A 45-year-old male with Bipolar I Disorder has been clinical…
A 45-year-old male with Bipolar I Disorder has been clinically stable on Lithium Carbonate 900 mg daily for two years, with a consistent therapeutic trough level of 0.8 mEq/L. During a follow-up visit, the patient mentions he has recently joined a “heart-healthy” weight loss program that involves a strictly low-sodium diet and intense daily cardiovascular exercise. He reports feeling increasingly “shaky,” nauseated, and slightly “foggy” over the past three days. What is the physiological mechanism behind this patient’s symptoms, and what is the most appropriate education regarding his dietary intake?
Read DetailsYou are treating a patient with schizophrenia. The patient s…
You are treating a patient with schizophrenia. The patient states that he does not want to take a medication that has really high extrapyramidal effects (EPS) side effects. Which of the following antipsychotic drugs has the highest rate of extrapyramidal effects?
Read DetailsA 17-year-old male is brought to your outpatient clinic by h…
A 17-year-old male is brought to your outpatient clinic by his parents due to escalating mood swings, risk-taking behaviors, and school refusal. He reports alternating periods of “feeling great and invincible” for several days, during which he sleeps 2–3 hours per night, spends excessive time on social media, and engages in impulsive driving. These episodes are followed by periods of low mood, irritability, and social withdrawal. He denies suicidal ideation but admits to recent marijuana use and vaping nicotine daily. His parents are concerned about his safety and request medication. Mental status exam reveals pressured speech, grandiosity, and distractibility. Urine drug screen is positive for THC. He has no prior psychiatric history and no known medical conditions. He refuses therapy but agrees to medication “if it helps him focus.” Which of the following is the most appropriate next step in managing this patient?
Read DetailsA 63-year-old female patient with a history of generalized a…
A 63-year-old female patient with a history of generalized anxiety disorder (GAD) and chronic kidney disease (CKD stage 3) presents for follow-up. She reports worsening anxiety, restlessness, and insomnia. She previously responded well to paroxetine but stopped it due to weight gain and constipation. She has tried alprazolam intermittently but prefers a long-term, non-sedating option. Her current medications include: Metoprolol 25 mg BID Lisinopril 10 mg daily Calcium carbonate 500 mg BID Vitamin D3 1000 IU daily Her GFR is 42 mL/min/1.73m². She denies suicidal ideation or substance use. As her PMHNP, which of the following is the most appropriate pharmacologic option at this time?
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