How to address a psychotherapy case study answered

How to address a psychotherapy case study answered

Case prompt: Trisha is a 28-year-old, unemployed white female. She is no stranger to therapy, having seen counselors for most of her teen and adult years. Her friends would describe her as a “wild woman” who takes no crap from anyone. She has held various part-time jobs for the last few years because she usually gets angry at her boss or coworkers and quits. While she has had a string of boyfriends over the years, she has been seeing one man for the last year or so. He too is unemployed and has both an alcohol and methamphetamine problem. She describes the relationship as “addictive and dysfunctional, yet exciting and hot.” Trisha is back in treatment at the urging of her parents, who describe her behavior as erratic and unpredictable. They also claim that she has periods where she “sleeps little and parties lots.” There were also several occasions in the last five years when she was so depressed she didn’t eat or want to leave the house. Her father also admits to periods of depression, and Trisha’s grandfather was diagnosed with manic depression, resulting in numerous hospitalizations in the 1950s and 1960s. Trisha’s only brother died in a car accident several years ago. He was drunk at the time, but she claims he had a long history of depression. Recently Trisha was arrested for disorderly conduct at a friend’s party. She had not slept for nearly 24 hours and was drunk and combative. When she was first approached by police, she solicited them for sex. They report that she was rather hyperverbal and hyperactive. They later had to investigate a complaint from local storeowners for bad checks she wrote in excess of $7,000.

1. Summarize the clinical case.
2. What is the DSM5 diagnosis? Identify the rationale for your diagnosis using the DSM5 diagnostic criteria.
3. According to the clinical guidelines, which one pharmacological treatment is most appropriate to prescribe? Include the medication name, dose, frequency and rationale for this treatment.
4. According to the clinical guidelines, which one non-pharmacological treatment would you prescribe? (exclude psychotherapy modalities) Include the risk and benefits of the chosen rationale for this treatment.
5. Include an assessment of medication\’s appropriateness, cost, effectiveness, safety, and potential for patient adherence.
6. Use a local pharmacy (Pensacola, FL) to research the cost of the medication. Use great detail when answering questions 3-5.


Question 1: The presented case describes a young White female in her late 20s suffering from mental health issues since her childhood. Trisha seeks medical care today following her recent erratic and unpredictable behavior. She is well-known to be wild by her friends and has been counseled in most of her teen and adult years. Trisha has problems keeping her job because of anger issues, engages in unhealthy and toxic relationships, has multiple sexual partners, and recently solicited police officers for sex following an arrest. Her parents claim that she has periods when she sleeps little and parties a lot and there were occasions when she hardly her house because of depression. Trisha’s family history depicts issues with mental health disorders including depression, mania, and substance abuse. Recently, she was arrested by the police following disorderly conduct. She was reported to be hyperactive and hyperverbal, had not slept for 24 hrs, and was overspending.
Question 2
The DSM-5 diagnosis for Trisha is bipolar mood disorder. This disorder causes extreme fluctuation in a person’s mood, energy, and functional abilities. The DSM-5 explains that bipolar disorder causes an intense shift in mood, energy levels, and behavior and most people exhibit depressive episodes (American Psychiatric Association, 2013). The classical sign of this disorder is mania, a condition in which the individual exhibits abnormally elevated or irritable mood. Mania is characterized by extreme emotions, thoughts, activity level, and talkativeness. Mood changes may make individuals engage in harmful activities like gambling, drinking recklessly, frequent sex, or spending extreme amounts of money (American Psychiatric Association, 2013). Trisha is reported to be hyperactive and hyperverbal, has not slept for 24 hrs, is drunk and combative, and has about $7,000 in excessive spending from local stores. Additionally, she has a history of depression that also runs in the family. These symptoms are consistent with the DSM-5 criteria for bipolar disorder diagnosis.
Question 3
The optimal treatment for bipolar disorder includes a combination of pharmacologic and non-pharmacologic therapy. The pharmacologic options for this condition include mood stabilizers, antidepressants, antipsychotics, and antipsychotics. According to evidence-based practice guidelines, the first-line treatment option for bipolar disorder is Lithium (Shah et al., 2017). Lithium is a mood stabilizer that is found to be effective during acute episodes of mania and is observed to prevent episodes or relapse. The recommended dosage of lithium is 300-600 mg PO twice to thrice daily (Shah et al., 2017). However, some people may require higher doses depending on the severity of symptoms and weight.
Question 4
The non-pharmacologic option that can help in the management of bipolar disorder is electroconvulsive therapy. The benefit of this approach is that it can help to manage the disease in highly suicidal patients, those presenting with catatonia, and those whose medication no longer works (Perugi et al., 2013). Risks associated with ECT include temporary memory loss, headache, temporary anxiety, and falls among the elderly.
Question 5
The medication chosen for Trisha is Lithium and is appropriate because of its effectiveness during manic episodes. The drug is effective in managing bipolar disorder, especially for those with an episodic course of illness and bipolar depression (Shah et al., 2017). Regarding the aspect of adherence, research demonstrates that over 85% of patients take the medication correctly.
Question 6
The current cost of lithium in Pensacola, FL ranges from $9.00 to $12.72. For example, Rite Aid sells 300 mg lithium ER (60 tablets)at a retail cost of $10.49 while Albertsons sells the same drug at $11.26.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Perugi, G., Medda, P., Toni, C., Mariani, M. G., Socci, C., & Mauri, M. (2017). The role of electroconvulsive therapy (ECT) in bipolar disorder: Effectiveness in 522 patients with bipolar depression, Mixed-state, mania and catatonic features. Current Neuropharmacology, 15(3), 359–371.

Shah, N., Grover, S., & Rao, G. P. (2017). Clinical practice guidelines for management of bipolar disorder. Indian Journal of Psychiatry, 59(Suppl 1), S51–S66.

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