzani & Price, 2021)
· Anticonvulsants: Valproic acid, lamotrigine (more effective for bipolar depression than mania) (Marzani & Price, 2021)
· Adjunctive benzodiazepines (e.g., lorazepam) for agitation or insomnia in acute settings (Marzani & Price, 2021)
Combination therapy is often required in moderate to severe mania, especially when functional impairment or risk behaviors are present (Marzani & Price, 2021).
Recommended Medication and Dose
Medication: Risperidone Class: Second-generation antipsychotic Starting Dose: 1–2 mg orally once daily
Rationale: Risperidone is FDA-approved for the treatment of acute manic or mixed episodes in Bipolar I Disorder. It has demonstrated rapid efficacy in reducing manic symptoms, including grandiosity, impulsivity, and sleep disturbance (McNeil et al., 2024). Compared to other SGAs, risperidone has a relatively favorable side effect profile in young adults and is less sedating than olanzapine or quetiapine, which may help preserve daytime functioning. It also has a lower risk of metabolic side effects when used short-term.
Given Sam’s age and lack of prior antipsychotic exposure, a starting dose of 1 mg daily is appropriate, with titration to 2–4 mg/day based on clinical response and tolerability. Monitoring should include assessment for extrapyramidal symptoms, sedation, and metabolic changes (McNeil et al., 2024). If symptoms escalate or do not respond adequately, adjunctive mood stabilizers such as valproate may be considered.
Clinical Considerations
· Avoid antidepressant monotherapy: SSRIs or SNRIs may worsen mania if used without a mood stabilizer or antipsychotic (Preda, 2024).
· Psychoeducation and psychotherapy: Cognitive behavioral therapy (CBT) and family-focused therapy can improve insight, adherence, and relapse prevention (Özdel et al., 2021).
· Safety planning: Given Sam’s impulsivity and legal involvement, risk assessment and structured follow-up are essential.
References
Marzani, G., & Price Neff, A. (2021). Bipolar Disorders: Evaluation and Treatment. American family physician, 103(4), 227–239. https://www.aafp.org/pubs/afp/issues/2021/0215/p227.htmlLinks to an external site.
McNeil, S., Gibbons, J.R., Cogburn, M. (2024). Risperidone . StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK459313/Links to an external site.
Özdel, K., Kart, A., & Türkçapar, M. H. (2021). Cognitive Behavioral Therapy in Treatment of Bipolar Disorder. Noro psikiyatri arsivi, 58(Suppl 1), S66–S76. https://doi.org/10.29399/npa.27419Links to an external site.
Preda, A. (2024). What are bipolar disorders? American Psychiatric Association. https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders#:~:text=These%20behaviors%20must%20represent%20a,hallucinations%2C%20known%20as%20psychotic%20featuresLinks to an external site. .
Yang, R., Zhao, Y., Tan, Z., Lai, J., Chen, J., Zhang, X., Sun, J., Chen, L., Lu, K., Cao, L., & Liu, X. (2023). Differentiation between bipolar disorder and major depressive disorder in adolescents: From clinical to biological biomarkers. Frontiers in Human Neuroscience, 17, 1192544. https://doi.org/10.3389/fnhum.2023.1192544
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