mania

Question 1

54 y.o. lady who lives alone presents with overactivity, pressure of speech and flight of ideas. she has neglected her hygeine and house. the environmental health officer has been called in to fumigate the house, which is covered in dog excrement and rat infested. you suspect that she has hypomania and decide to treat her acutely with haloperidol, and in the longer term with lithium carbonate.

(a) you discover that her husband had died 18 months earlier after a lingering cancer. how may this be relevant to the current picture? list 3 points.

Answer 1

1. she may be undergoing a grief reaction
2. she may be undergoing an adjustment reaction
3. he may have been her primary carer and hence, may have prevented her from deteriorating previously by helping her/encouraging her to seek help

Question 2

(b) list 3 “non-drug” factors that need to be put in place by the Care Programme Approach once treatment has been stabilised.

Answer 2

1. community psychiatric nurse review
2. outpatient review
3. home care assessment
4. social care

Question 3

(c) 6 months after discharge, she suffers an accidental overdose of the lithium she has been prescribed to treat her maintenance therapy. what 2 ix would you institute to monitor the situation?

Answer 3

1. U+Es (renal failure)
2. lithium levels

Question 4

(d) what is the main principle of therapy for the acute mx of this overdose?

Answer 4

supportive therapy

e.g. IV fluids, cardiac monitoring etc.