Assessing Bipolar Disorder in a 32-Year-Old Patient: Diagnostic Pearls and Clinical Strategies

This episode of Pearls and Prep features a detailed discussion about diagnosing and managing a complex psychiatric patient case. The host presents the mock patient, Michael, a 32-year-old who exhibits manic and delusional behavior leading to an emergency room visit. The episode delves into diagnostic criteria for bipolar disorder, differentiating between bipolar I and bipolar II, and ruling out other conditions such as schizophrenia. The importance of gathering collateral information, understanding medication impacts, and considering family history is emphasized. The host also discusses treatment strategies, including initiating Zyprexa for rapid stabilization, and underscores the importance of a multidisciplinary approach involving psychotherapy and community resources post-hospitalization. Listeners are encouraged to join the podcast’s Patreon for additional educational resources.

00:00 Introduction to Pearls and Prep

00:12 Meet Michael: The Mock Patient

00:48 Michael's Unusual Behavior

01:18 Exploring Michael's History

02:35 Initial Diagnostic Impressions

04:25 Differentiating Bipolar Disorder

04:48 The Importance of Collateral Information

05:14 Understanding Michael's Past Treatments

06:03 Bipolar Disorder Diagnostic Challenges

12:24 Bipolar One vs. Bipolar Two

21:21 Prognosis and Treatment Options

25:25 Conclusion and Additional Resources

The primary focus of this podcast episode revolves around the intricate evaluation of a patient named Michael, who presents with symptoms suggestive of a manic episode potentially indicative of bipolar disorder. Michael's recent behaviors, characterized by elevated energy levels, irritability, and grandiose ambitions, including an attempt to challenge a renowned boxer, warrant a thorough psychiatric assessment. As we delve into his case, we discuss the critical elements necessary for an accurate diagnosis, including the distinction between bipolar I and bipolar II disorders, as well as the implications of co-occurring psychiatric conditions. Furthermore, we explore the importance of collateral information from family and friends to ascertain Michael’s psychiatric history and to rule out other medical etiologies. This episode serves as an essential guide for understanding the complexities of diagnosing mood disorders and the significance of appropriate treatment strategies in acute psychiatric settings.

Takeaways:

• The case presented involves a 32-year-old plumber named Michael who exhibits symptoms potentially indicative of bipolar disorder, particularly mania.
• Michael's recent behaviors, including rapid speech and grandiose ideas, suggest a significant shift in his mental state that necessitates psychiatric evaluation.
• It is crucial to consider Michael's family history, particularly his aunt's diagnosis of bipolar disorder, when forming a diagnostic impression.
• The episode highlights the importance of differentiating between bipolar I and bipolar II disorder, emphasizing the features that characterize each condition.
• Understanding the potential impact of past antidepressant use, specifically Prozac, on Michael's manic episode is vital for accurate diagnosis and treatment.
• The necessity of hospitalization in cases of severe mania, as exhibited by Michael, underscores the importance of immediate and appropriate psychiatric intervention.

3

Exploring the Nuances of Bipolar I: Insights from a Mock Patient

Pearls and Prep

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In this episode of Pearls and Prep, Dr. Z discusses the complex case of 'Beanbag Benny,' a 34-year-old mock patient dealing with depression and cannabis use. The conversation explores diagnostic and treatment strategies for psychiatric NPs, emphasizing the importance of understanding patient history, motivational interviewing, and the nuances of medication selection. Dr. Z specifically highlights the use of Wellbutrin for treating Benny's depressive symptoms and guides listeners through the process of identifying key 'oranges to squeeze' for effective patient care. The episode concludes with Benny's positive progress and a call to action for listeners to join the podcast's supportive and educational community.

00:00 Introduction to Pearls and Prep

00:10 Case Introduction: Beanbag Benny

00:59 Patient History and Symptoms

02:43 Key Questions for Diagnosis

04:03 Understanding Cannabis Use

15:25 Motivational Interviewing Techniques

20:52 Formulating a Treatment Plan

26:39 Conclusion and Final Thoughts

27:53 Join the Community and Support

2

The Dance Between Dependence, Depression, and Dopamine: A Case Study of Beanbag Benny

Pearls and Prep

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Meet Carly, a 32-year-old librarian who suddenly has to deliver a eulogy after her co-worker tragically choked on peanut brittle during the library’s staff meeting. Now overwhelmed with public speaking anxiety, Carly turns to her psychiatric provider for help. In this mock psychiatric case study, we explore how propranolol, a beta blocker, can be used to manage performance anxiety and other anxiety disorders.

Perfect for psychiatric nurse practitioner (psych NP) students, PMHNP board prep, or anyone studying psychiatry, mental health, or psychopharmacology, this case covers everything from diagnostic criteria and differential diagnosis to clinical pearls you can use in real-world practice.

We’ll unpack:

• How propranolol works in the brain and body for performance anxiety and other anxiety disorders
• When to use propranolol vs. SSRIs, benzodiazepines, or therapy
• Key DSM-5-TR anxiety disorder criteria for accurate diagnosis
• Side effect profiles, contraindications, and patient counseling tips
• Real-world clinical scenarios to help you ace your psych exams or feel confident in practice

Whether you’re a psychiatric NP student, medical student, or a seasoned clinician brushing up on psychopharmacology, this episode delivers high-yield tips, evidence-based insights, and memorable teaching moments.

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🔍 Diagnosing Performance Anxiety: Key Considerations for Psych NP Students

Pearls and Prep

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Takeaways:

• Carly exhibits performance anxiety related to an upcoming eulogy, indicating potential social anxiety disorder.
• The therapeutic application of propranolol offers immediate relief for performance-related anxiety symptoms.
• Assessing the specific triggers of anxiety is crucial for accurate diagnosis and effective treatment planning.
• Carly's social functioning is impacted by her fear of public speaking, emphasizing the importance of targeted therapeutic interventions.
• The diagnosis of social anxiety disorder requires a nuanced understanding of the patient's fears and avoidance behaviors.
• Utilizing screening tools such as the Mini Social Phobia Inventory enhances diagnostic accuracy and treatment efficacy.