Case Study 9: Irritability - CRASH! Medical Review Series

[@pwbmd]

Something I didn't mention, which I'll point out because it gets asked a lot: A patient only needs to have ONE manic/hypomanic episode to qualify for a diagnosis of bipolar I or bipolar II, respectively. Most bipolar patients spend their lives depressed (if treated inadequately); manic episodes are episodic and relatively rare. USMLE likes to give you a patient presenting with signs and symptoms consistent with MDD, but they'll sneakily throw in a history of a (hypo)manic episode. You need to know that that instantly qualifies them as bipolar, rather than MDD. If you treat bipolar with antidepressants, especially SSRIs, you risk sending them back into mania. So we need to treat these patients with mood stabilizers or atypical antipsychotics for the longterm.

[@zasa9618]

It was so informative! thanks alot!

[@woloabel]

(On Wednesday of March 1, 2023). On the Matter of Case Study 9 with Irritability (By MD Paul W. Bolin-CRASH! Medical Review Series)....Dude, allow the Gentleman to Find his Voice. What has happened to Grand Bohemia, Artistic Volition, Pizzazz, Elan D'Etre. Anyway: 1) Vitals are WNLs; 2) Past Medical History (PMH) is Significant with Major Depressive Disorder (MDD) and Schizophrenia Diathesis (A Sibling with such Personality Derangement); 3) Medications on Record Sertraline (SSRI by Tradename Zoloft); 4) Physical Examination (Px): 1) General is No Acute Distress (NAD); 2) Skin Assessment is Normal; 3) Chest/Lungs are Clear on Auscultation; 4) CV is RRR and Absent of Pathological Sounds; 5) Abdomen is Soft, NT/ND, with NBS; 6) Neurological is absent of Focal Neurological Deficits with Normal DTRs; 7) Psychiatric Estimation (Avoiding rather gruesome, Opinionated Evaluations And/or Obtuse Criterias) the Patient is Alert and Oriented (3x), Well-groomed, Dysarthric (Loss of Fluency), Tangential Thinking (Artistic Licence mfers), Poor Evidence Of Cognition Trend (Physicians are not Mind Readers; Avoid committing such embarrasing appraisal), Enhanced Mood and Elevated (Possibly due to Stimulants), Restlessness and/or Hyperactivity Present (Pacing the Room), Delusional Grandiosity (Physician's Own Delusions must not be Present), without Pathological Suicidal/Homicidal Ideation (Right to Suicide and Justified Homicide is not traditionally a Medical Topic but It must be); 5) Differential Diagnosis (DDx): 1) Bipolar I Disorder (Manic); 2) Bipolar II Disorder (Hypomanic); 3) Schizoaffective Disorder (Subspeciation of Schizophrenia); 4) Mood Disorder due to a General Medical Condition (Governmental Harassment and Profiling must not be an Element) and/or Iatrogenic Aetiology; a) Hyperthyroidism (TSH is Low and SSx of Hyperactivity of Metabolism Derangement); b) Stroke (SAH and Ischemiae/Infartion); 5) Substance Intoxication/Drug Toxicity a) Stimulants of Overly Controlled Status Class: a) Cocaine (A Natural Alkaloid with an Infinite Benefit to Certain People (Especially the Most of Affluent; Scientific Name is Erythroxylon coca Native of Andean Upper Stretches and Culturally Venerated as Panacea); ) b) Amphetamine (Ritilan and 10x more Potent than Cocaine as a Stimulant); c) Methylamphetamine (The most Potent and Commercially Available Stimulant Mankind has Experience and Synthesized by German Pharmacopeia; and the truly Sophisticated yet Empathetic Physician does not discard the Potential Threat and Current Clandestine Used of d) MK Ultra Psychotics (Usually Sedative/Hypnotics/Nootropics Pharmacology Drug Classes); 6) Diagnosis (Dx): 1) CBC is WNL; 2) BMP is WNL; 3) TSH Serum Level is WNL; 4) Urine Drug Screen (Urine Toxicology) is Significant For Cannabinoids (Sedative/Hypnotic Drug Class; Where Tyrants usually ascertain arbitrarily whatever the fck they wish); 5)Head CT Imaging for Potential Lesion/Trauma/SAH/or Infection Therein; 7) Signs And Symptoms SSx of Mania (DIGFAST Mnemonic): 1) Distractibility; 2) Insomnia; 3) Grandiose Delusions (Increased Self-Esteem [Goodness Sake Narcissism] and Euphoria); 4) Flight of Ideas (Tangential Thought Process); 5) Activity (Increased Hyperactivity; sadly this is barring of Business [Private Enterprise and Initiative] and Fast-Paced Ingenuity); 6) Speech (Pressure; Dysphasia, Dysphonia, Dysarthria); 7) Thoughtlessness (Impulsivity, Risky Behaviro [Isn't it all]); 8) Marked Impairment (Mania; otherwise Hypomania); 9) The Diagnosis Herein is Bipolar Disorder I; 7) Management (Mx) And/or Treatment (Tx): 1) Bipolar I Disorder (Active Mania or Active Maniac Episode) is Via Second Generation Atypical Antipsychotics Drug Class (Olanzapine) with the Typical Dopamine Receptor (D2 Receptors for Revolutionaries or just about anybody deemed Outre). Zyprexa is Sold as a Dopamine/Serotonin Receptor Antagonist Agent with High Profit Margins (FDA-Approved for Political Dissenters; Conscientious Idealists Bar such Substance for worthless and tyrannical Zybernistic Application [SideBar Baby]); 2) Psychiatry Consult for Evaluation for Inpatient Management (Where the Patient [This is by far a Subject]) by Specialist, where the Patient must choose a Like-Minded, Reputable (Non Opinionated, Known State Acolyte if such Person so Wished) I mean there are so many Classes of Schools in Psychiatry just like in any Matter (This is not General Issue Medicine of Pigs); 4) Follow-Up For Long Term Management (Mood Stabilizers); Goodness, My First Grandiosity Diagnosis. A Shame because this Patient is simply Trying to Acertain the Civil Right Entitled and Enshried in the Magna Carta of Ages, the US Constitution. My Psychiatry Refferral was a Dire Failure for the State-owned Acolyte's Praxis is simply a Iatrogenic Biohazard and a potential Criminal Liability for Administering Against the Wish and Rational of my Patient. Haloperidol is Indicated for Schizophrenia and my Patient had a Tourette Syndrome Affliction along with the Stigmata herein Narrated; Iatrogenic Psychosis And Malpraxis Therein (Professional Ethics and Liability of Loss of Cognition and Competence) is A Real Thang, Dude. MD Paul W. Bolin es muss besser sein wenn und waehrend Ein Aerst GegenGesundheit immer ist. Heil!

[@hasali1579]

Self diagnosis be like

[@Katie-vy5rd]

The title made me think: UTI, hepatic encephalopathy, and as soon as you mention his, atypical, late nights, thought Bipolar. C an you get a STAT Thyroid panel in the ED? P.s. thanks!!

[@pwbmd]

Depends on your lab. But on exams TSH and T4 will be made available to you.

[@Katie-vy5rd]

@@pwbmd thank you so much.